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Home My WebLink AboutBuilding Permit # 4/2/2015 I 1 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ®� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 1n f 77 7 Paint PROPERTY OWNER /��hlyYretcV � Print r 166,Year Old Structure yes , no MAP NO: � PARCEL J 0 ZONING DISTRICT Historic District yes no v , Machine Shop Village' yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg E-Others: � ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain` ❑Wetlands ❑ Watershed District ❑Water/Sewer. DESCRIPTION OF WORK TO BE PERFORMED: Al77 le)-n e ao Y b-e- e9n Identification Please Type or Print Clearly) OWNER: Name: A Irl-)MA ei�- Cc 1 Phone: /�" ��✓ �'�� Address: !S (- CONTRACTOR Name:(--,/°1 rI S+`,WJRdt n Phone: tO--7993 -,-4-32-4 Address-,/,? � fi' -o..p, �J " a � 41� Supervisors Construction License: gf�' 0 -7 Exp. Date: .� Home Improvement License: Exp. Date: R ,*A� / e--� ?Cl I _ Phone: i�03— 3 V-V W1 0 Address: ]S Olin Yl 66"' 4/hls NY P4,;aVq Reg. No. FEE SCHEDULE:BULDING PERMIT;MOO PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Protect Cost: $ ®D FEE: $ to Check No.: Receipt No.: to the u gran untl NOTE: Persons contracting with unregistered contractors do not have access g ty f Signature of Agent/Owner G` Z Signature of contractor MI„— F, Pianc lA/aivarl ❑ C:P.rtifipd Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ PlansWaived-11 Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF=:SEWERAGEDISP:OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . . Swimming Pools ❑ Well ❑ . Tobacco.Sales ❑ Food Packaging/Sales ❑ i 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 Si nature�' . A/2 COMMENTS tu, Ltl 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/S_ignature Date Driveway Permit DPW Tovv3! Engineer: Signature: Located 384 Osgood Street FIRE D`EOMTWEN T =Temp Dempster on site yes no li Located-at 124 Mair,Street Fire'®apartment signature/date COMMENTS NORTff Town of E ndover No. --� 3 � y h ver, Mass, coc"I"twicK �1 �.e ADRATED �'Pp,��(y S U BOARD OF HEALTH Food/Kitchen PER IT T Septic System • THIS CERTIFIES THATLD ..0 .,1 .. ... . .. .�.�, ..........................W BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on ..... .IS...........11A.0014.. ..... .46 1 Rough to be occupied as ...... #.. ... �� ... .� .1...... a.�� Chimney ... tprovided that the person accepting this permit shall in every respect conform tot terms f the appli 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 T Rough q Service ........................... .................................................. Final BUILDING INSPECTOR 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. 111111111 0 St.Aran Lol K Apartments Klower /"1 L.rower Physical �M Pero+r Plant .. I Tower r, Marione-Mejait v PI reftr Field z Baseball U Tnwer St,Thomas Held Lot.l pTnwarr Apartments E Tstwer'�,! ✓ C Tower Softball Tower ly Field s �Lnl Hamot Health& � Caurs1rtot i p , Center Midop Asla /end IleaCttr Coates�l O'Brien "O Ila Fahce Plat �er Innovhjo � So t i Lot G � � f pr,kgih�tt Ucp+ninront r, IW// Ptln nUrt %� a bld4tlnst TpStld nc Monirnn lldRl iJ/� 4lpnac' e rT I#uu ei�ltSN �truse ' TowNL"M, Centre House, ch'.4insfrrrl �� inn plea llatlAJest Iva t i)r»cut /' "i�l Caccia IloiJ a�, {tv r ' lrrwelt Roger Ball / Iewxstaury lotF Center / a� rli� l/ii/� j"lamel ''�, tselham r PReallh r iltf(ng fyngrbornuylr ltu `�, r AMs C4 Rallly And ever � ;,, y "'rr "Lawrmnver ✓'' ., +Melhuen MaUtuaade rr° 5atem " Mandel : Library a tenter i;3 / rY HnvtrhW Oonreletewn 'a bYulcornw f%t f) ✓, Center ° n North F.ndmvgtr' It It 7cL .Hnxferrl Sullivan�j� Halt {eye I Qt t7 Aum inr Lot A Haan ,otle9late r�+ hurrah of 1'`Ila &hrlstthe Main Teacher Entrance s: ka ✓y1 p iv iia P'm x br, ,pt p du tl W b u. Mu y Iq C � rvn C. tl a z s .. r r f Certiftrat.e of jif t�ctnc� ` j