Loading...
HomeMy WebLinkAboutBuilding Permit #796-12 - 315 TURNPIKE STREET 5/3/2012BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: 7 � 6 —/2 Date Received OWNER: Name: Address:.%s nFSCRIPTION OF WORK TO BE PREFORMED: tLl/' /"'/ 'al *J / Z -7-5'2_03 ��r E Phone: �3` � � 7(,10O Ooa �� Address: �� (/�//1�J1�I -xre- /S, /U%T ��J- N�— FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED O®25.00 PER S.F. Total Project Cost: $ � FEE: C� Check No.: �'3iS Receipt No.:�� NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tning/MassageBody Art ❑rFoodPackagiing/Sales Pools ❑ Well ❑ Tobacco 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 DATE APPROVED DATE REJECTED DATE APPROVED CONSERVATION F1 DATE COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ 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 Located at 384 Osgood Street Driveway Permit 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 2007 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 ❑ 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) o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location 3/S� p S7 No. �T�%% — a Date .S^ �2- Check # 25261 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ F /Building Inspector N m m m X U) v m _) y CD C � d � O a Z y CD O CL r c IM =c CL a. y c v CD CDCL O Q d CD CD 0 CD C O H� CD CLO CO) a_ co CD � v CO) O 'v Z CD O CD O CCD t_ cs�o m _ O �• NC', cr N a <_ m CO) § m ®CL � m o a+ma� Z - ?.0 N —4 O�.d•► m N 06 c m m ..�0 m N G CO) O um m 7 OCD .0 -g) O _. Oco O �.ci O ZO N C2 .O C =N� a o i CL Rcm /�r�� � ? : `• VJ m CD O N :, ►� a mCD . _ y O d Go e f /Z^ �1 y I=\ Q VJ 1� W ►� `�_��'] N W.1CD �O � vJ H � N .� `• m9 o c -� ON coO O �0 CD o ca CD� y cir C/) ED cn WCD H �� smwo G a •o : J — Li o 0 co o n Co" 0 O o �, Z :-j 0 c ,. x �, x r. 7d x rC � Z :-j 0 c W. Tennis - o Courts ,4 Ash ° Centre .� �. t , Santagati 1 Halt;.. f Deegan ,tya�5r _ �' U. Hall, r Monican Tv��Centre Sakowich HoupseJ Volpe Campus Athletic �j•-_ Ce Complex Rogers 5 Cas' Senior Send-off Hatt Centermel BBQ Tent forthe'_\� Health Arts �tl Reilly° Center Mende! McQuade �- �RS Center Library o Welcome Center �s i�DCushin p� �a Sulliva�� QHatt t Hall Austinv\ Hall ,Collegiate �Vt y Church RW p� Q Main dEntrance AM St. Ann Apartments } Physical r Plant Z. Warrior Field W e Baseball St. Thomas Field Apartments N r N Softball Field' Tennis - o Courts ,4 Ash ° Centre .� �. t , Santagati 1 Halt;.. f Deegan ,tya�5r _ �' U. Hall, r Monican Tv��Centre Sakowich HoupseJ Volpe Campus Athletic �j•-_ Ce Complex Rogers 5 Cas' Senior Send-off Hatt Centermel BBQ Tent forthe'_\� Health Arts �tl Reilly° Center Mende! McQuade �- �RS Center Library o Welcome Center �s i�DCushin p� �a Sulliva�� QHatt t Hall Austinv\ Hall ,Collegiate �Vt y Church RW p� Q Main dEntrance AM C...ertif itate of flame R REGISTERED ISSUED BY. Date treated or "I+ APPUDATION AZTEC TENTS manufactured 4'• CONCERN No. 490 ALASKA AVENUE ' TORRANCE, CA 90603 ?12006 CAL COMB F41041 (310)328-6060 This Is to certify that the materials described below hereof have been flame retardant &rated (or are Inher- ently nonflammable). FOR CHRISTM PAMRENTALS ADDRESS 1a CLWON DRW CITY HOLDS STATE NH, 03M -- Certification is hereby made that: (check "b" or `b'j ❑ (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 Cafffomla and the Rules and Regulations of the State Fire Marshal. Name of 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..FAW* . Reg. No. ...... fift:4!...... The Flame Retardant Process Used WILL NOT .... Be Removed by Wash Ing (w1; or wil not) David Bradley Chuck Miller - President Nam ofAWk&W or Prodtclon SupMntendent To CUSTOMER ORDER NO. Rl59657 ITEMS MANUFACTURED: i -100'X40'(2 PC.) SERIES 2000 TP- ULTRA WHITE 2- 20Yd0' fi PC) QWIK TOP ONLY ULTRA WHJTE 2.205x20'(1 PC.) QWIK TOP ONLY- ULTRA MITE 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 pg1>19ALL 11 l Name (Business/Org/a�nization/Individual):Chr Sf'Xt1 Wi-Vek)l t C(70fj J-etyicc,. 4e- t^hkfy ,ix �r� �evrTit J Address: City/State/Zip: !� 0 �! IS, /�%t7 D 3D�19 Phone #: Are you an employer? Check the appropriate box: L.M I am a employer with 1-6- 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. x ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. [1 We are a corporation and its required.] officers have exercised their 3. ❑ 1 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.] f 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.(3 Other 7'IWZ% *Any applicant that checks box -41 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 atu an employer tltat isprovidiitg workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Policy # or Self -ins. Job Site Address: ^'01 eI45/1 City/State/Zim /t/'1fW��e 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investig4tions of the DIA for insurance coverage verification. Ido hereby certify under the pains andpenaWs of pgW1 that the information provided above is true and correct Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone A`oRo® CERTIFICATE OF LIABILITY INSURANCE si E1/ oil THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) 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 Village Marketplace Hollis NH 03049 CAM ACT Luci Fitzpatrick PHONE(603)965-3333 FAX:(603)-065-6800 E-MAIL loci@tebbettsins.com AD RES fNSURER(SJ AFFORDING COVERAGE NAIC# INSURERA:CitizenS Insurance Conipany of 31534 INSURED Christian Delivery & Chair Services, Inc. D/B/A Christian Party Rental 18 Clinton Drive Hollis NH 03049 INSURERB:Hanover Insurance Company 22292 INSURER C:Coslm orce and Industry Insurance 15172 INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUNIBER:CL1183101187 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. INSR LTR TYPE OF INSURANCE ADDLSUB POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD EIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ..XE OCCUR ENVO844363 /1/2011 /1/2012 -AMA ToX KITED pREM'ISE S Eaoccutt ce $)100,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & AOV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (geaccident)$ 11000,000 BODILY INJURY (Per person) $ A X ANY AUTO AUTOSWNED SCHEDULED ATOS ABV0716909 /1/2011 /1/2012 BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ a t HIRED AUTOSNON-OWNED AUTOS(Per Uninsured motorist comtHned $ 1,0 0 000 X UMBRELLA LIAROCCUR HCLAIMS-MADE EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 B EXCESS LIAB DED I X I RETENTION$ ID,OOC $ MMOS44365 /1/2011 /1/2012 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORlPARTNERIEXECUTIVE � X STATU-OTH LIMITS WC X I E.L. EACH ACCIDENT $ 11000,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) NIA 0009870539 9/1/2011 9/1/2012 E.L.DISEASE - EA EMPLOYE $ 1, 00,000 If yes describe under DESGrRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS i VEHICLES (Attach ACORD 101, Additbnal Remarks Schedule, N mora 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 isethTebbetts/LUCI 0105) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 ontnw n+ Tl n Annan name anti Innn aro mn)cMnerl marirc of Annon