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Home My WebLink AboutBuilding Permit # 8/19/2015 (2)Permit No#: Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Applicant 1111141,. 4kagkorit.k 016101,14 ,101011,, Date Received ust complete all items on this page 0011 10 ;11.0hLriugdoire , h h D 84 '„OACiA({#300$01000104.04041000 )1.'0. • AlkIk 4110000,k110,,,,vk t% ORTg TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 111 Addition 0 Alteration 0 One family 0 Two or more family No. of units: 0 Industrial CI Commercial 111 Repair, replacement CI Demolition 11 Assessory Bldg 0-1ithers: 111 Other — "791P l' Hirir pf ,t- /4 ad Fit, d i r„-dry„,,wov Of ill 4, 10.,„oilw efor,,,,„ ff, , r row wPftINY PhrNfairrH,P eo, prFr yr 0 1 DESCRIPTION OF WORK TO BE PERFORMED: emedth//- 6*hr e4,/e, 449//41541/ a wy1,1//41 1_0'11 be etil tr beizif 9' / Identification - P1ese Type or Print Clearly OWNER: Name: /tie.cll4' de; (2 / I ARCI-4G-T4ENGI-N-EER „ „?..) „ Address:/ Het AI# /5vv9 Phone/ Yer -91 3 Phone: :203—4/-7 G; 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: $ ,;:?6'61 FEE: $ Check No.. Receipt No.:(? NOTE: Persons contracting with unregistered contractors do not have access to nawrey,ori entiuw „ Signature contractor he guaranty fund m"'"V" ,"" Plans Submitted — Plans Waived _ Certified Plot Plan _ Stamped Plans TYPOF SEWERAGE DISPOSAL Pvblic Sewer — Tanning/Massage/Body 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on 0 "� 7' ' ( Signature COMMENTS f ( d Vd HEALTH COMMENTS Reviewed on 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 Town Engineer: Signature: Located 384 Osgood Street co CD ci O cp 03 CO CD (D COCO C O �• = CO CD U) CD 0 IMMO t� a) O U) c0' 0 cn CD 0 CD CD CD U) O CD O ID naap 01 NAM 210133dSNI ONIa11f18 co cn 0 cn I S3NIdX3 lI Cn cn VIOLATION of the Zoning or Building Regulations Voids this Permit. o = � CD �-0 c -5• Q n c "a = • FA. at 5• O_ 0 "",- O. CO n CD cn C. tD CDD CQ Q• O O tD CD -0 a ® O CO O 0•�. .y, co .a O a � rt O � CD• CD C O O W CD r, U) $ CD U CD ▪ C0 O -' to " O � O O O ra II TS O O O O O 0 paaa o; uolssp.wed set! 1VH1 S31lI12133 SIN! TURNPIKE STREEt NORTH AN 101, '011000000000,010011.00,101,00,001„010010000„0.0 000:0;00da Physical Plant Baseball Field Softball Field Lot I. SPINN% 4 ' "SII4Cfrealnit Aatgtptl nces Inn Ce Lot ititte an " i'INOTTI ie1 Asht cr e NNNI :NI: Cant NTNNNNNENNN„ 'NiiN iNiNi Lot It NNNiori ooert ,NNIEN West Lot NiiiNNN E Easels "`r'NIL .Ni NN Rogers for th Lot F CentHall er NNN Ar NCYRoilly , 0,, iot E Hell 000,001, McQuade N, Mendel Ntai t „TEN' „ LIhrary 1NN. Center T 1N, Welcome , No, Ceitter,iii-NNN 'Ns Not C Cushing Sullivan iiiiNNN 014,U Halt 0 0,00,00,0,00,00,,,,,,,00,00",00000000„,„„0,0,000000,0000„,„0„0,0000,00 000,00 0000000.00000 000040 00.00004,00,00000000,0 ,,,, 00000 00,00,00000, 0,00 000 100 11,0„,„0„ 00IW .0.000„,„ 00!00E000.0000,00,000, "g! 0,00A01 00%00 0,••••0 ",, 0, 0000,001.00,0 0 0 000001 d 0 101- 000 11111101 fitivittit 0,00dvv„tvvvvvvvvvvvvvvvo 010 1101 „ 00,010,10,00,1100000000000000000,00 01011100,0 0000000000,00,00,00,0, 11:1° '111 1111110101 vorrevii111111111 ,oN11. IN' NNE °IO' cra, lottttO St. Ann Apartments It Tower ,ENENIE Tower N1N ttft TOWN' Tower , VINNNTItTower tt Tow,'" St. 