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Home My WebLink AboutBuilding Permit # 4/2/2015 (2) i TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION Urn . rmt PROPERTY OWNER / I�"1`'1`✓Yt� � ! �"' '�P[int '100, ear Ola structure. yes no MAP NO; PARCEL: f LONING,DISTRIGT:, Historic DiSriet yes no Machine'Sho Villa eyes, no r rP 9 . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ElOne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 1�5thers: e ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESC IPTION OF WORK TO BE PERFORM / Identification Please Type or Print Clearly) OWNER: Name: ;4e)-Lima C76;/lewe- Phone: � Address: CONTRACTOR Nam . 3 //' ( h Ag �y Wen Phone- _ 93 `' 3 Address: Supervisor's Construction License ,,::7_s-Q67C<V Exp. Dated 2Z Zvl� Home Improvement License: Exp. Date: �grui r��, icni�inLGGR �1G1?lP/ e�U ! Phone: 6 4 - 204/- 0 Address Y' L� Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 31 � FEE: $ Check No.: Receipt No.: 2&G3__ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Sig nature of contracto mi__ n C+1.......-.`..-! 01--- F-1 i Plans Submitted❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped tam ed Plans ❑ TYPE_OF°:.SEWERAGE:DiSP:OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . _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.APPR.OVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS -CONSERVATION Reviewed on Signature 1,t Y COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionlreceipt submitted yes_.. Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & ®ate Driveway Permit DPW To v32 Engineer: Signature: Located 384 Osgood Street FIRE D'EPMIMEN Teiimp Dempster on site yes no Located-at 124 Mair, Street Fire'Department signatu e/date COMMENTS F NORTI� � own of . E _ 1� . ndover - 0 ;h ver, Mass, a*2 O� 0)0* o ..K■ 1 A- COCMICMCWICK 7i9 Aoj SATED i"% S U BOARD OF HEALTH Food/Kitchen PER T T _LD Septic System • THIS CERTIFIES THAT ...ti,. . ... .. ........... BUILDING INSPECTOR ................ ....... C. ...... has permission to erect ....... buildings on �� Zknv , . ,, Foundation ................... .... .... ....... . .. .... . � � Rough tobe occupied as . ............. .....V......................... ........................`........:.............................. .... ........ Chimney 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-Ap"ONPOW relating to Inspect''u ,AIVration 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 TARTS Rough Q Service ........... .. ................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. dk� Lot K St,Ann Apartments KTowera"Oii�'L rower b, physical � td lowor Giant d lower 0 Martune-Mejalt D, r,;,tiTowuc Field, m. BaseballilrA� 0 Tower St.Thomas plald Lot J UTow rApartments rf �5 ! C'Tw+ar F`Yawurlr �,.. KTowdar //; u; "' F Tnw'a.r 5Held t ., i ��Altw" I raid / t nt Hamot Health& Lot L SpnrFh- iAsh r,w (YIrlarn Yavaw Counseling Canter Medictrie 1, t✓�aktd Heattir Centra i� Ne o Ach1e0n# innevat1�l � nHcati Hatsrlouuulsht �r( P F"nr hprard olent/r i Lot GVanRTer, Mnnicon r 'Tlall Wast {sr t aNluusad x t'hr^lrn�(crrel Grarut �� Caccia Hou aL�i vkd''4 -xv tow✓u.(I PBagers i/iii % ! rawksbury IAatt Hama{",, t, Pelhamfqr kilo °� Iientth T n �borour�h ,t Alis a T'4TeIity ba Xwh Ctultrding �\ Y y 1 Lott Hall � '�a � a >Andavei Lawrmnce �� % L�ty�' 'w, Methuen m ° %/i%/ hleC na �% 'xt �,, 5atern aua, Mender r�� r'. Library r .Centers CDU 9 7> IluverhdoiU sr Geargwn ay Via roi ie ti ,° ora Center -ol D v �. \".North Andover Loi C .I A, Ftailt g 'x'yr •h3oxfuir¢1 Sullivan Ilett aaa�a `^�`."