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Home My WebLink AboutBuilding Permit #753-15 - 315 TURNPIKE STREET 4/2/2015At*5 Pw -�) L-�- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Issued: IMPORTANT: LOCA PROF Date Received icant must complete all items on this MAP NO: PARCEL:0.1 ___ ZONING DISTRICT .. Historic District yes no _ Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family ❑Industrial El Alteration No. of units: 11 Commercial ❑ Repair, replacement ❑ Assessory Bldg X ahers: ❑ Demolition ❑ Other 01 Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District 0 Water/Sewer - r DESGRIN I IUN UI- YYUMM I v t5m rr-rtrunivlw. /l -ice Phone:(/7"8&V"✓� �Id /X06 � 7'mr leme'V07 / wil OWNER: Name: x7U ;-e- o� Ur ad out IMO( Please Type or Print Clearly) Address: 3 /S 7 Urrt i k,.v S+ - II.Phone:_ �3.-53. CONTRACTOR Name:�YY►S+� -AhYle�4lto ,3 Address:/? C11, k14 --dr, 030419 Supervisor's Construction License: Exp. Date: Home Improvement License: _ _ Exp_ Date: Id Phone: ��%3'v��-0 Address: ]S 0//n4n br' oll)s NY MN'? 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: $ -;77 Check No.: Receipt No.: L) 6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of A ent/Owner 07 Signature of contractor F-1 n. ia:.,l ni,.+ Of n Q+,imninrl Plane n 4 •i r".. I I% ty- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TI'PE OF°.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt E]. Swimming Pools ❑ Well ❑ . Tobacco. Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc.. ❑ - permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM :.. DATE REJECTED: DATE A_PPR_OVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS .CONSERVATION Reviewed on - -S Si natur COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ' Conservation Decision: Comments Water & Sewer Connection/Signature � Date Driveway Permit DPW ToiNL, Engineer: Signature: FIRE DEPARTilli Af -Teiimp Dumpster on site yes Located -at 124 Mairt. Street Fire Department signature/date COMMENTS Locaiea OM Usgooa Street no 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 DANCER ZONE LITERATURE: Yes No MGL -Chapter -166. Section 21A -F and G min.$100-$1000 fine NOTES and DATA — (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department the foi(3wing 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 apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 /-le-O&/N,ir-4 (J < -)/L Location 1110d e9: ' All 4 & T " No. �S _7�7a-+�5 Date IN 7 'D- � � 75 3 - P5` 75-/-/5- Check s/'/5 Check #" 2 r- f jv1,3 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $�Z Foundation Permit Fee $ ' Other Permit Fee $� TOTAL $ uilding Inspector E WN rA w = LL O m s +V+ O 0 LL E ?O N u Q 0 to oc a Z z _ m -a i 0 LL s 0 :3 d' ? c C C U @ LL O F. a z Z z m a s o D' LL O a Z J W s = 0 Q' u �L In M LL a N s 3 0C O-' @ LL I- Z LLI Q W 0 LLI LL a L CO z +� v C i N N X Y Q E N 0 C �+ O •Q m �. ar CF �a IA o N V CD w N c 4 d 0 �C� i c as N' 'NG0P�Q` v i CL J L N L L m N _ :E J C O U) O N O .� p 0 N N o QUz N o = V N0 �o� r ! • N O ' 0) cry i M:5 0 C4() as Q as •� N H O Nca m a� •� 4. W O � +s-' co O O � LLJLi •� O 1-, N = O •� Z H N W � .E V = i rte• U N 0-0CL ~' co N -0 0 � O H M �O-. Q 0 0 o a z Z 0 m Cl) r• O CC � Z V Lu CL Z W O � U Cl) az M M(D C-, .ti ti w Lout K St. Ann Apartments K Tower , ' • L Tower Physical M Tema Plant JTower`' Martone-Mejail H Tmv,, 0 Baseball Field. � 0 G�7ower St. Thomas Field Lot J Apartments 0 Tower F Tower, " ,C Tower 8 Tower Softball L FTower Fields 0 (� A Town a, Lot 1 Hamel Health & Lot L Spots�h *01Counseling Center Medi e A t -Nd Health Centre O'Brien AcAQ�c Sbences lnnoVWIQ'I _ - -�\,, Hall,-- Police CentOr Lot G Housa?7 Baskett rY Department yulpe l t `1(J4 East Q s;dAn \ Court . Monican J + iatnttitic htertimad} Y+tt=b.se2 ( Centre ter Athte�les - Agan House Towel-`. Coma v '�` .Hatt West ,.