HomeMy WebLinkAboutBuilding Permit #662-13 - 315 TURNPIKE STREET 4/11/2013Permit NO:
Date Issued:
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
ANT: Applicant must complete all items on this
LOCATION 3-15- �Gfyn%ii� 5�ree-f sSOFIMIt FIdd oF� Cit 11e,,9AVe
Print
PROPERTY OWNER Mei PrmmkCo/ 1�& Unit #
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NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
100 year-old structure yes no
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
E Others: - —
❑ Demolition -
❑ Other
gl septic> D Well,
q'.Floodplai.hi Q Wetlands}
11'. Watersl?edibistricf
0' Water/Sewer
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DESCRIPTION OF WORK TO BE PERFORMED:
3 we wi// 20 Wd
soAT
Je4 lelr-
(Identification Please Type or Print Clearly) _
OWNER: Name: Phone:
Address
41 CONTRACTOR Name: � _11 VYSTiI-i-f'1 Phone:
Address:
Supervisor's Construction License:
Home Improvement License:
Exp. Date:
Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
FEE SCHEDULE. BULDING PERMIT. • $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
Total Project Cost: $9�' FEE: $f�
Check No.: U�%6 Receipt No.: 7t P7i- 4
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
'_ . ...
............. ...
;Signature of Agent/Owner Signature,of.contracto _
Plans Submitted ❑ Plans Waived ❑
Certified Plot Plan ❑ Stamped Plans, 0
TYPE OF SEWERAGE DISPOSAL
e • •
Public Sewer ❑
Tanning/Massage/Body Art ❑
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 APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
t
r
COMMENTS
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comm
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood 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
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc:.Building Permit Revised 2011 June/mi
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
❑ 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
❑ Flo or/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 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: Doc.Building Permit Revised 2008mi
Location 51,5 -1 kA (-&e )LD q - I
No. -G (.Pz - ( ��> Date
Check Aa6
26274
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL $
Building Inspector
(Cooerttf trate of 11ame R
REGISTERED ISSUED BY' Data treated or
APPLICATION AZTEC TENTS manufactured
�i CONCERN NO. 490 ALASKA AVENUE'
MRRANCE, CA 90603 0X2W6
ICAL COMB F41941 (310)328-6060
This is to certify that ft niatedWS descdbed below hereof have been dame retardant &&fed (or are lnher-
endy nonflammable).
FOR CHR►Sn4N PAMRLOVWAL.S ADDRESS 18 CLINTON DRIVE
clnr HOL,1IS STATE NH, 03049
Certification is hereby made that: (check "a" or "b')
a (a) The articles described below this certificate have been treated with a flame retardant chemical approved
and registered by the State Fire Marshal and that the application of said chemical was done in confor-
mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal
Name of chemical used .. »..» ......».»...»».»...»........ Chem. Reg. No. ......... .........
»...
Meathodof application ...»..............»..._...».... »..........».».»...»» »...» »» ..» »... «»
(b) The articles described below hereof are made from a flame -resistant fabric or material registered and
approved by the State Fire Marshal for such use; Fabric has been tested and oases NFPA701.86. *-]
N
Trade name of flametesistant fabric or material used.. Lr 9=wFaam . Reg. o ....... f t W.......
The Flame Retardant Process UsediMLL NOT .... Be Removed by Washing
(wIu or,ria'
David Bradley Chuck Miller - President
=WWO-WorkoxwSWUNUM To
CUSTOMER ORDER NO. Rl59657
ITEMS MANUFACTURED:
.ie- tooXV(2 P�c� J sus 200 TPL ULTRA WNTE
P =7V ft PCJ T DP OKY- ULTRA WTIF
a 2ftW' ft PC.) QWiK TOP ONLY-- ULTRA 11WHfrE
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4/10/13 315 Turnpike Street, North Andover, MA - Google Maps
Address 315 Turnpike St
Go Merrimack College, North
Andover MA 01845
Get Google Maps on your phone
9 Text the word "GMAPS" to 46645 3
https://niaps.g oog Ie.com/maps?f=q &source=s_q&hl=en&geocode=&q=31S+Turnpile+Street +North+Ando\oer,+MA&aq=1&oq=315+Turnpike&sl1=37.6,-95.66... 1/1
r
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
Pe
/ �-'
Name (Business/Organization/Individual): oh r1 S �i A7 De/1 Ver f �V1L4)Y �erV1z, ,dile , i>Arzry %4L
Address: /S' 0 l Y7 4z:l) Pr'1 de
City/State/Zip: N v 636 Ll 9 Phone #:_6 D .3 .3 Z�7
Are you an employer? Check the appropriate box:
1. EPfam a employer with c)- 5-_ 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. $
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.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
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. E] Plumbing repairs or additions
12.❑ Roof repairs
13. �ther 72E 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.
