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Home My WebLink AboutBuilding Permit #228-13 - 315 TURNPIKE STREET 9/20/2012 TOWN OF NORTH ANDOVER ��J G Z, APPLICATION FOR PLAN EXAMINATION Permit N0: zz a ,� / Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �/� ur�IPlKe .Slf 'eel_ Prip�t PROPERTY OWNER MerrlM e-k �fa//e Unit# 2 Prin MAP NO:�Z PARCELO I/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no 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 Others: ❑ Demolition ❑ Other ❑'Septic ❑WdU' QFloodjain ®;Wetl`andsDi WatershediDTAtict 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: /,l/ 3 /Z %reed 4,0 'x /Bo TFiyr; X/D '�n� �' x/�s'7?hf -he (Identification Please Type or Print Clearly) OWNER: Name: ry-Ixn.ie4 coIleyL Phone: Q70 Address: ,�/S Tccr�,pic s � /Val-A 4yellt/", mil CONTRACTOR Name: GhKS� II /Ju /«✓t?VPhone: SS3—5_15'2- Address: '.3ZAddress: `? ��l�G f�Ul��S NXI eloz-g Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARUIITP"'r+Trrw� R�/G!?lle � 64k Phone: F'10/0��2- /2- Ad dress: Address: G��h 0�: Al /y D30 Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED CO§T BASED ON U25.00 PER S.F. Total Project Cost: $ CD4 FEE: $ <T j&-0--- Check wCheck No.: Receipt No.: nz J NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund .. . nature.of Agent/Ovvne. : :. Signature_of con tractor- ■ 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 I 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: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories:________Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: requires i ELECTRICAL: Movement of Meter location, mast or service drop q res 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 i l Doc:.Building Permit Revised 20117une/mi FE 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o 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-) o 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 o 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) a 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 submitted with the building application Doc: Doc.Building Permit Revised 2008mi Locatioq RT _./(IA4�,t� No ? Date , 2Z 1 - 1 ?7 • - TOWN OF NORTH ANDOVER • • 4 _ Certificate of Occupancy $ 1/1 Building/Frame Permit Fee $ ' Foundation Permit Fee $ Other Permit Fee $ TOTAL Check f/ 25734 Building Inspector r 1 NORTH - . w. .: : : . j c . . ve- 0 - No. 228 — 13 41 = - h T �O LAI/i h ver, Mass, A • CoCNICHlwICK y1. ��ADRATED S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .. .... . ............�'...!I�.......el . .......... ............................&.. .................... BUILDING INSPECTOR own Foundation has permission to erect ..... buildings on . ............. ...........�.........� ............ .......... Rough to be occupied as ....).*.. .....: ............ .... ..�.�... ....... . ............. chimney provided that the person accepting 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 CONSTR TIO S S Rough Service .......... ....... ............. ..................................... Final BUILDING INSPECTOR I GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 Certif trate sof jf1ame Rtqt tame f�Q1STFREG AZTEC TENTS Dara bmW or coNUF V" 26M COLUMBIA ST MWMb ued TORRANCE,CA 90503 0212008 ["-L COAF8 r�Rot (s0o�2s-3687 This rs to army um"narta6k dow9ndbatowhereofhaw been!lamerelertlent[leafed(orare Nhersngynordlemrnrblsj. FOR CHR►SMN PARTYRENTAL 18 CUNTON DRW HOLDS,NH 03049 Cw Acadon Is hereby made that(check"a"or"b) F-1 (a) The articles described below this cerdfloste have been treated with a flame retardant eha tical approved and registered by the Stabs Rro Marshal and that the appiicationof said chemical was done In confor- mance with the laws of the State of California and the Rues and Regulations of the stats Fire Marshal. Name of chemical used_._...v..._.._..._................Chem.Reg.No.»».»....»....»»... Meathodof appllcaUon.m..».».........._»........».._..._.......»......»................................. a (b) The articles described below hereof aro made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPAY01.ML Trade name of fame-resistant fabric or material Used_L&MMAdANk .Reg.No.._».f.:W1...... The Flame Retardant Process Used ...!�:.�r.......Be Removed by Washing aWrvQ David Bradley Chuck Miller-President NwradAvicawa , CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2-20M Fes*&*Top UW with Doable valance 2-20x40 F"&W hop UW wNh Double Vafence 3-40x40 2pe.JumboTm Top UW 6-40x20 Jumborrac Middle Top UW 1-10040 Series 2000 Michas UW 2-20x20 Swim IWO 1pa Top UW 2-20x I)Series 1"50010—a Top UW 2-20x40 Series 95001pc.Top UIV Y ' PDF created with pdfFactory trial version www.adffactory.com IMPORTANT DOCUMENTI� s CCrtff lCaW of Flan?C JRCS19tanCC S 5 at! ISSUED BYDate of ShipmentREGISTRATION ®CHO� 8/312007NUMBER INDUSTRIES INC.5EVANSVILLE, INDIANA 47725 Tent Identificationr-12110 Q MANUFACTURERS OF THE FINISHED 04529627 5 TENT PRODUCTS DESCRIBED HEREIN 5 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to; S 5 269800 S Cj CHRISTIAN DELIVERY&CHAIR SER DJ 5 8 CLINTON IA PARTY RENTAL 5 55 5 HOLLIS NH 30496576 21 5 5 5 S S Certification is hereby made that: 5 55 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 S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPA184, ULC 109. S S Serial# 3067300(6) 5 S5 Description of item certified: S 5 FIESTA MARQUEE MIDDLE 9WX10 5 5 WHITE VINYL C Flame Retardant Process Used Will Not Be Removed By 5 S S Washing And Is Effective For The Lite Of The Fabric 5 SJOHN BOYLE STA ESV[LLE c Signed: -�------- 'W' 5 Cj Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 � G.P[J�rJ�[J�rJ�cJ�rnr.Pr�clr�rJ��.PtJ�r�r.