Loading...
HomeMy WebLinkAbout20X20 CANOPY %AORTH BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit 0- Date Received *r A .. Date Issued: �SsAcHU livir 6ix rANT: Ap�licant must complete all items on this page LOCATION ",.Print PROPERTY OWNER-, f 11, 14 'Print" n - MAP-NO:' PARCEL; Dist C' n,, Machine ,JJo0,,Vi1(Ago- ;,ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building Li One family Li Addition Li Two or more family Li Industrial Li Alteration No. of units: Li Commercial Ll Repair, replacement 11 Assessory Bldg 11 Others: El Demolition 11 Other O!Septic, o Well " —', 0floOd, ,ain" ," o-WetOn' Waters ed0( ai ,E] Water/$'ewer, - 7 Identification Please Type or Print Clearly) OWNER: Name: 2!2 CIL- ,- -" Phone: q '7f-- Address: CONTRACTCIR, Name Phone .... ....fw;" Address- 7 �,6.6c ion-,Lipense,�' Supervisor'�s'b` EX, )'a 'V E, Cts' Hbme�Improvement x ..... ........ ARCHITECT/ENGINEER Phone: Address: 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: $ 15-00 FEE: Check No.: "A Receipt No.: NOTE: Persons condciit�g u*k unregistered contractors do not have aAnls-s to, the guhrantv fund Signatu of Agent/Owner $ignature of contractor Plans Submitted 11 Plans Waived [I Certified Plot Plan 11 Stamppd Plans TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art r] Swimming Pools 0 Well ❑ Tobacco Sales 11 Food Packaging/Sales [I Private(septic tank, etc. ❑ Pennanent Dumpster on Site El 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connectionisignature& Date Driveway Permit DPWown Engineer: Signature: Located 384 Osgood Street L RTMENT,�7,,T FY,','I R E D P te -�eMpJ)qrqps rpn,sitQ yes Located at.124 in-Street, , 'ir %y� tzi� Ature/ xl11, COMMENTS,'- FORTH Town of Andover No. aqo •� ' Z y C, SAKE h ver, ass, COC NIC MI w.'. I x.95 RATE[) U BOARD OF HEALTH PERMIT T LLJ Food/Kitchen Septic System s THIS CERTIFIES THAT BUILDING INSPECTOR .. /� Foundation has permission to erect.......................... buildings on ............ .................................................. Rough to be occupied as .... ... ... .......... .. ......%&.. .. Chimney provided that the person accepting this permit shall in every respect co rm 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 ��AA Final PERMIT EXPIRES I 6 M NTH ELECTRICAL INSPECTOR LESS CONSTRUC TAR Rough Service .... ........... ..... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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 Approved by the Building Inspector. Burner Street No. Smoke Det. � CERTIFICATE OF LIABILITY INSURANCE DA 7/09/2015(MMIDDIYYyy)ACORN® 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: Association Benefits Insurance Agency PHONE I FAX AIC No Ext): AfC,No): 299 Ballardvale St,Suite 1 E-MAIL Wilmington,MA 01887 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: MA Retail Merchants WC Group Inc. INSURED INSURER B Martel Rentals,Inc. INSURER C: d/b/a Sudbury Taylor Rentals 712 Boston Post Road,Rte.20 INSURER D: Sudbury,MA 01776 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 08875 REVISION NUMBER: 00001 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 I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MMIDDIYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERAL LIABILITY DAMAPREMISES (RENTED PREMISES Ea occurrence) $ CLAIMS-MADE 1:1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 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 RETENTION$ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE —] E.L.EACH ACCIDENT $ 1,000,000 /q OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) 014000501815115 1/01/2015 1/01/2016 E.L.DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Town North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE NorthMain Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Nh Andover,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Certiftcate of Flame Resistance REGISTERED FABRIC ISSUED BY Date of Manufacture NUMBER JOHNSON OUTDOORS INC. BINGHAMTON,NEW YORK 13902 F-140.01 Manufacturers of the Finest JANUARY 2007 i 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: SUDBURY TAYLOR RENTAL CENTER CITY: SADBURY MA i 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 Fre Marshal Code, NFPA 701*, Underwriters Laboratory of Canada,and have been tested in accordance with the I Federal Test Method Specifications and meet or exceed the MilitaryFlame§vecifications of MIL-C-43006G. L-Tre.—Color and weioht of material 11 OZ vinvi YELLOWNVHITE t Description of item certified: PARTY CANOPY 20X20 i Flame Retardant Process Used Will Not Be Removed By Washing And. Is Effective For The Life Of The Fabric j Snyder Manufacturing,Inc. 40, Manufacturer of Flame Retardantvnvi Laminates 6 TENT DEPARTMENT,JOHNSON O RSI *Large Scale