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HomeMy WebLinkAboutBuilding Permit #394-15 - 208 SUTTON STREET 10/27/2014 BUILDING PERMIT o` t%ORoT" TOWN OF NORTH ANDOVER 2 - APPLICATION FOR PLAN EXAMINATION / Permit No#: ��' Date Received �s revJlr gSSNCHLI Date Issued:–/b IMPORTANT: Applicant must complete all items on this page LOCATION ZO�3 SO �d h ��• PROPERTY OWNER Z-&11 ke� P *nl zr Print 100 Year Structure yes MAP "f 1 PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes*n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential j]7 ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial Lik6lteration No. of units: >zrommercial ❑ Repair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer JIS/CRIPTION/PF WO�K TQ BE P FO ME : U e� w 14W C7 r t Identification- Please Type or Print Clearly OWNER: Name: u Phone �79) G 9)U ' 2 Z6� Address: Contractor Name: P�y LPSr ( c IcC.� Address: l Leecv. Supervisor's Construction License-.— '?7;'f Exp. Date: Home Improvement License: 11 Exp. Date: ARCH ITECT/ENGINEER r��14 �C�SSOG� Phone: (C/7 6 ) 5-3(^ f/6¢ Address: /'0 04 eo /Zd', /-,8,q44 * Reg. No. 0193 6® w FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ / 44,000 FEE: $ Check No.: Aw� .�/1' 7 Receipt No.: �/�� NOTE: Persons contracting with unregister d contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor J �i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS ' CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMM&'S" �a ���� /� t4d- C s�.. �L 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS I Dimension 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.$100-$1000 fine NOTES and DATA — (For department use) i I I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application o Workers Comp Affidavit o Photo Copy Of . And/Or C.S.L. Licenses o Copy of Contrac o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products x NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application u Certified Surveyed Plot Plan Li Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) D Mass check Energy Compliance Report (If Applicable) D 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) o Building Permit Application Li Certified Proposed Plot Plan u Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract u Mass check Energy Compliance Report o 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 appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording li must be submitted with the building application Doc:Building Permit Revised 2014 0 Location 20,? -->� '" "Y No. — Date F r . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ � Building/Frame Permit Fee '` 1 Foundation Permit Fee $ Other Permit Fee $ TOTAL �2 r Check# `t " Building Inspector w ONo oT 'Ly O b w moo` •V 19 �,S ACHOSES CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number: 394-15 on 10/27/2014 Date: April 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 208 Sutton Street MAY BE OCCUPIED AS Niless Fa� i' mous Roast Beef Restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: LBM Realty Trust c/o Aanis J.Bido 200 Sutton Street North Andover,MA 01845 Building Inspector Fee: Prepaid$100.00 Receipt: 28182 Cheek : 247 The Commonwealth of Massachusetts City\Town of North Andover Certificate 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 ficrther 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 Niki s Famous Roast Beef 208-15 i Indentify property address including street number,name, city or town Certificate Located at Expiration April 2016 i Use Group Restaurant Allowable 1 Classification(s) Occupant Load 28 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. j 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 Fire Chief BuildingCommissioner Inspection April 23,2015 Signature of Municipal Signature of Municipal zz Date of Fire Chief Building Commissioner Issuance April 23,2015 l rl , tko t . . )ve, I 4 W. .. t E i o ; . 0 No. th ver, Mass, /ad-7 / COCNICMEWICK S U BOAR,q OF HEALTH PERMIT T LD Food/Kitchen Septic Syst m S �/ BUILDING INSPECTOR THIS CERTIFIES THAT .................................. .............. ... ..........................................:...........,,.................. Foundation has permission to erect .... buildings on ��� 4A ...................... � .......................