HomeMy WebLinkAboutBuilding Permit # 4/2/2015 (3)TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:
Date Issued: 1411
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IMPORTANT: Applicant
C—AT1
Date Received
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)4 ZONING DISTRICTtld IStOne it n yes
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: 6 1age ,,', yes
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TYPE OF IMPROVEMENT
PROPOSED USE
R
Residential
Non- Residential
0 New Building
0 Addition
0 Alteration
0 One family
0 Two or more family
No. of units:
0 Industrial
0 Commercial
0 Repair, replacement
D Demolition
0 Assessory Bldg
e,,-(Dthers/vyy.
0 Other
D Septic 0 Well
ID Water/Sewer
0 Floodplain 0 Wetlands
0 Watershed District
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DESCRIPTIOOF WORK TO BE ED:
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Identification Please Type or Print Clearly)
OWNER: Name: 13COef14. Phone: 9 a
Address: //4 L71 Ak7d /41
CONTRACTOR Name: frk/
A
Aftrazi-.7/ /c1/ Phone: oY--z/740
Address: iE 13Vive. th/lis /VI/ '43W 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: $ //Z) Z2/J12 —
FEE: $ 42-f
Receipt No.: 071 (4)e) 3
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner/ Signature of contractor
Check No.:
.1-nn;+feari Fl
Plane INfaivrari
Cp.rtified Plot Plan
Stamped Plans
Plans Submitted,
Plans Waived Certified Plot Plan _ Stamped Plans
-TYPE_OF,SEWERAGEDISPOSAL
-
-,
Public Sewer —
Tanning/MassageBodyArt
E ..
Swimming Pools
❑
Well — .
.Tobacco. Sales
C
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.APPROVED
PLANNING & DEVELOPMENT C ❑
COMMENTS
CONSERVATION Reviewed on
COMMENTS 1,1;0 j,'()~-6 C. d-'
Signature
( 7-6
HEALTH Reviewed on
COMMENTS
Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
Comments
Water & Sewer Connection/Signature & Date
Driveway Permit
]DPW Tow2 Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Ter p Dempster on site yes no
Located at 124 Main Street
Fire Departmeritsignature/date'
COMMENTS
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VIOLATION of the Zoning or Building Regulations Voids this Permit.
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4/1/2015
Graduation Weekend Tent.GIF
https://mail.google.com/ /ses/mail-static/ /js/k=gmaiLmain.en2Ho6--9WYVVU.0/m=m j,Lit/am=PiMa4f7v_UGMM2SXPIL377 tXVLs7vP6_94EkOwsgP-b T-... 1/1
18 Clinton Drive, Hollis, NH 03049
603-882-1234 or 603-881-8833 fax
1-888-RENTENT
www.intents.com email: sales@intents.com
ERICA CALLAHAN
B BROOKS SCHOOL
I 1160 GREAT POND ROAD
L ACCOUNTS PAYABLE
L NORTH ANDOVER
TEL: (978) 725-6300
TEL2:
0 ER CONFI ATION 25163-2 Pg: 1
EVENT DESC:
EVENT DAY:
EVENT TIME:
DELIVERY:
PICKUP:
GRADUATION/PRIZE DAY
SUNDAY DATE: 05/24/2015
2:00 PM
TUE 05/19/2015 OR WEDNESDAY AM
TUE 05/26/2015 OR LATER
SALES PERSON: MG PO#:
ORDER DATE: 12/15/2014
TERMS: NET 10 DAYS
(978) 725-6258
MA 01845
QTY ITEM DESCRIPTION
FAX: (978) 725-6215
1 100' X 120WHI 11. TWIN POLE TENT
1 9' X 60' WHITE MARQUEE WALKWAY
BILL ST CYR
S BROOKS SCHOOL
H 1160 GREAT POND ROAD
I NORTH ANDOVER
60 FEET OF SOLID SIDEWALLS
220 FEET OF WINDOW SIDEWALLS
10 FEET OF RAIN GUTTER FOR TENT
440 FEET OF WHITE STRING LIGHTS
6 HALOGEN RING LIGHT W/ 6- 75 WATT BULBS-6"-BIG
BROOKS SCHOOL IS RESPONSIBLE FOR POWER DISTRIBUTION
1
24' X 30' PARQUET DANCE FLOOR
BROOKS STAFF SETS UP & BREAKS DOWN CHAIRS
1460 WHITE "FAN BACK" FOLDING CHAIRS
(978) 265-4485
MA 01845
PRICE
9,600.00
700.00
1.10
1.20
2.00
1.00
200.00
1,440.00
1.60
TOTAL
