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HomeMy WebLinkAboutBuilding Permit #229-14 - 315 TURNPIKE STREET 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age LOCATION 315 / 4�1� Sft^eC-+ Print. PROPERTY OWNER Meerrl rule'.� Print 100 Year Old Structure yes rno MAP NO: PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes 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 P,6thers:-zwT ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: �7/1 grle4 'lg .4 laLAle. J"us�eu�s��� f`Ie Wex-77e WOVIZ013 Identification Pleas Type or Print Clearly) OWNER: Name: err/t'Y,I�tC,eV C�/ eq� Phone: Address: T� s^h Ikc - � CONTRACTOR Name: r/S77f h t"�tr f1 MAI Phone: .3—903 ` �,1713 n / Address: � � ('ll�b'1M3'1 Supervisor's Construction License: Exp. Date: [Home Improvement License: Exp. Date: , R / `�1 I?�Vej 4�C�( ll JJ Phone: 1)3 - 2,37 'q 7� D Address: / '? ell\m-'67 a-' ]J� ,/V�Q3 � 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: $ FEE: $ Check No.: —7 I Z i? Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ;Signature of Ac enyOwner Signature of contractor Plans Submitted ❑ Plans Waived 0 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 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 tI)PW TowL Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMF_NT - Temp Dumpster on site yes no Located at 124 MainStreet Fire Departinent 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.$10041000 fine NOTES and DATA— (For department use El Notified for pickup - Date Doc.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 ❑ 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 i 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;4ted with the building application Doc: Doc.Bui!ding Permit Revised 2012 -�' Location No. — Date f • • TOWN OF NORTH ANDOVER • Fn . . Certificate of Occupancy $ Building/Frame Permit Fee $ 5L, � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# /aG ' 13'&Iding Inspector NORTH own of EAndover No. 2.ZT.- iti o h , ver, Mass, Ab CoCNICNlw.cK ��• �•9 °A'wreo S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT l `�F�.`"'`:.:?� ���....�� .,�'�-�.F:........................................................ ........... ..... .... ..... Foundation has permission to erect .......................... buildings on ..�.l:.' ......4G!4a: , ?/..'..lf::.. s :........................., �� Rough �✓ f ��i ... �............ .17.�?.�....�T.... 6 �'. Chimney to be occupied as ..................:x'1.2.........: ' :. ........ . ...... .... 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 CONSTRUCTION STARTS Rough .................Y...... rw...ti... . Service 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 9/11/13 315 turnpilae st north andow-Google Maps To see all the details that are visible on the screen, use the"Print" link next to the map. f ' S i F V N 40 ;�`4 r � z•. u r a. / asz +l �x t _. • 4 mal. _. � ,. WE MEW *AIL z - � r � §� ♦ 4�. ,- � Mme' '' https://niaps.g oog le.com4maps?q=315+turnpilae+st+north+ando\oer&ie=UTF-8&hq=&hnear=0)69e3O621823Md:0)695487b26ee9add,315+Turnole+St,+North... 1/1 • errlmac 315 TURNPIKE STREET,NORTH ANDOVER,MA 07845'WWW.MEI�RIMACK.EDU St,Ann Apartments Physical Plant Warrior 9 Baseball Field St.Tho as Field Apartments Softball Field Tennis Courts Ash Centre Santagati; Halt z Tow� Centre Sakowich Houses Votpe Cascia Complex Rogers Halt Center for th s • �' Arts .. 1 d WELCOME CENTER Come to the IVelcome Center to meet with our admissions team, tour the campus or just say hettoi Q VOLPE ATHLETIC COMPLEX Home base(Draft ourbVarrior student-athletes,Volpe also houses the Lawler Arena—the hockey rink for our Division 1 seam. AUSTIN BALL The tiur'sar,Registrar and Alumni Dffiees—the heart of our administration—are a!t totaled in Austin. (�SAKOWICH CAMPUS CENTER "Thr.