Loading...
HomeMy WebLinkAboutBuilding Permit #663-13 - 315 TURNPIKE STREET 4/11/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' Date Received I I Date Issued: XtIMPORTANT: Applicant must complete all items on this page LOCATION �/ S / G(4 / ST54WICH QX Print PROPERTY OWNER rrVY?g Go Unit # Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes 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 U—Ethers: ❑ Demolition ❑ Other �`Septi'c D Well' ,#Floodplaui� �, Wetlandsl I_ WatersfiedliDlstii I ❑' Water/Sewer ; r b umr 1 WIN Ur w UK1L 1 U ti , FEFd'UF N ED: 4Q9 L, �C � Tem /�I 7%_ Sal�owvc% �rrL 9 A A 1116e a� (Identification Please Type or Print Clearly) OWNER: Name: Phone: A Address: CONTRACTOR Name• Phone:®3 ��Y_S� 2z Address: �j}�j J`0� ��, f' Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. N FEE SCHEDULE. BULDING PERMIT. • $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Qv Total Project Cost: $ 9S FEE: $ --- Check No.: �.Q Q �J Receipt No.: = 01-4�3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,Sigureof gentOwne natSignature_of contracto 0 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Pl?ns El e V TYPE OF SEWERAGE DISPOSAL Public Sewer F1Tanning/Massage/Body Art 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 PLANNING & DEVELOPMENT ❑ DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decisio Comments Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signa FIRE DEPARTMENT.;- Temp Dumpster on site Located at 124 Main Street Fire Department signature/date' COMMENTS Located 384 Osgood Street yes 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.$10041000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date 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 �46VNtv) A" No.— V�— Date Checkv�-4A6 26273 W - 4r TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Building Inspector C m m m m y m y m Wv a -0 Cl)c� C, r. o 0 0SQ� m V� z o ?�� N G =y cD h o_ o CL m N SD O C 2 o m D _ o m' a V� n c COD �D Go =r CD co 0- Z N �` C �. `° ,a CD O Z -0 --4 oca < :9): r 0 "tm� � o0(a CL Cl) z � `n� �' � 0 2,1, 9 m C =r =' ♦) 0 p CD .O y �� Jlz CL CD cn M CD N a'CL �0�0', Cl) CL OD � � � r N 00 00CD; O o CL CD D Cl)cn 0 C CO CD C�nCDCD 0 y o W ., Z r' �N rt . $: CD v c °� � z:=r'7 O G) • D c� Z C - @ i►- < 0CD 0; a) o CL N p '± K ((D .fit p co C 7CQ (D T v A C S -n N L f1 (D 'A C Orq S m m -n N ;pT C S - C d S 7 (D O C S O C O_ D1 m C (D r) CD O O \ 7C = m M 7� H22 Z M 70 D Z M W ) Z M m 00 G �_ Z CA m O O m D 2 x40.0 0 0 wz 41 CD -% M w I' d 0 c 4/10/13 315 Turnpile St, North Andover, MA- Google Maps Go-1,QIc Address 315 Turnpike St MerrimackMemack College, North Andover, MA 01845 Get Google Maps on your phone Text the word "GMAPS" to 46645 3 https://niaps.googIe.com/maps?f=q&source=s_q&hl=en&geocode=&q=315+TurrokL-+St,+Norih+A Klmw+MA&aq=0&oq=315+turnpile+st+&sII=37.6,-95.66... 1/1 Q'Ir..'ertificate of if fame Re�i!6tance REGISTERED ISSUED BY. onto treated or APPLICATION AZTEC TENTS manufactured CONCERN NO. 490 ALASKA AVENUE TORRANCE, CA 90603 02J2006 's, CAL COMB F+HD Oi (310)328-6060 This Is to certify that the materials described below hereof have been flame retardant treated (or are inher. ently nonflammable). FOR CHRISTIAN PAMRENTAW ADDRESS 1d CLi ffM DPM cmr HOLDS STATE NH, 0 JA Certification is hereby made that. (check "a" or W) ❑ (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 Fre Marshal. Nameof chemical used .»»...»...»....»....»»»......»... Chem. Reg. No.......».»... ».» . Meathod of application.....»»..»..».-.............»».....»..........,._».....