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HomeMy WebLinkAboutBuilding Permit #336-14 - 315 TURNPIKE STREET 10/8/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: U 7M Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 3 i 7 u Print. PROPERTY OWNER �rrl`�et CK CC3 tJ LZ Print 100 Year Old Structure yes no MAP NO: z PARCEL:&G 4 ZONING DISTRICT: Historic District yes no Machine Shop Village yes ' no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others.T 7— ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORD TO BE.SPERFORMED:toyl / Q i �l�lT Z r �S® w i`l/ ' be,fwe4f-P7 Ae �O d ba# f sar-r13AU, 4�lals @ /ye"-1;- Iae4 Z011eye g� ,ov,a 1 w) I1/ be, 0h 0' a1,PQY 71L 1012 113 Identification Please Type or Print Clearly) 7� OWNER: Name: Merrjy-netck-' Gall-ege, Phone. x',37 62-03 Address: 31 s urs /�kp- s�• CONTRACTOR Name: Ckl PAA' Ptl~ , ern Phone: Q3_- $3 Address: �i r�`1/ IIVIJ OdY - Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: AQr�u„-EG:F4I= G-INIEE M l'61 Ae.l �0 A Phone:6 03 -2 �7 rYvr-m-C' �,��.vrr��z�. Address: 1,k7�n DelNvc- >Vfl 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: $ OD FEE: $ Check No.: —I 2-bq Receipt No.: 2—(Q y—i-� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Agent/Owne Signature of contractor Plans Submitted 0 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 g Packag in /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 Y PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 0 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS F t 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'Tow 2 Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Main Street Fire Departinert 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.$10041000 fine NOTES and DATA— (For department use i D Notified for pickup - Date . I Doe.Building Permit Revised 2010 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses l ❑ Copy Of Contract Li Floor/Crossection/Elevation Plan Of,Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products j NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit j New Construction (Single and Two Family) o Building Permit Application ❑ Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 Doc: Doc.Bui?ding Permit Revised 2012 Location No. � ! Date . = TOWN OF NORTH ANDOVER d • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#�Zo�. ' Buitdmd Inspector r � IAORTH - : 1c . : ver ver, Mass al.�,r 2013 o coc")C..l WICK y1' �ds R�TEO S 1 V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System p THIS CERTIFIES THAT ... .... [. .,. .' ,,,„ ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR m.... .... ..__.......... ... ll has permission to erect ....... buildings on . �..,I. �.A(.gvN ..tA"`T............ Foundation Rough to be occupied as ..: .1oto .. ..}. � Q� .......�.�1 Q1.1� .............. Chimney provided that the person accepting this pershall 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 CONSTRUCTION STARTS Rough Service .............. ”""""" Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building a' 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 W7113 315 turnpile st north andow-Google Maps To see all the details that are visible on the Go3, sle screen, use the"Print" link next to the map. OPP— c a+.'' • '�f ,. _yam... '�.. x '• � _�LL1G. ti. r ''. �+•° � \°�� eta! '' I ' � 1 y) *.y 4 _ - ? N. .i. G � 1 TVX ! ^k h.� t �a�'� R � �z Ti��• i yah V1,` t t 1�• 14• �y Ift IXk S vn S it.• r 4 s Mr•� S" i sp1 !i z ai Fw https://maps.google.condmaps?q=315+turnpile+st+north+ando\er&ie=UTF-8&hq=&hnear=0)9e30621823858fd:0)595487b26ee9add,315+TurnpiI e+St,+North... 1/2 AL 11 I'll p Certt"firate of flame Rett�tanre REa:rlIMEp AZTEC Mrs Oft"aled or CONCERN" 2666 COLUMBIA ST � rORRANCF,CA 90503 0212008 CAL COMB F-419 Of (800 Tide is b owft tf*tyre nwbdsb dssrrlbedbelow harsolMve been Mame rs6rdmf badW(orars kdnrsn*nwA&nrrndA* FOR CHRISTIAN PARTYRENTAL 18 CUNTON DRIVE HOLLA NH 03049 CwWcntlon Is hwaby made that(check"a"or"b') (a) The articles desalbW below this certificate have been treated with a Mme retardant chemical approved and reglsto a by the Stab Fin Marshal and that the applicallonof said chemical was done In cwfor- mance with the laws of the Stab of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used ._...............Chen.Reg.No...,.._.