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HomeMy WebLinkAboutBuilding Permit #827-2017 - 350 WINTHROP AVENUE 5/1/2018 BUILDING PERMIT 0 ORT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0 Permit No#. Date Received sSe • CHU Date Issued: ORTANT:Applicant must complete all items on this page 7 11 r -,LOCM 7J PRTY 4 � j 71-TA J . ;4 =4e ur util, REL ZONING flu DISTRICT S T s no-- R I Mjbfii s no L TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition 0 Two or more family 0 Industrial —0 Alteration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other I­ . . n 10 et 8 _ 0 Septic 0 Floodplain nd Wk. .8 0 a rsIi6aDistrict istri6 . _Water/-Sewer. DESCRIPTION OF WORK TO BE PERFORMED: A 36A2-6 0-YI io /17 Or--L4,5 a)Ll 7 q 2_4-?> Identification- Please Type or Print Clearly' �qq VOWNER: Name: 614­167- S - C=:i k Phone: Address: ��C) W i pc_ N. /9" evg-� gQ 7Arlirir Date,., Home impEit License: oxo; Date ARCHITECT/ENGINEER Phone: Address: Req. No. FEE SCHEDULE.BULDING PERMIT.$1Z00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ,Total Project Cost: $ FEE: $ Check No.: Z Receipt No NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund ig atUro of contractor Plans Submitted ❑ Plans Waived 01 Certified Plot Plan ❑ Stamped Plans ❑ TypF OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swunming Po s Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank; etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR®FFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVEL07MENT Reviewed On Signature_ .COMMENTS 1 , t CONSERVATION Reuiewed on Signature � i r f COMMENTS / i 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 Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -.Temp Dumpster on site ye5 no Located at 124 Main Street Fire Department signatureldate � COMMENTS r - -)imension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop.,requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) I i ® Notified for pickup Call Email ate Time Contact Name Doc.Building Pennit Revised 2014 s 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 ❑ Building 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/Cross Section/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 JOIE: 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 must be submitted with the building application Doc:Building Permit Revised 2014 Location �" ` � No.Z2 7 V 7 Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ c Check#6z CJ Bu lding Inspector C 1509 x r 1 NORTH . . .A . - Ve: :' 01?4 -zol-�Lti to h ver, MaSS, � coc..Ic.uwrc.. �'�' A0RA rjE S V BOARD OF HEALTH -PERMIT T L D Food/Kitchen Septic System THIS CERTIFIES THAT F0 � w ................•,•, BUILDING INSPECTOR has permission to erect ........... buildings on .... ,-' .../ .. .... .�(, .. �� Foundation Rough to be occupied as ..... ... ... Q g ��. �i��........... .... ... ..... cO'.. ................................. Chimney provided that the person accepting t is 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 y Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CON 0 S Rough Service . ....... . .... .... ........... ............ Final BUILDING I SPECTO 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. 2'he Commonweauh of Massachusetts _ Depart tentofIndastrialAccidents e F = X congress street,,5`utt 100 -= d Boston,MA 02114 2017 • °�+y sJyv' www.mass govtdia WvkexcompensationlwuranCeAfi ��B aTO BE� a �OAOxs ,-triczans/ Iumbexs. .Blease Print Le ' I A ••lioxmation ation/Individual): c Name(Business/Ozga�iiz • Address: �r� � �� W— n t' Thone#: C � � Moo CztylStatalZxp: � I�-1)'7r (�'y .... .. : :_.. __ employGhecItiie appropriafa box: Type of project(Tegro�t'ed); Areyou an er? employees(fall and/or parttime). 