•Sak,"as it's knov:n on campus, is the central spot for students who head here to eat at Gee r4�i�Place. wo1 k out in the fitness center and gatherfor moststudentevents. { MPO RTA NT DOCUMENT o s Certificate of Fla Reidstance 5 PSS ap ISSUED BY Date of Shipment 5 5 REGISTRATION CHORS 3/3/2008 5 SNUMBER INDUSTRIE INC. 5 EVANSVILLE, INDIANA 47725 Tent Identification 5 F140.1 MANUFACTURERS OF THE FINISHED 04590598 5 5 TENT PRODUCTS DESCRIBED HEREIN 5 This is to certify that the materials described have been flame-retardant treated 5 5 (or are inherently noninflammable) and were supplied to: 269800 5 5 CHRISTIAN DELIVERY&CHAIR ER DBA CHRISTIAN PARTY RENTAL 5 5 18 CLINTON DR 5 HOLLIS NH 269800 5 5 5 5 5 Certification is hereby made that: 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 5 5 Fire Marshal Code. All fabric has been tested and passes NFPA 701-99, CPAI 84, ULC 149. 5 5 Serial# 9151210(1) 5 SDescription of Item certified: 5 CENTURY END 60WX20 HOLE SNYDER 5 5 cS WHITE VINYL WITHOUT WEB GUYS 5 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 MFG NEW P1•IILADELPHI&OH Signed' 2 ca4Lc5 S Name of Applicator of Flame Resistant Finish ANCHOR INDUSTRIES INC. 5 frJ�cPr.PrJ��r frl�rJ1�r.Pi�I��.I�r�E I�PrJr�rJ�r PrJ�cJ�rJrJ��P�1'c1�rJO��.frJ�ctticl�tPtPrJ�cP�1'�PrJcPr�c.i�rJ�cfr�cl'Icfc�OnCUM rPtJ�cJr��ItJ�t3'rJ'�P�.I�c.fc1r�c(cl�r� C! 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 J� L - Please Print Legibly Name(Business/Organization/Individual):Ch r/5h,4)? ,l/ell Very tCIXI"l�"�r✓ICC� Address: City/State/Zip: /� D I1 IS i lVIJ D3a V9 Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.O1f'am a employer with 3 Z3- 4. ❑ I am a general contractor and I 6. Q 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. $ EJ 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 ME]Electrical repairs or additions 3111 am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.] t employees. [No workers' e comp. insurance required.] 13.P-dthe� 7t *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 an:an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: J^\J Policy#or Self-ins.Lic.#: w GZD 3 1 ®� Sl 76 Expiration Date: 12-Ml- Job Site Address:, 1 LfyIo City/State/Zip: IV,,f7nda ile,- / ,46'19q- _ 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 Investig4tions of the DIA for insurance coverage verification. I do hereby certify un,*r the pains and genalties of rjury that the information provided above is true and correct Signature: / Date: � 7 Phone#: /� G % 7� 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia ACOR0DATE(MWDDIYYYY) 4*.� CERTIFICATE OF LIABILITY INSURANCE 9/4/2013 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 endomement(s). PRODUCER CONTACT Tracy Plcardi Tebbetts Insurance Agency PHONE ( )465-3333 465-3333 Fay o.(603)465-6800 P.O. Box 848 ADDtL .tract'@tebbettsins.com 3 Market Place INSURERS AFFORDING COVERAGE NAIC# Hollis NH 03049 INSURER A:Citi zens Insurance Company of 31534 INSURED INSURERB: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 NUMBER:Kaster 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVQ POLICY NUMBER MMIDD MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE a OCCUR ZBV0844363 /1/2013 9/1/2014 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea MBINED SINGLE LIMIT 1,000,000 A X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED V0716909 /1/2013 /1/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED OPeaaideY DAMAGE $ HIRED AUTOS AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 BEXCESS LIAB CLAIMS-MADE AGGREGATE $ 4,000,000 DED I X I RETENTION$ 0 UHV0844365 9/1/2013 /1/2014 $ C WORKERS COMPENSATIONX WC STATU- TORY I X OTH- AND EMPLOYERS'LIABILITY Y I NLIMITSER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? NIA (Mandatory In NH) CID31098170 /1/2013 /1/2014 E.L.DISEASE-FA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If 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(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN9025 rgmnn5i m Tho Ar_npn noma anti Innn ora rania arart morim of Ar npn