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Home My WebLink AboutBuilding Permit #752-15 - 315 TURNPIKE STREET 4/2/2015�* hdda. )-o cF TOWN OF NORTH ANDOVER % APPLICATION FOR PLAN EXAMINATION Permit N0.• � `5Z-� Date Received Date LOCATION PROPERT` 141zl�� IMPORTANT: Applicant must complete all items on this page MAP NO: PARCEL:.. ZONING DISTRICT: .. Historic District yes n0 no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family 0 Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement 0 Assessory Bldg5thers: renAs 0 Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer _ DESC IPTION OF WORK TO BE PERFORM Identification Please OWNER: Name: Address: 3/S CONTRI Address Mic-Jia,e-) Lz)5"4nc_ Supervisor's Construction License:rS Date: 66&2-12-014- Home Improvement License: _ Exp. Date: _ II �(l Q Phone:I - 20y 4/7� Address:1��/1p1^. f �lS, /1 0301 �9 Reg. No. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: 6�) _ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner jW Signature of contractorA .. .. 1 �1 r- 1 _ -- _ A A i_e_ ._ _1 n /�...-J.:F: r. ,J P' I-4. r)i-- I I C+—.f4 plonc —)II 1-ti`s Plans Submitted ❑ PlansWaived-❑ Certified Plot Plan ❑ Stamped Plans ❑ 3 YP1 OF_SEWERAGEDiSP:OSAL' - Public Sewer ❑ Tanning/Massage/BodyArt ❑ ... Swimming Pools ❑ Well ❑ . .Tobacco. Sales ❑ -Food Packaging/Sales ❑ Private (septic tank, etc.. ❑ - Permanent Dumpster on Site F1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED: PLANNING & DEVELOPMENT' ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on DATE.APPROVED �4 5 Siqnatu Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes . a • Planning Board Decision: Comments _1 "Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW ToivL Engineer: Signature: FIRE C)EMRTMEN' T --Temp Durimpster on site yes Located -at 124 Mair, Street Fire'Departmerit signatureldate COMMENTS Locaieg its4 no Street Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes ill® MGLChapter166.Section 21A=F and G min.$100-$1000.fin.e NOTES and DATA — (For department use D Notified for pickup - Date F i Doc.Building Permit Revised 2010 Building Department The fol.)wing is -a -list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L: Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the aper -al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must by subm.tted with the building application Doc: Doe.Bui?ding Permit Revised 2012 ocation�� lo. 770 1 76a.. - S" 7 S --O— // \I 75r 3 ^ i 5, Check #" X8603 W fr Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ wilding Inspector z ' ` 1 :05 c0 o -a o = -t ,Z r o 0 �r J to z o a C0 CD o o o. 0 mcn N W m -0N _ �. o CD n c� (D D CD o W 300 ^' Z N A C =_ =r. -a ' C --1<CL r- m c� r m co ""-cn CD _ -0 �♦ l� Qcl)— c zo�:�• -� o r 06 rn o ��y: U.� < 0 CD � �-I � < C o Q �. t/1 ID Cj) CD 5 CD y 1+ C C cr.0 °D =r UWA Z .` _ CD o CD 44 CD Z CD N cD Z =CN� D—I Q='� I o CL CDcn = t —� y cn O Z A65 y O v : o, '� CD > CD � ifl < m o"r CD o CL) s (n 3 O (D* Ln 1 N 0 co O 7 •n m n T 7 N ;;a O S D v+ N A TN 7 N (D 77 O DCq S m mC �� n2 H m 0 T > X O aqq 3 v W H 'v O 0 T Dl ri 3' :0 O DCq S T O 7 d r! O :D C ° z Z m O � N (D n N m 3 T O Q � A (D 3 D 70 v o m D 2 0 O lm]t<;�re:e 1;7;iaAttY it+.lil�j o :a},A�4e1F1 �:Yarilu 1 0'N60.,wk a-.9 OU/MLtaru '`n . a " 6 twtltw htr'JiNnwh") vYj I tma1ukl O aYYrrTPYtii 4 .C„7aLiQ�HA7Gklilt: O I.