�'.................................................. ugh o �I ! / ��� to be occupied as ....................!... l�!. ... .?.1........ ....6c�aT.......:.. ...................................... Chimney provided that the person accepting this permit shall in every-respect conform to the terms ofthe application - , al '714 G4 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. � Fina! PERMIT EXPIRES IN 6 MON HS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS . - - Bough Service.\ ............ ...... ..................... Final . - - j BUILDING INSPECTOR - GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final a Display in a Conspicuous Place on the Premises — Do Not Remove ��� V 1f p Y p No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. •a't � h Smoke Det. ....... _..., 1. �r i i i �I ��. OMO D7k 1N P. a ♦y p` Y X79 ACfttg CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number: 394-15 on 10/27/2014 Date: April 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 208 Sutton Street MAY BE OCCUPIED AS Niki's Famous Roast Beef Restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: LBM Realty Trust c/o Aanis J.Bido 200 Sutton Street North Andover,MA 01845 Building Inspector Fee: Prepaid$100.00 Receipt: 28182 Check : 247 The Commonwealth of Massachusetts City\Town of North Andover Certificate 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 ficrther 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 Niki's Famous Roast Beef 208-15 Indentify property address including street number,name, city or town Certificate Located at Expiration April 2016 Use Group Restaurant Allowable Classification(s) Occupant Load 28 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 Fire Chief Building Commissioner Inspection April 23,2015 Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance April 23,2015 rw_ J� r 1 F µORTW . W" i _ 1C . . Ve_ . 0 � - No. �� * _ >�h ver, Mass, /d Id-7 / C OC NIC„t WK S V BOARq OF HEALTH PERMIT T LD Food/Kitchen j Septic Sys t m i THIS CERTIFIES THATZ"S BUILDING INSPECTOR Foundation { has permission to erect .......................... buildings on .................... ........................................................ ugh 04 tobe occupied as ................................. ..................,.. ........................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms ofthe application - vQ 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. 9 Fina! e �� PERMIT EXPIRES IN 6 MON HS 'ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS o.ugh _ Service.\ ............ ........ ....................................................... Final - BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Finale ; �� sp ay p 0 No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. , � I� I . O M,SSACNl15ES4g CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number: 394-15 on 10/27/2014 Date: April 23, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 208 Sutton Street MAY BE OCCUPIED AS Niki's Famous Roast Beef Restaurant IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: LBM Realty Trust c/o Aanis J.Bido 200 Sutton Street North Andover,MA 01845 Building Inspector Fee: Prepaid$100.00 Receipt: 28182 Check : 247 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 469000.00 m $ - $ 552.00 Plumbing Fee $ 69.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 69.00 Total fees collected $ 790.00 208 Sutton Street 393-15 on 10/27/2015 Tenant Fit Up Niko's Roast Beef NORTH Town of s E , And( ve . No. - �oh ver, Mass, z;__2 7 .Q COC"ICMt WICK 1' SRATED ►p�\,�'(5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �.�.1. ./.:�... l .f: . ... !'Uf .................................................... BUILDING INSPECTOR .............. . .... . .... 0����/� Foundation has permission to erect .......................... buildings on ............................................................................. Rough to be occupied as ................ �G�!.!........�C� �J`.........���s�3��. ...................................... 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 UNLESS CONSTRUCTION ARTS Rough Service .............. ...... ac,� p:::�, ........................ 