7. C(NdWtconstruction 1.❑I am a employer with 2_❑I am a sole proprietor or partnergh'P sndhave no employees working forme in 8. ElRen7 o delink capacity.LI�Toworkers'comp.insurance required.] 9. ❑Demolition P aay 3.Q I am ahomeowner doing all work myself jN-0workers'comp,insurancerequired]' 10❑Building additiflR ¢_Qlamahomeowneraudw�7lbeJ ngcoufzactorstoconducts7lworkonmyproPerty.IwiU II.[(Elec�icalPepausoradditions ensorethat all co�tors eitherhave workers'compensation insurance or are sole (Plwnbing repairs or additions proprietors with no employees. 5.❑T am a general conuacfoz and Ibave hsedthe sob-contractors listed onthe attached cheek I3.[]Ro6frepairs se sub-contractors have employees andhaYeworkers'comp.insurance. I4.�Other 6. �e area c"PratioA and its,offices have exercisedtbeirrigbt of exemption perMGL G. 152,§1(4),"4!v have no empldyees-[Noworlres'comp.in=ance_regnired_] anewaffidavitindi�v Bach *Any applicantthatcheclsbbit#lmustalsofillo e are doing all workw?ndthenhireordsidecontractosmustsUfit Pensation policy atiom Homeowners who snbmii•this affidavit indicating ey tConiractorsthat checkthisBoxmustaitachedanadditiondsheet showing the name ofhesub c contractors andstatewheflrerornotthosee lies ave employees. If the sub-coniiactors have employees,they must pro Aide their workers co P Y am an em 'Dyers that is providir2gworkers'compensation insurancefor my employees Below is tliepolicy arzd job site X p information. P3 j 7 D Insurance Coampany Name:. ExpirationDate� Policy#or Self-ins.Lic.#: � we City/State/Zip: lob Site Address: the otic number and expiration.date). Attach a copy ofthe vvoxkexs' compensationpolzey declaration (showzag p y by a ffib up to$1,500-00 Failure to secure coverage as required underMGL e.e2 £a and/or one-year imprisonment, STpunishableal-violation OP WORK ORDER and a fine of4 to 12$0.00 a as well as civil penalties in the£zm o day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for irLsurance coverage verification. under the airzs andpenalties ofperjury tizat the information provided move is tr ire c ��c/orrec Ido lieneliy certify p d a �' ' / � Date: u Si ature: _ i Q Phone#: -l $ Qfficial use only. Do riot write in this area,to be completed by city OF town n o • pexzniE/Lieense# City or Town' Issuing Authority(circle one): ector 5.pinxnbing Znspectox I..Board of Ifealth 2.Building D epartment 3.City/Town Clerk d.L+lectrieal Xnsp 6.other Phone#€: r meati +-PPvu-m: 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'd'efizted 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,dust&of an individual,partnership,association or other legal entity,employing emplbyees:.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 b6 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 bush ess ox to construct buildings in the commonwealth for any applicantwhd ltas not produced-acceptable evidence of compliancewith t$e znsurance coverage iequ ed." 