-........_.... Meathodof application. ....._..»_.....».»....._.»».»».....»».,».»»»».».»............»....».. (b) The articles described below hereof ars mads from a flame-rssbsbmt fabric or material registered and approved be the Side Fin Marshal for such use;Fabric has been tested and passes NFPA7014K*-] Trade name of Mme-resistard fabric or material used..jwmmw .Reg.No. — 21I..-The Flame Retardant Process Used ..W!LL mor:...W.. ...Be Removed by Washing wcryAiwQ David Bradley Chuck Miller-President CUSTOMER ORDER NO. R168629 ITEMS MANUFACTURED: 2-XlZW Fi *&1 Top UW wM Doubt valence 2-26x60 Fuca W Top UW with Double Valance 3-60x60 21.Jumbo Trac Top UW 6-6led0JumboTrac Middle Top UW I-I0ft 0 Serfs 2000 Middle UW 2-20W20 Serfs 130011.Top UW 2-20xs0 Serfs 13001p.Top UW 2-20x60 Series 15M 1p.Top UW I �O PDF created with pdfFactory trial version www.adffactory.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly �e�iVer Chr�sf i:9� Name(Business/Organizadon/Individual): C'h riSfign / L,{�g11", rVtrNG• PA—P--1 ,t2 jVTi4L Address: /9 Oli r'r 40PI Pr de City/State/Zip: aal l t 5 T /\J/a 63 D q q Phone#: 3'9-913-.a.3 2-6 Are you an employer?Check the appropriate box: Type of project(required): 1.I..4 i yoam a employer with a 5- 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. Q Demolition working for me in any capacity. workers'comp.insurance. 9. Q 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.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' 13.Q'6ther TT S 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. Insurance Company Name: OY✓11'Yle►'r� Q{'lli( 1l�/d�ls��YSu�"aj'1C�°- Policy#or Self-ins.Lie.#:_ 11Yt�..=�_0 9 -7 _ Expiration Date: 2-01y /l _ J Job Site Address:.3 ,U L _j4c �� Ciry/State/Zip:-�-- ANDO VOr A ,� ' 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 of perju that the information provided above is true and correct Signature: Date: d 8 Phone#: Jf 216 Oficial use only. Do not write in this area,to be completed by city or town qj)cial, City or Town: Permit/Ucense# 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� CERTIFICATE OF LIABILITY INSURANCE 9A/T4/201( 3) 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(ies)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 CONTACT Tracy Picardi Tebbetts Insurance Agency PHONE (603)465-3333 FAX IAICo:(603)465-6800 P.O. Box 848 ppAlE .tract'@tebbettsins.com 3 Market .Place INSURERS AFFORDING COVERAGE NAIC# Hollis NH 03049 INSURER A:Citizens Insurance Company of 31534 INSURED INSURER B.Hanover Insurance Company 2292 Christian Delivery & Chair Service Inc. INSURER CNCCI 15172 dba Christian Party Rental INSURER D: 18 Clinton Drive INSURER E: Hollis NH 03049 INSURER F: COVERAGES CERTIFICATE NUMBERJ4aster 13-14 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. ILTR TYPE OF INSURANCE B POLICY NUMBER MOLDCDY EFF MPMILDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE Fx�OCCUR ZBV0844363 9/1/2013 9/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE TA RE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X I POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea acddeD INGLE LIMIT 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED kBV0716909 /1/2013 /1/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED ROaoadentDAMAGE $ HIRED AUTOS AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA UABOCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS UAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 UHV0844365 9/1/2013 9/1/2014 $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N X TORY LIMITS I X I ER ANY PROPRIETOR/PARTNER/EXECUTIVE 0 E.L.EACH ACCIDENT $ 1 000 000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) CID31098170 /1/2013 /1/2014 E.L.DISEASE-EA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,K more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Seth Tebbetts/TPIC ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgninnsi m Tho A(`npn norma and Innn aro ranietomrl mnAfe of A(`npn