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HomeMy WebLinkAboutBuilding Permit #351 - 315 TURNPIKE STREET 10/21/2011 BUILDING PERMIT pORTy, 'qa S t 6 : 00 TOWN OF NORTH ANDOVER ° : r i APPLICATION FOR PLAN EXAMINATION 4( _ b 4 A w`y Permit N0. Date Received �, ORATED �SSACHUSE� Date Issued: -'kv Applicant must complete all items on this page p LOCATION Print PROPERTY OWNER : ert-/r rftC Print MAP NO, PARCEL: - ZONING DISTRICT Historic District ,yes no' Machine'-Shop Village :yes -no . J 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: Ca✓1 Ur- '164t l Q Z2 we- Gu/// 4s'I sl// e Z9 "x60 � �rwoe %rkn 49/ err/ Ci ep <Pte• /`(e!' A e]Z-2 Identification Please Type or Print Clearly) OWNER: Name: M'I e_Y-rs;vv1&c le_ e"d1<jg_ Phone:9 XT-3$6 -5-3Z 3 Address: 2/,�- Tura 1 s rP N Aodctle�a IVA CONTRACTOR •Name: 4r]/ 5 '+ �^ � t' f Phooe: Address: "k7 Pel. _463 Supervisor`s Construe#ion-License. Exp Date.: Horrie lrriprovement�Ltcense Exp Date: ARCHITECT/ENGINEER Phone: Address: 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: $ -7 FEE: $ '30 Check No.: 05�& Receipt No.: NOTE: Persons con acting with unregistered contractors do not have access to the guaranty fund Signature;of Agent/Owne "'"''� Signature of contracto r _ _ 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 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 Located at 384 Osgood Street FIRE DEPARTMENT =Temp,Du.mpster on site yes no Located at'124 Main Street � a Fire Department signature/date ; /0470-// 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 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 36 No. Date �+ NORTH TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ SSACMustt Building/Frame Permit Fee $ Foundation Permit Fee $ 0 Other Permit Fee $ TOTAL Check # C/ 24Building Inspector TONM NORTH of _ 0 No. ,j,S/ dover, Mass., COCKICKEWICK 7�SD�AYE D BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......: ......... ................. .6...lem............�r.,.. ....... Foundation +w has permission to erect........... .......................... buildings on ..... ..'T................. .�.......�i�....... Rough to be occupied as....... �. .............. ... *-............&.6.4.60. .................................. Chimney provided that the erson ac tin thipermit sha I in eve respect conform to the terms of the application on file in Final P P P 9 P every 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 ..........S 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. 315 turnpike st north andover ma- Google Maps Page 1 of 1 To see all the details that are visible on the ( ale screen, use the"Print"fink next to the map. -4� ` 1 L � r r+,_ 125 �p c ti \ a 1 _ { 1 1 xh, f � �. .'ice'•/i / � � •t�5/. � - tx !' . ;.:, •°�L,,j fir,\} '� `. «W ' r i lma�;ry 020T1 5' aIGIo I ter` l�I er���rcc�1� Cal A-AjPOVO r�� / ��� / V!// AlleW ltl� ,2.lvll httn://ma,os.i2ooizle.com/mans?hl=en&ascrl=l&nord=l&riz=1T4GGLL enUS345US345... 10/19/2011 The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /I__ Please Print Legibly Name Business/Or anization/Individual :Cy/'r/Sfi4n Address: Cay 4�7n 61-1 Ile- City/State/Zip: ���s f1/f>` ��r`�4�9 Phone#: 40 3 —883— 53 Z Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 3 0 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' insurance$ 9. E] Building addition [No workers comp.comp. insurance required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I L Plumbing 3.❑ I am a homeowner doing all work g repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 1 employees. [No workers' 13.�OtherTe,-7/5 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 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: COYYIIii'I('.l G_ 41 nd ,�t1r t(Sh, _TnSVU1-V7<e Policy#or Self-ins. Lic.#: wG 60297653'? Expiration Date: Job Site Address: -3/'S /l.