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 insuzance 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=contractor(s)name(s),address(es)andphonenumber(s)alongwiththeir certificate(s)of insurance: Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno 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 maybe submitted to the Department of Industrial ` Accidents for confirmation ofinsurance coverage. Also be sure to sign and date t'ae affidavit. Theaff2avitshaald be returned to the city or town that the application for the permit or license is being requ(Fted,not the Department of Industrial•Accidents. Should you have any questions regarding the law or if you are required to obtain a-�rorkers' compensatio:6 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 atthe 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 b een officially stamp ed 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. Anew affidavit must be$fled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or comm excial venture (i.e.adog license orpermit toburn leaves etc)said personis NOT required to complete ete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617.727-4900 ext.7406 or 1-877-MA.SS.AFE Fax# 617-727-7749 Revised 02-23-15 www.mass.gov/dia 3 ux'v vU�"`��'e`'f' �a� �-��p�_� �� L L Date. . HORTk °f -to , TOWN OF NORTH ANDOVER 1 O D PERMIT FOR GAS INSTALLATION �,SSACHUSES This certifies that . . `�!^j. . .C.�.� '. . . . . . . . . . . . . . . . . . . . . has permission for gas installation .2p �z"� ti� ' . . . . . . in the buildings of . . . �v. . . . . !.`�. .� '.o°. . . . . . . . . . . . . . . . . • . at .,-� �.�. . !i�. 'r" . . n.v`�, North Andov r, Mass. " Fee. . .ta.�. . . Lic. No.I.3��`�. GASINSPECTOR Check# n 4398 MASSACHUSETTS UNIFORM APPLICATON FOR PERMTr TO DO GAS WrING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Locations /i/f w Permit# Amount$ Owner's Name New❑ Renovation ❑� Replacement ❑ Plans Submitted ❑ w v� U a Cfjx a o . c w ° a c o w @ x G a O x w w v� d x w -< i 1 0 0", SUB-BASEM ENT BASEMENT IST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH . FLOOR 5TH. FLOOR 6TH. FLOOR 7TH . FLOOR 8TH . FLOOR L] or type) (75— (J�� ��✓ C�one: Certificate Installing Company Name Address .5 ��'�%2 Z S rJ f1✓� ❑ Partner. Business Telephone r ��5 0 -S 7 2 Z Firrn/Co. Name of Licensed Plumber or Gas Fitter �J /�J C. (�✓ / INSURANCE COVERAGE Check one: I have a current liability Insurance poli"' it's substantial equivalent. Yes D No❑ If you have checked M,please indi a the type coverage by checking the appropriate box- Liability ox Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed un ermit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Sta Code anapter N2 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title ❑ Plumber /' 3 Z K City/Town ❑ Gas Fitter License Numoer �l�ter { APPROVED(OFFICE USE ONLY) ❑ Journeyman TOWN OF NORTH ANDOVER OFFICE OF LICENSING COMMISSION 120 MAIN STREET NORTH ANDOVER,MASSACHUSETTS 01845 NORTil Donald B.Stewart,Chairman William B.Duffy,Jr. ,°� A Telephone(978)688-9500 Susan M.Haltmaier. + * FAX(978)688-9556 Rosemary C.Smedile ' *° James M.Xenakis �9Ss�CH- 0 Memorandum u 10 To: Building Inspector z � k1� Chief of Police / co Fire Chief L Board of Health e �u Commission on Disability Issues CJ cN From: JanL E As ' own Clerk Date: Nove ber 23, 2004 Subject: Bollywood Grill 350 Winthrop Avenue 4 Attached please find the plan for Alterations to the Premises, from Bollywood Grill, 350 Winthrop Avenue,North Andover, MA. This is a formality as the alterations have already been completed. It a requirement of the Alcohol Beverages Control Commission,that alterations to any establishment holding a liquor license be approved of by the local licensing authority and then by the A.B.C.C. Please review and respond by Friday, December 10,2004, as this will be on the agenda for the Licensing Commission on December 20,2004. My E-mail address is 'eaton townofnorthandover.com ifou would like to