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. RESTAURANT EGUIRMEN 10/26/2014 Invoice Project: NIKI'S From: Alternative Sales John Lumnah 135 Route 125 Kingston, NH 03848-3526 (603)642-3873 (603)642-3873 (Contact) Job Reference Number:483BJS Item Qty Description Sell Sell Total 1 1 ea USED EQUIPMENT $2,900.00 $2,900.00 ALTERNATIVE SALES Packed: ea ***RECONDITIONED*** BLODGETT 1000, DOUBLE STACK PIZZA OVEN 2 1 ea CONVECTION OVEN $2,125.00 $2,125.00 Blodgett Oven Model No. BDO-100G-ES SNGL Packed: ea Convection Oven, Gas,single deck,standard depth, capacity(5) 18"x 26" pans, stainless steel doors, dual pane thermal glass windows, (5) stainless steel racks and (11) rack positions,chrome plated door - handle, manual controls,cooling fan, porcelain cavity, lights,full angle iron frame, stainless steel construction, 25"stainless steel legs, 45,000 BTU,3/4 hp blower,cETL, NSF ENERGY STAR 1 ea (1) One year parts and labor warranty, standard 1 ea Gas type to be determined 1 ea 115v/60/1-ph,8.0 amps,cord&plug,3/4 hp, 2-wire with ground, standard 1 ea Venting to be determined 1 ea 25" legs,adjustable,stainless steel (set), standard 3 1 ea USED EQUIPMENT $1,185.00 $1,185.00 ALTERNATIVE SALES Model No. P13832 Packed:ea ***Reconditioned*** 67" Pizza Prep 4 1 ea USED EQUIPMENT $450.00 $450.00 ALTERNATIVE SALES Model No. P13851 Packed: ea Sommerset Dough roller 5 2 ea HAND SINK $90.00 $180.00 KCS Model No. KCS-HS1 Packed:ea Hand Sink S/S,wall mount, 15 wide x 17 front-to-back,3-1/2 drain basket, 1-1/2 drain connection.Gooseneck faucet included. Initial: NIKI'S Page 1 of 5 Alternative Sales 10/26/2014 Item Qty Description Sell Sell Total 6 1 ea WALK IN COMBINATION COOLER FREEZER,SELF-CONTAINED $4,500.00 $4,500.00 Bally Refrigerated Boxes Model No. NIKIBALYWALKIN Packed:ea Outdoor Structure Bally Prefabricated Exterior Dimensions: 13'-6" Length x 7'-9"Width x 7'-7" Height 2 Compartments.With Floor Ceiling:Single Span Panel Thickness: 4" Exterior Vertical Used(6-10")with 4" Partition,4" Floor, 5" Reinforced Ceiling Base Finish: Vertical and Ceiling Panels: Embossed Galvalume (26 GA) Special Finishes: interior Floor-Stainless Steel (Type 430) (16 ga) Doors/Openings: 136"x 78" Hinged Door In a 46'x 82" Panel 136 x 78" g Hin ed Door Ina 46"x 82 Panel Accessories and Extras: 1 Bally Standard Pressure Relief Port(<400 sq/ft) 1 Moisture Proof Switch Plate 112 S/F Outdoor Membrane Roof $ Freight: 1,327.00 $1,327.00 g Extended Total: $5,827.00 7 lea REFRIGERATION MECHANICAL COMPONENTS $5,600.00 $5,600.00 Bally Refrigerated Boxes Model No. NIKIBALYREFRIG Packed:ea Refrigeration: 1 PTT 067 H 6BEC 208-230/1/60 6860 BTU Outdoor 1 PTT 044 L 6B 208-230/1/60 4530 BTU Outdoor 8 1 ea WORK TABLE $170.00 $170.00 KCS Model No.WG-2460 Packed:ea Work Table,S/S 24"X 60"L top,without splash. 18 gauge. Rounded bull nose corners 36" Height. Galvanized adjustable undershelf, & frame. 9 1 ea USED EQUIPMENT $850.00 $850.00 ALTERNATIVE SALES Model No. P13577 Packed:ea ***Reconditioned***Automatic Berkel Slicer 10 1 ea USED EQUIPMENT $750.00 $750.00 ALTERNATIVE SALES Model No. P13993 Packed: ea ***Reconditioned*** 27"Sandwich nd Unit t 11 1 ea USED EQUIPMENT $150.00 $150.00 ALTERNATIVE SALES Model No. P14107 Packed: ea ***Reconditioned***Vollrath 2 burner hot plate 12 1 ea COUNTERTOP GRIDDLE $1,939.00 $1,939.00 Initial: NIKI'S Page 2 of 5 Alternative Sales 10/26/2014 Item Qty Description Sell Sell Total Star Mfg. Model No.824TA Packed: ea Ultra-Max®Griddle,gas,24%,32-3/8"D, 18"H, 1"steel griddle plate, mechanical snap action controls, (2) controls,aluminum steel construction, stainless steel front with black trim, heavy-duty metal knobs,wrap-around stainless steel splash guard, 3-1/2"grease trough &stainless steel drawer,4" adjustable legs,60,000 BTU 1 ea 3 year parts&labor warranty,standard 1 ea Gas type to be specified 13 2 ea USED EQUIPMENT $300.00 $600.00 ALTERNATIVE SALES Packed:ea ***Reconditioned***fryer 15 1 ea USED EQUIPMENT $1,595.00 $1,595.00 ALTERNATIVE SALES Packed:ea ***Reconditioned***60" Mega Top Sandwich Unit 16 1 ea MOP SINK $209.00 $209.00 E. L. Mustee Model No.63M Packed: ea Sink, Mop Service Basin. High impact resistant DURASTONE structural fiberglass 24"x24"x10" Integral molded-in Drain for connection to 3" ABS, PVC(sch.80)or Cast. 16-A 1 ea SERVICE FAUCET $145.00 $145.00 Fisher Model No.8253 Packed: ea Service Sink Faucet, 1/2" inlet, long spout and vacuum breaker, polished chrome, includes EZ-Install adapter, POP packaging 17 1 ea WORK TABLE, 60"WITH PREP SINK(S) $500.00 $500.00 KCS Model No. WS-2460WS-R Packed: ea Work Table with sink on right,All S/S 24"X 60"L top,with 5"splash. 