9,600.00
700.00
66.00
264.00
20.00
440.00
1,200.00
1,440.00
2,336.00
SPECIAL INSTRUCTIONS: SUB TOTAL: 16,066.00
GRADUATION DATE MAY 24 @ 2 PM/ PRIZE DAY IS MAY 25 @ 10:15 AM
REHEARSAL MAY 21 @ 10:30 AM CUSTOMER SETS UP CHAIRS SALES TAX: 0.00
ERICA'S CELL IS 978-376-9304 DELIVERY: 80.00
$4000 DEPOSIT PD 12/31/14 0.00
TOTAL: 16,146.00
DEPOSIT PAID: 4000.00
BALANCE DUE: 12146.00
Customer Acceptance Signature
Cirtiftcate of flame l'ke5t5taiigere
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).
Date Manufactured
1/8/2014
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
Trade Name
CA 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
OAF
F-593.02
Exclusively Expo
PolySateen Liner
F-434.01
Ferrari
Precdntraint 502
F-444.01
Ferrari
Precontraint 702
F-444.08
Phillips Textiles
Phil -Tex Liner
F-500.01
PVC Tech.
Deco Cloth / Velon
F-504.01
Snyder
Weatherspan
F-140.01
Tri Vantage
Flreslst Sunbrella
F-368.05
Tri 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
Verseldag
Duraskin 131673, B1515
F-530,0I
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
Z318T100E040B/0 #100x40 2pc Series 2000
TP UW
#OId Style to match
previous orders#
Includes Jumper Ropes
Only
Blockout White
(Tie Downs Not Included w/
Top)
EACH
1
1
Z39900430 5/8" Polydac CP Jumper 45' EACH 2 2
Z318Z00180B/0 *100x20 End S2000 TPLA EACH 1 1
UW
w/ New Plates Includes
Jumper Ropes Only
Blockout White
(Tie Downs Not Included w/
Top)
Z318Z00190B/0 *100x20 End S2000 TPGR EACH 1 1
UW
w/ New Plates Includes
Jumper Ropes Only
Blockout White
(Tie Downs Not Included w/
Top)
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Applicant information
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.
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 #:603-883-6326
Are you an employer? Check the appropriate box:
1.0 I am a employer with 40 employees (full and/or part-time).*
2.111 I 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
4.01 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 ur 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.t
6.0 We a,c a cuipulation. and its U1nceis have excieised their light of exemption per IvIGL
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 Q Building addition
i i,u repairs vi additivtiia
12. ❑ Plumbing repairs or additions
13.DRoof repairs
14. rj Other TENTS
*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.
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: . 1160 Greed-- Pon KGB ' City/State/Zip: ,%�! ppo ver 110- J'S
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.
I do hereby certify under a pair n; enalties of perjury that the information provided above is ue and correct
Si nature: �� / Date: (-9 > —
Phone #: 603-883-5
Official use only. Do not write in this area, to be completed by city or town official
Ciiy or Town; Pe rtiiii/Licezise tF
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 RAMPSNIRE 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(les) 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 Ar"r'urw u 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
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) 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:
I Christian l& aService Inc. Delivery ChairService uTa.
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 Pub;:c Safety
Board of Building Regulations and Standrress
l:. ,i i" .a'tiri. Sum
License: CS-067484
MICHAEL P LEBJ- NC
611 PIERCE ST
LEOMINSTER MA 004S3...
�J L't,'' Ex pi ratio:,
Comcnissionar 06/22/2016