Loading...
HomeMy WebLinkAboutBuilding Permit #169-12 - 315 TURNPIKE STREET 8/30/2011 yORTH BUILDING PERMIT °�1t��° .bgtio TOWN OF NORTH ANDOVER ? °� -� *° ° APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received �14w°gwre° �SSACHUS�� Date Issued: gzgdyl IMP RTANT:Applicant must complete all items on this page :LOCATION i Eirrt AGk. Tus^ �• j j **Pa �� 5 - n " :PROPERTY OWNER eyv-l'r" 1�(C - csl tqly Pdn# MAP NO: PARCEL: ZONING DISTRICT- Historic District ' yes no Machine Shop Village dyes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building2 TATS One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other �/�j� Septic Well Floodplain Wetlands Watershed District Water/Sever DESCRIPTION OF WORK TO BE PREFORMED: Oki o -o( C)a ' -oil Vv e- car`/ / I�KSAA I l aG 4.�'X/DD j u e MfM*la �d6e, I)Q A/0A iAt&v /&. e&;,7(j>/-tl wl �eo�31W1 Identification Pleg4 Type or Print Clearly) OWNER: Name: M erri►-via ck Phone: 97-837 Address: 7-ut-�-� i S�. erA� ,4 lDe)! ee /VA Q 8Y,�— CONTRACTOR Name: �l S_rr # i'A e 1 4/ Phone: U3 Address: (.:.1 J h� , !^l V� �t Dt� 9 Supervisor's Construction License; e- 751Exp. Date: f093��r�/ :Home Improvement License: Exp. Date: ARCHITECT/ENGINEERMic�a e1 �a 1d Phone: _�a3- L/ 8 Address: 19 Clirl)-ok? LkJV& 9//)', Nl� elt q 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: a� (D S� �— FEE: CJ �- Check No.: � �d/ Receipt No.: a 11 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund . - Signature of Agent/Owner Signature of contractor �- 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH f' COIViANTS 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 Located at 384 Osgood Street FIRE-DEPARTMENT -TempDumpser-onsite yes no Located at 124Main Street. Fire Department signature/date COMMENTS "`" ---�/'f Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: 6 D D ---- Yv - moo d 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 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) ❑ 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 e No. Date NORTh TOWN OF NORTH ANDOVER O �,�a0 :.'�q,0 + 6 , 6 , • 0 9 Certificate of Occupancy $ s�CNUs Building/Frame Permit Fee $ f Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f D 2 4 5 ) 9 Building Inspector AORTH Tomm Of o , over, Mass., COCMICMEWICK S RATED fly BOARD OF HEALTH Food/Kitchen . - PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........M-16..... #40140to -.0 . .. .. .......... ..........��1—�. ..... .. ....................................................................... Foundation has permission to erect........................................ buildings on ....................,X15..770.......... ..................................... Rough •� i Chimney to be occupied as........ .. ............ ..................... .... .. ... ..................... ................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 M LATHS ELECTRICAL INSPECTOR. UNLESS CONSTRUCTI T QTS ,� Rough / Service ................... ....................................... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. 7 Mi,errimack —5 TURNPIKE STREET,N Q AT HAND f)VP'I, A[,18445 WW1h'+1FRR I M AG K.F.DU J- 7ox �6 a xA t fi Rh 1�'j �y vim titrL fl sr J i �r TA t V t. 4rtv4 k• 7 , - _ ;mo- hy-�+� 'j r• � �, k� i( ,�,� ,. ' owt '.F nu e aAUSTIN HAI 1. 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 Name(Business/Organizationfindividual):a I'4/Ar) Del)b'ev'y r- 66a/r _TnG • /� -DBA: Gh r is-�iah P,:V-4y R�f-rA J Address: / g C-lin-Im Drive, City/State/Zip: [41D I 1 IS . A�t7 636 9 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.