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KELLY MILLER CIRCUS ON 6/22/2015
VtORT#1 .4Y' BUILDING PERMIT � ��u�• w `, °� TOWN OF NORTH ANDOVER4 ` �d APPLICATION FOR PLAN EXAMINATION : " Permit NO: �� � Date Received '� a� r���«"�,• � Date Issued: ✓ i PORTANT:Applicant must complete all items on this page �11 r rr ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non4 Residential c.1 New Building 0 One family 1.1 Addition D Two or more family Li Ind rial 11 Alteration No, of units: ommercial D Repair, replacement 0 Assessory Bldg _ E Others: 1;1 Demolition 0 Other m. 6..+1 M bf t 'C tw"t Erb # Idcntification Picasc type or Print Clearly) OWNER: Name; � �` (1111112'u. � Phone; ���- + Address: CO— it 43 y + Y r r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULGING PERMIT:$1200 PER$1000,00 OF THE TOTAL ESTIMATED COWED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No,; Receipt No,: NOTE: Persons coratractitig aadth It re ` tcarccl contructois clo not have access to t/re guaranty fund r � l ; � � � �,�� i � � �r #��p �rp�� tkORT Town of '� 00 �.. E I, Andover iso . o . . 5. 0" ® ® +_q 4- LAKE y T h ver, ass, 1J� R �p� COC NICHE WICK T,9 AO'gArE0 �T D S 11 BOARD OF HEALTH Food/Kitchen PERM T Septic System E BUILDING INSPECTOR THIS CERTIFIES THAT ! .......... .... ..................................... ..... .... ..... ......... ............ .. . .. .. .. .. ... has permission$o erect .. .... buildi% ngs On ... Foundation ....... ............ ................. ... ....................... . ! EE�� ............................ Rough to be occupied as ....... .. .... .... ....... ..... ... . .. 1 ....... '.�l��!�� Chimney provided that the person acceptin 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 PERMITMONTHS ELECTRICAL INSPECTOR UNLESS T Rough Service ................ .. .. .ti! �....................... Final BUILDING INSPECTOR GAS INSPECTOR CCupancV Permit Required to Occupy Bu 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Ray Sirois From: Ray Sirois Sent: Wednesday, March 18, 2015 11:08 AM To: 'raysirois@verizon.net' Subject: FW: 2015 North Andover Lions Circus, Lawrence Municipal Airport, Osgood street From: Deems, Maura [mailto:mdeems@townofnorthandover.com) Sent;Wednesday, March 04, 2015 4:26 PM To:Ray Sirois Cc: Brown, Gerald; Leathe, Brian; Kfoury, Eric Subject: RE: 2015 North Andover Lions Circus, Lawrence Municipal Airport,Osgood street Mr.Sirois, We would need a letter from the Airport Commission confirming that you have the permission to use the grounds. As in the past you will also need the following: 1) Building Permit Applicationt/ 2) Certificate of Insurance Liability and Workers Compensation Coverage 3) Letter from Board of Selectmen to waive the building and electrical permit fee 4) Flammability Test Report of Tent Material 5) Layout of Circus Seating,Tent Structure Plan 6) Electrical Permit to be issued so that an inspection can occur -- �•id�,f Please call with any question or concerns. Thank you, Maura Deems Building Department Assistant Town of North Andover 978.688-9545 