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HomeMy WebLinkAboutBuilding Permit #366-14 - 315 TURNPIKE STREET 10/18/2013 BUILDING PERMIT "_DT b;�tio TOWN OF NORTH ANDOVER C APPLICATION FOR PLAN EXAMINATION * ,� Permit NO: 3�`�' —H Date Received A�� 7�p°AA7ED SPP`•(� �SSACHUS�( Date Issued: © Lob IMPORTANT:Applicant must complete all items on this page ri LOCATION r! S T R� Y t� I N�a4 AkJove f< Print PROPERTY OWNER ��Q i �q C l� C4 LLQ •e.., Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no !Machine Shop Village 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 Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: CAQrv'v-A L. Pc)P, fie /-/Oy�ne C6rr-) v , WRQk-an Identification Please Print Clearly)OWNER: Name: M<RRi ►�AC,I, CdTpeor ��� Phone!( � � RSg 63 Address: �3 15 �U Iglr"1 erL° CM''' CONTRACTOR Name: A MOS c rwvehT .11 Chong/72D/ 1-37-PI q0 Address: Y Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST PASED ON$125.00 PER S.F. ,o o Total Project Cost: $--�-� FEE: $ '" Check No.. �r 2 O`t"�j� Receipt No.: 9�� I0 NOTE: Persons contracting with un r tered 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 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 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 2008 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 I Revised 2.2008 �\e\n)/4v-r-k, Location / WQ J A(-0 No. Date IDI IS 11-3 . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ ► ,'� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# zh�o # Building Inspector NORTH own of t EAndover o . - No. Iq 4( 4 `Aµ! h ver, Mass, 2w3 COC NIC HI WICK � A0RAT1E S U BOARD OF HEALTH Food/Kitchen PESeptic System THIS CERTIFIES THAT .......41T BUILDING INSPECTOR ..... .... ... ... ............. ..� ................ .................. ..... . .... . .. .l.� � �..�� Foundation , has permission to erect ......................... buildings on .. ! ...... .............. .>•..... �� 1 ................................................................. Rough to be occupied as ..... .. . . .. .. ... ........... Chimney provided that the person acce ting this permit shall in ery 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 TS Rough Service t ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit 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 HuthkaR&MM Jim64 1 Summer Simi 781-337-1901 FAX 781-335-5298 1-988-KI IMUDE hobnaa it collicaS1.110 I Inc A Oiir full brochure is mailable at wv►w.naamusem nt � Equipment Contract for 2013 This contract is made on September 26,2013, between North American Amusement Inc. and committee stated for the following event: Committee Name: Merrimack College Contact Person: Rachel Robohm Date of Event: October 26,2013 Contact Address: Merrimack College Running Time:. 11:00 am to 4:00 pm Location: Grass area next to Rogers Center Total Rental Fee: $3,400.00 Contact Phone: Deposit: Please Sign&Return Contact Fax: Balance due on Arrival: $3,400.00 Contact Cell: The checked equipment is rented for the above date(s) &time(s): INFLATABLES RIDES RIDES GAMES X Moonwalk v Tubs of Fun O Aztec Ride O R&Y&B Games&Booths O Wacky Shack O Sky Fighter Jets O Spirit Merry Go Round O Dunk Tank O 1VEW 3 Lane Bungee Run O Kiddie Ferris Wheel O 70' Rapid Slide O Speedpitch cage O Boxing Ring O Kiddie Race Cars O 52'Chair Swing O W!Inflatable Strike Zone O Sports Tug of War O Bumble Bee Ride O Magical Fun House O NEW!Inflatable Football O 55'Extreme Obstacle Course O Fun Jeep Ride 0 Whisper Go-Karts O NEW Inflatable Soccer O Chaos Obstacle Course O Gyro-Orbitron O Uncle AI's Plane Ride -O Inflatable Basketball