[0-I am a employer with D 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. $ 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 officers have exercised their 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 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. Other comp.insurance required.] *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. $Contractors 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. l Insurance Company Name: /51 Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: /l/ AlvDo Iye'-, IVA 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 perjury that the information provided above is true and correct Si nature: E93— 2 / Date: 97 Phone#: ��— D — 5-32,(p 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#: Information 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. #617-727-4400 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax##617-727-7749 www.mass.gov/dia .4`. t CERTIFICATE OF LIABILITY INSURANCE 8%30/2) 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: It the certificate holder is an ADDITIONAL INSURED,the poltcy(%s)must be endorsed. If SUBROGATION IS WANED,subject to the brms a"conditions of the po ft,certain POUdes may require on endorsement. A statement on this ce►tifiaate does not confer righb to the cerMicate holder In lieu of such endorses PRODUCER TACT Seth Fe betty Tebbetts Insurance Agency PHONE (603)465-3333 lff*FAx No !6031792-4651 4 Main Street .Seth@ tebbettsins.coat 0000159 Hollis NK 03049 N APFORDNGOdvERAGE NAICf INSURED NSURERAICitizens Insurance Company of 31534 *gMaManover Insurance C 2292 Christian Delivery 6 Chair Service wmnmc:CEMTIS 18 Clinton Drive NSUP"D NSUR9tE• Hollis NH 03049 NSHREBF: COVERAGES CERTIFICATE NUMBER:CU083000923 REviSION HUMBER: 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. AWL SU" LTR TYPE OF INSURANCE pOLICYNWIN@t IMPOAM POLICY LUTISTS GENERALLUtBILITY EACH OCCURRENCE E 1,000,000 X COMMERCIAL GENERAL LIABILITY ISES acu&L. $ 100,000 A CL IMS4AADE ❑x- OCCUR ZB7 0814363-03 /1/2010 /1/2011 MEQ EXP y are person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENI AGGREGATE LIMIT APPLI ES PER PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY 'PR LCC i AU70MOMLF IJAaIL1TY COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO (Ea aodd-O A ALL OvynlEo autos 716909 /1/2010 /1/2011 BODILYIN URY(perpe=n) S SCHEDULEDAUTOS BODILY INJURY(Pa aoddenQ $ HIRED AUTOS PROPERTY t NON-OWNED AUTOS Ummmid meta stowaned $ 1,000,000 MedG21parwa $ 5,000 X UMBRERJ/ILIAS OCCUR EACH OCCURRENCE $ 4,000,000 EXCESSILL0 CLA%rw-,KASE AGGREGATE $ 4,000,000 pEM71BLE $ B X AamwON f 10,000 L 0844365-03 /1/2010 /1/2011 >! C WORKERSCOMPEMAMON ANDEMPLOYERIPLtABUJITY VYC STAIYl 01H- ANYPROPRIETOR/PARTNEwDOECUtIVE — EL EACH ACCIDENT $ 1.000.000 OFflCERlAIHI r.AXCL. MN r NIA (Mmxkt yin NFO 8C 9870539 /1/2010 /1/2011 EL DISEASE-EA EMPLOYE $ 11000,00 Hyas daemDeunder DESCRIPTION of OPERATIONS below EL DISEASE-POLICY LIMIT a 1,000,000 DESCRII"M OF OPERATIONS i UMAMONS/VEHICLES WtuhACOMilM.AdOk%WftWAftSdn&ftftOWOSPCOIS ngddd} CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE VALL. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIIE Seth Tebbetts/SAT irsrs.r ACORD 25(20=09) ®IOM2009 ACORD CORPORATION. All rights reserved. INS025 t2wwq) The ACORD name and toga are registered marks of ACORD dr. ,,,q-- sF i� "�"• l jT fir' l mac{§'ate,.,T�},, ^� r� : # �- Si S; .S p� .