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HomeMy WebLinkAboutBuilding Permit #710-14 - 315 TURNPIKE STREET 4/15/2014Permit N0: Date Issued: I LOCATI TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION RTANT: Appli 7 -Urn Db PROPERTY OWNER herr must Date Received all items on this Print V 100 Year Ula Structure MAP NO: PARCEL: ZONING DISTRICT: Historic District Machine Shop Village yes no yes no ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family El Industrial 11 Alteration No. of units: ❑Commercial 11 Repair, replacement ElAssessory Bldg p�Others: ���r ❑ Demolition ❑ Other ❑ Septic El Well ❑ Floodplain El Wetlands ❑Watershed District ❑ Water/Sewer nCcr01DT1nM nP wnRK TO RE PERFORMED: ©r► or ccbtoJ+- I�ZSIA// a 4-I �X8 TAT, evno va l �vi`ll �e on ora�ou� Identification Please Type or Print Clearly) OWNER: Name: Address: 31.E S51L , CONTRACTOR Name: Ch,`8i/ Al Address: 1 ? (,1! - 8?3 7-,5759 NIA 6/911-S" Phone ll �s R/J o30 �19 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER /y//, Is4zI Phone: D3-2��' �� d /D = / nn �! l � 0309 Address: 1 !tel �� P?"' IIS / V 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: $ V,0 FEE: $ Check No.: -I � 7175 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Agent/Owher Signature of contractor Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 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 PLANNING & DEVELOPMENT COMMENTS DATE REJECTED 1' DATE APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes - Planning Board Decision: Conservation Decision: Comments Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Tows Engineer: Signature: Located 384 Osqood Street NKt ULPARTMENT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departinerit signature/date COMMENTS Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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) El Notified for pickup - Date 1 Doc.Building Permit Revised 2010 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 u Building Permit Application u Workers Comp Affidavit u Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract Li Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) u 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) u Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o 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 subm:ated with the building application Doc: Doc.Bui!ding Permit Revised 2012 Location (�� U ep `�- No. d — Date I L% Check #� `' ) TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 30— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f Building Inspector o 0 0 0 as = CDCD O c �•nID 0 -DL rt .► � C'1 � iTl C y. N O cn ,Of CD T_ _ O O rt Q. Rr O Fn v W O N O cD 2 O O O-:� snow cc CL � CD O 0 '� rt 0 ? CDIm CD CD � O O rn. low O 0. cn -� ca z :30 c rt 0 CL N CD U) CD 'N w M cn �� O C7 O : 0 O O S O N :�O y � V CD 0 cn DcD= 2) O 0 �s - O O O O O Q v) El O ;7(D o N — (D z O CO C � T j' ' T N In O F• FW T �' DJ X O C 00 T y n 3 3 (D x O C 00m T O C °* p N (D 'O L T O O a n n C � T my � —i m O T M A V O C W p M C v Z M m O 3 O O W > v0 D x � � y Ci -a O n � CD Do z CL r— m m ;a �o ' cn D cam' N 0� O M O Z .� Cl)CD� vCD �o CD� o m CL Cl) cr %< — CD o CCD OCD O Z� T W � 9 0 z Z CL CD O ca CO 41D ;z A' Ocn `� W Z c CD O � O Z G) CDN C 0 O W . o 0 0 0 as = CDCD O c �•nID 0 -DL rt .► � C'1 � iTl C y. N O cn ,Of CD T_ _ O O rt Q. Rr O Fn v W O N O cD 2 O O O-:� snow cc CL � CD O 0 '� rt 0 ? CDIm CD CD � O O rn. low O 0. cn -� ca z :30 c rt 0 CL N CD U) CD 'N w M cn �� O C7 O : 0 O O S O N :�O y � V CD 0 cn DcD= 2) O 0 �s - O O O O O Q v) El O ;7(D o N — (D z O CO C � T j' O C A0J ao T N In O :Q O C 00 T �' DJ X O C 00 T y n 3 3 (D x O C 00m T O C °* p N (D 'O L T O O a n n T my � —i m O T M A V O C W p M C v Z M m O 3 O O W > v0 D x I St. Ann Apartments Physical Plant Martane-Mejait � Baseball � Field � J St. Thomas ' Field •• ,Apartments Softball Field .. -• _ i o Q Sporpa Medicine Y W,aSid Healthy Ash Centre 11� lop itd Aca4ftft Sclbnces O'Brien {nCen tk n 3 `i '�. - - Halla Residence Center Besketiylt Deegan � 1 Village '� Court \ Volpe 1 :.-; - Mon{can ttCenter Merfv{nack �7eE' an ° TowW,\ Centre 9 Complex - �,. Hall West Q - Housei �- • Rogers Cascia Hall. , Center, for the $akowi�h Arts Q liReilly, Camputi, Nall Furter, 4 6 POc Mendel`. - McQuade Library a� Center. �e° _. ;. T a Welcome\ 'i�,s Center � :Cushing nPo Sullivan'•.Hall, � � Hall - 9. 