'Thomas INN fl iowerp Apartments I tower./NENNNE Tower INNEN, It Tower F levier NiNN 1NN NEN N A Lower N, NNINNt Hamel Health 8, aLi' Counseling Center gie /NEN O'Brien Itall E" EN Police iNtENNIN 11 Department NONE' NE EENN SN/ Monition TiovirtiNNENCntre teasel 'tit Chelmsford NEN v Dracut NNIEN \c, • Lowett • 'Tewksbury *Pelham *Tyngsborough • Andover \ \ • Lawrence • Methuen \ \ • Salem Hrwrrhitt \ \ • Georgetown IN. North Andover • Boxford 0)NiN Austin Lot A tO Hall ,„„, collegiate Tiurch of INNNNIN Nhrist the Male NN Teacher Entrance tiN op 4,00, °00°e'00'""'000100'""'001000'b 000d0000'°'000°''V' 000 '00001111'100001111 '110101'..° 00000001010 010100 10 000 0 0 M000 11111 11111111111111 10110 " " 0,0000I00011111 I010N1 m00000000m0000000000011IIIIIIIIIl 1111111 IIIIIIIIIIIIIII 11 :11111,,11,„00000 00,0000,000,0 11111111111111 010001100000000010, 00 01 viva vvv vvv„, 001 v v0000 ovvvvvovvvvvov „, iivo viv „ovvvv„v3 vvvvvv 1000v 0001 vor °moo on 11 11111111111111 14000io 00.00voevv:_00',nvulvo ovivollovuov 001 10 1 liVIIIIV01 Vdoilloo dvod 11111 011111111111110 000 110111111" 11110 11111100011111111111110111: I 0 S 00 N VIE INN 111,16100011000 III000 1111111 1111111111 1111111111 111111111111111 NIN 1 110111,11011110000i001°1 100 001 11111 1 1 Ill 111111 11111 101 10,00doon DIII,•1 '001,00t0,11I1 "Rti00 04 11111111111 111111111111111 000001 oir 111111111111111111111 1111111 00111 II 000 11111111111111101111100 0100000000001 Hill poloolonoomo °11°1111°° °11411.1M0d11.111f° 1111111 „vo, „RvvvvvoofiVvvvovovovvvovi,VVNvvvv,„vvjvvvvvv6, 1010 vog1 00000v ovvvrEV0V000 0govv, ,000a00, vdovvvvvvvvvv0v0vvvvvvvvvvvvivv000000vvvv0000 ovvovv1000000oolod 01 00001 01 10 11111110 1111111 11111111111111110011100 VIVIIIVONO 1.11 00 11111 1„ 1 IV010„„001 110 4101 111 111111111111111 00001,1000,00 0011111111111100 1011 V IOVVVII 0111 )111 Nll 1111E1111 11111111101111ii 11 11 0001 -0°100 00001 111111111 1 1111111111111111 00lb0 111111i11' 11 N1111111111 '111111 11111111 II 1111111 111 1111 111111 111 I I 1111111 111 1111 HEHEEd III 111111111111E01 000010 100 1"011 " 11111111111111111 1 Novoig 00,400o10,0010..0 11 1111111 Ito 'y 0 too001j00 tvv 0111111111". ,,,,,,, ,11,01 lo 0,00,0„000 °°11.111111181111.1rflilli N100 I Il IIII 01 IIIIII010001 0,00 , rIIIIN "1 1 10 11000111,1010i 1000i00001,100,10;00000001,10 ,,0000q,0,1100600 Ed 1 01 0 11111111111111111 11111111111111110111001111111111100000000 10 III IIII 000 Hood 0000000 0 „1,00000000, El 0000000 11111 NT 0 1, NE 1111 1111 IMPORTANT DOCUMENT Certfficate of Flame resistance ISSUED BY CHORRegistration Number INDUSTRIES INC. Sales Order # F-140.01 SO-614935 Date of Shipment 4/10/2015 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: 269800 CHRISTIAN DELIVERY CHAIR SERVICE INC DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 03049 USA 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 # 8150200 (2) Description of item certified: CENTURY END 40W X 20 HOLE 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 aA4 Signed: ANCHOR INDUSTRIES INC SNYDER MANUFACTURING INC, PHILADELPHIA PA Registration Number F-140.01 IMPORTANT DOCUMENT Certificate of Flame qcsistance ISSUED BY CHOR,gr...4,111® 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 4/7/2015 269800 CHRISTIAN DELIVERY CHAIR SERVICE INC DBA CHRISTIAN PARTY RENTAL 18 CLINTON DR HOLLIS NH 03049 USA Sales Order # SO-614929 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 # 8150100 (4) Description of item certified: CENTURY MIDDLE 40WX20 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 a0.4_ Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC Applicant Information The Commonwealth of Massachusetts Depart nt of Industrial Accidents 1 Congress Street, Suite 100 Boston, 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 New Hampshire 03049 City/State/Zip: Hciiis, Phone • 3-5326 Are you you an employer? Check the appropriate box: 1 lam a employer with 40 employees (full and/or part-time).