`'SiiYllfitar *msJ dow takwT, o "hu., lam, r; ,Acyl;, Q ;t[rtri * luowi foo r h PJr Y o �,xnd=sr a '0 "16 MAMPUP UW - O 47tii14�'� v�XCr. ... a riNMra.M- 1 ic;1:, O�10j�ty'.�r�t'{�.} Ca.7l.1C:1%I[ar :lltyu%IAII 19prri�7.7 s ca:eywV�itii-' Q 3+tr`rr c, e7/hry o .4rtt1: nit":a� o mlAilow C4 "l isrSFlei4 h_1C�I 7 e s O �c�K7kly lti»ridter D G1:�Ktx��i7� 6 L�mR7A�j' r Loot K St. Ann Apartments K Tower, - - L Tower `Physical j ` M Tower Plant J Tower r ` Marton-Mejait —r'.H Towar Field_ G Tower Baseball o St. Thomas Field ,' Lot J Apartments . • OTower" P E Tower/ r ,. <� , C Tower '': B Tow -'r : /' ` Softball s FTower Field;- O 4, •- A Towzr .� Hamel Health & Lott Lot L Sport-, �;y Counseling Center Ash S O Medietoe Centro g' (`• ; altd Health O'Brien . Ac40"Ot Sciences Hall ` 'Police Innovyrion -- , \\ CentAr 3' g v Lot House* t BaskethW Department Zee lt� Net ,` Court. Volpe " Q ^346 Monlean iptntr;K M 4 ac ! ' Villan' '. 2 �', Centre Cegtt r Atht lcs 'began Houses Tow t- 4 Hall West ` HouseY puSe 1 • Chelmsford \\ Complex Lot HDracut ' { �.-. HousE " ', . , , • .' -� • Lowell Cassia �.( `� -, \> Rogers •Tewksbury Lot F Center,, Hall. ',: ,.+carnet Pelham for the Building \ • Tyngshorough $ °tli+ Building Arts 6'Reil( 0 y �•, CCampue• • Andover Lot I Pall � -trenter' . Lawrence � 9 • Methuen 9O McOua a •' • Salem Mendel `, Library ibra>•Y deo Center i I 7 %t • Haverhill rrro WelcomeGeorgetown di Canter 1 A ,y-' n • North Andover CushingPo •Boxford Hall Sullivan\ Halt�R,t� t✓ i✓^�l� / / �9� ,p Lot S7 7e.,71 Aatt , \ OLot F .. H A olleglate urch of "E `CCCCCChrist the Main a. Teacher Entrance N O lm]t<;�re:e 1;7;iaAttY it+.lil�j o :a},A�4e1F1 �:Yarilu 1 0'N60.,wk a-.9 OU/MLtaru '`n . a " 6 twtltw htr'JiNnwh") vYj I tma1ukl O aYYrrTPYtii 4 .C„7aLiQ�HA7Gklilt: O I.`'SiiYllfitar *msJ dow takwT, o "hu., lam, r; ,Acyl;, Q ;t[rtri * luowi foo r h PJr Y o �,xnd=sr a '0 "16 MAMPUP UW - O 47tii14�'� v�XCr. ... a riNMra.M- 1 ic;1:, O�10j�ty'.�r�t'{�.} Ca.7l.1C:1%I[ar :lltyu%IAII 19prri�7.7 s ca:eywV�itii-' Q 3+tr`rr c, e7/hry o .4rtt1: nit":a� o mlAilow C4 "l isrSFlei4 h_1C�I 7 e s O �c�K7kly lti»ridter D G1:�Ktx��i7� 6 L�mR7A�j' r 18 Clinton Drive, Hollis, NH 03049 603-882-1234 or 603-881-8833 fax 1-888-RENTENT www.intents.com email: sales@intents.com SHARON SHAUGHNESSY B MERRIMACK COLLEGE I ACCOUNTS PAYABLE L 315 TURNPIKE STREET L NORTH ANDOVER TEL: (978) 837-5203 TEL2: (978) 809-5618 ORDER CONFIRMATION 25144-2 Pg: 1 EVENT DESC: COMMENCEMENT - O'BRIEN EVENT DAY: THURSDAY DATE: 05/14/2015 EVENT TIME: TOTAL DELIVERY: TUE 05/12/2015 PICKUP: TUE 05/19/2015 SALES PERSON: MG PO#: ORDER DATE: 12/10/2014 TERMS: NET 10 DAYS (978)837-5203 MA 01845 FAX: (978) 837-5524 SHARON (978) 809-5618 S OBRIEN PLAZA- IN FRONT OF SAK H ON GRASS I NORTH ANDOVER MA P QTY ITEM DESCRIPTION PRICE TOTAL 1 10' X 20' WHITE FRAME TENT(HPT2) 270.00 270.00 1 60'X 90' WHITE CENTURY TWIN POLE TENT 3,510.00 3,510.00 60 FEET OF SOLID SIDEWALLS- 10' X 20' 1.35 81.00 300 FEET OF CATHEDRAL WINDOW SIDEWALLS- 60 X 90 1.50 450.00 10 FEET OF RAIN GUTTER TO JOIN 10'X 20' TO' 60' X 90' 2.00 20.00 5400 SQ. FT. OF "PUTTY" ULTRA DECK PLASTIC