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Home My WebLink AboutBuilding Permit #229-13 - 315 TURNPIKE STREET 9/20/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ZV Z IMPORTANT:Applicant must complete all items on this page LOCATION ,3/S �ur`I,DI�e sfreei Pr' t PROPERTY OWNER Merr"n./ak C co ll-e9G Unit# Print MAP NO:y2� PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village ye- e 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 SES (]<Septic 0 Well' (]-Floodplain, DlWetlands; D' Wate`rshedDistriefi 0'Water/Sewer i DESCRIPTION OF WORK TO BE PRRF0RMFD- 0n or ca bdct+ 7 /Z - k ls � �,7 �� v //f • 1 � / 6 D X 9D a 4 /D ' 207EAJr cW 7%e a ' r/e,00i �°/g ,dal / 4774- Rerrilsw4 �fD/led e-- ®ya/ eyI/l k ew Zo,�z�/Z (Identification Please Ty7e or Print Clearly) p OWNER: Name: Phone: Address: /S a i-nal k S'*- lV• 41?4loyey- MA CONTRACTOR Name: e/�44- �Cf e!2 Phone: 60 3—l��3 S3 2 Address: X57 Llil�/7�`'/ Alye- /S , A& e 3 6 V q Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARC+1 TCr'T/CAI/�"R Ml cam/lGtel 6-rVu JJPhone:-& 8 C! ` '3a �9 Address: /!'f�7Jy1 y`. �l�S f7 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: $_,_ D FEE: $ � Check No.: 107i([r--- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OvvneSignature_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 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.: ELECTRICAL: Movement of Meter location, mast or servicedroprequires approval of I Electrical Inspector Yes 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 Doc:.Building Permit Revised 2011 June/mi 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 1 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 eparfinent 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 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 Location�/� No.-278 Dateg. • ' TOWN OF NORTH ANDOVER � • Syt'1L`ED X��' r Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check#_(a Zfl- v s 25734 Building Inspector t%ORTH T )wn �.. tAndover oh ver, Mass, e� 1, !Low COCHICHIWICM S V BOARD OF HEALTH Food/Kitchen PERMI� T T LD Septic System THIS CERTIFIES THAT ........... .................... ' '`................ . BUILDING INSPECTOR . .........�.......... ..�.................................. Foundation 00 has permission to erect ..................�...... buildings on .......... ..... ......... ............... ...... Rough to be occupied as ... ..... ....... .. .�.Z.�rwl............... .... N. ................... Chimney provided that the person accepting this permit s all 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6. ONT S _ ELECTRICAL INSPECTOR • UNLESS CONSTRUCT ST TS Rough Service .............. .. ... ..... ......... .................................... Final BUILDING INSPECTOR 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 � NORTfy . own ,ofE . ve 4Q � - I0 No. h �O h ver, Mass, LAN( . �. • �� coc"Ic Ml WICK p�pATE1) S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........... .. ............................... BUILDING INSPECTOR Foundation has permission to erect ...... buildings on '� .,....% Rough to be occupied as ...�.... .......ealil . .�.�............. .... ............. chimney provided that the person accepting this permit s 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. ONT S ELECTRICAL INSPECTOR • UNLESS CONSTRUCT ST TS Rough Service .............. .. ... ..... ......... .................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy BuildinPermit Required to Occupy Buildinz 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 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/Organization/Individual): /��_s � Veryf Cf/CI��" /1 Cti isb;4Y7 A � /� �� L� , l�af�. r ar e��. l Address: II�n}o!'J Drive- City/State/Zip: 14o//I'S A 49-y9Phone M j6oU Are you an employer?Check the appropriate box: Type of project(required): 1.[&'rani am a employer with --?0 4. ❑ I am a general contractor and 1 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 required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL i I.E]Plumbing repairs or additions c. 152 1(4),and we have no myself.[No workers comp. 9§ 12.❑Roof repairs insurance required_]t employees. [No workers' comp.insurance required.] 13.0-�fther *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. Insurance Company Name: cmir7eJ J ree_ a�d I—y7d �S k-i J_k7su "anze— Policy#or Self-ins.Lic.#: VQC 06 9 9'70 5-3 % Expiration Date: / Z D/3 Job Site Address- l al" Ike S -, City/State/Zip:/I/ Ah vCz" NV 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 pen lues of perju the information provided above is true and correct Signature: Date: Phone#: �PD3 — 23 - 'z/76 Z) 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#: e AGGROCERTIFICATE OF LIABILITY INSURANCE DATE(MNVDOfYYYY) L--� 9/5/2x12 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 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 NAMEACT Luci Fitzpatrick Tebbetts Insurance Agency PHONE.,,,, (603)465-3333FAX .