O Mechanical Bull O Viking Ship O Battery Operated O Hi-Striker Bumper Cars O Wild One Roller Coaster O NEW!Aladdin Ride X Football Game Trailer Obstacle Course O NEW. Lagoon of Doom Food O Basketball Game Trailer Log Roll Power O Fun Foods O Jacob's Ladder Climb FID#04-2947586 • Generator O Fried Dough O Zero Gravity Chamber Game North American Amusement Inc. has the right to change equipment,of equal value, due to mechanical problems. In the event of cancellation due to rain, please notify the office at(781) 337-1901 before 7:00am the morning of the event and the deposit will be refunded in full. No refunds for any other reason. Please Send Directions! I have read front&back and understand the information. Please sign&return within 10 days of receiving. Signature Title Tax Exempt# Please Read Back&Sign Both Sides CERTIFICATE OF LIABILITY INSURANCE DATE(MM//2013YYYI TM4%C.ERTIFICATE 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 ORPRODUCER.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 and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: SAMPSON INS AGENCY INC PHONE FAX 97 LIBBY PARKWAY STE 110 (AIC,No,Ext): (A/C,No): E-MAIL WEYMOUTH,MA 02189 ADDRESS: 22LTS INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: CONTINENTAL CASUALTY COMPANY NORTH AMERICAN AMUSEMENT INC INSURER B: INSURER C: INSURER D: 641 SUMMER STREET INSURER E: WEYMOUTH,MA 02188 INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMIDDIYYYY) (MWDDIYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE 0 OCCUR. PREMISES(Ea occurrence) ED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY [::]PROJECT [::]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAB 0 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE Is RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-0489N896-13 05/12/2013 05/12/2014 LIMITS ANY PROPERITOR/PARTNER/EXECUTIVE N N/A E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONSILOCATIONSNEHICLES/RESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO TH E CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION MERRIMACK COLLEGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 315 TURNPIKE ST BEFORE TH EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORD N E WITH THE POLICY PROM 2. AUTHOR R RESENTATIVE NORTH ANDOVER,MA 01845 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rigWreserved. 1. Department of Public Safety License to Operate Amusement Devices Bobbie-Jo License#: MA-002-13 (781)337-1901 North American Amusements- Bob Perkins Expiration Date: 5/12014 North American Amusements Certified Maintenance Mechanic 641 Summer Street Robert Perkins,Jr. Weymouth MA 02188 U.S.I.D. t1 Device U.S.1.D. 4 Device U.S.I.D. 4 Device 09910 Whisper Electronic Go 10823 Kiddie Vikrnp,Ship 1002749 Firc Dog Moonwalk Kans 13386 Kiddie Battery Bumper 1004073 Sorcerer's Castle 09911 Kiddie Race Car (`;rs Mocmwalk 09912 Maeical Playhouse(N/M) 13387 t Incle AI's Plane Kiddic Ride 09914 Aztec Ride 13327 Aladdin let Ride 0991± 6vto(NN) 1000.16 Niremc Adrenafinc 10112 Kiddie Feris Whcel Obslacic(oursc 10113 Skc Fi_l-hter lets 100049 Inflatable Chaos Obstacle . Course• 10362 Tubs of Fun I00141> Inflatable t>ti'ackx Shack 1043A Spider Tubs of fun I001807 Moonwalk 10436 Fling 13ug/13wnhle Bee 1001943 Moonwalk 10437 8-Spirit Merry Go Round I00I945 \goumtalt: 10438 70'Rapid Slide 2668 Wild One Roller Coaster 10675 52'Chair Swing r� Obstacle Cocuse Cnrmmrssioner"nf Public Safeh' Issued Dale Pape 1 of I 3 ALLIED- SPECIALTY INSURANCE, INC, 10451 GULF BOULEVARD, TREASURE ISLAND, FL. 33706 Toll Free 1-800-237-3355 Nati�ana.l 1-800-282-6776 Florida 