9 Austin ,9P 109 Field PPo w 6 Austin, HallF Collegiate `� Burch of •`l�Po Christ the Main t MERRIMACK ATHLETICS COMPLEX Teacher Entrance Tho D Ci oce Dunki i' Donuts Family Lobbyh' °d z ACADEMIC INNOVATION Markets Lab . N f I The Commonwealth of Massachusefts Department of Indus&W Accidents Office of Invesdgations IF 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Bulltiers/Contractors/Electricians/Piumbers Aanlicant Information Please Print Legibly Name(BusinesslOrganization/individuat): Lfl 1^I11 / r NG t t' DBA ; G h r t s{,r�a.ty p^4 y /2cnfat Address: ht Prr YG city/State/Zip: 14 a 11 l � f, . AI { 030W Phone #:_ bd3-S.8'3 Are you an employer? Check the appropriate box: 1. Rlefam a employer with U57 4. ❑ 1 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, t 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 13.9Qther��TS `,Any applicant that checks box #1 mustalso 611 out the action below Aowing their worim' compm"t ni policy imformatim t i%meowDers who submit this affidavit indicating they are doing all wodi and than hire outside comtracttm mast submit a new affidavit indicating such. tCoutrusers that check this box must attached an additional sheet showing the name of the sub-caniraotors and than wormers' camp. policy information. lam an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. /� �^ Insurance Company Name: 1 y cc ,L Policy # or Self -ins. Lic. #: wG I P 310 181 -7 Q Expiration Date: q Ll 2at'tj/` Job Site Address; City/State/Zip:pz.-J4 Ve r� Attach a copy of the workers' compensation policy declaration page (showing the polity 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 €mp isonment; 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 Investig4tious of the DIA for insurance coverage verification. I do hereby cerdify under the pains and p hone #: duty` the information provided above is true and correct. Ofilcial use only. Do not write in this area, to be compktad by city or town offiafat City or Town: PermitiLkense # 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 #• ^`,C)R O® CERTIFICATE OF LIABILITY INSURANCE 9�4�2013 Y' 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 848E-MAILDE 3 Market Place Hollis NH 03049 NAME: NTACT Tracy Plcardi PHONEtl,(603)465-3333 FAX (AIC, Nole (603)465-6800 :tracy@tebbettsins.com INSURERS AFFORDING COVERAGE NAIC # INSURERA-.Citizens Insurance Company of 31534 INSURED Christian Delivery & Chair Service Inc. dba Christian Party Rental 18 Clinton Drive Hollis NH 03049 INSURER B. -Hanover Insurance Company 2292 INSURERCNCCI 15172 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBERtlaster 13-14 REVISION NUMBER: 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. 1LTR TYPE OF INSURANCE ADDLSURR POLICY NUMBER MIDDY EFF M POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR ESV0844363 9/1/2013 /1/2014 TO RENTffff— PREMISE Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY CMBINED SINGLE LIMIT Ea accident 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS V0716909 /1/2013 9/1/2014 BODILY INJURY (Per accident) $ PeOP.ER nt AMAGE $ NON -OWNED HIRED AUTOS AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 B 14DED EXCESS UAB CLAIMS -MADE I X I RETENTION$ $ UHV0844365 9/1/2013 9/1/2014 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) NIA ID31098170 /1/2013 /1/2014 X WC STATU- XTORY LIMITS OTH- ER --- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of Insurance ACORD 25 (2010/05) INS025 r9nirmi m 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 Tebbetts/TPIC ©1988-2010 ACORD CORPORATION. All rights reserved. Tho ar npn names aneil Innn ara raniata►oel mar4e of arnQrl 3 �ertifiCate of Re5t5tanceCame 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 Invoice Number: 0202537 -IN Customer P.O.: Customer Number: CHR030 vendor Tra a ame AZTEC TENTS Date Manufactured Mardi Gras F - 2665 COLUMBIA ST 1/8/2014 F-222.04 TORRANCE, CA 90503 lam -Tex 12, 14, 16, 18oz F-419.01 (800)228-3687 Clear Vinyl 16ga / 20ga This is to certify that the materials described below have been flame;,retardant treated (or are inherently flame retardant). F-593.01 DAF DAF F-593.02 Exclusively Expo Christian Party Rentalse / } 18 Clinton Drive - Hollis, NH 03049 k` Precontraint 702 F-444.08 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 Invoice Number: 0202537 -IN Customer P.O.: Customer Number: CHR030 vendor Tra a ame EACH Bruin Mardi Gras F - Bruin 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 16ga / 20ga F-593.01 DAF DAF F-593.02 Exclusively Expo PolySateen Liner F-434.01 Ferran Precontralnt 502 F-444.01 Ferran Precontraint 702 F-444.08 Phillips Textiles Phil -Tex liner F-500.01 PJC Tech. Deco Cloth / Velon F-504.01 Snyder Weatherspan F-140.01 Tri Vantage Firesist Sunbrella F-368.05 TO Vantage Patio 500 F-121.02 Tn Vantage Big Top F-121.10 Tn Vantage Vanguard Weblon F-069.01 TO Vantage Weblon / Coastline F-069.01 Verseidag Duraskin 81673, 81515 F-530.01 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 Name of Applicator or Production Superintendent General Manager- Manufacturing Title of Applicator or Production Superintendent ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z22130CM2002 30x20 Mid Jumbotrac Top EACH 2 2 UW Blockout White- w/ 2Ratchet Tensioners Z22140CE4002 40x40 2pc Jumbotrac Top EACH 1 1 UW Blockout White- w/ 8Ratchet Tensioners Z22140CM2002 40x20 Mid Jumbotrac Top EACH 2 2 UW Blockout White- w/ 2Ratchet Tensioners Z22520FC2002 #20x20 1 pc Festival Top EACH 2 2 UW w/ Ratchet Tensioners& Flag Blockout White #with Double Valance Z22520FC4002 #20x40 1 pc Festival Top EACH 2 2 UW w/ Ratchet Tensioners& Flag Blockout White #with Double Valance Z211203002 #20x30 1 pc Top Only UW EACH 2 2 Blockout White #with Double Valanace /ZFRT Daylight Freight Prepay & Add