^,,.,...,,�•---f �/✓��.��•�� / a �ZG 7t 111 ,per Lot Et �� rya " a ale r ` HL,otA e Hail; �% attegiate `' x urch at 0hrist a tS„ t he CTeacher Entrance 5 !J a rxa a v a a u � e w a ma a iNa. vw p �x n al a i . fl M ORDER CONFIRMATION 251442 Pg: 1 EVENT DESC: COMMENCEMENT-OBRIEN EVENT DAY: THURSDAY DATE: 05/14/2015 &kl6f[A M�T� kiN*L 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: 12/10/2014 TERMS: NET 10 DAYS SHARON SHAUGHNESSY (978)837-5203 SHARON (978)809-5618 B MERRIMACK COLLEGE S OBRIEN PLAZA-IN FRONT OF SAK I ACCOUNTS PAYABLE H ON GRASS 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 I 10'X 20'WHITE FRAME TENT(HPT2) 270.00 270.00 1 60'X 90'WHITE CENTURY TWIN POLE TENT 3,510.00 3,510.00 60 FEET OF SOLID SIDEWALLS- 10'X 20' 1.35 81.00 300 FEET OF CATHEDRAL WINDOW SIDEWALLS-60 X 90 1.50 450.00 10 FEET OF RAIN GUTTER TO JOIN 10'X 20'TO'60'X 90' 2.00 20.00 5400 SQ.FT.OF"PUTTY"ULTRA DECK PLASTIC FLOORING INSTALLED 1.00 5,400.00 5400 CARPET INSTALLED(SQ FT) "CADET BLUE" INSTALLED 1.00 5,400.00 LIGHTING&FURNITURE MAY BE ADDED I TENT PERMIT 250.00 250.00 SPECIAL INSTRUCTIONS: SUB TOTAL: 15,381.00 FINAL SCHEDULE TO BE DETERMINED IN SPRING SALES TAX: 0.00 DELIVERY: 115.00 0.00 TOTAL: 15,496.00 Customer Acceptance Signature IMPORTANT DOCUMENT Certificate of Flame Wsistance ISSUED BY Date of Shipment 2/24/2014 Registration Number CHOW F-140.01 `A' INDUSTRIES INC. Sales Order# SO-601120 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 269800 CHRISTIAN DELIVERY CHAIR SERVICE INC DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 03049 USA G15TE� CaC/��Q � fr RETp Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, ULC 109. Serial# 8151030 1) D Description of item certified: CENTURY MIDDLE 60WX20 SNYDER WHITE VINYL WITHOUT WEB GUYS Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MANUFACTURING INC, PHILADELPHIA PA Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC qtr 1� .' ' '� ".•< i` ,' �P' , .�?y .{ � # ' "., 4tY 'M'cu Y r s`a<N'7 a AM Iffir, C 6aia oame esis ance PAGE 2a ergs Date Manufactured AZTEC TENTS 2665 COLUMBIA ST INV NUMBER: 0176130 07/02/2009 TORRANCE,CA 90503 P.O. NUMBER: �F (800) 228-3687 CUSTOMER NO: CHR030 '" This is to certify that the materials described below have been flame retardant treated (or are inherently flame retardant). en e, m a ame I BrunMar 1 Gras F- 2 Bruin Mesh F-222.04 CHRISTIAN PARTY RENTALS California Comb. Lam-Tex 12,14,16,18oz F-419.01 *2 Coated Fabrics Clear Vinyl i6ga/209a F-570.02 18 CLINTON DRIVE DAF Clear Vinyl 16ga/209a F-593.01 Hollis, NH 03049 DAF DAF F-593.02 * 1zExclusively Expo PolySateen Liner F-434.01 x r Ferrari Precontramt 502 F-444.016 i Ferran Precontramt 702 F-444.08 Phillips Textiles Phil-Tex Liner F-500.01 ''. PJC Tech. Deco Cloth/Velon F-504.01 Snyder Weatherspan F-140.01 p:,rgsi TO Vantage Flresist Sunbrella F-368.05 "t 84 TO Vantage Patio 500 F-121.02 '., �'T Certification is hereby made that the articles described below hereof are made TnVantage Big To F-121.ID � from a flame-retardant fabric or material registered and approved by the TnVantage Vanguard Weblon F-069.01 California State Fire Marshal for such use. The fabric has been tested and TnVantage Yebion/Coastline F-069.01 ' !, passes NFPA 701 Large Scale. See chart to right for trade name of Verseidag DuraskinB1673,81535 F-530.01 4, 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 ��' AIse '- . ITEMS MANUFACTURED TYPE PRODUCED 10x20 1pc Festival Top UW S 