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HomeMy WebLinkAboutBuilding Permit #187-2017 - 999 OSGOOD STREET 8/22/2016 } NORTH mdm ' bgtbto hb� �r0 BUILDING PERMIT TOWN OF NORTH ANDOVER � w APPLICATION FOR PLAN EXAMINATION Permit NO: 1/6 lorl Date Received Date Issued: 9-vi � �4SS/1CHUS t� IMPORTANT: Applicant must complete all items on this page LOCATION 9 a5 "�►v Pnnt PROPERTY O ER�� ,�lQ�,tZ�l t..5 �f,, Pnnt MAP NO: r 1 PARCEL ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family 0 Addition 0 T wo or more family ❑ Industrial 0 Alteration No. of units: 0 Commercial ❑ Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other 0 Septic 0 Well 0 Floodplain 0 Wetlands 0 Watershed District ❑Water/Sewer sC Tr t /� t 7'p �e�pv✓�v� $ K 5 ��n�.�c. �c✓�t- O+� I d�s� �is G-✓�-�l �a-�t� �O w� SVy�C�c.�"1 D �!Zgj��©I l� IC ` (JC l r d i'. Identification Please Type or Print Clearly) OWNER: Name: �G foV6-zZGt Phone: Address: CONTRACTOR Name: Phone: Address: , 01�rAl 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 BASED ON$125.00 PER S.F. Total Project Cost: $ 419.06 FEE: $ XI) 'r~ Check No.: I23!�) Receipt No.: alo NOTE: Persons contracting with u7gistered contractors do not have access to the guarantyfund ig_nature of Agent/Own r Signature of contractor � -- Plans Submitted`0 - Plans Waived ❑ _ '_:Certified Plot Plan 11Stamped Plans El TYPE OF'SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales El Food Packaging/Sales 0 Private(septic tank, etc. ❑ Permanent Dimnpster on Site ❑ ` I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On-: Signature_ I 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 t5 Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP"gRTIUIENT - Temp D mpste onsite Street 'yes> ��n Loeatetl at 124 Mam Fire DepP t signature/date fiC©MMEN,�T�S 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 Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4 Building Permit Application 4. Certified Surveyed Plot Plan 4 Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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:Building Permit Revised 2014 I Location No. C1 Lc�l� Date8 _7, • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ <' Other Permit Fee $ - TOTAL $ Check# 't 1 f Building Inspector f NORTf1 q Town ofndover 2 _ Fa G `� 0 No. l ��h ver, Mass, �I co,MIC MI wICM �a pDRATED S U BOARD OF HEALTH Food/Kitchen ,. PERMIT LD Septic System THIS CERTIFIES .. e &A.... .... „�� tQ ISS BUILDING INSPECTOR THAT ....... ....... ................... ....................... . ..... .. ..... ......... Foundation has permission to erect.......................... buildings on ....... ... ... .. . ... ... ��......... Rough g to be occupied asTerson "acce ....,..... ...... . . .LAgh......... ..�. ....... .. ..... .... ..... ..� Chimney provided that the n this permit shalPin eve re ect conform to the terms of the Ica !on g p rY p pp 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 CONST!;Q.C�ION ST Rough Service .. ....... .. .... 4BUIL6DING Final SP OR 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. L 11 Cushing PI Unit D Status: Reservation Chelmsford,MA 07824 Contract#: 7677 ILJZAJ�r-7 cpm www.twinbrospartyrentals.com Event Beg: Thu 8/25/2016 8:00AM 978-337-9730 Phone Event End: Sat 8/27/2016 11:00PM s�a-sa r��so us Omer Operator: Eric Jeannie Grico 978-655-7455 Phone 999 Osgood St. North Andover,MA 01845 Ordered By: Jeannie Salesman: Kyle Delivery and Pickup Delivery: Thu 8/25/2016 8:OOAM-8.30AM Contact: Pickup Date: Sun 8/28/2016 Phone: Used at Address: 999 Osgood St. ; North Andover, MA 01845 Delivery Notes: Jeanie called in and said we are pulling the permit. Please arrive closer to 8am. Qty Items Rented Each - Price 1 15x15Ft.High Peak Frame Tent White $259.00 $259.00 Tent can be set up on grass,pavement,or a patio and requires an area of 16'x16'for installation purposes.If being set up on pavement or where we can't stake into the ground,make sure water barrels are on your order so we can anchor it down. 4 50 Gallon Water Barrel $12.00 $48.00 Water barrels include a white barrel cover.Customer is responsible for making sure that there is a working water spick at within 125'of where the tent will be being set up so we can fill the water barrels.This should be made sure of before we arrive for delivery. 