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Home My WebLink AboutBuilding Permit #33 - 80 MAPLE AVENUE 7/16/2007 AORTH BUILDING PERMIT TOWN OF NORTH ANDOVER F p APPLICATION FPLAN EXAMINATION * �, Permit NO: Date Received � Z `� �9s A4reD SAC HU`+ Date Issued: W- 1-IMPORTANT: Applicant m comp to all items on this page Axa•,', �c�a A( �,,; 11 � � �"� _ •�'�an ! MA �W✓e» �"�A' yKSf � Mak'� �, �N ?� � �n��` , Awa � ZONING� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family F1 Addition [I Two or more family 11 Industrial Iteration No. of units: ❑ Commercial 1 thers: �C h ❑ Repair, replacement ❑ Assessory Bldg ❑ M-molition ❑ Other n lay �� tl �ds � W�tes ciIr �� e t�� ell F � 3 DESCRIPTION OF WORK TO BE PREFORMED: .. Identification Please Typ=A.) learly) /7"Z 5/ !,010 l OWNER: Name: L� L� Phone: `' Address c)/c:2/ hbej /' "z ft �CIl1;'SS f 011-1-4 t pE' t1 fll'a C3 onrubti6i LA, i i ARCHITECT/ENGINEER R&VI" ��( � �� '� Phone: Address: 026 ;?— yl/GC„ Reg. No. �0�7 FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ y FEE: $ 'r,W Check No.: � /0 _Receipt No.: 2,0 NOTE: Persons contracting with unregistered con ractors do not have access to a guaranty fund na tureb contrcto ' Snatur�e of�er� wi�e ,.. .. 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 ,wilding Permit Application ❑ iffer�eyetl Plot Plan , Workers Comp Affidavit � ,p0 0 Copy of H.I.C. And C.S.L. Licenses 0., Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) y ❑ Mass check Energy Compliance Report (If Applicable) y ❑ 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 heRegistryust mof De decision One copy and proof of recording that the appeal period is over. The applicant must then get this recorded must be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/BodySwimming Pools ❑ Art ❑ Well ❑ Tobacco Sales ❑,/ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site LJ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM / I DATE REJECTED DATE APPROVED P NNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED C SERVATION ❑ F1j COMMENTS DATE REJECTED DATEP OVED 7f13v HEALTH ❑ l 7 COMMENTS a-o I 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 Located at 384 Osgood Street FIRE DEPS ,Eli ANT ft) Dempster Yr tedt�424 ` r�Ell y# SAR3Rl�,f.. #a•D�i.� t ''r/ Sfha` reai.� ., ..w�,,., n.. �... ,.,p, a.. ,. ...., .-: �- _.; A°y„ ,t. .:,„ . -•.:. •. ...., ��` „.ter*, ,.'. �.t.:'. 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.s100-s1000 fine NOTES and DATA— For department use r 0 O ❑ Notified for pickup - Date ..................................................................................................................................................................................................................................................................... ................................................................................................................................................................... ......................................................... Doc.Building Permit Revised 2007 Location .1, �- Date No. • NORT1y TOWN OF NORTH ANDOVER O F S Certificate of Occupancy $ �.�s"••° '�� Building/Frame Permit Fee $ ,4 s�CHUSE Foundation Permit Fee $ Other,Permit Fee $ TOTAL $ a Q Check # 243 �)G Building Inspector ,d f pORTH Q �tLEO I6• IiIO l C ti C O � jL11 � I ' �' � ebb •� O ♦wce q, 'pA COCMCNl wKM♦V ��SSACHUS PUBLIC HEALTH DEPARTMENT Community Development Division Att. C/o Nick Ippolito,Maint. Dir. St. Michael's School 80 Maple Ave. No. Andover, MA 01845 July 12, 2007 Re: Plan review"St. Michael's School kitchen" C Dear Mr.Ippolito, The Health Department has received your application submitted on July 9, 2007 for a remodel of the kitchen at the St. Michael's School. This plan has been approved. The Building Department will receive a copy of this approval letter. The following detail is the process going forward. Once basic construction is complete and the equipment is in place, please contact the health office for a construction inspection to verify that you have built it to plan. At that time we will sign off the building permit. The final health inspection should be requested approximately 24- 48 hours prior to opening the establishment. At the final inspection, it is expected that the premises will be ready for business.. Some items needed to receive the permit to operate are: 1) The establishment will be clean of all construction materials 2) The handsmk and bathroom will be stocked with a wall mounted paper towel and soap dispensers 3) The ladies room will have a covered trash can for feminine item disposal 4) Bathroom must have"employee must wash hands before returning to work" signage 5) Handsinks should be labeled"hand wash only" 6) There must be test strips for the Chlorine sanitizer on site 7) Directions on mixing the sanitizer should be posted. 8) The three-bay should be labeled "wash, rinse, sanitize" 9) Gloves must be on site. Please note that the state does not recommend the use of latex gloves due to some person's sensitivity to latex that may cause them illness. 