E-mail your response. Thank you in advance for your immediate at in this mattekEDEIVED NOV 3 0 2004 BUILDING DEPT. R Froezer Ice Mach Refrig Re*% Servic S"� Walk-in Ref Ei Prep Area-Ex d r Kitchen-Ex Ge Dishwashing Hoo -Ex _ G J° KFC To Hood(Exist) �0k Hood Ex HC ow Dining t i FD-Ex Hood-Ex y� Hallway-Ex A- Closet F. Toil M. Toil & I . . r Walk-In Refri 1 0 CEO CBI L------i Dining 5a. ■ First Floor Plan Scale 1/4"44" NORTH 0 O 0 - 4 ®veer h Q - L == o dover, Mass., 3 `� -a �40� T COC HIC ME WICK � ADRATED S H BOARD OF HEALTH Food/KitchenPERMIT T D Septic System THIS CERTIFIES THAT.7)e 7�a..... �........... .7 .... R.....��..D....ytvo a/'d��v� Fo NSP5 f �T� �/ Q /�e S� BUILDING INSPECTOR ............. eudat-ien- { has permission to dte�at.../.................................... buildings on .................................................. Rough ��7�c��t.�ZA F to be occupied as.... . .6rM-clvrdv � ... eChimney ... ........ A . ......... .. ............h.. ..... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in ""o'Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of .v. Buildings in the Town of North Andover. G1o? _ 4 — 8 cj►�/, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. A" HERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION STARTS ELECTRI AL T Ec - `......� ..................... Service BUILDING INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough _v Display in a Conspicuous Place on the Premises — Do Not Remove 1 S' No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. BurnerFlRE DEPARTMENT Street No. SEE REVERSE SIDE smoke Det. THE COMMONWEALTH OF MASSACHUSETTS TOWN OF NORTH ANDOVER In accordance with the Massachusetts State Building Code, Section 106.5 this CERTIFICATE OF INSPECTION IS ISSUED TO BOLLYWOOD RESTARAUNT I CERTIFY THAT I have inspected the premise known as BOLLYWOOD RESTARAUNT Located at 350 WINTHROP AVE in the TOWN of NORTH ANDOVER COUNTY OF ESSEX, Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: BY STORY Story 1st Capacity 70 Story Capacity Story Capacity Story Capacity Story Capacity Story Capacity Place of Assembly or structure. Capacity Place of Assembly or structure. Capacity 350-2002 JUNE 20, 2002 JUNE 20, 2003 Certificate Number Date Certificate Issued Date Certificate Expires Building Official 3550 5 Date.....(.. d-- ir N°RTM o TOWN OF NORTH ANDOVER '° PERMIT FOR WIRING ,SSACMUS� This certifies that ....... ... ...!... 1...:..........5...nc............. s ... ..�.�••••• 'fias permission to perform .......... ..�a.................................................... J / wiring in the building of............ ................................................. at....��..�...v......V v..< <� c7 u > � . orth Andover, s. ...... ....... .�....... ............ �S' L33. ECTRICAL INSPE Check # , Commonwealth of Massachusetts Official Use Only . LL/ ` of Fire Services Permit No. Department Occupancy and Fee Checked _ BOARD OF FIRE PREVENTION REGULATIONS (Rev. 11/99] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC), CMR 12.00 (PLEASE PRINT IN INK OR TYPE L INFORMATION) Date: 5�`&0 012- City or Town of: U (PV IJ&0 i)-2.t_ To the Inspector of Wires: By this application the undersigned gives notice of this or her intention to pertNu-e— Owner m the electrical work described below. Location (Street&Numbe 35-0 W ✓-4� r G or Tenant 0 lyq W-o O eq— Y' I Telephone No. W-C -7,Yi R) Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Ithorization No. Existing Service Amps / Volts Overhead❑ Undgrd❑ No. of Meters e New Service • Amps f Volts Overheadg ❑ find rd No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the followin table may be waived by the Inspector of Wires. No.of Recessed Fixtures No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Lighting Outlets No.of Hot Tubs Generators KVA No.of Lighting Fixtures Swimming Pool Above ❑ In- o.o Units-Emergency Lighting g g rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No. of Gas Burners o.oDetection and Initiating Devices No.of Ranges No.of Air Cond. Tonal No. of Alerting Devices Heat Pump Number Tons KW No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Municrch l F-1 Other No.of Dryers Heating Appliances KW curi S stems ces or Equivalent No. of Water KW No.of No. o Data Wiring: Heaters Sins Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: Attach additional detail if desired.or as required by the Inspector of Wires. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Ele tric Work 4 4, '4 (When required by municipal policy.) Work to Start: 4& (),-9' Inspections to be requested in accordance with MEC Rule 10, and upon completion. I cert, under the pains and penalties ofperjury, that the information on this application is true and complete. FIRM NAME: LIC.NO.: Licensee: John S. Bassett Signature LIC.NO.: 1533C (Ifapplicable, enter"exempt"in the license number line.) Bus.Tel. No.- 603 5945928 Address: Alt.Tel.No.: OWNER'S INSURANCE WAIVER: I am aware that the Lid, see does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: Signature Telephone No. Date. .r) -3 °3 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,O��rm^A�•(5 �,SSACH This certifies that . . . . . . . . . . . . . . . . . . has permission to perform . . . . �� �.r v^' . . . .��/.�'�'`. . . . . plumbing in the buildings of . . . l.. ... .� ` . w n .. . at. . 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. North Andover, Mass. -o Fee. �L15.'. . . .Lic. Na� y . ��to� 2 .+. . . . .� PLUMBING INSPECTOR Check # I f s 5651 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO ISO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS `7 De /J�' Building Location `t �l U Owners Name d /( E oo l Permit# Amount ! S D Type of Occupancy New Renovation Replacement ® Plans Submitted"Yes No FIXTURES StBTEW WS90M ISL RDM ZD FIDQ2 �FIDCR M FIDOt 5]H RDCR 61H FLO(R 7IH HDCt SIH RDM (Print'or type) f Check one: Certificate Installing Company Name Z- u "d C�7 J/ 1-1 Corp. Address 2�S�� ❑ Partner. Business Telephone u Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity D Bond Insurance Waiver: I,the undersigned,have been made aware that the licensee of this application does not have any one of the above the surance Signature Owner F1 Agent I hereby certify that all of the details and information I have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and insta!!0iof5rperformed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massa Plum ode�nd-Chapter 142 of the General Laws. By: Signature ot LicensMum r Type of Plumbing License Title . 3 2, (Y City/Town License TNum5er Master �Joume an APPROVED(OFFICE USE ONLY r i Location �' �^, ?� "� 14 No. No. Date "03 NORT„ TOWN OF NORTH ANDOVER O? 6. 