FLOORING INSTALLED 1.00 5,400.00 5400 CARPET INSTALLED(SQ FT) "CADET BLUE" INSTALLED 1.00 5,400.00 LIGHTING & FURNITURE MAY BE ADDED 1 TENT PERMIT 250.00 250.00 SPECIAL INSTRUCTIONS: SUB TOTAL: 15,381.00 FINAL SCHEDULE TO BE DETERMINED IN SPRING SALES TAX: 0.00 DELIVERY: 115.00 0.00 TOTAL: 15,496.00 Customer Acceptance Signature IMPORTANT DOCUMENT Certificate of Efitme Wgistance ISSUED BY Date of Shipment 2/24/2014 CHORegistration Number W F-140.01INDUSTRIES INC. Sales Order # '% 1 SO -601120 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 269800 CHRISTIAN DELIVERY CHAIR SERVICE INC DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 03049 USA Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, ULC 109. Serial # 8151030 1) Description of item certified: CENTURY MIDDLE 60WX20 SNYDER WHITE VINYL WITHOUT WEB GUYS Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MANUFACTURING INC. PHILADELPHIA PA Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC Mud LertiTicate OT r- lame Date Manufactured AZTEC TENTS 07/02/2009 2665 COLUMBIA ST TORRANCE, CA 90503 (800)228-3687 esistance PAGE: 2 This is to certify that the materials described below have been flame retardant treated (or are inherently flame retardant). CHRISTIAN PARTY RENTALS 18 CLINTON DRIVE Hollis, NH 03049 Certification is hereby made that the articles described below hereof are made from a flame-retardant fabric or material registered and approved by the California State Fire Marshal for such use. The fabric has been tested and passes NFPA 701 Large Scale. See chart to right for trade name of flame -resistant fabric or material used and additionally referenced on the label of the fabric panel. INV NUMBER: 0176130 P.O. NUMBER: CUSTOMER NO: CHR030 vendor TnecleNarce Bruin Mardi Gras MITT" Bmin Mesh F-222.04 California Comb. Lam -Tex 12, 141 16, 18oz F-419.01 Coated Fabrics Clear Vinyl 16ga / 20ga F-570.02 DAF Clear Vinyl 16ga / 20ga F-593.01 DAF DAF F-593.02 Exclusively Expo PolySateen Liner F434.01 Ferrari Precontraint 502 F-444.01 Ferran Precontraint 702 F-444.08 Phillips Textiles Phll-Tex Uner F-500.01 PJC Tech. Deco Cloth / Velon F-504.01 Snyder Weatherspan F-140.01 Tri Vantage Firesist Sunbrella F-368.05 Td Vantage Patio 500 F-121.02 Trl Vantage Big TOP F-121.10 Tri Vantage Vanguard Weblon F-069.01 Tri Vantage Weblon / Coastline F-069.01 Verseidag IDuraskin 83673, 81515 7530.01 THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley Name of Applicator or Production Superintendent General Manager- Manufacturing Title of Applicator or Production Superintendent ITEMS MANUFACTURED TYPE PRODUCED 10x20 1pc Festival Top UW S 2 w/ Rope Tensioners & Flag SINGLE PEAK 10x20 ipc Festival Top UW S 1 w/ Rope Tensioners & Flag TWIN PEAK Festival Cable 10X S 4 0 0 `�Z Sep 25 14 06:16p Mike LeBlanc 978 534 7983 p.1 Massachusetts - Department of aub:;c Safety �•t Board of Building Regulations and Standzras License: GS -067484 ' • MICHAEL P LEBI:`ANG ::. 