18 gauge.Adjustable undershelf, &frame. 19 1 ea USED EQUIPMENT $1,900.00 $1,900.00 ALTERNATIVE SALES Packed:ea ***Reconditioned*** Hobart 60 quart mixer 20 1 ea WORK TABLE, 30",STAINLESS STEEL TOP $100.00 $100.00 KCS Model No. WG-3072 Packed:ea Work Table,S/S 30"X 72"L top,without splash. 18 gauge. Rounded bull nose corners 36" Height.Galvanized adjustable undershelf, & frame. 21 1 ea, REACH-IN UNDERCOUNTER REFRIGERATOR $695.00 $695.00 Beverage Air Model No. UCR27A Packed:ea Undercounter Refrigerator,one-section, 27"W, 7.3 cu.ft., (1)door, (2) shelves, stainless steel exterior&top, aluminum interior, rear- mounted self-contained refrigeration, 6"casters, 1/6 hp, UL,cUL, UL- EPH, MADE IN USA 1 ea 3 years parts& labor warranty(excludes maintenance items) lea Additional 2 yr compressor warranty,standard Initial: NIKI'S Page 3 of 5 Alternative Sales 10/26/2014 Item Qty Description Sell Sell Total 1 ea 115v/60/1-ph,4.0 amps,standard 1 ea Door hinged on right standard 1 ea 6" Heavy duty casters,standard 22 2 ea CORNER SINK,(3)THREE COMPARTMENT $450.00 $900.00 Turbo Air Model No.TSA-3C-D1 Packed: ea Sink,Corner Type Three Compartment,with 2-18" corner type drainboards, 18"front-to-back x 18"wide sink compartments, 11" deep with 11" high splash, 18/304 stainless steel bowls,galvanized gussets&tubular legs with adjustable ABS feet, NSF approved 2 ea Crating charge, will-call is not applicable $40.00 $80.00 Extended Total: $980,00 23 1 ea USED EQUIPMENT $650.00 $650.00 ALTERNATIVE SALES Model No. USED EQUIPMENT Packed:ea 1 door freezer 23 1 ea USED EQUIPMENT $550.00 $550.00 ALTERNATIVE SALES Model No. USED EQUIPMENT Packed:ea P 137641 door cooler 24 1 ea COUNTERTOP GRIDDLE $1,200.00 $1,200.00 Star Mfg. Model No.848TA Packed: ea Ultra-Max*Griddle,gas,48%,32-3/8"D, 18"H, 1"steel griddle plate, mechanical snap action controls, (4)controls, aluminum steel construction, stainless steel front with black trim, heavy-duty metal knobs,wrap-around stainless steel splash guard,3-1/2"grease trough &stainless steel drawer,4"adjustable legs, 120,000 BTU 1 ea 3 year parts&labor warranty,standard 1 ea Gas type to be specified 25 1 ea BAGEL TOASTER $225.00 $225.00 ALTERNATIVE SALES Model No. USED EQUIPMENT Packed:ea Bagel Toaster 50 1 ea DELIVERY $200.00 $200.00 ALTERNATIVE SALES Model No. DELIVERY Packed:ea Delivery&Set in Place. Standard Ground level delivery to be done during business hours Monday through Friday from 8:00 AM to 5:00 PM by non-union personnel. Based on site conditions, products will be set in place and made ready for mechanical connections by others. Packing materials and trash to be removed. Deliveries that involve stairs,obstacles that do not provide reasonable access or require . elevation must be disclosed prior to the delivery or additional charges may be applied at time of delivery. Merchandise $31,675.00 Tax 6.25% $1,979.69 Total $33,654.69 Initial: NIKI'S Page 4 of 5 Alternative Sales 10/26/2014 Acceptance: Date: Printed Name: Project Grand Total:$33,654.69 Initial• NIKI'S Paee 5 of 5 Pleasant Home Service 615 Chestnut Street Lynn, MA 01904 www.pleasanthOmeservice.com Tel# 1-877-492-7721 Tob Address Billing Address 208 Sutton St. Same North Andover, MA ustomer Name: ustomer Name: ianis J. Bido ame Payor • 1 dpayment and lh upon job completion. Payment: /2as own Store Renovation dining area and kitchen, build new top half wall. Remove wall between one handicap code bathroom. Expand existing bathroom and make Build new front counter and backlt°heneandnrep area. New drop ceiling in dining area, p install ceramic tiles in dining area and vinyl commercial tiles in kitchen and prep area. Install new bigger window in drive thru and smaller window in kitchen area. Re-trim windows and doors. Prepare, prime and paint walls, woodwork, windows and doors. The estimate is $14,400 This included labor and materials. ing to All work to be completed in a substantial workmanlike rom above spemanner c fi ation involving specifications submitted. Any alteration or deviation extra charge s ec ill become ane g p extra cost will.be executed only upon written orders and w over the above estimate. 