1° •• OOs r1 a ' Certificate of Occupancy $ # i # #o �'�s'••° E<�' Building/Frame Permit Fee $ S ACMu`+ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ �' Check # 16343 : 11 - � Building Inspector/ o )S� TOWN OF N�RTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING RI OTHER THAN A ONE OR TWO FAMILY DWELLING s Section for Official Use Dnl BUILDING PERNUT NUMBER: / DATE ISSUED: 0 SIGNATURE: - Building Comnussioner/I or of Buildings Date A 1.1 Property Address: 1.2 Assessors Map and Parcel Number: ^ ,) I VX i4l ro 0- 31 /V - A (1 p�o i A Ertr Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: v Zoning District Proposed Use Lot Area Frontage ft 1.6 BUILDING SETBACKS(ft) m Front Yard Side Yard Rear Yard G` Required Provide Reqttired Provided ReqWred Provided \� 1.7 WaterS°�ly M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: 1` Public { Private 0 Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ 2.1 Owner of Record 1 a dei ,I�T1( 4 2'7 l�d' � 54 , r o�EF7� O Name(Print) �,�n n �u 9 Address for Service: I_ X1.4 71' T1 oZ®c m Sig—*Tffe (� Telephone 2.2 Authorized Agent JAsl)l d c�&21 HAKtU�tyd Ate. 13 s70�J i1.4 0110 Z Nam ri Address for Service: 3 3Z- O ASi Telephone Z +<y Mx q.. 't. dei S,. 90 •3.1 Licensed Construction Supervisor Not plicable ❑ Q �S7oit/ M� L I 0 9� 6 P Address License Number O In e��c L! 11���0 m Licensed Construction Supervisor: 4 C\�0 .4 -�� (' 1244453z, 4 5 L Expiration Date d r' Si % elephone 3. Re 'stered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number m r Address r Expiration Date' ^Z YI Signature Telephone as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name 0 Si Owner/ nt Date Item Estimated Cost(Dollars)to be r Completed by permit applicantQ 1. Building (a) Building Permit Fee U t) Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing 3 O U O Building Permit fee (a)x(b) / 4 Mechanical(HVAC) f 5 Fire Protection ` 6 Total (1+2+3+4+5) Check Number UD uYSv)�.�,e�Ytia ys{ Ae �'t'`. N'.( �T��`f ra^ lpp#� ,;:;✓t rl�f{�G. }r Ya-k.{�,> r��.+i;$"Yj r � x';:; r r z >.� P >� s vt yd'gv F^ si���Y NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3 SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS , SIZE OF FOOTING X MATERIAL OF CBI NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE s. a tr`�, ;"��'-r�'�R 'K' „ t, s s*'kx +.e r` � � y'4�. -k •.c r 'y.._. _ -.r .. r ,..�.tv.....: .�,''" a�.5, "��!' mss. e. Workers Compensation Insurance affidavit st be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building rmit. -Signed affidavit Attached Yea....... No.......❑ sEc o>�l s lP> cel ©tal��src�r A c�NM-1 , t c xvrl MC>rrs COl+iS TgIICTI4N CQflL_1P�T��b ;1l6(+1:+ ANtI > � r GFr OF�g1CIAS'�D S1�'Aj 5.1 Registered Architect: - A ALM It Name: I , 5L)MA4 11 q2. Address Am,17A Sio6tA , Telephone s.2 Regis ed ►fgale � vr, Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ _ Name: Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable ❑ Company Name: Responsible in Charge of Construction New Construction 0 Existing Building Repair(s) ❑ Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: t�&arX 7g USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 ❑ IA ❑ A-4 ❑ A-5 ❑ IB 0 B Business ❑ 2A 0 C Educational ❑ 2B 0 F Factory ❑ F-I ❑ F-2 0 2C 0 H High Hazard 0 3A 0 IInstitutional 0 I-1 0 I-2 0 I-3 0 3B 0 M Mercantile ❑ 4 0 R residential ❑ R-I 0 R-2 ❑ R-3 0 5A ❑ S Storage 0 S-1 ❑ S-2 ❑ 5B 0 U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: m BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include •Basement levels Floor Area per Floor s Total Area s •Total Height ft Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �R I, �t4 -4v ,as Owner of the su�ject property Hereby authorize =�� Cffi,- a L, to act on My behalf,in all matters relative two work authorized by this building permit application -/0 Signature of Owner ��6 �) : Date 3 17 - ✓>'re VammonlupQl� a�:/,f2'a�ac�usel�'e BOARD OF BUILDING REGULATION; License: CONSTRUCTION SUPERVISOR