From: Ray Sirois [mailto:rsirois(@martiniinsurance.comj Sent: Wednesday, March 04, 2015 4:02 PM To: Deems, Maura Subject: FW: 2015 North Andover Lions Circus, Lawrence Municipal Airport, Osgood street Importance: High Maura, FYI.....thank you From:Ray Sirois Sent:Wednesday, March 04, 2015 4:00 PM To: 'gabrown@townofnorthandover.com' Subject:2015 North Andover Lions Circus, Lawrence Municipal Airport, Osgood street Importance: High Mr. Brown,Good Afternoon.... � I Again this year we are very fortunate to have the Kelly Miller Circus back for another year of fund-raising. This year,like last year,the circus will be held on the airport grounds. We have received permission from the Airport Commission &Mike Miller the Manager to hold the circus there on Monday June 22nd for 2 shows at 4:30&7:30. I am writing to you to ask as to what town permit form I would need to complete? In past years we hadu sed the application from the School Department but we will no longer be on town property. 11te Catintionspeaftle ty'°Mos adittsell UwI Congren,Street,, ttfte 10 Boston,,MA(12114-2017 twtwtw.tttttss.gotrld hit Workers'Compensation lusuraauce Affidavit:�twwi@at�w vlt`"cwwwtw ctcw��t Ra�tw�e��wwstt"�wewwwir�w . ,1701t1?LaILED NV"ITH"t"lit.$"I @tMt1"6°tNct AtT'r tttktt.I't'6°. i rlie:uat Information Please Print 1.c oltnl aaMtt 1lwmstaaz asitttr a$zvi sah r lzwa4d�arctaaasl " h . AN Qs-rt* ». w Are you wawa employer?Check the apprwaptiate No.– Type of project(required): LE-1laaaawaeesatrtrrye'a-wtiith____ ctrrTrlswyce;(fiallaxwadhirpart-tinw)."` 7. New cons4ruction "d.[]i am as swab prsgarietnror taaatnca'sltip and have sac empluyees wwinkh%for wane in S. �1Ceanwa ala�lin any r,aap ir}a.INO wmwarkerw*comp insuz arwcc rragtworriQ 9.IQ1 am a laaysatearwwvwea staaont all uwk awwysclt:(Na workers"cramp.irnuumce requ4cd.l w {�1)ewrrawliti»tatt 10 1ltwilalirag asalalitiaan 4,1:]l am as l omeowwa.wer aand will lar,haaini contraela'azs to conduct all vvaaak on tsy proptity. twill caumetk taallceanlraactatscwtlatrhaavcvwvxwtcrs"compenstationinsuzwratrwawrearsatwle 11.0 ElectFical repairs or additions propricttvrs wvilla no eanploycas. x l 2.[]Plumbing repairs or additions 5 n t am as generad c+aratractor and t have hired the saala•axaattzncarwrs listed on the attached sleet. 1 .� f repairsttur u sir9acamwda trwrsa luwva aayceta uucr lwna a vvwszl crs"enrrwp.inTi rawace;.t ]r—w a"a.El We Lit a ca spuratiusx arad its aa[ficecs Crave excasuascd thriz ra�le2 cat°�a ccnatst'ucawa pcx t.Ptll,e. 14.w Other 152,§t(t),mid we have no crrtpleayccs,(No vw^nwkers"cramp.hasumucc requited l •taas'y aappltcarst tlut cbecias latex tit neat alus tall putt tlic section rr laavvslwaawvind wkaair rvnrr rs"compensation policy irdfbnnaali aa,a. t rtn aweaawataers vvtao saatuwi4 trait tett"ittavit a"ndicatin tlacy are doing alt%ark atud trwrsw hin:owide contractors marmot submit a=kv affidavit imitating such tQuAractors flea dwtw`dt otos boar must attaetrcd an additional street showing lite waaaraac otttan sawtr•w°wuwtwa ctrrasaawd aceta wdttwetrmtu saw wear wlwawsea�wtaaies ttav� csnplayecs rfthesub warttausluveemployccs,theymu5tprovide their vw°caskcrk'comp.policy Invubec f herr area t�era7etoycr ltpat it 7artr l it7irrg�twflor7lers"eoerrirerwsartiwrar iraseertratttt trr aaayy e�ferwlw g+cam ftel u,is f1se polley aradjawb site irrJirarraaatiore. Insurance Cornpaany atwae:m. _....._.