-Kxrse i_. Houses. � • Chelmsford Lot H • Dracut \t 0 !��•-, Housd'V,5` -� •Lowell Cascia , . Rogers ( •Tewksbury Lot F Center Hall -,; Name! . Pelham fOr the Hedlth \• Tyngsborough O'Reill SAOw "O Building Arts �Camduy.. y, •Andover otE Alit .Ccnter' • Lawrence q •Methuen �Oo, Mendel MiOuade • Salem Center "1 7 brarY a • Haverhill 5Welcome"�% • Georgetown 02 Center tot R•North Andover C 0 CushinHat! g po .Boxford Sullivan', CeY1 Hall A J 13. �Q.lry°q lot Hall Lot A F �lleglate y "\,urchof thrist the Main Teacher Entrance � U4�1af1MrtW�1?Jt•u157.'L1 o IA.Y•tsii•Ta� 0 RKIK•i" 4Ctl7itk Li Jkll� o ANObIFF, RO•i.l1 O'uteJN: e1�.IL�: o Ul 1ty:;1:Y.r.LY: o c�y+lC.tr%tiff 'kri�Utr};l+xl) Il ct7�^elt�) o `Jin7.XtiYNt;um�llLtrat" OiJCYiC `Ir^�7alGL] !t3.x7ta"r O1ler� Is tai �ii+ta' O $41r.01T, a O 101ii;'';�krJ nx na Lliga, o '1ey]tp"� ISL P INt57Fh�GR[i�llr �,•n•.�.: Ot-%�C]�I.+ C,Ix1iL1t7 9�ICI:IFII LiUdrgl.� -.. O lCid•)tYlpRli .-.. - 7 O U7iilk9•Tu[v ��tl-itr a Lear: 3 Certificate of 'Came Re'a5tance 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. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Invoice Number: 0202537 -IN Customer P.O.: Customer Number: CHR030 vendor Trade Name AZTEC TENTS Date Manufactured Mardi Grs F-2 2.0 2665 COLUMBIA ST 1/8/2014 F-222.04 TORRANCE, CA 90503 Lam -Tex 12, 14, 16, 18oz F-419.01 (800) 228-3687 This is to certify that the materials described below have been flamerPtardant treated (or are inherently flame retardant). Clear Vinyl 169a / 20ga F-593.01 A � Christian Party Rentals 10 18 Clinton Drive PolySateen Liner 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. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Invoice Number: 0202537 -IN Customer P.O.: Customer Number: CHR030 vendor Trade Name Bruin Mardi Grs F-2 2.0 Bruln Mesh F-222.04 California Comb. Lam -Tex 12, 14, 16, 18oz F-419.01 Coated Fabrics Clear Vinyl 16ga/20ga F-570.02 DAF Clear Vinyl 169a / 20ga F-593.01 DAF DAF F-593.02 Exclusively Expo PolySateen Liner F-434.01 Ferrari Precontaint 502 F-444.01 Ferrari Precontaint 702 F-444.08 Phillips Textiles Phil -Tex Liner F-500.01 PVC Tech. Deco Cloth / Velon F-504.01 Snyder Weatherspan F-140.01 Tri Vantage Firesist Sunbrella F-368.05 Tri Vantage Patio 500 F-121.02 Tn Vantage Big Top F-121.10 7n Vantage Vanguard Weblon F-069.01 7n Vantage Weblon / Coastline F-069.01 Verseidag Duraskin 81673, 81515 F-530.01 Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z22130CM2002 30x20 Mid Jumbotrac Top UW Z22140CE4002 40x40 2pc Jumbotrac Top UW Blockout White- w/ 8Ratchet Tensioners Z22140CM2002 40x20 Mid Jumbotrac Top UW Blockout White- w/ 2Ratchet rjs ners Z22520FC2002 #20x201 pc Festival Top UW w/ Ratchet Tensioners& Flag Blockout White #with Double Valance Z22520FC4002 #20x40 1 pc Festival Top UW w/ Ratchet Tensioners& Flag Blockout White #with Double Valance Z211203002 #20x30 1 pc Top Only UW Blockout White #with Double Valanace /ZFRT Daylight Freight Prepay & Add EACH EACH EACH EACH EACH �u EACH 2 1 2 FA FA 2 I 1 E E 2 2 Sep 25 14 06:16p Mike LeBlanc 978 534 7983 p 1 Massachusetts - Department of ?ub:;c Safe;v Board of Building Regulations and Standcrcis License: CS -067484 MICHAEL P LEB`ANC 611 PIERCE ST = s LEOMINSTER MA 01453. . 