Number: CS 083561 s Birthdate: 12/06/1979 Expires: 12/0672006 Tr.no: 83561 Restricted: 00 JASON M CHUI 60 DEAN RD WESTON, MA 02493 Administrator CI4/[cftf7CJ.7 1[:yrJ Cit7CJlJCTt]YJCICICII7CJ VtWIZIHK 11VJ INN, rAut 171 KIIIAC-00RD_ CERTIFICATE CF LIABILITY INSURANCE ID 1 �04 22/03 4 PRODUCER THIS-CERTIFICATE 18 ISSUED ASA MATTE IN ORMATIO Dadgam insurawne Agency, Inc. ONLY AND COWFEM NO R1Gf1TS UPON THE CERTIFICATE 600 West Cu rings Park HOLDER.THUS CERTIFICATE ROES NOT AMEND,EXTEND OR Suite 6725 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Woburn MR 01801 Phone:781-933-2626 Itaz:781-932-6361 INSURERS AFFORDING COVERAGE NAIL 0 WWI= arsuRER A First Financial Insurance Cc . MURER 8: Liberty Mutual I nsuranm CO. IDS Construction, Ing, INSURER C: ssbella Protection 99 Harrison Avenue, lid floor INSURER O: Boston NA 02111 INSTIRER E COVERAGES THE PCIIC}ES OF NSURANGE LISTHD BELJDW HAVE BEEN ISSUED TO THE NSURED NAMIED ABOVE FOR THE POLICY PERIOD NDICIITED•NOTWITHSTANDING ANY REOIRRl81AENT,TE MA OR OONWION OF ANY CONTPACT OR OTHER DOCUMENT VMITH RESPECT TO WHICH TINS ceRTIFICATE MAY BE ISSUED OR MAY PERTAN.TME NSURAWK AFFORGFD BY TM POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEMA,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AQOREOATE LMRE MOM MAY HAVE SEEN REDUCED By PAD CLAW, LTR"ImmWA POLICTIFFECTIVE TYPE of NCE POLICY MUNBER DATE Ulm GENERALUASUTY FACHOCCURRENCE $1000000 >1 X 00MMERCIALGTaRALLIAimTn To BE ISSUED 02/25/03 02/2S/04 PRWISE6 XR oxummmx100000 C LWMS MADE a OCCUR MEG FXP(Any one pawn) $5000 SONALGADV INJURY $ 1000000 GENERAL AWREGATE s2000000 GOWLAGGREGATELIMIT APPLIESPER: PRODUCTS-COMRWAGG $1000000 POLICY ZT JETLAC Ben. -'0- AUTONAM LE t.VV61 M COMBWED LIMB C ANYAUTO 00016400000 03/24/03 03/24/04 (Ea—W-4x1000000 ALL OWNED AUTOS BODILY INJURY X SCHEDULED OkUMS (Pe PPWQ = MRED AUTOS BODILY ROURY NOWNIINED AUTOS Ww"we" s ` PROPERTY OAUAGE 9 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCE&SATMBRELLA LIABILITY EACH OCCURRENCE f OCCUR 71 CLAIMS MADE AGGREGATE i S DEDUCTIBLE —- RETENTION $ t WOWERINCOMPEM&AMNAND TORY Lows ER B EWLDYERV LL48MM m"ro —mm 09/10/02 09/10/03 EL.EACHACCTOEMT $1000000 ANY PROPR MV40ARrNWMeCUTIVS OVIRCERIMEMBER O(CLUDEDO E.L.DISEASE-EA EMPLOYEg S 100 D 000 $Pt& sdet LL PRO b1lISlON9 bebw E.L.OtmASE•POLICY LIMB S 1000000 OTHER DESCRIPTION OP OPERATIONS I LOGATIONG I VOOMM/QCLYSOM ADDED BY OMR9E Mff I9PEGAL PRW4WI1D s Carpentry NOC CERTIFICATE HOLDER CANCELLATION To IgRM SHOULD ANY OF THE ABOVE DESCRBND POUGES BE CAMMLEO KPe RF THE EIL mTION DATE THBTWF.THE aww osum WILL ENDEAVOR TD MALL 20 DAYS WRITTEN Town of li Andover NOTICE TO THE CERTNRCATE"OLDER MAIM TO THE LEFT.BUT FAIWRE TO DO SO SHALL Attn: Building Depastmm t WOW No 6*30ATIOy oA UADUTT OF ANY KIND UPON THE INSURER,RS AGENTS OR Andover MA REPRESENTATIVE& AunIDR�Ts AT11iE ar•nwn 91 ranm1511 m eRnan I!nwPAPATInTM , North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that.the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S.150 A.. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through.the Office of the Building Inspector G The Commonwealth of Massachusetts a Department of Industrial Accidents A Office of Investigations Boston, Mass. 02111 °�M 5�• Workers'Compensation Insurance Affidavit Name Please Print Name: Location: City Phone # Q1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity E�I am an employer providing workers'compensation for my employees working on this job. Compaa name: Address �� (�ci(-r'-1 5 0✓� / i 1 Ci . Z/ ) Phone#: Insurance.Co. Policy# Company