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Home My WebLink AboutBuilding Permit # 4/2/2015 I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit O: Date Received —x-J Date Issued: MPORTANT:Applicant must complete all items on this page LOCATION - �- f` Pnnt ;.PROPERTY OWNER 'Pant 100 Year Oltl Structure yes no MAP NO � PARCELhe� ZONING DISTRICTHistonc Distract yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition 11 Two or more family ❑ Industrial El Alteration No. of units: 11 commercial ❑ Repair, replacement ❑Assessory Bldg *"Others- El ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Rerv►U vwl Lar► l I 19 e, o Y7 711 Identification Please Type or Print Clearly) y' �� OWNER: Name: ria � ash 04/ Phone: ��-J� Address: l 1 b Q TRACTOR Name: tr1�S 7 1lpw � Phone: Oa CN 1 I l Address: 1ln 1� Pel�l� L�bl�ric. Supervisor's Construction Li r �--` �ln71g4 Exp,,Date:, lei �ZZZ2 Home Improvement License: Exp. Date: Mj kael oy I � Phone: �� P V760 Address:/ 3 ClMkn At-)V(` /-W i!I/ /Ufa ORVV 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: $ 11) 3®61) FEE: $ -- Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of contractor Signature of Agent/Owner r Si n— � .__ _ _ oi„�n Q k.: ;++ori F1 Planc Wniwarl ❑ C:P.rtlfit-d Plot Plan ❑ Stamped Plans ❑ i Plans Submitted ❑ Plans Waived-❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE_OF-:SEWERAGE:DISPOSAL Public Sewer ❑ Tannin g/ Massage odY 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_A_PPROVED PLANNING & DEVELOPMENT' ❑ ❑ COMMENTS .CONSERVATION Reviewed on Signature j 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 & ®ate Driveway Permit DPW Toivo Engineer: Signature: Located 384 Osgood Street _ FIRE O'EPARTrill ENT -Temp Dempster on site yes no Located-at 124 Mair Street Fire Department signati reldate COMMENTS SORT H Town O ,. . - _.. . ndover r-. r:• 7 "t No. C I q,,fs��K. h ver, Mass, Z COCHICNCWICK y1. �®A�RATEO )kip S V BOARD OF HEALTH PERMIT T -LD Food/Kitchen Septic System THIS CERTIFIES THAT4mZZ �. .... ��.�!!I F- ............. BUILDING INSPECTOR / � Foundation has permission to erect .......................... buildings on ..�..�.( .....!*4.0`.+10.................................... Rough ZA) 1, � • tobe occupied as ..... ..h.. ............"......... .. ............................................................................... 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-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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO RTS Rough 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 Burner Until Inspected and Approved by the Building Inspector. Street No. Smoke Det. 4/1/2015 Prom Tent Locatlon.GiF E o n tirf VIII � e 0 h� II i f r ��l G de 16)GI N alt L i hr r� 4 hitps://mail.google.corn /scs/mail-static/ fjs/k=gmail.main.en.2Ho6--9WYWU.O/m=m_i,t,it/am=PiMa4F7v_UGMM2SXPIL377 fXVLs7vP6 94EkOwsgP-b T-... 1/1 ORDER CONFIRMATION TION 25369-3 Pg: I EVENT DESC: PROM-40X50F EVENT� " t EVENT Dom, SUNDAY DATE: 04/26/2015 18 Clinton Drive,Hollis,NH 03049 DELIVERY: FRI 04/24/2015 OR EARLIER 603-882-1234 or 603-881-8833 fax PICKUP: MON 04/27/2015 1-888-RENTENT SALES PERSON:MG PO#: www.intents.com email: sales@intents.com ORDER DATE: 02/12/2015 TERMS: NET 10 DAYS MATT GRANT (978)273-8378 MATT GRANT (978)273-8378 B BROOKS SCHOOL S ON TOP OFF ROOF I 1160 GREAT POND ROAD H 1160 GREAT POND ROAD L ACCOUNTS PAYABLE I NORTH ANDOVER