Date Manufactured AZTEC TENTS Invoice Number: 0202537-IN 2665 COLUMBIA ST Customer P.O.: 1/8/2014 TORRANCE,CA 90503 (800)228-3687 Customer Number: CHR030 This is to certify that the materials described below have been fla,mp retardant e^or ra a ame e . Brun tsar iGras F- 2.0 Bruin Mesh F-222.04 treated (or are inherently flame retardant). i�, I' California Comb. tam-Tex 12,14,16,18oz F-419.01 Y Coated Fabrics Clear Vinyl 16ga/20ga F-570.02 Christian Party Rentals DAF Clear Vinyl 169a/209a F-593.01 l , OAFDAF F-593.02 .5 18 Clinton Drive ExduslVely Expo PdySateen Liner F-434.01 Hollis, NH 03049 Ferrari Precontraint 502 F-444.01 rl -. Ferrari Precontralnt 702 7-444.08 Phillips Textiles Phll-Tex Liner 7500.01 ,I PJC Tech. Deco Cloth/Velon F-504.01 Snyder Weathempan F-140.01 I Tri Vantage Firesist Sunbrella F-368.05 I Certification is hereby made that the articles described below hereof are made Tn Vantage Patio 500 F-121.02 ' I from a flame-retardant fabric or material registered and approved by the Tn Vantage Big Top F-121.10 California State Fire Marshal for such use.The fabric has been tested and Td Vantage Vanguard Coastline F-069.01 Tri Vantage Weblon/Coastline F-069.01 passes NFPA 701 Large Scale.See chart to right for trade name of Vemeidag Duraskin 81673,e1515 F-530.01 flame-resistant fabric or material used and additionally referenced on the label of the fabric panel. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager- Manufacturing Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z22130CM2002 30x20 Mid Jumbotrac Top EACH 2 2 UW Blockout White-_w/2Ratchet Tensioners Z22140CE4002 40x40 2pc Jumbotrac Top EACH 1 1 UW Blockout White-w/813atchet 1 Tensioners Z22140CM2002 40x20 Mid Jumbotrac Top / EACH 2 2 UW Blockout White-w/2Ratchet ns' Hers %' Z22520FC2002 #20x20 1 pc Festival Top EACH 2 2 UW w/Ratchet Tensioners& Flag Blockout White #with Double Valance Z22520FC4002 #20x40 1 pc Festival Top EACH 2 2 UW w/Ratchet Tensioners& Flag Blockout White V #with Double Valance (/ Z211203002 #20x30 1 pc Top Only UW U EACH 2 2 Blockout White #with Double Valanace /ZFRT Daylight Freight Prepay&Add Sep 25 14 06;16p Mike LeBlanc 978 534 7983 p.1 0 Massachusetts -Department of Pub;;c Safc;;i F Board of Building Regulations and Stand,-.,,as C' License: CS-067484 "v MILL P L1;JBwc 61.1 PIERCE ST LEOMINSTER MA 01453,,.' Commissioner 06/2212016 ORDER CONFIRMATION 25063-2 Pg: I EVENT DESC: COMMENCEMENT-ROGERS *L EVENT DAY: THURSDAY DATE: 05/14/2015 ekl6flAh EVENT TIME: 18 Clinton Drive, Hollis,NH 03049 DELIVERY: TUE 05/12/2015 603-882-1234 or 603-881-8833 fax PICKUP: TUE 05/19/2015 1-888-RENTENT SALES PERSON:MG PO#: www.intents.com email: sales@intents.com ORDER DATE: 11/21/2014 TERMS: NET 10 DAYS (347)755-231.0 SHARON (617)809-5618 B MERRIMACK COLLEGE S ROGERS CENTER I ACCOUNTS PAYABLE H L 315 TURNPIKE STREET I NORTH ANDOVER MA L NORTH ANDOVER MA 01845 P TEL: (978)837-5203 TEL2: (978)809-5618 FAX:(978)837-5524 QTY ITEM DESCRIPTION PRICE TOTAL 1 40'X 80'WHITE FRAME TENT(KT) 2,600.00 2,600.00 240 FEET OF CATHEDRAL WINDOW SIDEWALLS-FULL SIDES 1.50 360.00 5 WHITE VINYL COVERS FOR CEMENT BARRELS 7.50 37.50 5 WEIGHTED BARRELS TO SECURE TENT 18.00 90.00 240 FEET OF WHITE MARKET LIGHTS(7 WATT ROUND BULBS) 1.50 360.00 3200 SQ. FT.OF "PUTTY"ULTRA DECK PLASTIC FLOORING INSTALLED 1.00 3,200.00 3200 CARPET INSTALLED(SQ FT) INSTALLED"CADET BLUE" 1.00 3,200.00 300 FRUITWOOD CHIAVARI CHAIRS W/IVORY CUSHIONS 14.50 4,350.00 30 5'ROUND TABLES 10.63 318.90 20 Y ROUND TABLES 9.69 193.80 30 Y ROUND 42"HIBOY TABLES 10.94 328.20 MC IS RESPONSIBLE FOR POWER DISTRIBUTION TO LIGHTS 1 SET UP/BREAK DOWN FEE FOR TABLES/CHAIRS 450.00 450.00 1 TENT PERMIT 150.00 150.00 SCHEDULE: TENT ON TUESDAY AND FURNITURE THURSDAY SPECIAL INSTRUCTIONS: SUB TOTAL: 15,638.40 EVENT IS 5/14 THRU 5/17 PRICES REFLECT EXTENDED RENTAL: 1.25 X ONE DAY PRICE