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Home My WebLink AboutBuilding Permit #531-14 - 1060 OSGOOD STREET 1/9/2013 i TOWN OF NORTH ANDOVER / /APPLICATION FOR PLAN EXAMINATION Permit N0: L Date Received Date Issued: -7 IMP TANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER _ �? Print 100 Year Old Structure yes no MAP NO: � PARCEL: L ZONING DISTRICT: , Historic District yes no Machine Shop Village yes no .TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial *Alteration No. of units: OLCommercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain g Wetlands ❑ Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Llo R 9-64S Identification Please Ty a or Print Clearly) OWNER: Name: Address: CONTRACTOR Name:_ �� -2 .v,, Phone: 7� JT? _a� Address: ,,,r.t�,c - Znc _ - Supervisor's Construction License: _ Exp. Date: Home Improvement License: _ Exp. Date: t 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: $ FEE: $ ,-r-;0 `� l/0252Lq 2( � Check No.: r Receipt No.: p NOTE: P rsons contra in it cnregis co tractors do not have access to the guarantyfund 'ignature,of Agent/OwMe gnature of contractor rtified Plot Plan ❑ Stam ed Plans ❑ Plans Submitted _J Plans Waived Ce p 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ _ :TI'PE_ORSEWERAGEDiSPOSAL Public 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 -DATE REJECTED: DATE.APPR-OVED PLANNING & D'EVELOPMENT' 0 COMMENTS CONSERVATION Reviewed on Siqnature COMMENTS r ' HEALTH Reviewed on l Si natur Hlk(�--v Signature COMMENTS -oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i t'lanning Board Decision: Comments . I Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Tows Engineer: Signature: - 84 Located 3 Osgood Street FIRE DEPARTIV ENT -,Te' mp Dumpster on yes no Located at 124 Mair, Street - Fire"Departme►it signature/date`' COMMENTS -Dimension- Number Number of Stories: Total square feet of floor area, based on Exterior dimensions._ .Total land area; sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of .Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-Chapter 166 Section 21A-F and G min.$10041000 fine NOTES and DATA— (For department use LI Notified for pickup - Date i Doc.Building Permit Revised 2010 Building Department The fol[owing is`=a-list of the requlred.forms to be filled out for-the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits L).. B,Uilding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.-L Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo%,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Building Permit Revised 2012 Location i 0 -0f No. '? �} / ' 1 l_ Date j 1 • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ lodes Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Sw✓ $ TOTAL $ Check# t Building Inspector Q,NORTH 1 e O"`19 37S�ClNstt CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 531-14 on 1/9/2013 Date: May 27, 2014 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1060 Osgood Street MAY BE OCCUPIED AS Falafel Cafe and Grill _IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Kamel Zefto 1060 Osgood Street North Andover,MA 01845 Budd-in gInspector Fee: PrePaid $100.00 Receipt: 27212 Check : 991 NO RTf-► Town of tAndover y( h ver, Mass T LANE � AP�,t'�� S u BOARD OF HEALTH PERMIT T LD Food/Kitchen6 Septic System 44 THIS CERTIFIES THAT - -- /� € BUILDING INSPECTOR .... F64........s.. :. :::........ `. : ...............:...... ........................................... /'�� Foundation has permission to erect .......................... buildings on . . ?. ....... .. ,�1., ?. ....::- :!.................. Rough to be occupied as ...... ......�....... ................:................... .. ...:':....................................,... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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. LUM NG INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough 3 Final �'�' �'r•p�i�°f � PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T Rg S Rough too--, o /} , ` ................. ...�. .......i.........,�................:................... Service BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough , Display in a Conspicuous Place on the Premises - Do Not Remove Final AV No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street k No.- Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts 'G City\Town of North Andover Y i t Ce t ica e of Inspection In accordance with 780 CMR,Chapter 1 (The Sixth Edition of the Massachusetts State Building Code) and Chapter 304 of the Acts of 2004 (an Act to further enhance fire and life safety), this temporary certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Falafel Cafe & Grill 1060-2014 Certificate Located at 1060 Osgood Street Expiration May 2015 Use Group Restaurant Occupancy Load Classification(s) Limit 20 This temporary certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall allow for the temporary use as herein described and in conformance with any and all conditions as identified below. It shall be framed behind clear glass and\or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post the certificate,failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Temporary Use Name of Municipal Name of Municipal Gerald Brown, Bldg. Insp. Date of May 27, 2014 Fire Chief Building Commissioner Inspection Signature of Municipal Signature of MunicipalDate of May 27, 2014 Fire Chief Building Commissioner �� --�` Issuance NORTIy Town of ndover _ 0 dqI (C-4 h ver Mass OlA,(E cOc MIGNEWIc. ATED S V BOARD OF HE PERMIT T L D Food/Kitchen ��' Septic System L /` a THIS CERTIFIES THAT .... .!