The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #182-14 - 315 TURNPIKE STREET 8/27/2013 TOWN OF NORTH ANDOVER PPLICATION FOR PLAN EXAMINATION Permit N0: ' Date Received Date Issued: I ORTANT: Applicant must complete all items on this page LOCATION J/ir a_r1?a1L PROPERTY OWNER M-Grr)rW4) t/ (� Print 100 Year Old Structure yes no MAP NO: OZ J PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition ❑Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others:76AI7_ ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District_ ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: // a o'n , I Tr a f- h� Aghki IYA// Identification Please Type or Print Clearly) OWNER: Name: /t/r'cri^i4_4_;L �Z`- Golle Phone: 97Y-�dy' Address: Tu*-h iAe- CONTRACTOR Name: CS�• �it/�Dv /t/l�} /� Id�'/j"�S1RYJ r to ! Phone: la P3 4,R3-S'32J Address / Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: lav �p �1 D3° Address: C, /h�h di-1 r,� %4�4111 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: $ 7i CDU FEE: $ Check No.: Receipt No.: C;� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Own gnature of contractor Plans Submitted ❑ Plans Waived ❑ 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 0 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 Reviewed on Signature COMMENTS X_ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature Date Driveway Permit DPW'Towp_ Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMFiVT - Temp Dumpster on site yes no Located at'124 MainStreet Fire Departmer t signatureldate COMMENTS : 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 NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folowing 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) 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 o Certified Proposed Plot Plan a 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 a 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 app:al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm::tted with the building application i Doc: Doc.Bui?ding Permit Revised 2012 Location 36S, �t No. Date 3 . • TOWN OF NORTH ANDOVER • SEED 4 Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee J $ Other Permit Fee $ TOTAL $ Check# r 0 f- J / U J Building Inspector NO RTH Town of 2 tAndover 192 No. Iq. h , ver, Mass, 13 COCMIC„tw.CM y1. �,9 p°R�►rEv ^P�,��(9 S U BOARD OF HEALTH PER IT Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............ ...... '!.�!!!! ........................ ......................t. ..................... Foundation has permission to erect .......................... buildings on ......I13ttr....... � �.�1.. ... .... .. Rough to be occupied as .........I..... ... ........ ......... `. ... ..Jac.......!.�!..... . W Chimney provided that the person acceptin this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TA S Rough ma Service ................. .... ... ... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinje Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE To see all the details that are visible on to the map. t � 4 ..r��+ -se• .x,44.. � # �~ .- /'• :.. w. �lli�' t 19 AF ie Aw -16 Ilk 4t Z4 GD Ar . fp mm jt . :b Y ) a (r y r�, t *A E• ,�" , lob Ur♦ _ FF U x T! hilt.... � �_Y o ��0��LLu 1 M 1 10►RTAt NT ®®C U M E NT �� '11 o S of Tlaiw (jRes1Sfz117Ce 5 SREGISTRATION ISSUED BY 5 APPLICATION ' F1 I �:� ® Date of Shipment S 5 NUMBER 1r► INDUSTRIES INC. 3/2/2007 STent Identification5 EVANSVILLE, INDIANA 47725 5 S F140.1 t MANUFACTURERS OF THE FINISHED 04440 57 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 (or are inherently noninflammable) and were supplied to: 5 5 269800 CHRISTIAN DELIVERY&CHAIR SER S S DBA CHRISTIAN PARTY RENTAL S 5 18 CLINTON DR HOLLIS NH 30496576 5 S 5 T S 5 g S S 5 Certification is hereby made that: 5 5 The articles described on this Certificate have been treated with a flame-retardant approved 5 5 chemical and that the application of said chemical was done in conformance with California 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109.S 5 Serial # 5 5 8147010C(11 5 5 Description of Item certified: 5 CENTURY MIDDLE 80W X 30 5 10'SPACING WH SNY BO N 1610R C Flame Retardant Process Used Will Not Be Removed By S 5 Washing And Is Effective For The Life Of The Fabric 5 5 9 �n GQT-6_ P.,mr S�glled: � 5 LW'1 S Mame of Applicator of me Resistant Finish ANCHOR INDUSTRIES INC. @l rJ�rJ�r�tJcP[J"rJ[1c1'c PrP frJrJ�rJ��!cl�cPcP[J�rJ�rJrfc l�rJ�t1rl� c PcJ�[.farJ�[1r.fr�r�c f[.!�[I�rJ'r.PrJ�Pc!acJ�c f�C fc1rJ�[J�rJi�r�cic1-r_fc lcaclrJ�rJ�t I�r�rnrJtPrJ'r�rJ� Cerfiftrate of flame Re.M�tanre FWANER O AZTEC TENTS Da%tressed or c"UGNM na 2666 COLUMBIA ST m wmkdww T'ORRANCE,CA 90503 0212008 CAL COMB Fff9.01 (600)22sl-3667 Ibis Is b cwlify Un t go naiad*dswf and blow hereadhove been!fame jubdsntbsaled(orars kdwnn!