SALES TAX: 0.00 FINAL SCHEDULE TO BE DETERMINED IN SPRING DELIVERY: 115.00 0.00 TOTAL: 15,753.40 Customer Acceptance Signature The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 m : .. Bostott, MA 02114-2017 tiff tiv►vw,mass. gav/dib Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print LeEibiy Name (Business/Organization/Individual):Christian Delivery&Chair Service, Inc. DBA Christian Party Rental Address:18 Clinton Drive City/State/Zip:Hollis, New Hampshire 03049 Phone#:603-883-5326 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 40 employees(full and/or part-time).* T ®New construction 2. I am a sole proprietor or partnership and have no employees working for me in � 8. ®Remodeling any capacity.[No workers'conmp.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 iiiai all cuniraciors ei[her have workers'wmpcnsaiiun insurance or are svie 1 1. Liectr iVaI repairs or adultiolla proprietors with no employees. 12.E]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.t I®t 14.�✓ Other TENTS 6.r_1 IWC arc a wepuruiiuu and its uri�ccis liuvc exmcrscu ihu euglii ufcxeinpiwu pc;i ivi(`ri,c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I I *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. lain an employer that is providing workers'compensation insurance for my employees. Below is the policy awl job site information. insurance Company Name:New Hampshire Motor Transit Association Policy#or Self-ins.Lic.#: P000749NHMTA2015 Expiration Date:01-01-2016 Job Site Address: /� rf"o1/v/ 6/rit-e City/State/Zip:/y /4?de l/p'", G1/9�� Attach a copy of the workers'compensation poiicy deciaration page(showing the poiicy number and expiration date). Failure to secure coverage as required under MGL e. 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 under a pains std pens ties of perju that the information provided above is true and correct Signature: Date: Phone#:603-883-5326 Official use only. Do not write in this area,to be completed by city or town official %-fly or T UWII." �Ct`Illit/LIi,'i'.ilst'ff Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/'I'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other I� Contact Person: Phone#: I) W��^�� °"° =°~""'°^ =°° '"^°°~°"` ^"°""^`'"" � po.mmoxw� � con�vu NH 03302-3898 (603)224-7337 � ��80�U��J�� K�� 0�� CERTIFICATE u��m�� u �� n xorm��n��one�� 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 ORPRODUCER,AND THE CERTIFICATE HOLDER. This ishocertify that: Christian Delivery&Chair Service Inc. DBA Certificate#: 1 Christian Party Rental 18Clinton Drive � Hollis, NHO3O4Q � Is,atthe Issue date ofthis certificate,insured»'the Company,under the pv/icy(lea)listed below. The insurance afforded uvthe listed vmx*m4/u � subject to all their terms,exclusions and conditions and is not altered by any requirement,term or condition or other document with respect to which this certificate may»aissued. | COVERAGE AFFORDED UNDER wmLAW opTHE FOLLOWING STATE: wx / TYPE OF POLICY EXP DATE POLICY NUMBER LIMIT OF LIABILITY Extended Policy Term Workers'Compensation 09/01/2016-01101/2016 P000749NHMTA2016 Bodily Injury By Accident $1,000,000 Bodily Injury by Disease Policy Limit $1,000,000 Disease Each Person $1,000,000 ADDITIONAL COMMENTS: � *If the certificate expiration date mcontinuous or extended term,you will oe notified if coverage is terminated or reduced before the certificate expiration date. � NOTICE OF CANCELLATION: (Not applicable unless o number n[days is entered below.) 8e[nva the stated expiration deha,the company will not cancel orreduce the insurance afforded under the above po|i�eeun0otleast 30doya Notice� � � NHMOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST � |Chhe0enDe|�ery&Chair GemkmInc. | /dbaChhmbanPartyRenta| / 18Clinton Street Hollis, NHO3O4Q ° � Concord, NH 603-224-7337 0206/2015 Office Phone Number Date Issued� � �