--... 4 -- -- �. . BUILDING INSPECTOR .... ,....... ...... .....�...............1...... .......................................... ,! �� Foundation has permission to erect .......................... buildings on .1.6k.0.....'��..t . ,, ?. '.» ,�.....:::�.!.................. •�-• Rough to be occupied as ...... ................ . ............................................................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Ina Ss/_t�z/ �� on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Az Construction of Buildings in the Town of North Andover. LU ING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. ; Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR �? 62 UNLESS CONSTRUCTION T R� S Rough • 0 Service ................. ...(.. .. BUILDING'INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Fina' 4u �. No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE NORTH own of O _ L11 h , ver, Mass, l toc.ucK&WICK 1. RATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT .....el. ..t ..Lm. XBUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .1.646.0..... �QQ.a -..V.r. Rough to be occupied as .. ......'�':...... ............... ........v/A; .s...............................-:....................................,... 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 IN 6 MONTHS ELECTRICAL INSPECTOR J? V UNLESS%� CONSTRUCTIO S Rough VV .. ... ..... ........................ Service ................. ... .. ............. . .... BUILDING INSPECTOR Final i � GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina. _ No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE NORTH Town of _� �� Andover No. I_1 h h , ver, Mass, l COC NICHlw"K �•9 ORATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Fel.�...�,.. �. XBUILDING INSPECTOR Foundation has permission to erect .......................... buildings on .��E?.I ....dL?.a ..... I..�............... w Rough tobe occupied as ....�.� ......'�"...... ..........v�A� ..............................-.....................................,... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR v? V UNLESS CONSTRUCTIO S Rough ° 'I polo Service . ... .. ............... ..................................... Final � 0 BUILDING INSPECTOR GASINSPECTOR 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 I Until Inspected and Approved by the Building Inspector'. Burner it Street No. Smoke Det. SEE REVERSE SIDE -- I \2CQiUtM\ �OOn m U n Xt f� f � NN G6 SFS Jo, 9 �o 121'` ij7 - �-� a� ell Qkl 000 s� jAJ C)'A 6 f } LL 7 no Ile 00) Cn --W -� - THE COMMONWEALTH OF MASSACHUSETTS 1 TOWN OR ITY OF `i'r �/ r Establishment Name: /A,_ Date: Page: of Item Code C-Critical Item DESCRIPTION OF VIOLATION/'PLAN OF CORRECTION Date No. Reference R—Red Item Verified PLEASE PRINT CLEARLY _ (JW - _ i ' In I r0--y/,54 Apvr OTU- i" WA - r `j yj, l _ 0 s ``n k 5H D v-2 46 1 o it u� l V N 04 U 1im A Discussion With Person in Charge: Corrective Action Required: ❑ No O Yes ❑ Voluntary Compliance ❑ Employee Restriction/ Exclusion ❑ Re-inspection Scheduled ❑ Emergency Suspension LL03 Embargo ElEmergency Closure Voluntary Disposal ❑ Other: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print LeOblv Name(Business/Organization/Individual): cvww Z� p_--�, Lr Address: 10 City/State/Zip: P� c�cls Phone#: 1 77 3 7 S 2, o Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. �• F1 Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 1011 Electrical repairs or additions 3.LAI I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' comp.insurance required.] 131i Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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 their workers'comp.policy information. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. X do hereby cert ride sins andp al' s ofperjury that the information provided above is true and correct. - Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs per sons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance I rance p requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to cavy workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy inAddress" locations in (city or formation(if necessary)and under"Job Site the applicant should write"all town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMzx nweatth of Massachv..sPits Department ofTndustriat Accidents Office of Investigations 600 Washington Street Boston,MA.Q21 It Tel,#61.7-727-4900 at 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.MaSS.gov/dia