512, Commissioner 06/22/2016 6�96fgAh ATT hiN'k 18 Clinton Drive, Hollis, NH 03049 603-882-1234 or 603-881-8833 fax 1-888-RENTENT www.intents.com email: sales@intents.com B MERRIMACK COLLEGE I ACCOUNTS PAYABLE L 315 TURNPIKE STREET L NORTH ANDOVER TEL: (978) 837-5203 TEL2: (978) 809-5618 ORDER CONFIRMATION 25063-2 Pg: 1 EVENT DESC: COMMENCEMENT- ROGERS 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: 11/21/2014 TERMS: NET 10 DAYS (347) 755-2310 SHARON S ROGERS CENTER H I NORTH ANDOVER MA 01845 P FAX: (978) 837-5524 (617) 809-5618 1I&M QTY ITEM DESCRIPTION PRICE TOTAL 1 40'X 80' WHITE FRAME TENT(KT) 2,600.00 2,600.00 240 FEET OF CATHEDRAL WINDOW SIDEWALLS- FULL SIDES 1.50 360.00 5 WHITE VINYL COVERS FOR CEMENT BARRELS 7.50 37.50 5 WEIGHTED BARRELS TO SECURE TENT 18.00 90.00 240 FEET OF WHITE MARKET LIGHTS (7 WATT ROUND BULBS) 1.50 360.00 3200 SQ. FT. OF "PUTTY" ULTRA DECK PLASTIC FLOORING INSTALLED 1.00 3,200.00 3200 CARPET INSTALLED(SQ FT) INSTALLED "CADET BLUE" 1.00 3,200.00 300 FRUITWOOD CHIAVARI CHAIRS W/ IVORY CUSHIONS 14.50 4,350.00 30 5' ROUND TABLES 10.63 318.90 20 3' ROUND TABLES 9.69 193.80 30 3' ROUND 42" HIBOY TABLES 10.94 328.20 MC IS RESPONSIBLE FOR POWER DISTRIBUTION TO LIGHTS 1 SET UP / BREAK DOWN FEE FOR TABLES/CHAIRS 450.00 450.00 1 TENT PERMIT 150.00 150.00 SCHEDULE: TENT ON TUESDAY AND FURNITURE THURSDAY SPECIAL INSTRUCTIONS: SUB TOTAL: 15,638.40 EVENT IS 5/14 THRU 5/17 PRICES REFLECT EXTENDED RENTAL: 1.25 X ONE DAY PRICE SALES TAX: 0.00 FINAL SCHEDULE TO BE DETERMINED IN SPRING DELIVERY: 115.00 0.00 TOTAL: 15,753.40 Customer Acceptance Signature The Commonwealth of Massachusetts x Department of IndustrialAccidents I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Auuiicant information Piease Print Leeibiy Name (Business/Organization/Individual): Christian Delivery & Chair Service, Inc. DBA Christian Party Rental Address: 18 Clinton Drive City/State/Zip: Hoiiis, New Hampshire 03049 Phone #:603-883-5326 Are you an employer? Check the appropriate box: 1.O 1 am a employer with 40 employees (full and/or part-time).* 2.0 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.E] I am a homeowner doing all work myself [No workers' comp. insurance required.] t 4.E] I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure ihai ail wniraciuis ciihcr have workers' wmperisauun insurance or are suie proprietors with no employees. 5.❑ 1 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.t WC o.0 w c W a wipuraiiuii anu iia urTiccra hove cxaciseu urcu , igui ui cxcunpiiuu pct ivivi, c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. Remodeling 9. ❑ Demolition 10 [] Building addition r..LJ Lr"urCar rcpana yr aUUMV110 12. ❑ Plumbing repairs or additions 13.❑Roof repairs 14. jn✓ Other TENTS *Any applicant that checks box # I 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. 2Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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. rn3. t,rl^ee Corrtpany rTame. New Hampshire Motor Transit Association Policy # or Self -ins. Lic. #: P000749NHMTA2015 Expiration Date: 01-01-2016 Job Site Address: ��5 �U6'��✓/ �TY e City/State/Zip:,&, }[!%,dD OfriM14 Attach a copy of the workers' compensation policy deciaration 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 a pains fid pen ties of perju that the information provided above is trueandcorrect Rianatnre• date• �T ��✓ Phone #: vvo-0013-aoco 77ia l use only. Do not write in this area, to be completed by city or town ofciaL _ T_ ..T_ •. __ 11 11 l.lty Uf lUWIt; l'Cfllllt/LICCOxC R Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other iContact Person: Phone #: I z?%ffIfiWM 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(ies) listed below. The insurance afforded by the listed policy(ies) 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 09/01/2015-01/01/2016 P000749NHMTA2015 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 /Wr4wr Authorized Representative Concord, NH 603-224-7337 02/06/2015 Office Phone Number Date Issued