6 6 Foot Banquet Table S8.00 $48.00 1 Delivery Green Zone TenVinfla $50.00 $50.00 Delivery Price Is,For Order OfA Tent or Inflatable 1 Multi Rental Discount ($75.00) ($75.00) Previous Customer 1 Permit Fee $150.00 $150.00 We are pulling_the permit. Delivery is normally scheduled two weeks prior to your rental date. Payments made on this contract: RentaVSale Paid $100.00 Credit Card Amex xxxx-xx)=-41009 Auth:215393 Total $100.00 Rental Contract Payment is due in full at time of delivery.We accept cash or check at time of delivery.checks can be made Rental: Party Rentals,If paying by credit card please call a minumum of 48 hours prior to your scheduled delivery date sowecan process $280.00 your credit card.We will be giving you a courtesy call half an hour before we arrive for delivery and set-upt Deposits reserve rental items.Deposit amounts,orders of$500 or less is$100,orders$500 to$1.000 is$200.Orders$1,000 to Sales: $150.00 $2,000 is$400,and orders over$2,000 is$600.Deposits are not refundable if you cancel within a month of your rental date. Delivery Charge: $50.00 This is a contract. The attached contract contains Important terms and conditions including lessor's disclaimer from all liability for Injury or damage and details of customer's obligations. These terms and conditions are a pan of this contract-READ THEM!You can view the contract at(www.tw!nbmspartyrentalsdoomtrentakmntract-policy) Subtotal: $480.00 I certify that I have read and agree to all terms of this contract.Contract needs to be signed at time of delivery. Hampshire Sales Tax: 0.00 Total: $480.00 Paid: $100.00 Amount Due: $380.00 Modification# 7 Printed On Fri$/19/2016 9:68:64AM software by Point-of-Rental software www.polm-of-cental.com ContraC-Params.rpt(1) I The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avylicant Information Please Print Le ibl Name(Business/Organizationdndividual): im. titen4 n W Address: ! G Uv AIA /P l u[C_ v/I l`_ �/ CARP City/State/Zip: C Il rt J��r4 /`T h- U l 9�q Phone#: 7 e' 3 7 ' 3° Are you an employer?Check the appropriate box: Type of project(required): Lal am a employer with � q employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp,insurance required.]t ❑ 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11. ]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.= 6.F-1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.1�Other e h 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 isproviding ivorkers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: v 0'464 ce CQ � 7 d Policy#or Self-ins.Lic.#p "YY ry l� 3 0?a d a ?6 Expiration Date: � a l Job Site Address: (3 g [ 0�9�a�1 C-A City/State/Zip: *611^14 /r�NO✓�s /� d'/��,j�' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify�thepains and penalties of perjury that the information provided above is true and correct. Signature: Date: 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 M ACO® DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 8/19/2016 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 CONTACT Commercial Lines NAME: Byette Insurance Agency, Inc. PHONE (978)851-6678 1 FAc No;(978)851-0106 853 Main Street E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Tewksbury MA 01876 INSURERA:Wes— Insurance Co 25011 INSURED INSURER 8: Tim Aalerud INSURER C: 11 Cushing Place, Unit D INSURER D: INSURER E: Chelmsford MA 01824 INSURER F: COVERAGES CERTIFICATE NUMBER-CL1672712744 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 A DL S BR POLICY NUMBER MM/uDD EFF PM/LDICDY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO CLAIMS-MADE F—IPREMISES Ea OCCUR RENTE-D occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F--]PRO JECT ❑LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1-1 DED I I RETENTION$ $ WORKERS COMPENSATION x PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? A a N/A (Mandatory in NH) WWC3220286 7/7/2016 7/7/2017 E.L.DISEASE-EA E PL YEE 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Job Description: Set up of a 15x15 frame tent for an event from 8/25/16 to 8/27/16. Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Jeannie Grico THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 999 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE K Hendrickson, CIC/KA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 ont4nn Certificate of Flame Resistance REGISTERED FABRIC ISSUED BY Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 10-23-2015 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as hereafter specified by the material supplier. NAME: Town of North Andover CITY: North Andover,MA 01845 Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701*, Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G. FTH133, 15x15 Frame Tent 15x15Ft.White High Peak Frame Tent Serial 100499 Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvl Laminates TENT DEPARTMENT,JOHNSON OUTDOORS INC. *Large Scale C