name: Address City:. Phone* Insurance Co. Policy Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to$1,500.00 and/or one years'imprisonment-m-wa l_as_civi pmakmjn-tbelcxmjof a-STi2P3MDRKDRDEP and afmWl$1DAQD)$jlaY mei 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. /oto hereby the pains and penalties of perjury that the Mormahm provided above is true and comeet Signature G p Y/3 6 ,print name �'1 C U) PbDne-# Official use only do not write in this area to be completed by city or town officiar City or Town Permit/l icensi � Building Dept Check if immediate response is required Llcens#V Board. p Selectman's Office Contact person: Phone A E] Health Department F, Other . . I�es�zra�Nfi FORM U - LOT RELEASE FORM 3-� rs, 03 INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION APPLICANT /I/ //I— LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT(S) STREET ST. NUMBER **************** OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS t' TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS (L FOOD INSPECTOR-HEALTH DATE APPROVED v%l 2A! os • DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED II DATE REJECTED COMMENTS l� C l/l {,L,) �,J I cAJ `��4� 01 c G'� CJ,� ✓�Q �� �t��� 1S)d.pS ��` �1JN of t,,.��' ��� ����J� � �I�E-off° �nSP-. PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE_ Revised 9W jm May 05 03 10:: 08a (61 7) 338-8082 p. 1 I D A Full Service Company Coll ftzvctlma Inc. 89 Harrison Ave.,2 FI Boston,MA 02111 T0,(617)-338-8688 Fta:(617)33S-5082 Apr 114,200 Bollywood Indian Restaurant 350 Withdrop Ave. N.Andover,Ma P R 0 P 0 S A L Kitchen work 7. Reinstall new owner supplied walk-in Cooler. 2. Install one new H.G. restroom and finish with half wall tile. 3. Sot up now kitchen equipment as shown.(electrical&plumbing) 4. Patoh all exiting kitchen quarry the as needed. S. Install s.s.panel at back of the dishwasher and other wall. Ner+r_dlnieat_P_ m 'l. Remove existing suspended ceiling and joists. 2. Install new suspended ceiling as per final design. 3. Alter existing sprinkler height as needed. 4. Install new lighting fixture AS per final design. (Fixture allowance$3,000) S. Install carpet 1 ceramic Nis In dining room as per final design. 6. Refinish existing wall as needed and install new vinyl wall paper. 7. Install interior doors and miscellaneous hardware as needed. Total: $76,000.00 s�ta�a'eema: ACCEPTANCE OP rROPO S A L THEMOVEMr=P'MCIFICAVOMANO0QN0=NSARC SAW-ACTURYANDHL•REBYACCEPTEG, YOuMEAutmoxa&? TO DS1 THE N'ORKAS SPFCFLED.ALL EXTRA WOM TO SE COAftEreo ONLY UPON Wl..rM!N OROMS AND Wd16FCOME AN LX W CHARGE OVER AND ABOWE THE ESTMATE. OWNER TO GARRY FIRE HAMP&SURANGE. 1 Client: ata Edwin Chug Date NORTH T E own of Andover 0 (A No. q61 0 t- I-- over, Mass., 80 0 RATED P'? Cl BOARD OF HEALTH Food/Kitchen PERM 'IT . T D Septic System THIS CERTIFIES THAT.1>9.14.4.1.4.04&..JRl, 1 %4C.6pI.t 6CA 6116k11BUILDING INSPECTOR ........ ... ... ..... ...... ... ...... .4 .. . ... ... ....... . ...... Foundation has permission to erect.. buildings on ....3SP W%A210%%fop AWL Rough Chimney to be occupied as..... Ittv A ..... ....... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final rovi 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. / & sb 00� PLUMBING INSPECTOR IDVI3 1 ob VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION S ELECTRICAL INSPECTOR T TSS Rough ........-*INA**.................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not. Remove Rough Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. LEE REVERSE SIDE Smoke Det.