2 w/ Rope Tensioners & Flag SINGLE PEAK 10x20 1pc Festival Top UW S 1 w/ Rope Tensioners & Flag TWIN PEAK Festival Cable 10X S 4 2 Sep 25 14 06;16p Mike LeBlanc 978 534 7983 p,1 FMassachusetts - Department of?au;;c S;;e""y Board or Building Regulations and Stand,--tw, License: CS-067484 MICHAEL P LEJa)N`A C , 611 PIERCE ST LEOMINSTER NA 01853 . Comrnissinnr:r 06/2212016 The Commonwealth of Massachusefts Department of IndustrialAccidents o I Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia 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 'hone#:603-883-5326 Are you an employer?Check the appropriate box: Type of project(required): 1.[R]I am a employer with 40 employees(full and/or part-time).* 7. ElNew construction 2.0 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. El Demolition 3.a I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10[]Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will ii n ri .«,...i aa:.: ensure ihai all coniraciurs eiiher have workers'cumpensaiion insurance or are Buie s r.L._.I rsre�u r�ai rcpairs or duuururw 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 TENTS r_1 14,n Other I6.L VY C ale a CVlput anuli uull il$i uf1ium huvc tmumiscu thoit[iglu of uxullipiiull pct MGL U. 152,§1(4),and we have no employees.[No workers'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 andjob site information. I ttra„ce Company TTa„a New Hampshire Motor Transit Association Policy#or Self-ins.Lic.#: P000749NHMTA2015 Expiration Date:01-01-2016 Job Site Address:_ �� f'��/ c�77"e City/State/Zip:/ ,A1,jJ l/eY�M� 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 under a pains nd pena ties of perju that the information provided�aabove is true and correct Signature: Date: �7 Phone#:603-883-5326 Official use only. Do not write in this area,to be completed by city or town official . _ %iiy Of i uwri; PeruiriiLi�e�i�e ff 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#: NEW HAMPSHIRE MOTOR TRANSPORT ASSOCIATION P.O.Box 3898 Concord,NH 03302-3898 (603)224-7337 CERTIFICATE OF INSURANCE 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. This is to certify that: Christian Delivery&Chair Service Inc. DBA Certificate#: 1 Christian Party Rental 18 Clinton Drive Hollis, NH 03049 Is,at the issue date of this certificate,insured by the Company,under the policy(ies)listed below. The insurance afforded by the listed policy(ies)is 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 be issued. COVERAGE AFFORDED UNDER WC LAW OF THE FOLLOWING STATE: NH TYPE OF POLICY EXP DATE POLICY NUMBER LIMIT OF LIABILITY Continuous* Extended Policy Term Workers'Compensation 09/01/2015-01/01/2016 P000749NHMTA2016 Bodily Injury By Accident $1,000,000 Bodily Injury by Disease Policy Limit $1,000,000 Bodily Injury by Disease Each Person $1,000,000 ADDITIONAL COMMENTS: 'If the certificate expiration date is continuous or extended term,you will be noted if coverage is terminated or reduced before the certificate expiration date. NOTICE OF CANCELLATION: (Not applicable unless a number of days is entered below.) Before the stated expiration date,the company will not cancel or reduce the insurance afforded under the above policies until at least 30 days. Notice of such cancellation has been mailed to: NH MOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST Christian Delivery&Chair Service Inc. dba Christian Party Rental 18 Clinton Street Hollis, NH 03049 I� Authorized Representative Concord, NH 603-224-7337 02/06/2015 Office Phone Number Date Issued