7077 . PROCE [FOR 7NOS E:57UMa'TE: AUTHORI, IGNATURE: DATE: CUSTOMER SIGNATURE: r t ` DATE: Z �/ J Thank you for doing business with us! ill INSTALL ADDITIONAL HAND 51NK A5 5HOWN 10-14-2014 PREP AREA ADDITIONAL HAND 51NK A _ MOP SINK GREASE TRAP KITCHEN 3-BAY%K X HGP 5ATH X, 1 NIKI�5 ROAST 5EEF ID-14-2014 ZOS 5UTTON 5TREET 5K-1 NORTH ANDOVER, MA I i f i a V i «;:COMMONWEALTH OF MASSACHUSETTS :' ; Ms • • ' • • ling ISSUE$ T:HE FOLLOWING LICENSE REG I STERID ARCH-I,T--EC$+�,. �,. PAUL to R LESSARD 18 LEAVt°* ST SQL>EM 01 970-499 9 .4 08/ 4. . 65071 j 1 "RADII OP ID:VF ACORU' CERTIFICATE OF LIABILITY INSURANCE DATE(10MM/DD/YYYY)/2014 124 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(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 Phone:617-926.400000N E CT Guard Insurance Agency Fax 617-926-8334 PH°NE FAX 279 Mt.Auburn Street ac No Ext: AIC No): Watertown,MA 02472 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC S INSURER A:Preferred Mutual Insurance Co. 15024 INSURED Dimitrios Avramidis INSURER B: 615 Chestnut St Lynn,MA 01904 INSURER C: INSURER D: 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. I�TR TYPE OF INSURANCE POLICY NUMBER �MIUDD EFF PM�p EXP RLIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY BOP0100721162 10/24/2014 10/24/2015 DAMAGE PREMISETO RE(EaoccurD $ CLAIMS-MADE FKOCCUR MED EXP(Any one person) $ 10,00 PERSONAL BADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT a accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LJAS OCCUR EACH OCCURRENCE $ :4EXCESS LU1B CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATIONWC STATU- TH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS E ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N 1 A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ K describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) INTERIOR AND EXTERIOR CARPENTY/ ROOFING EXCLUDED CERTIFICATE HOLDER CANCELLATION NORTHAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 OSGOOD ST ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrlgl Accidents Office of Investigations 600 Washington Street Boston.,HA 02111 www.mass.gov/dia Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/fndividual): PCe t)( L� Say� �`(�L 4.1 lei Address: !� ��c�(/c �j/ Z- City/State/Zip: G� �2'� *11, l 9Z0 Phone#: Q 70 Z!D 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.)<I am a sole proprietor or partner- listed on the attached sheet. ❑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 10.❑Electrical repairs or additions 3.❑ 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.❑Roofrepairs insurance required.]i employees.[No workers' 131J Other comp.insurance required.] 'Any applicant that checks box41 must also fill out the section below showing their workers'compensation policy information. i Homeowners who submit this affidavit indicating they 2te 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 requiredunder 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 maybe forwarded to the Office of Investigations of the DIA-for insurance coverage verification. X do hereby certify under the gins and penalties ofperju tliat the information provided above is true and correct. Signature: Date: G z211Z ¢ Phone#: -2- 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 ane): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.PIumbing 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 persons 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 employes." 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 producedacceptable 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 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 carry 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 information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or 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 bum 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 Commonwealth of l-a ssa.,chwetts Department of Industrial Accidents Office ofIavestigatitou 6.00 Wasbungtou Stxeet Boston}MA.02111 Tel,#617-727-4900 eyt 406 or-1-877-MASS.AJFE Revised 5-26-05 Fax 0 617-727-7749 utwwmass,go fc..a kv; DEVAL L.PATRICK BARBARA ANTHONY GOVERNOR Commonwealth of Massachusetts UNDERSECRETARY OF OFFICE Division of Professional Licensure OF CONSUMER REGULATFFAIRS ION AND BUSINESS REGULATION GREGORY BIALECKI BOARD OF STATE EXAMINERS OF PLUMBERS & GAS FITTERS MARK R. KMETZ SECRAND ECONOMIC C DEVELOP ENT 1000 Washington Street • Boston . Massachusetts • 02118 PROFESSIONAL DIRECTOR,DIVISION OF CENSURE October 