(603)466-6800 P.O. Box 848 A' .luci@tebbetteins.com 3 Market Place INSURE S AFFORDING COVERAGE MAIC A Hollis NH 03049 INSURER 4Citizens Insurance Go an of 31534 JNSURW Iwm B:Ha.nover Insurance Co 2292 Christian Delivery & Chair Service Inc. INsuRERc:Commerce and Industry Insurance 15172 D/B/A Christian Party Rental INSURERD: 1S Clinton Drive INSURERE: Hollis NH 03049 INsuRERF: 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. ILSR AD SUOR TYPE OF INSURANCE POLICY NUMBER PMroCDY EFF POLIC P LIMITS GENERAL LIABILITYMMfD EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIASIUrY P AMAGFEMI S E Ell e $` 100,000 A CLAIMS MADE OCCUR BV0844363 /1/2012 /1/2013 MED EXP(Any one person) $ 5,000 PERSONAL 2ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATELIMRAPPLIES PER: PRODUCTS-COMPIOP AGO $ 2,000,000 X POLICY PRO- iFeT LOC $ AUTOMOBILE LIABILITY COMB�IN D S NGLE LIMIT ] 000 000 A R ANYAUTO BODILY INJURY(Per person) S ALLOSOWNED SCHEDULED 0716909 /1/2012 /1/2013 BODILYINJURY(Peraeddent) $ NON-OWNED PROPERTY DAMA E $ H1REO AUTOS AUTOS p EIRE $ X UMBRELLA LU►B Ll OCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS UAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION 0844365 /1/2012 /1/2013 $ C WORKERS COMPENSATION X WC STA TU X OTH• AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Y1N EL EACH ACCIDENT S 1,000,000 OFRCERIMEMSER EXCLUDED? NIA (Mandatory in NH} 0009670539 /1/2012 /1/2013 E.L.DISEASE-EA EMPLOYEd S 1,000,000 Mr,desedbe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMrr 1$ 1.000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space to 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 26(2010/05) 01988.2010 ACORD CORPORATION. All rights reserved. INS rent 1 n 02S nrt5 1 The Af`AQI1 n2mn and lnnn awa ronrctarad marlrc of ARA1Z7'1 i I M PO RTA NT DOCUMENT S cerusleave of Fla Izesi� ee s S 1� t� 5 ISSUED BY S Date of Shipment 5 REGISTRATION CHOR 3/3/2008 S SNUMBER INDUS7RIE5 iNC. S EVANSVILLE, INDIANA 47725 Tent Identification Ej S5 F140.1 MANUFACTURERS OF THE FINISHED 04590588 5 TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated S S (or are inherently noninflammable) and were supplied to: C� 269800 S S CHRISTIAN DELIVERY&CHAIR SER 5 5 DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR S 5 5 5 HOLLIS NH 269800 5 5 5 S • SCertification is hereby made that: S The articles described on this Certificate have been treated with a flame-retardant approved S chemical and that S thea application of said chemical was done in conformance with California pp S 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 109. 5 S Serial# S 5 8151210(1) 5 Description of item certified: CENTURY END 60WX20 HOLE SNYDER WHITE VINYL WITHOUT WEB GUYS 5 Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And is Effective For The Life Of The Fabric 5 5 SNYDER MrG NEW PHILADELPHI&OH Signed: S Name of Applicator of Flame Resistant Finish I ANCHOR INDUSTRIES INC. Pj �P�PcncPtPrJ�r f�Pr frJ�t:Pr�rJ�tP c.I�rJ�rJ�1:Pr�cl�r�1J 01MVIi1 PrJr�c1'�1'cJrJ�cf�rJc1"rJP00 EIRIM�EOUREit� Prrd3 r3d"L3r-JcJ��J'rJ�cJc�.f� 011 r - - __Fl ertificate o ame sis ance PAGE. 2 Date Manufactured AZTEC TENTS 07/02/2009 2665 COLUMBIA ST INV NUMBER: 0176130 TORRANCE, CA 90503 P.O. NUMBER: (800) 228-3687 CUSTOMER NO: CHR030 This is to certify that the materials described below have been flame retardant treated (or are inherently flame retardant). vendor a ame tum Ma I ras - Bruin Mesh F-222.04 CHRISTIAN PARTY RENTALS California Comb. Lam-Tex 12,14,16,18uz F-419.01 18 CLINTON DRIVE Coated Fdbd6 Clear Vinyl 16ga/20ga F-570.02 DAF Clear Vinyl 16ga/20ga F-593.01 HOIIIS, NH 03049 CAF DAF F-593.02 . ' _ Exclusively Expa PolySateen Liner F-434.01 } Fertari Precontraint 502-_.._.. __F-444.01 .. Ferrad Precontraint 702 F-444.08 f - Phillips Textiles Phil-Tex Liner F-500.01 PVC Tech, Deco Cloth/Velon F-504.01 Snyder Wsatherspan F-140.01 Tri Vantage Fireslst Sunbrella F-368.05 Certification is herebymade that the articles described below hereof are made Td Vantage BigPatp F-121.12 7n Vantage Big Top F-121.10 from a flame-retardant fabric or material registered and approved by the T Vantage Vanguard Weblon F-069.01 i California State Fire Marshal for such use. The fabric has been tested and Td Vantage Weblon/Coastline F-069.01 passes NFPA 701 Large Scale. See chart to right for trade name of Verseidag Duaskin83673,63515 F-531.11 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 General Manager-Manufacturing x Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent ITEMS MANUFACTURED TYPE PRODUCED 10x20 ipc Festival Top UW S 2 w/ Rope Tensioners&Flag SINGLE PEAK 10x20 ipc Festival Top UW S 1 w/ Rope Tensioners &Flag TWIN PEAK Festival Cable 1OX S 4 I 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. td I r T .r � x., sytfi 5.. i� � �i�1 � ��.;, .may a•$ 005 KA yam.. ot 5-1 114 I mo . V ' s r�..; 6� - Imagery #2 Dwiwwog, 1 V,M monwet!!rof Ma h p Data O rt hh 1� httt)s://mans.soo Eile.com/maps?hl=en&a=315+turnpike+st+north+andover&ie=UTF-8&h... 09/19/2012