(jrlw dlamnwW FM CHRISMN PARTYRENTAL 1S CUNTON DRIVE ` HOLDS,NH 03049 Cwfflcmflon Is hereby mads OWL-(check"a"or"`b") F1 (a) The articles described below this certificate love been treated with a Mme r+elardant the nical approved and registered by the State Fin Marshal and that the appikallonof said chemical was done In confor- mance with the laws of the State of Callfomla and the Rules and Regulations of Ste State Fire Marshal. Name of chemical used_...»..»»...»...»...»......»...»».Cham.Reg.No..»»».».»».....».. Meathodof application._..-.--..-....»»..........m..._.».»........»..»....»».»...».»»..,.....»» l (b) The arlides described below hereof are mads from aflame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and mosses NFPA701.K i Trade name of flame-reabntont fabric or material used-la m .Rag.No......1:4L��...». The Flame Retardant Process Used..w!!:L!�r.......Be Removed by Washing twe orwn� David Bradley Chuck Miller-President CUSTOMER ORDER NO. R16W29 ITEMS MANUFACTURED: 2-2MMFi 6WI Top UWwiNi Double Vkhow 2-20x40 FesBval Top UW with Double Valance 3-40x40 2pm JumboTme Top UW 0-40x20 JumboTnc Mlald/e Top UW I-10Qx30 Safes 2000 Midland OW 2-M20 Series 15001pc.Top UW 2-20x30 Series 100 1p.- Top UW 2-20x40 Series 15001pe.Top UW Zo �2 PDF created with pdfFactory trial version www.pdffactory.com A� CERTIFICATE OF LIABILITY INSURANCE DATE(�M'QQ2YYY,r' 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 pollcy(ies)must be endorsed. tf SUBROGATION IS WAIVED,subject to the terns 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 endorsements). PRODUCER N NTACT Lt1Ci Fitzpatrick Tebbetts Insurance Agency PHDNa (603)465»3333 Fax Nol.(603)465-6900 P.O. Box 848 .luci@tebbetteins.eom 3 Market Place INSU AFFORDING COVERAGE NAIC A Hollis NH 03049 INSURER 4Citizens Insurance C2MMy of 31534 INSURED pJSURER B Hanover Insurance C2Mpy 22292 Christian Delivery & Chair Service Inc. INsuRERc:Commerce and Industxy Insurance 15172 D/B/A Christian Party Rental INSURER D: 18 Clinton Drive INSURER E: Hollis NH 03049 1 INSURER IF COVERAGES CERTIFICATE NUMBER-CL129501357 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 TYPE OF INSURANCEAD SUOR POLICY F P Im LICY UM M QD M LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY -PREMISES $ 100,000 A CLAJMS4AADE �X. OCCUR BEV0844363 /1/2012 /1/2013 MFA EXP( are $ 5,00 PERSONAL aADVINJURY $ 1,000,000 GENERALAGGREGATE S 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,000 7X POLICY JECT PRO- LOC $ auToracBILELIAeLnYEa ILIMIT poddent) fi 1,000 000 A X ANY AUTO BODILY INJURY(Per person) S AA�otSNNEQ SCHEDULED 0716909 /1/2012 /1/2013 BODILY INJURY(Per acdderu) $ NO HIRED AUTOS N-OWNED P DAMA $ AUTOS p EiBE $ X UMBRELLA LIABOCCUR EACH OCCURRENCE S 4,000,000 B EXCESS UABH CLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTIONS 0844365 /1/2012 /1/2013 $ C WORKERS COMPENSATION X WC STA X OTfb AND EMPLOYERS'LIABILITY 1Y[, ANY PROPRIETORIPARTNERIEXECUTIVE YEN E.LEACH ACCIDENT S 1 000 000 OFRCER1MEMBER EXCLUDED? NIA (MancIdoryInNH) 009870539 /1/2012 /1/2013 EL.DISEASE-EAEMPLOY $ 11000,000 Ryyaess�desabsrmder DESCRIPTION OF OPERATIONS be E.LDISEASE-POLICY LIMIT S 1 000 000 but DESCIUMM OF OPERATIONS I LOCATIONS t VEHICLES(Attach ACORD 101,AddIUonal Remarks Schedule,H mon spec IS rsgaired) CERTIFICATE HOLDER CANCELLATION 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 Tebbett is/LUCI �•�—` ACORD 25(2010/05) ®19882010 ACORD CORPORATION. All rights reserved. INS025 r?n+nnm m T'ha Artr132n nama and Innn am ranretarad martre of Ar.nPn The Commonwealth of Massachusetts fn 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 Name(Business/Organization/Individual): Address: City/State/Zip: //V/ AM 03aPhone #:_1 63 --8193--.S3 241 Are you an employer?Check the appropriate box: Type of project(required): 1.❑gym a employer with 'VV 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. $ E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13. ther 1e��- comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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. / T- Insurance Company Name:een9/'Ylerce- And •L�-O tfso0 / Y/'1Sui A/7Nz_ Policy#or Self-ins.Lic.M V\f[ 4 d 98-h,�1 S3 q Expiration Date: Zd/ Job Site Address: 31E sJ'' City/State/Zip: Dove) l eflew 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 uer the pains and penalties perjury that the information provided above is true and correct-3 Signature Date: e Z3 � 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 Person: Phone#: Informationn and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-NIASSAFE Revised 5-26-05 Fax#617--727-7749 www.mass.gov/dia