2, 2014 Jianis John Bido 1 Belleau Woods Street Georgetown, MA 01833 Re: Variance PV50—Takeout Restaurant—208 Sutton Street—North.Andover Dear Mr. Bido: Please be advised on October 1, 2014 in the Board Meeting Room, 1000 Washington Street in Boston Massachusetts, the Board of the State Examiners of Plumbers and Gas Fitters deliberated on and voted to Grant a variance from 248 CMR 10.10(1.8)(i).The Board voted to allow the following: • elimination of the current employee rest room in the back of the restaurant • the installation of one unisex restroom in the establishment that is ADA compliant for patrons and staff. This variance decision is based on the presentation information and documentation provided by the applicant and is applicable to this end user and this site only. All other plumbing and gas fitting work, if applicable, shall comply with the rules and regulations of 248 CMR 3.00 through 10.00 and all other applicable statutes and codes. Sincerely, For the Board, 2 Mj" E. J hofsw Wayne E. Thomas, Executive Director Board of State Examiners of Plumbers and Gasfitters cc: Plumbing and Gas Inspector TEL: 617-727-9952 FAX: 617-727-6095 TTY/TDD: 617.727.2099 http://www.mass.govocabr/licensee/dpi-boards/pll I � .e'.i�tb lfij6 North Andover Health Department (ommunity Development Division August 7, 2013 Jianis John Bido 1 Belleau Woods Georgetown,MA Re: New food establishment review;Niki's Famous Roast Beef Pizza and More,208 Sutton Street,North Andover, MA 01845 Dear Mr. Bido, The Health Department received your completed Plan Review application submitted on July 29,2014,for the new establishment"Niki's Famous Roast Beef'located at 208 Sutton Street,North Andover. Unfortunately,the application cannot be approved at this time.The following items below were noted deficient,missing or incomplete from your application.Please revise as needed and resubmit to the Health Department. After submitting items requested,and ensuring that all Health Code concerns are addressed,an approval letter will be generated and the building permit can be signed. It is important that the Health Department ensure compliance to the food code and provide safe food to the public. If you have any questions,please contact the Health Office. If you disagree with any items listed you can put your request in writing. Thank you for your cooperation in this important matter of public health._ We would be happy to speak with you in regards to any portion of this review. Sinceroy, S san Sa er, S/RS Public Health Director Cc: Gerald Brown, Inspector of Buildings 208 Sutton Street Property owner North Andover Health Department, 1600 Osgood Street,Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Items of Deficiency noted Corrective Action Page 6 #1 foods in advance answer "none". Consider your baked item; Fill in answers appropriately manicotti,chicken and broccoli etc.These are not cooked to order #2 N. Andover requests a Servsafe trained person be on staff during Train additional staffas operation.Most places have at least 2 persons on staff trained needed Page 8#8 unclear answer;explain how chicken salad,tuna etc.will be Complete answers as needed made safely;minimizing time in the danger zone. #9 describe how"cleaning the area"will prevent cross contamination #10 you have hamburgers on the menu;are they only well done only or cooked to order? f' Page 7-#4 No Written illness Policy provided as required Please submit written policy Page 7 - #7 and #47 The location of the Prep Sink does not protect the Move prep sink out of ware food. The prep sink should not be in the ware wash area. Separation of wash area. sink use is a key component to limiting opportunities for cross contamination. Page 17#49 question unanswered. Please change to 2,drain No Spec sheet of the three bay sink. Shown that it has only one side boards or identify flow of board. Generally 2 side boards are needed for"wash, rinse, sanitizing", cleaning(left to right.or right with dirty dishes on one side and drying dishes on the alternate side. to left)Change fixture detail Basin size is based on need of items to be washed. Must have two drain where drying will take place. boards or an alternate plan. Page 10 &11 incomplete Information on wall surfaces vague or Completely,fill out all boxes i incomplete;details can be shown on the plan as well. that relate to this project,note 1)Where is FRP(fiberglass reinforced panels)wall covering being placed "not applicable"in each box vs.stainless.Highlight floor plan walls where FRP is to be installed. with no answer needed and 2)Washable surfaces are from floor to what height? submit.Adddetail to,the.floor 3) All coving must be curved and in all high wash areas including plan where needed. Show bathroom. elevation detail if needed to 4)Ceiling has no description on type of ceiling tiles(washable?)where? clarify wall surfaces. 