HomeMy WebLinkAboutBuilding Permit # 4/2/2015 (2)Permit NO: ) 0 —)
Date Issued: V
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
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tructure yes
iOtotic strict yes no
Machine Shop e yes no
TYPE OF IMPROVEMENT
PROPOSED USE
R
Residential
Non- Residential
0 New Building
0 Addition
0 Alteration
0 One family
D Two or more family
No. of units:
0 Industrial
0 Commercial
0 Repair, replacement
0 Demolition
0 Assessory Bldg
I -ethers:
ret,/±.-‹
0 Other
0 Septic 0 Well
0 Water/Sewer
0 Floodplain 0 Wetlands
0 Watershed District
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification Please Typeior Print Clearly)
OWNER: Name: /3,-1.)04.< Phone:97f- 72-5-- 649
Address: //o12 622e41/- ,0,7d £d
ARCHITT-I-E—N-G-1-NEER Jde)
Phone: 61);
Address:/efa/7hi7 4/4 /t/1/ Ze5/9 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: $ 7eve --
Check No.: L Receipt No.: cc '7
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
FEE: $
Signature of Agent/Owner
Plane IMahicari
Signature of contractor
Cprlifipri Plot Plan
Stamped Plans
Plans Submitted:
Plans Waived Certified Plot Plan _ Stamped Plans
.T..YPE-OPSEWERAGEIDISP:OSAL -
Public Sewer —
Tanning/Massage/Body Art
—
_
Swimming Pools
❑
Well
C
.Tobacco. Sales
C
Food Packaging/Sales
❑
Private (septic tank, etc.-
.. .
- Peinianent Dumpster on Site
❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED: DATEAPPROVED
PLANNING & DEVELOPMENT C
COMMENTS
C
.CONSERVATION Reviewed on Li ( S
COMMENTS
IV\ S'i—a,t
HEALTH
COMMENTS
7\4 rvuLAAI
R -viewed o'
Signature »7
//t/C9/77-1
t''r`'O/1G
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Comments
]DPW Town Engineer: Signature:
Located 384 Osgood Street
' FIRE DEPARTMENT - Temp Dempster on site yes . no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
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VIOLATION of the Zoning or Building Regulations Voids this Permit.
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9 1.0Z/1./t,
18 Clinton Drive, Hollis, NH 03049
603-882-1234 or 603-881-8833 fax
1-888-RENTENT
www.intents.com email: sales@intents.com
HEATHER FERRARA
B BROOKS SCHOOL
I 1160 GREAT POND ROAD
L ACCOUNTS PAYABLE
L NORTH ANDOVER
TEL: (978) 725-6300
TEL2:
0ItER CONFI ATION 24934-8 Pg: 1.
EVENT DESC: ALUMNI WEEKEND
EVENT DAY: SATURDAY DATE: 05/16/2015
EVENT TIME:
DELIVERY: THU 05/14/2015 OR EARLIER
PICKUP: SUN 05/17/2015 NOON
SALES PERSON: MG PO#:
ORDER DATE: 10/31/2014
TERMS: NET 10 DAYS
(978) 725-6300 x3214
MA 01845
QTY ITEM DESCRIPTION
FAX: (978) 725-6215
BILL ST. CYR
S LOWER FIELD
H 1160 GREAT POND ROAD
I NORTH ANDOVER
1 20' X 20' WHITE FRAME TENT(HPT)
1 60' X 100' WHITE CENTURY TWIN POLE TENT
1 9' X 10' WHITE MARQUEE WALKWAY TO CONNECT TENTS
100 FEET OF SOLID SIDEWALLS- 20'X20' & 9'X 10'
320 FEET OF CATHEDRAL WINDOW SIDEWALLS- 60' X 100'
20 FEET OF RAIN GUTTER (2 - 10 FOOTERS) TO CONNECT 9X 10 TO TENT
360 FEET OF WHITE MARKET LIGHTS (7 WATT ROUND BULBS)
ABOVE LIGHTS ARE INSTALLED ON PERIMETER OF 60X100 & 9X10
6 HALOGEN RING LIGHT W/ 6- 75 WATT BULBS-6"-60 WIDE- CTR POLES
2 50 FT WHITE STRING OF 60 WATT BULBS- 20' X 20' CATERER TENT
BROOKS SCHOOL IS RESPONSIBLE FOR POWER DISTRIBUTION TO LIG
1 16' X 21' DANCE FLOOR
9 8' LONG X 14" HIGH BLACK STAGE SKIRT- FRONT & SIDES OF STAGE
2 STEPS FOR STAGE [15" HIGH]
TO INCREASE TO A 16' X 28' ADD $152
CARPETED STAGE DECK ARE AVAILABLE FOR ADDITIONAL FEE
1 16' X 28' STAGE "PAIMTED WOOD TOP" [15" HIGH]
(978) 265-4485
MA 01845
PRICE TOTAL
275.00 275.00
3,600.00 3,600.00
150.00 150.00
1.05 105.00
1.15 368.00
2.00 40.00
1.10 396.00
200.00 1,200.00
45.00 90.00
616.00 616.00
8.00 72.00
30.00 60.00
1,064.00 1,064.00
SPECIAL INSTRUCTIONS: SUB TOTAL: 10,089.60
ADDITIONAL CONTACT: ERICA CALLAHAN 978-376-9304 CELL
FINAL SCHEDULE TO BE DETERMINED IN SPRING! SALES TAX: 0.00
PAID NON REFUNDABLE DEPOSIT $2000 NOV 20 M.C. DELIVERY: 115.00
0.00
TOTAL: 10,204.60
DEPOSIT PAID: 2000.00
BALANCE DUE: 8204.60
Customer Acceptance Signature
Registration Number
F-140.01
IMPORTANT DOCUMENT
Certificate of Flame qcsistance
ISSUED BY
_NCHOR®
INDUSTRIES INC.