-v�' "­Q "+s13 :a+E....r `sr k� �_ �+`�. �=.t.v. Certificate flf Yn�e ��i�t�r�c� �PAGE: 1 Date Manufactured i AZTEC TENTS y. 04/27/2011 2665 COLUMBIA ST INV NUMBER: 0186276 TORRANCE, CA 90503 P.O. NUMBER: - t_ (800) 228-3687 CUSTOMER NO: CHR030 This is to certify that the materials described below have been flame retardant r' treated (or are inherently flame retardant). en or ra a ame CA Dart.9 h . f-1- Bruin Marti Gas F-222.02 `°,'g �- Bruin Mesh F-222.04 n CHRISTIAN PARTY RENTALS California Comb. lam-Tex 12,14,16,18oz F419.01 a 18 CLINTON DRIVE Coated Fabrics Clear Vinyll6ga/20ga F-570.02 Hollis, NH 03049 DAF Clear Vinyl l6ga/20ga F-593.01 DAF DAF F-593.02 Te g- R..; - Exclusively Expo PolySateen Liner F-434.01 ' -�- Ferran Precontaint 502 F-444.01 ' Ferran Precontaint 702 F-444.08 Phillips Textiles Phil-Tex Liner F-500.01 " j PVC Tech. Deco Cloth/Velon F-504.01 T' Snyder Weatherspan F-140.01 pp Tri Vantage Firesist Sunbrella F-368.05 Tri Vantage Patio 500 F-121.02 Certification is hereby made that the articles described below hereof are made Tri Vantage Big Top F-121.10 T from a flame-retardant fabric or material registered and approved by the Tri Vantage VanguadWeblon F-069.01 ' California State Fire Marshal for such use. The fabric has been tested and Tri Vantage Weblon/Coastline F-069.01 Vameitlag Duaskin 83673,83515 F-530.01 - i passes NFPA 701 Large Scale. See chart to right for trade name of i flame-resistant fabric or material used and additionally referenced on the label Fr `= of the fabric panel. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager-Manufacturing 1 Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent ��f'- �"`; _ "�i"�f."`_ n ax['s r s4.:• a ���, "��`�„.�` �'a,S �=+' �x "�* ^F°''� '..4 mom' 'F�v . � �r� ��'� tr �� �.se.,. $ t� 1t �x 'fix`�S �. , �FF���.:t�•c r A ori -� �s-^a o� ���-��' ITEMS MANUFACTURED TYPE PRODUCED 20x40 1 p Top Only UW S 1 A:. ro � F �Ce�ttftrate of fame 'Re'qt'.5tare ' REGISTEREDAZTEC TENTS Date treated or ' APPUCATION manufactured CONCERN NO. 2665 COLUMBIA ST r TORRANCE,CA 90503 022008 CAL COMB r-419.01 (800)22&3687 This is to cerfify that the materials dascribed below hereof have been flame retardant treated(or are inherenfly nonflammable). FOR CHPJST1AN PARTY DENTAL 18 CLINTON©RIVE ' HOLLIS, NH 03049 Cel�cadon is hereby made thatF-1 check`°a„®P��b,� (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 applicationof 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. Nameof chemical used...........................................:Chem.Reg.No......................... Meathodof application............................................. ................................................ (b) The articles described below hereof are made from a fame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. Trade name of flame-resistant fabric or material used..Undn& Fabric Reg.No.......!M18.8t...... The Flare Retardant Process Used .*!L NOT Be Removed by Washing ' (vrtll or Wit not)•••• David Bradley Chuck Miller- President Name of Applicator or Production SLperiMentlem Title .s '�.�tn �a =•., e n0 R n'�• .�6 Q Ai:� n. ^4.�0,%�. "a1 ' ��, x.a ..��, Q.'.O,�.�., `. `s 6�'.:0�,i Q•:,.�'�. CUSTOMER ORDER NO. 8168629 ITEMS MANUFACTURED: 2-20x20 Fes ail Top UIW with Double Vallance 2-20x4O Festival Top UW with Double Valance 3-4Ox40 2pc.JumboTratc Top UW 6-40x20 JurnboTrac Diddle Top UW 1-1011x30 Series 2000 Middle UW 2-20x20 Series 15001pm Top UW 2-20x30 Series 1500 fp_- Top UW 2-20x40 Series 15001pc Top UW PDF created with pdfFactory trial version www.pdffactory.com _��--- �►l�ass.a�t�aa�ett�; - Ilcl�.tt-taa�ca.at r,l. '�'aal,li� ti.��'�a� tiaf,wd of Buildi:ra<..', Re,, alaiii-m ; and Stamhard.s. ..�. Construction Supervisor License- License: icenseLicense: CS 6751 Restricted,to: 00 ate, �.y JOHN D CROWLEY � "R 36 PAGE AVE' LEOMINSTER, MA 01453 -- -- - -� Expi atiq,n: 1.013112011 ( +�inisai� ae,n��r Tr#: 6096