tContractors 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 nay employees. Below is the policy and job site
information.
Insurance Company Name: r%�
�DWff1ek-1fe_
ii r'd>`1 CE,
Policy # or Self -ins. Lie. #: WC V 7 7 ,3 9 Expiration Date: 1Z,2613
Job Site Address:. �/�- L.11''% Rk-kq, S%- City/State/Zip: P/t ;W
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!y that the information provided above is true and correct.
Phone #: 4 e � — t?0 3 3�2,6'
Official use only. Do not write in this area, to be completed by city or town 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 #:
,4coRo►CERTIFICATE ®F LIABILITY INSURANCEF9/5/2012
DATid(MMIDDfYYYY)
�----�
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 rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
Tebbetts Insurance Agency
P.O. Box 848
3 Market Place
Hollis NH 03049
CANT Luci Fitzpatrick
PHONE • (603) 465-3333 FAQ Rol: (603) 465-6900
AflatAlt .luci@tebbettsins.com
INSU AFFORDING COVERAGE NA1Ctt
INSURER Citizens Insurance Co=any of 31534
INSURED
INSURERS -JIanOVer Insurance qompany 22292
Christian Delivery & Chair Service Inc.
D/B/A Christian Party Rental.
iNsURERc:Commerce and Industry Insurance 15172
INSURER D
18 Clinton Drive
Hollis NH 03049
INSURER E:
INSURER F:
%1VYCr%M%2Ca 1:GKIU K;AItNUMbl=X1,11LYSUaib'r RPMAInuIMIIAIFRI=a•
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.
'MSR
LTR
TYPE OF INSURANCE
D
POLICY NUMBER
POLICY EFF
MMIDD
POLICY EXP
MMlDD
LIMITS
GENERAL UABIUTY
EACH OCCURRENCE S 1,000,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE T RELATE
PREMISES Ea ccm encs $ 100,000
A
CLAIMS -MADE D OCCUR
EZVO844363
/1/2012
/1/2013
MED EXP (Any one Person) $ 5,000
PERSONAL& ADV INJURY $ 1,000,000
GENERAL AGGREGATE 6 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS -COMPIOPAGG S 2,000,000
X POLICY PRO- LOC
$
AUTOMOBILE LIABIU Y
SINGLE LIMIT
COMBINED
1,000,000
A
X ANY AUTO
BODILY INJURY (Per person) $
ALL OS OWNEDSCHEDULE
AUTOS
0716909
9/1/2012
/1/2013
BODILY INJURY (Peracddent) S
NON -OWNED
HIREOAUiOS AUTOS
PR PERTY DAMAGE
Peranddent $
EIRE $
X
UMBRELLA LIIABOCCUR
HEACH
OCCURRENCE $ 4,000,000
B
EXCESS UAB
GLAIMS•MADE
AGGREGATE $ 4,000,000
DED X RETENTION
$
0844365
9/1/2012
/1/2013
C
WORKERS COMPENSATION
X we sTArU X oTH
ER
AND EMPLOYERS' LIABILITY YIN
EL EACH ACCIDENT S 1,000,000
ANY PROPRIETOMPARTNERIEXECUTPIE
OFRCERJMEMBER EXCLUDED?
NIA
EL.DISEASE -EAEMPLOYEE $ 1,000,000
(Mandatory In NH)
C009870539
/1/2012
/1/2013
Ifyas,descnbsunder
E -L. DISEASE -POLICY LWIT $ 1 000 000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (Attach ACORD 109, Ad itional Remarks Schedule, If more apace is required)
IMIr-A �.l
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
Beth Tebbetts/LUCY
25 f201 0105)
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