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Home My WebLink AboutBuilding Permit # 7/28/2015�,. ® OR #1 �I r BU ILDING PERMIT dopy�4�mn ,6�Ho M TOWN OF NORTH ANDOVERv. - y APPLICATION FOR PLAN EXAMINATIONIle - �y Permit N®: Date Received pp '{�q S`OSNI[Mlw.Sw V7', ,� � �•9'SS RYeU w5��.��J Date Issued: 11 �cwu IMPORTANT: Applicant must complete all items on this page r / / /.. // ,/ .,. ✓ i,,,, i� , ,.,.,, r ,mg /i � /� /i/.... / ,,,. / ✓� /�.., //,/, r/i. / / r... r ir,/!� /��//,..��,� / / i/r ✓/ rrr rr.r/ / / /„ /i/ �%.. // .,,, I'; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: [I Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other n,.,,/,%r/� �i, P rr/, d //,,� // r ��a V //:�iiii/iii rrr,,..,„.,,rr�/_/.❑/„,,,,,�..,/..�..r,,.%vc/iii//,�r „ .,.,. , .,, ' earl 40r, I-n Identification Please Type or Print Clearly) OWNER: Name: iilA � 0 ” c� Phone: "fie- ' �„� � 7 YJT Address: cl c/ C7 cA,, (V ;�„„, rr irrt r,�r„; ,/.ro_r^,/1,,,,......,,r„r r ,��,,/// r//,/r,//,.i�ir,i/„l/ii,r,,c,,,,,,, ,,,, a rr �✓."rr/-,�,rl� .,r^; ,. �. ///r r . ar ice,i„,/ „ � ,/ / � rrrrii� �,,,, // ;.%/ /, rr... �,, ✓ r,. , ,/ r ..,rrr rrr.,, ; ,.ai /i./ /� ///. %,.„ r /,/ ., ,�, ,.. ,,.r,„/ ✓ ii1/cure%�ivniy/v�% % ,� /// ” ,. r �, r f✓ //,i r / / r ,r r r / , / r r ,r r ,/ . , / ✓ /, / J � / I r / r /, r , i r / rc r, / ii / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER .F. L. 1 Total Prosect dost: $ � FEE: $ 436, 6 Check No.: ! F T D Receipt No.: . ” NOTE: Persons contracting with unregistered contractors do not have access to the Juarantyfund Signature of Agent/Owner, Signature of contractor Plans Submitted ❑ Plans Waived 0 Certified Plot Plan 0 3,tarropped Plans 0 TYPEOFSEWERAGE DISPOSAL L ❑ Public Sewer Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools Swimming Pools Well well Private(septic tank etc. ❑ Tobacco Sales 111TFood Packaging/Sales El E] Permanent Dumpster on Site F1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT. Reviewed On Signature COMMENTS CONSERVATION Reviewed on— Signature COMMENTS 'HEALTH Reviewed on Signature COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ Planning Board Decision: Comments Conservation Decision: Comments Water ')Sewer Connectionis Driveway Permit DPW Tqwn Engineer: Signature: Located 384 Osgood Street E,D8 Ak FIR[ j tMENT,: 7,,Jernp,Dumpste at 124rMain Strut r ,r,Qn $itp", -yes d" VFi�re e tU r ate, 0"t id Fir ,e COMMENTS TjORTH Town of Andover h ver, ass o �ALAKE 1 9 9 _ COCKICNE WICK � D �\V ® RATED ok? 7S V BOARD OF HEALTH Food/Kitchen ER IT LD Septic System • THIS CERTIFIES THAT . ... .® ............ .r. . ......................................... BUILDING INSPECTOR Q�Q has permission to erect .......................... buildings on ... 1��1.4.......o- .. . ad.....a ........... Foundation �/ Rough tobe occupied as ...I.S...!�..�. ..... .P.........T ...................................... 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 I ONT S ELECTRICAL INSPECTOR UNLESS C STRU TS Rough Service .... ...%1. .. .... ....... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Status: Reservation 111 •, 11 Cushing PI Unit D Contract#: 5597 :Po. Chelmsford, MA 01824 www.twinbrospartyrentals.com Event Beg: Sat 8/1/2015 8:OOAM 978-337-9730 Phone Event End: Sat 8/ 1/2015 11:OOPM Operator: Tim Jeannie Grico 978-655-7455 Phone 999 Osgood St. North Andover, MA 01845 Ordered By: Jeannie Salesman: Justin Delivery and Pickup Delivery : Sat 8/ 1/2015 7:OOAM -8:30AM Contact: Pickup Date: Sat 8/ 1/2015 5:30PM Phone: Used at Address: 999 Osgood St. ; North Andover, MA 01845 Qty Items Rented Each Price 1 15x15Ft.High Peak Frame Tent White $209.00 $209.00 Tent can be set up on grass,pavement,or a patio and requires an area of 16'x16'for installation purposes.If being set up on pavement or where we can't stake into the ground,make sure water barrels are on