(rl'1 01/c-e. si. City/State/Zip: /��/9/U��(/fir, Ql c�y 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 uder the pains and penalties o erjury that the information provided above is true and correct Sijznature: Date: /zZD /./ Phone#: 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#: A�oRo® CERTIFICATE OF LIABILITY INSURANCE 8/31/o 1"' 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 CONEACT LnCi Fitzpatrick Tebbetts Insurance Agency PHONE (603)465-3333PAS (603)465-6800 P.O. Box 848 E'�L S .lucitatebbettains.com 3 Village Marketplace INSUMM AFFORDING COVERAGE NAICN Hollis NH 03049 INSURER A.-Citizens Insurance Com anX of 31534 INSURED INSURE B:Hanover Insurance COMPanY 22292 Christian Delivery & Chair Services, Inc. INSURERC:COMMOrCe and Industry Insurance 15172 D/B/A Christian Party Rental INSURER D: 18 Clinton Drive INSURER E. Hollis NH 03049 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1183101187 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 TYPE OF INSURANCE POLICY EFF POLICY EXP POLICY NUMBER MMIDD MMIDD UIMTS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea ccu re ce $ 100,000 A CLAIMS-MADE XX OCCUR 844369 /1/2011 /1/2012 MED EXP(Any one ) $ 5'(300 PERSONAL 3 ADV INJURY S 1,000,000 GENERAL AGGREGATE E 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 7X POLICY jscT PRO- LOC $ AUTOMOBILE LIABILITY M,"N1,n S N LE LIMIT S 11000,000 X ANY AUTO BODILY INJURY(Per person) $ A A ALL SCHEDULE V0716909 /1/2011 /1/2012 BODILY INJURY(Pe racdde t) s AUTOS NON-OWNED PRO=,DAMAGE HIRED AUTOS AUTOS $ Uninsured motorist combined $ 11000,00 X UMBRELLA LIAROCCUR EACH OCCURRENCE $ 4,000,000 B EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION$ 10,00C LTHV0844365 /1/2011 /1/2012 $ C WORKERS COMPENSATION X WG STATU- X OTH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECLRIVE YIN E.L.EACH ACCIDENT $ 11000,000 OFFICERIMEMBER EXCLUDED? F NIA 009870539 /1/2011 /1/2012 (Mandatory In NH) E L DISEASE-EA EMPLOYEE,$ 11000,000 If yyes deserfbe under DESGIRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N mom 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 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Seth Tebbetts/LUCI ACORD 25(2010/05) ©1988.2010 ACORD CORPORATION. All rights reserved. INS025 rmlnnal m Tho Al nl2r)name enrl Innn ens ronlc/nroel mads of A/ rk0n .,,t: :,�:. Oxy: . :, �}:.�., :..,p:, ,�:. -• ., -�, �: , ,�.., :.. .,�: , - .,,�:, .,�- .. :.�;. • �:_�_ trttf trate of iffame Re.5tqtanre REGISTERED AZTEC TENTS Date treated or APPLICATION 2665 COLUMBIA ST manufactured �- CONCERN NO. TORRANCE,CA-90503 ®2f24�� > CAL COMB F-419.01 (800)228-3687 This is io certify that the materials describedbelow hereof(save been flame retardant tread(or are inherersfly nonflammable). FOR CHPJSTL4N PARTY RENTAL IS CLINTON DRIVE HOLLIS, HH 03049 Ceram"aoa�eon is hereby made that (er6�e�> "a"®P rcb,� (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 onformance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Nameof chemical used............................................Chem.Reg.Ido......................... .... Meathodof application...............................-............................................................... (b) The articles described below hereof are 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 NFPA701-96. r Trade name of flame-resistant fabric or material used..LandndadFabdc Reg.No....... re.of_,,,, t The Flame Retardant Process Used MMqT... Be removed by Washing (win or win not) �y David Bradley Chuck Miller- President y Name of Applicator or Pmducton Supwntwdent Twe . �r'�*A"•"i'?�."a �4�, ,.-,e`'`� �5,..,R �g _z;;a ,c;6,a „a::��6�'F'�,':� � .:,�.:����. x.;� :,•�,�c�.0, ..• ¢io :3' :..-'6�`?i �.4�.�'•— CUSTOMER ORDER NO. 8565629 ITEMSMANUFACTURED: 2-241x2®Fes€isral Top UW with Doable Valance 2-20x40 Festal Top UW with Double Valance 3-40x40 2pc.Jumbo Trac Top UW 6-4Ox20 Jumbo T=Middle Top iW I-100x30 Series 2000 Middle UW 2-2OX20 Series 1500 fpe.Top UW 2.20X30 Series 1500 fpr.Top UW 2-20x40 Series f500 1 pc Top.tom PDF created with pdfFactory trial version wwyr.pdffactory.com