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:
Date of Shipment
2/24/2014
269800
CHRISTIAN DELIVERY CHAIR SERVICE INC
DBA CHRISTIAN PARTY RENTAL
18 CLINTON DR
HOLLIS NH 03049
USA
Sales Order #
SO-601120
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)
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
certificate of iftame 1eitaifie
Date Manufactured
1/8/2014
AZTEC TENTS
2665 COLUMBIA ST
TORRANCE, CA 90503
(800) 228-3687
This is to certify that the materials described below have been flame retardant
treated (or are inherently flame retardant).
Christian Party Rentals
18 Clinton Drive
Hollis, NH 03049
Certification is hereby made that the articles described below hereof are made
from a flame-retardant fabric or material registered and approved by the
California State Fire Marshal for such use. The fabric has been tested and
passes NFPA 701 Large Scale. See chart to right for trade name of
flame -resistant fabric or material used and additionally referenced on the label of
the fabric panel.
Invoice Number: 0202537-IN
Customer P.O.:
Customer Number: CHR030
Vendor
1 rade Name
LA Cert. #
Bruin
Mardi Gras
F-222.02
Bruin
Mesh
F-222.04
California Comb.
Lam -Tex 12, 14, 16, 18oz
F-419.01
Coated Fabrics
Clear Vinyl 16ga / 20ga
F-570.02
DAF
Clear Vinyl 16ga / 20ga
F-593.01
DAF
DAF
F-593.02
Exclusively Expo
PolySateen Uner
F-434.01
Ferran
Precontralnt 502
F-444.01
Ferrari
Precontralnt 702
F-444.08
Phillips Textiles
Phil -Tex Uner
F-500.01
PVC Tech.
Deco Cloth / Velon
F-504.01
Snyder
Weatherspan
F-140.01
In Vantage
Flreslst Sunbrelle
F-368.05
Tr' Vantage
Patio 500
F-121.02
Tri Vantage
Big Top
F-121.10
Tri Vantage
Vanguard Weblon
F-069.01
Tri Vantage
Weblon / Coastline
F-069.01
Verseidag
Duraskin B1673, B1515
F-530.01
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
UW
Blockout White- w/ 2Ratchet
Tensioners
Z22140CE4002 40x40 2pc Jumbotrac Top
UW
Blockout White- w/ 8Ratchet
Tensioners
Z22140CM2002 40x20 Mid Jumbotrac Top
UW
Blockout White- w/ 2Ratchet
Tensioners
Z22-2520FC2002 #20x20 1 c Festival Top
UW
w/ Ratchet Tensioners&
Flag
Blockout White
#with Double Valence_
Z22520FC4002
#20x40 1 pc Festival Top
UW
w/ Ratchet Tensioners&
Flag
Blockout White
#with Double Valance
Z211203002 #20x30 1 pc Top Only UW
Blockout White
#with Double Valanace
/ZFRT Daylight Freight Prepay & Add
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The Commonwealth of Massachusetts
Department of Industrial Accidents
1 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 Legibly
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:
1. ID I am a employer with 4'0 employees (full and/or part-time).*
2.0 1 am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.0 I am a homeowner doing all work myself. [No workers' comp. insurance required] t
4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that ail contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.0 I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.$
6.0 We ale a colpoiatroil and its officeis have exeiuised their right of exwllptlon per MGL e.
152, §1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. ❑ New construction
8. ® Remodeling
9. ❑ Demolition
10 Building addition
i i t-1 rn .-: i
',Lit•act,u rt,ar repairs Vr auunania
12. ❑ Plumbing repairs or additions
13.DRoof repairs
14. nOther TENTS
*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.
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' comp. 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. #: P000749NHMTA2015
Expiration Date: 01-01-2016
Job Site Address: . / 110 C GF'C4 Po t'1 Rd' City/State/Zip: Al••,'ip9 ": ;1 s—
Attach a copy of the workers' compensation poiicy 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
Signature:
Phone #: 603-883-5
26
enalties of perjury that the information provided above is ue and correct,
Date: c.;/✓��//>�
Official use only. Do not write in this area, to be completed by city or town official
Ciiy or Town: Perriiii/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 #:
RE 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
Christian Party Rental
18 Clinton Drive
Hollis, NH 03049
Certificate #: 1
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 Arromucu UNDER WC LAW OF THE rOLLOVviNG STATE: NH
TYPE OF POLICY
EXP DATE
POLICY NUMBER
LIMIT OF LIABILITY
Continuous*
Extended
Policy Term
Workers' Compensation
09/01/2015-01/01/2016
P000749NHMTA2015
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 notified if coverage is terminated or reduced before the certificate expiration date.
NOTICE OF CANCELLATION. (Not applicable unless a number of days is entered below.) Refore 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:
I �.nuauan vcnvcl yxrem VIU
c a w.
dba Christian Party Rental
18 Clinton Street
Hollis, NH 03049
NH MOTOR TRANSPORT ASSOCIATION SELF-INSURANCE GROUP TRUST
Authorized Representative
Concord, NH 603-224-7337 02/06/2015
Office Phone Number Date Issued
Sep 25 14 06:16p Mike LeBlanc
978 534 7983 p,1
Massachusetts - Department of P b;;c Safety
Board of Building Regulations and Stand ms
License.: CS-067484
MICHAEL P LEBJANC
611 PIERCE ST
LEOMSTER MA O13. ,
Commissioner
EXpira •io:,
06/22/2016