your order so we can anchor it down. 4 50 Gallon Water Barrel $12.00 $48.00 6 6 Foot Banquet Table $8.00 $48.00 1 Delivery Green Zone $50.00 $50.00 1 Multi Rental Discount ($11.00) ($11.00) Discount 1 1 Permit Fee $100.001 $100.00 Delivery is normally scheduled two weeks prior to your rental date. Payments made on this contract: Rental/Sale Paid $50.00 7/9/2015 4:12PM Credit Card Amex xxxx-xxxxx-42015 Auth:286505 Total $50.00 Rental Contract Rental: $294.00 Payment is due in full at time of delivery.We accept cash,or check at time of delivery.Checks can be made payable to Twin Bros Party Rentals.If paying by credit card please call at least 24 hours prior to your scheduled delivery date,so we can process your credit card.We will be giving you a courtesy call half an hour before we arrive for delivery and set-upl Sales: $100.00 Delivery Charge: $50.00 Subtotal: $444.00 Sales Tax: $24.62 Total: $468.62 Paid: $50.00 Amount Due: $418.62 Modification# 8 Printed On Tue 7/28/2015 9:29:48AM Software by Point-of-Rental Systems www.point-of-rental.com Contract-Params.rpt(1) Certzjtcate REGISTERED ISSUED BY FABRIC Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON, NEW YORK 13902 11/3/2014 F-140.01 Manufacturers of the Finest Tent Products Described Herein This is to certify that the products herein have been manufactured from material inherently flame retardant as here after specified by the material supplier. NAME: Jeannie Grico CITY: North Andover,MA 01845 Certification is hereby made that: The articles described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701*, Underwriters Laboratory of Canada, and have been tested in accordance with the Federal Test Method Specifications and meet or exceed the Military Flame Specifications of MIL-C-43006G. 15x15 High Peak Frame Tent,CAN/ULC-S108 Description of item certified: 15x15 High Peak Frame Tent Serial#017847 Flame Retardant Process Used Will Not Be Removed By Washina And Snyder Manufacturing, Inc. Manufacturer of Flame Retardant Vinvi Laminates TENT DEPARTMENT,JOHNSON OUTDOORS INC. *Large Scale Client#: 1045955 TWINBROS ACORDT. CERTIFICATE LIABILITY INSURANCE DATE(MM/DD/YYYY) 1 7/28/2015 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 policy(ies)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 CONTACT NAME: USI Rental Specialties CL PHxtONE ggg 489-7165 FAX 888 489-7105 A No,El): A/C,No 1616 Smith Road,Suite D E-MAIL ADDRESS: Temperance, MI 48182 INSURER(S)AFFORDING COVERAGE NAIC# 888 489-7165 INsuRERA:St Paul Fire and Marine Ins 24767 INSURED Tim Aalerud INSURER B:Travelers Indemnity Co of CT 25682 dba: Twin Bros Party Rentals INSURER C 11 Cushing Place Unit D INSURER D: Chelmsford, MA 01824 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 CONTRACTOR 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. LTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY ZPP15N8522A1547 5/01/2015 05/01/2016 EACH OCCURRENCE ..$1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES ERENTED occurrence) $100,000 CLAIMS-MADE r_7V OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY DPRO LOC $ JECT AUTOMOBILE LIABILITY Ea MN"d SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION XEUB4106T24115 6/24/2015 06/24/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $5OO 000 OFFICER/MEMBER EXCLUDED? � N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Inland Marine ZIM15N852671547 5/01/2015 05/01/201 Blanket: $350,000 Equipment Floater Deductible: $1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate holder is listed as additional insured/additional protected person or organization for general liability as per written contract. RE: 120 Main Street, North Andover, MA 01845 CERTIFICATE HOLDER CANCELLATION Jeannie Grico SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 999 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S15877708/M14995951 LXSAH