�,»» ......... a (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 Passes NFPA701.96. Trade name of flame -resistant fabric or material used..L'%U%dfAW* . Reg. No. ...... Ntlz?!...... The Flame Retardant Process Used INILLNOT.... Be Removed by Washing pvitl or+riB not) David Bradley Chuck Miller - President or CUSTOMER ORDER NO. R159657 ITEMS MANUFACTURED: 1• l00WW (2 PC.) SBM 2000 TP- ULTRA WHITE & W1iPW' (1 Pt ;j QW1K TOP ONLY- UL7RA WHITE k 20x30'(1 PC) QWIKTOP ONLY -ULTRA WHITE PDF created with pdfFactory trial version www.pdffactorv.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ky 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly ' fiAn DJ� }��Ch,��sfi:9� Name (Business/Organization/Individual): Ch riSPelt-C6djrV)Z, Liza . PAgnZ -AL Address: l9 N r? 40kV Pri City/State/Zip: �-I 1115 , %l H iQ30 q 9 Phone #:—(o 0 3 ' 9'83'.53 2-6 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.] officers have exercised their ❑ 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.�ther *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 my employees. Below is the policy and job site information. /I Insurance Company Name: 1✓ e w kneYZ'e- u ret hee— Policy # or Self -ins. Lic. #: WC d 0 � 7G5.3 1 Expiration Date: 1 ,-7613 Job Site Address:_ �1 I urn v)klo, City/State/Zip: , 'A L' M1! 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 perjury that the information provided above is true and correct Phone #: 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 Phone #: 'ac©Rc'CERTI'FICATE OF LIABILITY' INSURANCE DATE(MM,DD�YYY, 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 1S 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 e4S 3 Market Place Hollis NH 03049 M,OgMEACT i+S3C7 Fitzpatrick PHONE(603}465-3333 FAX: (503) 455-5604 p.MAIL .laci tebbettsins.r om INSURERSAFFORDING COVERAGE t NAEC # INsuRERA-.Citizens Insurance Co=any of 1534 INSURED Christian Delivery 5 Chair Service Inc. D/B/A Christian Party Rental INSURER a Iianover Insurance Company 2292 INSURER c: Commerce and Industry Insurance 15172 INSURER D: IS Clinton Drive Hollis NH 03049 J. INSURER E: INSURER F: VV YC.f�l11.]CJ 1. M""M-"I►Mi 4ft1 OCinOlAl�l�i ilf�G'r'f. 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. INSR LTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MM/DO POIfCY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rX OCCUR 3SVO844363 /1/2012 /1/2013 DAPRISES EMA e oaw $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGA7E $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC PRODUCTS -COMPIOP AGG $ 2,000,000 1 1 $ A AUTOMOBILE X LIABILITY ANYAUTO AUTOSN� SCHCOULED AUTOS 0716909 9/1/2012 /1/2013 CCOMBINED SINGLE LIMIT1,000,000 BODILY INJURY(Perperson) $ BODILY INJURY (Per accident) $ NON-OMED HIRED AUTOS AUTOS PR PERTY DAMAGE Per acddent $ ELBE $ X UMBRELLA LiASOCCUR HCLAIMS-MADE EACH OCCURRENCE $ 4,000,000 B EXCESS UA13 AGGREGATE $ 4,000,000 DED X RETENTION $ 0844355 /1/2012 /1/2013 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETORIPARTNERIEXECUTiVE OFFICERWEMBER EXCLUDED? (MandatotyIn NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA 0009870539 /1/2012 /1/2013 YJC STATLI IS X S[ X EL EACHACCIDENT $ 1,000 000 EL DISEASE - EA EMPLOYE $ 11000,000 E.L DISEASE -POLICY L)Mrf 5 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 1(11, Additional Remarks Schedule, ff more space 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 TebbeitslLiTCx I-` ACORD 25 (2010105) ©1988-2010 ACORD CORPORATION. All rinhht ranarvad INS025 Mninrim n1 Tho Al:nOn namo anti Innn arA ranictorori marirc of Ar'npn