__._.._._ ...__. _.__....�__..._.. _.,.._............. Volicy 4o Self-ins.Lic./t: ........ . . .... .. .__ _. Expiration Platte: !seta Site Address: 'fir .av , as q p taw a e ea C:ityr9Staatt"C,ip: Attach a copy of theworkers'compensation policy etc tatraaticnt page(showing the policy number and expiration clate Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by as fine up to$1,500.00 haul/tar carte-year inaprisonruent,as well as civil penalties in tate form of STOP WORK ORDER and ar fmc of up to$250.00 as day against the violator.A copy of this statttanent ntay be forwarded to the ttfftcc of laveslig etio mos of the DIA far insurance coverage yeriCtcadtion. [tomo 7te^a by eert ypa ettttfer dine pairts watadpetud dew taftaerjutyy thatthe irtf rrtaarrtioet pi watwidett ertaove is tante treat corrcaa°t. Sill-LIA—UreL.'. Date. Ofj7cint riser ord v. Do not write in this aaren,to he coanitteteat by t°itya or 10tvil tr ficial City ur,roly a: Perwwcilll.icense At _ Issuing Authority(circle one): 1.Doane!ofIteanith 2.lluilding Department 3.C:ityaP' own Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other -Contact Person.,_ � ._ lwhtnte c ___ i ��` ® DATE(MM/DDNYYY) J CERTIFICATE LIABILITY INSURANCE 05/05/2015 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CAME C ComP5ource Mutual Insurance Company _PIAM,NdEQ Ext):(405)232-7663 ext.5102 A/C,No]: EMAIL ADDRESS; _ INSURERISI AFFORDING COVERAGE NAIC 0 INSURER A:CompSource Mutual Insurance Company 36188 INSURED INSURER B: KELLY MILLER BROS CIRCUS LTD INSURER C: PO BOX 829 INSURER D: HUGO,OK 74743 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. /NSR TYPE OF INSURANCE ADD S R Nqn ma POLICY NUMBER MMIDDIYYY MM/UDD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ CLAIMS4MADE D OCCUR PREMISES 11 $ MED EXP(Any one person) T�$ i I PERSONAL 8 ADV INJURY 1.$ i GEN-L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE F S POLICY❑PRO• JECT ❑LOC PRODUCTS-COMPIOP AGG $ OTHER. $ AUTOMOBILE LIABILITY I I aaocidCOMBINED ennSINGLE LIMIT Ea Eccid $ i ANY AUTO BODILY INJURY(Per Person) $ LL OWNED SCHEDULED BODILY INJURY(Per amdem)�3 AUTOS NON-OWNED I I PROPERDAMAGE $ - tI HIRED AUTOS AUTOSIper UMBRELLA UAB _ OCCUR ' EACH OCCURRENCE $ EXCESSUAB CLAIMS-MADE I I AGGREGATE IS 1- QED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE 0TH• AND EMPLOYERS'UABIUTY ANY PROPRIETORIPARTNEMEXECU'FIVE YIN E.L.EACH ACCIDENT $100,000.00 A OFFICER/MEMBER EXCLUDED? NIA 0225$$65 15 1 03/012015 03/012016 E.L DISEASE•EA EMPLOYE S 100,000.00 (Mandatary In NH) If os,dosTION OF OPERATIONS below ser"under SCRIPE.L.DISEASE-POO LIMIT $500,000.00 DE I i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 10t,Additional Remarks Schedule,may be attachad It Moro space Is rsqulrod) Reference: Re:Town of North Andover Lawrance Airport Commission North Andover Lions Club CERTIFICATE HOLDER CANCELLATION North Andover Lions Club Attn Ray 5irois SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 316 Candlestick Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, North Andover,MA 01845 AUTHORIZED REPRESENTATIVE A4 '� ©1888-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD e • Town of North Andover Office of theM Town Manager North Andover Town Hall 120 Main Street North Andover, MA 01845 e-mail: amaylor@townofnorthandover.com Andreu, TV Maylor Telephone (978)688-9510 Toum Manager Fax (978)688-9556 March 24, 2015 Mr. Ray Sirois 316 Candlestick Road North Andover, MA 01845 Dear Mr. Sirois: I am happy to inform you that the Board of Selectmen approved your request to waive the building permit fees for the erection of the tent for the Kelly Miller Circus on June 22, 2015, Additionally, I have approved your request to erect a sign near Route 125, hang a banner at the Fire Station on Johnson Street and place small signs around town advertising the circus. Please note all signs and banners must be removed by the end of the day following the circus. Good luck with the event! Sincerel Andrew W. Maylor Town Manager AWM/lab Infonnation .lo Build On �5nginearing o Consui'ittg•"resting REPORT TO: Kelly Miller Circus PROJECT: Flammability l Tent Material ssistance 2.579 E. Kirk Road Hugo, OK 74743 ATTENTION: Mrs. Tavana Brown PSI PROJECT NO.: 823-76030 DATE: April 30, 2009 PSI LAB NO.: SPT-70043 Professional Service Industries, Inc. (PSI) has performed testing on the referenced project. The results of our tests are presented in the accompanying report. Our services for this project were performed in accordance with PSI Proposal No. 823- 9063, dated January 13, 2009. The proposal included a proposed scope of services, estimated costs, unit rates, and PST's General Conditions. ,Authorization to perform this project was in the form of signed acceptance of the aforementioned . proposal, acknowledged April 24, 2009. The results contained in this report are related only to the itern(s) tested. The pages of this report (including attachments) shall not be reproduced, except in full, without written approval of PSI. All testing was conducted by and under the continuous, direct supervision of Professional Service Industries, Inc. Please contact us should you have any questions concerning this report. Respectfully submitted, Professional Se 'c,e ndustries, Inc. Denis . olumbare John V. Meser Laboratory Technician, Special Test 'Manager, Special Test/Electrical Page 1 of 3 Project No. 823-76030 Report Date: April 30, 2009 Laboratory No. SPT-70043 Page 3 of 3 RESULTS �. Combustion Time Combustion Tune :Char Length of Specimen of 0ri�pings Sam` 1e 1D inches seconds seconds Red/l 1" 0 0 Red/2 10.5" 0 0 Red/3 10.75" 0 0 Ave'r`age: '10.75" 0..:.. :` 0 Yellow/l 10" 0 0 Yellow/2 1101 0 0 Yellow/3 105' 0 0 Avdtage: ;: 10.5„ :0 Blue/l 10" _ 0 0 Blue/2 loll U" .0 0 Blue/3 11.5" 0 0 Average: 10.5„ 0 ; 0 Conclusion The tested materials MEET the specified requirements of NFPA 701, Large Scale Burn Test, 2004 Edition. _ _. _ ... � i Ix+::..'