MA 01845 L NORTH ANDOVER MA 01845 P TEL: (978)725-6300 TEL2: FAX:(978)725-6215 QTY ITEM DESCRIPTION PRICE TOTAL 1 40'X 50'WHITE FRAME TENT(KT) 1,300.00 1,300.00 180 FEET OF CATHEDRAL WINDOW SIDEWALLS 1.20 216.00 2 VALUE TENT DOUBLE DOORS 6 FOOT WIDE- 350.00 700.00 18 WHITE VINYL COVERS FOR CEMENT BARRELS 7.50 135.00 18 WEIGHTED BARRELS TO SECURE TENT 12.00 216.00 180 FEET OF WHITE MARKET LIGHTS(7 WATT ROUND BULBS) 1.25 225.00 2 HANGING WHITE CHANDELIER(4 GLOBE) 80.00 160.00 BROOKS IS RESPONSIBLE FOR POWER DISTRIBUTION 1 18'X 40'DANCE FLOOR 1,440.00 1,440.00 1 170,000 BTU TENT HEATER(PROPANE NOT INCLUDED) 15/20 AMP CIR 275.00 275.00 2 100 POUND TANK OF PROPANE-2 TANKS PER HEATER 110.00 220.00 2 EMERGENCY LIGHTS WITH LIGHTED EXIT SIGN COMBO 60.00 120.00 2 FIRE EXTINGUISHERS 15.00 30.00 1 TENT PERMIT-ESTIMATED 200.00 200.00 AN ADDITIONAL HEATER PERMIT MAY BE NEEDED! FURNITURE MAY BE ADDED SPECIAL INSTRUCTIONS: SUB TOTAL: 5,237.00 STUDENT CONTACT: HARPER DREW SALES TAX: 0.00 DELIVERY: 115.00 0.00 TOTAL: 5,352.00 Customer Acceptance Signature 0O• ' MOAN xrz�x xn£�` '$f'iv:� '��'�"�'`•da:� '�a�n:�'� Y`�5z��n�� sati�� .n§` '�"♦fa� ra5i,`>}�` ;axias§ ♦,�x Certificate of jrlame Rem'.5tanre T REGISTERED ISSUED BY: Date treated or APPLICATION manufactured AZTEC TENTS CONCERN NO. 490 ALASKA AVENUE TORRANCE, CA 90503 0412006 CAL COMB r--419.01 '�►�ae€�Q4 (310)328-5060 RETS ' This is to certify that the materials described below hereof have been flame retardant treated(or are inher- ently nonflammable). FOR CHRISTIAN PARTY RENTALS ADDRESS 18 CLINTON DRIVE ' CITY HOLLIS STATE NH, 03049 Certification is hereby made that: (check a'a" or "b") (a) The articles described below this certificate have been treated with a flame retardant chemical approved F-1 and registered by the State Fire Marshal and that the application of said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used • ............................................Chem.Reg.No......................... Meathod of application (b) The articles described below hereof are made from a flame-resistant fabric or material registered and 6 * approved by the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. Trade name of flame-resistant fabric or material used..LaminatedFabda . Reg.No. ......f:.*MA! ......... ., The Flame Retardant Process Used .........WILL.........NOT..... Be Removed by Washing (will or will not) % David Bradley Chuck Miller- Presidents Name of Applicator or Production Superintendent , Title $4 41 £ $ Pu8 p Rx" D c Sa �. £a. s 84 � r• � ¢?. ��.�`4 .. ® �� a, a ."T" ,'R fad" `Rx" F X.•lax `!"®' 4a,s:® .,'X!�®4.Y ac n we�t,4Wo�y CUSTOMER ORDER NO. 8160265 ITEMS MANUFACTURED: 1-40'x40'(2 PC.)JUMBOTRAC TOP ONLY CLEAR-WITH WHITE TRIM 1-40'x10'JUMBOTRAC MIDDLE TOP ONLY CLEAR-WITH WHITE TRIM 2-405x20'JUMBOTRAC MIDDLE TOP ONLY CLEAR-WITH WHITE TRIM 1-30'x3O'(2 PC.)JUMBOTRAC TOP ONLY-ULTRA WHITE 1-305r20'JUMBOTRAC MIDDLE TOP ONLY-ULTRA WHITE .:.... The Commonwealth of Massachusetts µ= Department of Industrial Accidems W I Congress Street, Suite 100 Boston,MA 02114-2017 w ..: www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicaut Information Please Print &gibly Name(Business/Organization/Individual):Christian Delivery&Chair Service, Inc. DBA Christian Party Rental Address:16 Clinton Drive City/State/Zip:Hoiiis, New Hampshire 03049 Phone#:603-863-5326 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ 1 am a employer with 40 employees(full and/or part-time).