3 Certificate Number: 93 CERTIFICATE OF INSURANCE This certificate neither affirmatively nor negatively amends, extends or alters the coverer e afforded by the poicy(ies) described hereon and is issued as a matter of information and confers no right upon the holder. The policy{ies) identified. below by a policy number is in force on the date of certificate issuance. Insurance is afforded onl�r with respect to those coverergges for which a specific limit of liability has been entered and is sub'ect to all terms of the policy having reference 'thereto. Nothing herein { con�ained shall modify any provision of said policy. In the event of cancellation of the policy, the company issuing said policy will make all reasonable effort to send Notice of Cancellation to the certificate holder at the address shown herein, but the Company assumes no responsibilities for any mistake or failure to give such notice. Any insurance made a part of the policy includes as a person insured with respect to an occurrence taking place at a Carnivals site, ((1 the fair or exhibition association, sponsoring organization or committee (2) the owner or lessee there of(3) a municipality granting the Named Insured ppermission to operate a(n) Carnivals, but only as respects F�odily injury or property damage caused by or contributed to by the negligence of the Named Insured while acting in the course and scope of their employment. NAME & ADDRESS OF INSURED ADDITIONAL INSURED: North American Amusement, Inc mown of Andover MA � 641 Summer Street Weymouth MA 42188 Merrimack College 315 Turnpike Street North Andover, MA 01345 NAME ADDRESS OF CERTIFICATE HOLDER: Merrimack College 315 Turnpike Street North Andover, MA 01845 DATES: 10/26/13 to PRIMAi2Y COVERAGE EXCESS COVERAGE Company: T.H.E. Insurance T.H.E. Insurance Company Company Policy Number: CPP0100933-03 ELP0010215-03 LIABILITY LIMITS BI/PD .AGG: $5,000,000 $1, 000,000 OCC: $1,000,000 $1, 000;000 Excess of Excess of �1, 000,000 Food Products: $1, 000,000 ' , VVV, VVV Policy period: From: 5/01/13 5/01/1.3 0/00/00 To: 5/01/14 5/01/14 0/oo0o * - COMBINED SINGLE LIMIT Covera e shown herein applies only to those items scheduled on or endorsed to the policy. tom, June 25 2013 ry X[)'I'HtIK1"L2E3—S WILDING PERMIT TOWN OF NORTH ANDOVER '�'�°,-. >f•° APPLICATION FOR PLAN EXAMINATION � Permit NO. Date Received pate issued: t R�'A1�T:A Iicaot must leteA I items oto this a ge - �$ .- h a y 4 t !� t���b� � rN. � "'S. s•.fi"`� ��s'.ail�°��" �° ���`l'� „r z TYPE OF IMPROVEMENT PROPOSED USE Residential Non*Residential New Building One family Addition Two or more family industrial Alteration leo, of units. Commercial Repair*replacement Assessory Bldg Others! Demolition ir?thar _ *tel ^� '. �.^�.�.and� :; �,.. �.+,��+� �. �r r � t .�s � •:d- +;. Id+e"tficatt#m terse or Mat Clesrty) OWNER: Name: mocke� C I I Address: 3 lie TDA i I� ST- � f�haimv�� .a.�y��yi' �aT K qz tf x y x 1 ``";{�ira � r ;��" �. ° 'S 9..�.k�.h +"`-.' �. a w�'R'� �3�w �`.➢ta 7� �° � �71Ji�"��'p'L.r� ,e� c�y, � �',r a ^n •-e s- �' '��.�x ''� '� t e�r"y�y.�+��"+� dr''S��'R��`�� ?; � #:� .r. y.,y��R �� t �' 4•t 1 ..r y.3u .h i� X4..7!• T��a..��,�t�4 7 �r� c cif.� +3 �C��I"�'!4}��7'.�,.��j etWw��� c� �ti� f Y � } k �' r�,°.1fi�a ;r»:h'FS,�.M,�t..: •,q:�'C, *:r". � . ARCHITECT/ENGINEER - —Phone: i Address: Reg. No. FW SCNMW-iBUL 3 P9RNT,'$IZVO PMM0.00 0.00 OF THE TOTAL ESTM4 MO COSTBASED tiN$12&06 PFR&F. Total Projett Cost: I=EE: Check No.: Receipt No.: ,.vo E: Persons conmrt eg wrtli unr contractors do not have access to the guarantyfund Sig*aturG f eritlC3�woer Signature Of ritra-to, a r