HomeMy WebLinkAboutBuilding Permit #660-13 - 315 TURNPIKE STREET 4/11/2013BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more.family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
--Others,���
Demolition
Other
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DESCRIPTION OF WORK TO BE PREFORMED:
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Identification PIease Type or Print Clearly)
OWNER: Name: Phone:
ARCHITECT/ENGINEER Phone:
Address:
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: $ �/ ��� '00 FEE: $__ f
Check No.:k4aReceipt No.: 7 -(to Z-1 2 -
NOTE: Persons contracting with unregistered contractors do not have access to the „vouaranty fund
F
Plans Submitted Plans Waived Certified Plot.Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Well
Private (septic tank, etc.
Tanning/Massage/Body Art
Tobacco Sales
Permanent Dumpster on Site
Swimming pools
Food Packaging/Sales
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
C0K 1\ Ir"•.ITI1
L.�iivHvici%j i a
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer ConnectionDriveway Permit
DPW Town Engineer: Signature:
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 No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
RL
Building Department
The following 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
o 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
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
o 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)
o Mass check- Energy Compliance Report (If Applicable)
o 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
❑ Cel li:lel: r{L2�U JU r VL i'ian.
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o 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
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doc: Building Permit Revised 2008
Location
No.-��p Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Check #
(4b
26272 Building Inspector
4/10/13
315 Turnpike St, North Andover, MA- Google Maps
Address 315 Turnpike St
Go,-� � Merrimack College, North
Andover, MA 01845
Get Google Maps on your phone
Text the word "GMAPS" to 466453
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Certif itate of iflame Re5t'.5tanre
REOMMMW AZTEC TENTS nate aaeoed or
�
2865 COLUMBIA ST
LU NQ TORRANCE, CA NM 0212008
CAL COMB F41101 (800)228.3687
7hls Is to certify Bial the materlwfs ds=*Wbdm hwedhm+e been f wmjobuafantbeeled(oram lnhsrw*nonRananahls).
Fm
CHR/SMN PARTYRENTAL
18 CUNTON ORVE
HOLDS, NH 03049 a
Cwdf badon Is hereby made fhatr {check la- or IV)
F] (a) The amides described below this cordfloate have been treated with a flame retardant chemical approved
and registered by the Sime Fire Marshal and that the appgeationof said chemical was done in confor-
mance with the laws of the Stale of Callfornla and the Rules and Regulations of the Stdo Fire Marshal.
Nameof chemical used ..._ ....................._.. ......... ..-. Chem. Reg. No.. -..w...-_..._....
Meathodof appitcatlon._...._............._....._................................»...._._...,..........
r� (b) The articles described below hereof aro made from a Game -resistant fabric or material registered and
Ij ��► I� approved be the State Fire Marshal for such use; Fabric has been tasted and oesses NFPAT01.96.
Trade name of flame-realstant fabric or material used_ Lm*"dr*& . Reg. No. _..X41......
The Flame Retardant Process Used l."S- anon....... Be Removed by Washing
a arwa rwtl
David Bradley Chuck Miller - President
NonectAppIcAw; is
WIN
CUSTOMER ORDER NO. R168629
ITEMS MANUFACTURED:
2 - 2WO Festiva/ Top UW w ffi Double valance
2- 20x40 Fesflral Top UW with Double valance
3 - 40x40 2pc, JumboTnec Top UW - t �O
6 -4tjd0 JumboTrac Middle Top UW
I -10OW30 Series 2000 Md*9 UW V[
2-20x20 Serres 1500lpc. Top UW
2-20x30 Sedles 1600 iptn. Top UW
2 - 20WO Sedes 13001pa Top UW
PDF created with pdfFactory trial version www.pdffactory.com
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):
Address: l 6140k) Priyc,
City/State/Zip: N 001'5, Phone M-6
Are you an employer? Check the appropriate box:
1. Eg"fam a employer with o?- !�7__
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.[6ther %s
*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_
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information. %
Insurance Company Name: Ce ko kY1 e r;ife_
u rethCe—
Policy # or Self -ins. Lic. #: \Nl Cy G q2:z 6,'5 ,3 9 Expiration Date: 1 13
Job Site Address:
City/State/Zip: ,
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 the pains and penalties of perju that the information provided above is true and correct,
a
Phone #: k _
Official use only. Do not write in this area, to be completed by city or tows: official,
City or Town: Permit/License #
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 #:
a 4
. � CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDDIYYYY)
6.."��
9/5/2012
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.
IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer ri;hts to the
certificate holder in lieu of such endorsement(s).
P"onucER
TebbettS Insurance Agency
P.O. Box $Qg
3 Market Place
Hollis NH 03049
NAMEncT Loci Fitzpatrick
PHONE No(603}4b5-3333 FA1AIC No: (603)455'6&00
pDDRE , luci@ tebbettsins . cora
INSu AFFORDING COVERAGE NAIC>x
INSURER A'Citi zens Insurance Co 311 of 1534
INSURED
Christian Delivery & Chair Service Inc.
D/B/A Christian Party Rental
INSURERS Hanover Insurance Company 22292
INSURER C :Commerce and Industry Insurance 5172
INSURER 0:
IS Clinton Drive
1401.1i,s NH 03049
INSURER
INSURER F:
LIUVCRAUE.J C:rK111.1t.A ilF N1 IMRFR•C'L1J 5}5(17 Z57 OcInain&I w 1u M0. n.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INS"
LTR
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFF
MM/DD
POLICY EXP
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X 1 COMMERCIAL GENERAL LIABILITY
DAMAGE TO PREMISES (Ea occu nce $ 100,000
A
CLAIMS -MADE [Z OCCUR
ZRV0844363
/1/2022
/1/2013
MED EXP (Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GENERAL AGGREGATE S 2,000,000
GEN`I.AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOPAGG S 2,000,000
X POLICY PRO- F-1 JECT F1 LOC
S
AUTOMOBILE LIABILITY
COMBINED tSINGLE LIMIT1,000,000
(Eaa
A
X ANY AUTO
BODILY INJURY (Per Perron) $
ALLSCHEDULE
AUTOS
0716909
9/1/2012
/1/2013
BODILY INJURY (Per accident) $
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE
Psracdderd $
ELBE $
X
UMBRELLA LIABOCCUR
HCLAIMS-MADE
EACH OCCURRENCE $ 4,000,000
13
EXCESS LIAR
AGGREGATE $ 4,000,000
DED I X I RETENTION
$
0844365
/1/2012
/1/2013
C
WORKER$ COMPENSATION
X WC STATU XOFFt
AND EMPLOYERS' LIABILITY YIN
�,I ER
E.LEACH ACCIDENT $ 11000,000
ANY PROPRIETORIPARTNERIEXECUTIVE
OFFICERJMEMBER EXCLUDED?
NIA
EL DISEASE - EA EMPLOYE $ 11000,000
(Mandatoryln NH)
0009870539
/1/2012
/1/2023
if yesescribe under
, d
E_L DISEASE -POLICY LIMIT 1 $ 1,000,0()0
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more apace Is required)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Seth Tebbetts/LUCI
ACORD 25 (2010105) Q 1988-2010 ACORD CORPORATION. All rinhtc ronarvpr(
INS025 onim'a ni Tito Af C)Drl n2ma on`i Innn ora ronteferarl martin of Ar npn