5)Page 11 most boxes incomplete. Page 9#1 States no hot holding.Are you keeping meatballs hot?Are your Answer question;:change as gyros traditional kept hot or frozen product? needed Page 3 MSDS Sheets — No Material Safety Data Sheets for cleaning; Identify all cleansers that you Soaps, Floor Cleaner,Degreaser etc.Note they should be kept in a binder will be utilizing. Submit on the premise;accessible in an emergency.(note page 16) MSDS sheets for all f chemicals on site. North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 i Pg 15 says there is a grease trap inside.No Grease trap shown on plan.No Please submit and locate on Equipment specification sheet.Must be labeled as shown on page 15#1 plan Page 5 #4 Storage of paper goods,non-refrigerated foods etc.;no shelving Please complete and submit showed at all;no spec sheets for shelving;toxics are noted as being stored spec.sheets,Note:wooden in this room. Show shelving. Chemicals must be away from the food shelving not acceptable and items. all must be>6 inches above floor etc. Page 15 # 31 Location for employee belongings? No such area shown. Please consider employee Employees will have coats at minimum;must have suitable locker or area needs and complete answer. Page 11 #8 you answered"no"to pest control.How do you plan to ensure answer pest control without a professional company contracted? Page 12 #16 The grease receptacle should be in the enclosed area that Comply with dumpster houses the trash dumpster. Note also that no diagram is shown on the regulations;must be in an. dumpster application as to the location. enclosed.area provided:on non-l?orous surface. Show on application Page 7 cooking what type of temperature measuring device Fill in.answer; generally metal stem thermometers:0 to 220 degrees? Page 7 #5 incomplete; only chlorine, quaternary ammonia or iodine is Please coinplete answer- acceptable nsweracceptable answer.Must know concentration of chemical being used Page 14#23 unanswered.Not shown on plan? Provide proof of capacity. Page 13 complete form.No initials found. Complete form-.add initials ra ; Page 3 #6 the plan shows that the cooking area does not have a Please revise plan as hand sink within ten feet. One hand sink must be within each of the needed so that there is a areas of a kitchen;ware wash,prep and service. A sink must be Band sink accessible within easily accessible and within 10 feet of the areas. There is not a hand 10 feet of cooking,washing sink within 10 feet of the prep and cooking area or the front and preparation and service unpackaged dessert display is likely the pay area.There should be a areas. Possibly back to sink available to access between service and payment. back w/the service area hand sink- North inkNorth Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 f R Plan shows pizza oven not against a wall rather in middle of the Consider alternate location walk way. This unit needs to be vented and employees need to be for the pizza oven protected from the heat Plan shows slop sink in the prep area,next to prep table. Food must Consider alternate location be protected. The mops must be hung over the slop sink. for the slop sink. Page 16 #40 No hood shown; Exhaust Hood design should be approved Add hood details to page 16 by the Fire Dept.before you apply for the permit to build and location on the floor plan Specification sheets submitted; specific units noted do not match Review each unit to be sure the plan. Please be sure the item number matches what size fits.For the proper size is being example item 3 is 67 inches long; yet#3 on the plan shows room purchased. for only a 4 foot unit. Item 4 is 46 inches long and the plan shows room for a 2 foot unit. 1 North Andover Health Department, 1600 Osgood Street,Suite 2035, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476