611 PIERCE ST = A LEOMINSTER NA 01458. . Commissioner 06/22120/6 The Commonwealth of Massachusetts q I Department of IndustrialAccidents o I Congress Street, Suite 100 Boston, MA 02114-2017 , J'V www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbem TO BE FILED WITH THE PERMITTING AUTHORITY. Auuiiicant information Please Print Legibly Name (Business/Organization/individual): Christian Delivery & Chair Service, Inc. DBA Christian Party Rental Address: 18 Clinton Drive City/State/Zip: Hollis, New Hampshire 03049 Phone #:603-883-5326 Are you an employer? Check the appropriate bog: 1. I am a employer with 40 employees (full and/or part-time). • 2.0 i am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.a I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure ihai ail coniraciors eiiher have workers' compensauon insurnnce or ure soic proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. 'these sub -contractors have employees and have workers' comp, insurance.: r—1 ... IU.0 Y/'G a1G a l:UlpUla11U11 alld Its U111CGIS 1laYG CXCMIJOU UIC11 Il#lil Ul GXGIIIpUUII put 1VIvL L. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. Remodeling 9. ❑ Demolition 10E] Building addition i r. J ixc�uliai ICpalra yr auulalvrw 12: ❑ Plumbing repairs or additions 13.❑Roof repairs 14. nvOther TENTS *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance New Hampshire Motor Transit Association Policy # or Self -ins. Lic. #: P000749NHMTA2015 Expiration Date: 01-01-2016 Job Site Address:�� f ��/ c� 77"e City/State/Zip: /y, xI e leernee7 r Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under Phone #: Uva-00a-Ua4U provided above is true and correct Official use only. Do not write in this area, to be completed by city or town ol)`iciaL !.�• T_ T_ R -_. CUY or 1 uwd. rcrifiluLlcense H Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 9f%ffIfiLf]A NEW HAMPSHIRE MOTOR TRANSPORT ASSOCIATION P.O. Box 3898 Concord, NH 03302-3898 (603) 224-7337 CERTIFICATE OF INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S) AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. This is to certify that: Christian Delivery & Chair Service Inc. DBA Certificate #: 1 Christian Party Rental 18 Clinton Drive Hollis, NH 03049 Is, at the issue date of this certificate, insured by the Company, under the policy(les) listed below. The insurance afforded by the listed policy(les) is subject to all their terms, exclusions and conditions and is not altered by any requirement, term or condition or other document with respect to which this certificate may be issued. COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATE: NH TYPE OF POLICY EXP DATE POLICY NUMBER LIMIT OF LIABILITY Continuous` Extended Policy Term Workers' Compensation 09/01/2015-01101/2016 P000749NHMTA2016 Bodily Injury By Accident $1,000,000 Bodily Injury by Disease Policy Limit $1,000,000 Bodily Injury by Disease Each Person $1,000,000 ADDITIONAL COMMENTS: 'If the certificate expiration date is continuous or extended term, you will be notified if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (Not applicable unless a number of days is entered below.) Before the stated expiration date, the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days. Notice of such cancellation has been mailed to: Christian Delivery & Chair Service Inc. dba Christian Party Rental 18 Clinton Street Hollis, NH 03049 NH MOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST Authorized Representative Concord, NH 603-224-7337 02/0612015 Office Phone Number Date Issued