�cJ�rJ�rJ'r.P rJ�r�r�cJ�rJ�r�r�r�rJcP�PrJ��rJ�cl�cnrJ�rJ�[Pr��PrJ�rJ��PrJ�rJ�r..PtPrJ�rJ�cPr�rJ�r�r��rPr..f�rJ�r��P>:PrJ�r�cJ�r�cPcJ�t.Pr..1�rJ� Cl oEPEJEJ�rJ�E PAPE f acPEPE.I�EJ�EJ aE�aEnEPE1EJi IMPORTANT DOCUMEN7"' 0p o Ss Certificate of Flan?e --"-C Res �'�infi,��ee 5 ISSUED BYS S REGISTRATION o- �'� o Date of Shipment 5 �cHo�® 8!3/2007 5 S NUMBER INDUSTRIES INC. 5 I .7 �I EVANSVILLE, INDIANA 47725 Tent Identification 5 SF-12130 'y MANUFACTURERS OF THE FINISHED 04329627 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 S This is to certify that the materials described have been flame-retardant treated 5 5S (or are inherently noninflammable) and were supplied to: 5 269800 5 CHRISTIAN DELIVERY & CHAIR SER S S5 ' D8 ON CHRISTIAN IA PARTY RENTAL S 55 HOLLIS NH 30496576 5 5 5 5 5 5 5 5 SCertification is hereby made that: S 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 S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 SS 5 Serial# 3067300(6) 55 SDescription of item certified: 5 5 FIESTA MARQUEE MIDDLE 9WX10 S WHITE VINYL (! 5Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of The Fabric �5 5 JOHN BOYLE STAESVILLE NC Signed: 5 Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 tJ'[J`rJ�[J�>:PcJ�rnrJ�rJePrJ�cl�r�rJ��1`cJ�c1�rJ�rJ`rJ�rJ�rPrJ0EUrrAr-ji larJ�rJ�r101UrJ�r MI'[1: �rJ�E.PrJCl ��DDD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UT www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly �.� ]� /, fit/ , Name(Business/Organization/Individuai): L!�/f l 5/mn //�!! VerZ±1[ hQ/�' sell, �/!!� P l3A 1 /�risfi�4Y1 Pa r)4y A4 4zt. / Address: 1 L/)vlhh prIye.. City/State/Zip: 1 0111'_S ' Ally O�WPhone M Z12,a' Are you an employer?Check the appropriate box: Type of project(required): 1.[g'1 am a employer with� 4. El am a general contractor and I 6. E]New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 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 officers have exercised their 10.[1 Electrical repairs or additions required.] 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 comp.insurance required.] *Any applicant that checks box#I 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 isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. — 7 Insurance Company Name: OrMrneYL'e ctrnd 1 S4k ' S(,{rane6, Policy#or Self-ins.Lic.#: W C DO 9 E 769 S3 9 Expiration Date: Zz1-2-D 3 Job Site Address:-�JIS/Il tv i'I /�Q ST City/State/Zip: A/,,Ah7We 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. Ido hereby certify under the pains and pen lues of perjur the information provided above is true and correct. Si afore: Date: D /2 Phone#: �v a� 2 7 _ 76 22 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#: ACCORD CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDOfYYM 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(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 pONTAC7 Luci Fitzpatrick Tebbetts Insurance Agency PHONE (603)465-3333 FAx t603yd66-6800 P.O. Bax 848 EMAILADORESS..luci@tebbettsine.com 3 Market Place INSURERAFFORDING COVERAGE NAIC A Hollis NH 03049 INSURER Citizens Insurance Ca an of 1534 INSURED INSURER B Hanover Insurance Company 22 92 Christian Delivery & Chair Service Inc. INSURERC:Commerce and Industry Insurance 15172 D/B/A Christian Party Rental INSURER D: 18 Clanton Drive INSURER E: Hollis NH 03049 INSURER F: 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.LIMBTS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY EFF POLL`'CY P LIH POLICY NUMBER M/DD M fDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 }( COMMERCIAL GENERAL LIASILifY PREMISES E E c .- $ 100,000 A CLAIMS-MADEX]OCCUR ZBV0844363 /1/2012 /1/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABIU Y CEO SCI�NEDden NGLELIM 1,000,000 A X ANY AUTO BODILY INJURY(Par person) S AUFOSN� SCCTHEEDULED NSV0716909 /1/2012 /1/2013 BODILY INJURY(Per acadent) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS P EIBE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS UAB CLAIMS-MADE AGGREGATE $ 4,000,000 DEO X RETEN-n N 0844365 /1/2012 /1/2013 $ C WORKERS COMPENSATION XINC STATU X DTH• AND EMPLOYERS'LIABILITY ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) KC009870539 /1/2012 /1/2013 E.L.DISEASE-EA EMPLOYE $ 1 1 000 1 000 DESGIRI N OF OPERATIONS below E-L,DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,AddMonal Remarks Schedule,M more spas Is required) 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 Tebbetts/LUCI ACORD 252010105 ®1988-2010 ACORD CORPORATION. All rights reserved. INS025 MMmm M Tho At rIZI1 name and It~aro rante#arad mart-&^f ArnPn 315 turnpike st north andover- Google Maps Page 1 of 1 To see all the details that are visible on the screen,use the"Print"link next to the map. ti�� i et4 RV R V M f . k 1 https://maps.google.com/maps?hl=en&q=315+turnpike+st+north+andover&ie=UTF-8&h... 09/19/2012