* T New construction 2.LJ 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. 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will El t r—'1 . : t ensure ihai ail cuniraciurs either have workcrs'cumpensaiiun insurance or are sole r c.0 t L tccu rcat rcpair5 Or ad"uutuvu� proprietors with no employees. 12.®Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors Iisted on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp,insurance.t p 14. PIOthei. TENTS u.E vrc ate a umputaGun and iia uitiucis ltavu cxetoiseal ihuii t ighi u1 rxumpiiun pct TAGL,u. f 152,§1(4),and we have no employees.[No workers'comp.insurance required.] ( I *Any applicant that checks box 41 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. tContractors 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'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name:New Hampshire Motor Transit Association Policy#or Self-ins.Lic. #: P000749NHMTA2016 Expiration Date:01-01-2016 Job Site Address:_/ 6 0 r � Ao Rd ' City/State/Zip. A ., I 0Aelo,"i t-- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 7 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. Ido Itereby certify under to paiit ../tn enalties of perjury that the information provided abovI,s u and correct. Signature: == f" - Date: / Phone#:0-03-003-53426 Official use only. Do not write in this area,to be completed by city or town official l.,ity or .T ow1l: l"ePlltll/LiCf:113r ff Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector° 5.Plumbing Inspector 6.Other IIContact Person: Phone#: I) � HEW "^°~"u.= =,"° ,""°"°*"` ^°"=^,"° P.O.Box 3898 Concord,NH 03302-3898 � (6c3)u24-m37 / � 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 BYTHE POLICIES � BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)AUTHORIZED REPRESENTATIVE ORPRODUCER,AND THE CERTIFICATE HOLDER. This |stocertify that: Christian Delivery&Chair Service Inc. DBA Certificate#: 1 Christian Party Rental � 18 Clinton Drive � Hollis, NHO3O4S Is,atthe issue date mthis certificate,insured »mpw The insurance afforded uvthe listed pollcy(les)is subject mall their terms,exclusions mwvvoo/"vnmanmwoot^/tereovvunvre« irement,term or condition or other document with respect mwhich this certificate may»vissued. COVERAGE AFFORDED UNDER WC LAW oFTHE roLLVYOwaSTAT E. NH TYPE OF POLICY EXP DATE POLICY NUMBER LIMIT OF LIABILITY IExtended Tpolicy Term Workers'Compensation 09/0112016-01/01/2016 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 .If the certificate expiration date is continuous or extended term,you will be notified if coverage is terminated or reduced before the certificate expiration date. Nor/oe OF CxwoEL/xT0w- (Not opn,pmi-un|eau a numhw,o/ooyx ioAnm,ex opmw> 9afo,p mn nommu evpimnvn oux".the company will no/ cancel or reduce the insurance afforded under the above policies until at least 30 days. Notice of such uonma|!aUon has been mailed to: NHMOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST 'ChhaUan 'Delivery&I11hairService Inc. / dbaChristian Party Rental ' 18Clinton Street Hollis, NHO3O4A ~ Authorized Representative Concord, NH 603-224-7337 0206/2015 � Office Phone Number Date Issued � Sep 25 14 06:16p Mike LeBlanc 978 534 7983 p,1 Massachusetts -Department of Pub„c Safe"y Board of Building Regulations and Standzmds it License: CS-067484 � MICHAEL P LEkWC 611 PIERCE ST LEOM NSTER MA 01453 , Commissioner 06/22/2016