* 2.11 I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] a homeowner doing all work myself. [No workers' comp. insurance required.] t I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all CUllirdet01 S vither have workers' compensation insuource or are sole proprietors with no employees. 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 Wc am a cur pulativa arid iLs ufati s Bove exercised 'dint tight acx.cmpiiun pci MGL c. 152, § I(4), and we have no employees. [No workers' comp. insurance required.] *Any applicant that checks box # I must also fill out the section below showing their workers' compensatio 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. IContractors 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. Type of project (required): 7. 0 New construction 8. Remodeling 9. El Demolition 10 Building addition Electrical repairs or additions Plumbing repairs or additions Roof repairs 14. nother TENTS I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site inforntation, Insurance Company Name: New Hampshire Motor Transit Association Policy # or Self -ins. Lie. #: P000749NHMTA2015 01-01-2016 Expiration Date: Job Site Address:, ;V, ic >/ • /V, 4/ , /VA City/State/Zip: .1 4' Attach a copy of the workers' compensation policy 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 the pains and penalties ofpedu • 70 Signature: / Phone 603-883-532o .fh he information provided above is true and correct Date: A' / Official use only. Do not write in this area, to be completed by city or town official City or Town; PermitiLietiiSt: 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 #: AC• C TIFICAT F LIA = ILITY IN U "ANC DATE (MM/DD/YYYY) 8/29/2014 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 THE ROWLEY AGENCY INC. 139 Loudon Road P.O. Box 511 Concord NH 03302-0511 INSURED Christian Delivery & Chair Service, Inc, dba Christian Party Rental 18 Clinton Drive Hollis NH 03049 CONTACT Rhonda Noble NAME: PHONE (603)224-2562 (PkIC.Na. Eat): MAIL rnoble@rowle a en com ADDRESS: Y �J cY FAX (603)224-8012 (NC. No): INSURER(S) AFFORDING COVERAGE INSURER A :Hanover Insurance Company INSURER B NAIC # INSURER C : INSURER D: INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER:14/15 - no w • 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP IMM/DDIYYYYI LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY ZBV084436307 9/1/2014 9/1/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE 7POLICY I()a LIMIT APPLIES PER: JE(° I) LOC _ PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X X X LIABILITY ANY AUTO ALL OWNED X �{ SCHEDULED AUTOS NON -OWNED AUTOS ABV071690907 9/1/2014 9/1/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 $ BODILY INJURY (Per person) BODILY INJURY Peracddent) $ PROPERTY DAMAGE (Per accident) $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UHV084436507 9/1/2014 9/1/2015 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED X RETENTIONS 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A WC STATU- TORY LIMITS OTH- ER E.L, EACH ACCIDENT $ E.L, DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS! LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Covering operations of insured during the policy period. CANCELLATION "For Informational Purposes Only" SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Rhonda Noble/RLN ACORD 25 (2010/05) INS025rontnrr rn1 ©1988-2010 ACORD CORPORATION. All rights reserved. Tho nruno l name and Innn aro rcnicfcrcrl marks of A(:f1Rrl