. .'....,,:tW(nu eEEx CnE_.[D fpa CGx'li+.GL • -: �• i^ I WIix 11: :-AFNExi::E:Ialin>E [ xcLv.oa.s-ate PERraTLcert Gf L,LaG+s wauara.0 q,� CCO[:[SECT:.15 3)1 K/MU aZltS CR ffGfCP3 .•Q ^,-- i.+[xLGs.a•:ven[S:Eti(RaTF CIixE AATKI£ �� ; i i .. rl i•";;:�J:. IwIC hrPrli}W3 rfRSrME afGaIACWIT57 A DEvaRr,.L.CA)Il,grt•dfOLE aTADO11lW. 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Sl \ I i I 1^ L::.StnLu•EeEDa0.+l aU6.uWalaiE 'A I ! 11 \ l � � _ 1 I � fr.•r--x.sw.•+sswi�:a"v swc I .: I 1 I ! �:G'• I DREG.Fa A0.E) � I �.� t^CI:.��.E.CSAYY.W.W+✓KE E 1 1 1 I Iii ! D Glaaat PXES 'Gaol!n:_O L'.0)l.SMiti.RAYll vuT4lla N.D)E I ) r.. I ,�� I i ; 'I.E%+'.•..'wJ)CIe.E Sr+DWET _ 1 Imo- —I 11 1.�• t , I S i RG.n... ..r i Q �I 9 • � t r L Y+ n TENT SECTION xctKELLY MILLFR CIRCUS „e.no w ............................ A_Z Box Dig rronklin n,couch .. •1. isSPI L.JACKSCII.LUIfE] ,rt+.«...,,n p•.Fry,1CJ, .10 .,.•.n--'.f,1,. ,,,lissss„w k 3, 1]•1y1 i c p G G ..................... ........ .......... .................. ..................... .... ��, ''`..`�-� I ,+-+, ••�.'"-:'� •^� �7 Ell. wnao.r,a rmdcrcw 4, ll.u�iouwr..un4a4ur . ... I . .,. Y.4 rowGa.nNaara fI �" ii ,• `e._�/-,�.�,•�,,,`�'`".:/`-r--+ I � b...iul4P 4uDW�,d..n04/<ia,al w+r 1! .i5.........••••••� !! I., a.,:a,.,pwdYNrOat aT Yn+rGrwm idN '... �' •• ,^�� ��_.,_ �f� _ �� HarK,.�r.�lA 4V�aruitw4 ',. ot 05 1...-, � E;(4C4iY.:.Ct3K.fG 1G•r(r �• ��^:: Sia i;w.�liu4<C.t K[ll-f,r C.1.7 4: •' :: ( 6:1•[.i.:•:ii i4!4lW�(a(M:l MI41G.CH,ti[4. `a'moi- --�'•.;. - Z try aau .v I r ,n' moat s.,.r,..�.....-,..�..�.,srw ED wo. I Y ANVI i:In wr...i Wxa 4 mounlinp tube for roivag-t 1I2".3"ndongle lube 3r16"Yan 166 PEOPLE(a)9.SFT PERS('i_1 w -jEn `d! roiling 1 1/4"square lube 3/1 Yoll =s,. "fin' kith 5/e"HR round uprighls Yo r� l roma rolls- 16 x 26 I r /s Y i E^EVATION OF SIDE VIEW g tD '...... tongue-6'•r4 t/4'•You E!EVATION OF BACK VIEW ! 4 Y�4 SPEEDY BLEACHER Q SEAT E FOOT BOARD 9 SIB"x2" TOP OF TENT SIDE WALL STRINGER 272"SO. RAI SCG- iii K, P VERT. SEAT BCARO 1In-SO.X 371E �Sy+6 CsvBE B FOOT AT 6-.Tu6c " I TUBE t6 ` c 1 7(� I —•-1 1 SO.TUBING G F= r rr-x vr6•n�o6-. I wNOE ii 16-GA 1i i! SEAT WAGON BLEACHER-COMPLY WITH NEW YORK STATE DEPT. yrx'71$•n,n–F�j 1; OF LABOR INDUSTRIAL CODE SECTIONS 36.3.7,C-1,2,3. STEP AT 1X I.O.C.— I Pyr m 1 N— 8 CHAPTER 4 OF N.F.P.A.102. AISLE IS ao•WOE WrFOOr804RDI n -`TUBE nr6•xY W FRAMING f I TUBE 13. O 1� \5Y TUSE "1 S2ADJ. LEG I TYPE r _ CONTINUOUS. SO.TUBE '..... TJ'.TENDING JJ;: SEATING WAGON SECTION z 1 I :aro...r.r•zrc.ru iO SCALE:11!2"=V-0" ?„ u z p ag In t m I rl r rl �• '.... � II SEA 7WAGON#3(206 SEATS) SCALE:114rr=V-0rr .s IL a o BACK VIEW OF FRAMING r' e SCALE:114'r--V-0" INFORMATION ON ELECTRICAL SPECIFICATIONS THERE ARE BREAKERS ON ALL CONNECTIONS ALL CABLES ARE S.Q.W.-FOR OUTSIDE USE 20 AMP OUTLETS HAVE GFI ALL CIRCUITS/CABLES ARE GROUNDED BACK TO THE GENERATOR SYSTEM PASES INSPECTION IN: MD,MN,NY,PA, IL,TX,MI, OI-I,AR, MS,TN, KY, IN,MO, OI{ I