10)You must obtain copies of the state and federal food codes and keep them on premises 11)At minimum, employees should be trained on the sick policy and sanitation basics. i 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com Please contact this office if you have any questions. We look forward to continue working with ' you through this remodel of your kitchen. Thank you for your cooperation. Sincer Z'S u Sawyer S/R Public Health Director Cc: Nfichele Grant, Health Inspector North Andover Building Dept. i 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com NORTH Town of : Andover 3 _ X_ LAK O dover, Mass., COCMICMEWICK ADRATE `S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT /C. 6 ¢�yJ ' �' '�G ""' �//�� UILDING INSPECTOR /'..1,l.... .. C..S.-......... .......... Q ................... Fdoundation has permission to erect......... ........................... buildings on .&F.P... ... 41ve......................................... Rough to be occupied as �,�.�r.Glc.1.. .. ...6.. �� EPS ........................................ Chimney .. .. ... . Y .............�....... ......... . provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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. J1'o/may- PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITT EXPIRES IN 6 MOtWHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONARTS Rough .............. ................ ......................................................................:... rvice BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premise's — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. y�,7 n�Q O o Oq,lDo, o, w N ct� �►. .A✓ z w o � ri w•;: G � . 00 CP G�� \ c G�,� NO O \ NN' •> ZN t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgovId Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers u de`rs/Cont A licant Information ractors/Electricians/Plumbers Please Print Legibly Name(Business/Organization/individual): / . 1 cK Address: 14 v TFiC� City/State/Zip:A l0 7 / � Phone#: 7k�- 7F�! Are you an employer?Check the appropriate box: 1• I am a employer withgeneral Type of project(required): employees(full and/or P ),�� ❑ have-hired the sub-contractorsconctor�d I 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet,t 7. Remodeling and have no employees These sub-contractors e 8. Demolition for me in ancapacity.ty. workers'comp.insurance. [No workers'comp, insurance 5. ❑ We area corporation and its 9 E]Building addition F required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 1/.❑Plumbing 1 repairs or additions myself.[No workers'comp. C. 152 1(4), repairs or additions insurance required.]t employees. and we have no 12.❑Roof repairs [No workers comp.insurance required.] 13.[]Other *Any applicant that checks box#I must also fill out the section below showing their workers'compolicy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new afl5davit indica 'Contractors that check this box must attached an additional sheet showing the name of the sub�ont oto and their workers' . bng such. I am an employer that is providing workers'compensation insurance for my employees. Below is the policyy an d bb cy information. information, / J tte Insurance Company Name:SC Policy#or Self-ins. Lic. #: Expiration Date: - Job Site Address: vC City/State/Zip Attach a copy of the workers'compensation policy declaration page showing the policy number and�x expiration Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the Policy P date). fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER Of up to$250.00 a day against the violator. Be advised that a copy of this statement may impositionof criminal penalties of a Investigations of the DIA for insurance coverage verification, and a fine y be forwarded to the Office of I do hereby �•�_ '"'.r�erw/y u der the pains and penalties of perJury that the in provided above is true a d correct Si nature- Phon Date: #: -- Official use only. Do not write in this area,to be completed by city or town offlciaL City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing mbing Inspector Contact Person: ------------ Phone#: Q JUL-11-2007 15:11 FROM:RCAB REAL ESTATE 617 779 4510 TO:197eGeG5408 P.2/2 ACORD, CERTIFICATE OF LIABILITY INSURANCE °07/112007' PRODUCER 617-7.46-5745 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ROMAN CATHOLIC ARCHBISHOP OF ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOSTON, A CORPORATION SOLE HOLDER. THIS CERTIFICATE DOES NOT AMEND, 1=XTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, I 2121 COMMONWEALTH AVENUE BOSTON„ MA 02135 INSURERS AFFORDING COVERAGE INSURED INSURERA. MASS. CATHOLIC SELF INSURANCE GROUP ST. MICHAEL PARISH (299-000) INSURER ---_- 196 MAIN STREET INSURER C. NORTH ANDOVER, MA 01845 NsuHEH Ir - INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE 13FEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, 'PERM Ox CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS GERTWICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUDJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED dY PAID CLAIMS. INSR p0iacr'EFFirCTIVE�POLICY EXPIRATION ----- TYPE OF INSURANCE POLICY NUMBER LIMIYS _GENERAL LIABILitY EACH OCCURRENCE _ S - COMMLHCIAL(iENFHAL I IARII l'(Y FIRE DAMA(,F(Any nne fi(e) S CLAIMS MADE n OCCUR MED EXP(Any one person) 5 iPERSONAL a Am IN.IIJHY g ___-•__ OENERALAGGREGATE S GIr N'I A(ifSNFI;AT F I IMIT APPLIFIIS PER PRODUCTS-COMWOF AGC1-7 b POLICY rRO• - 1 Loc ---------- JFCT i AUTOMOBILE LIABILITY l;(�MRINFn SINGLE LIMIT ANY AUTO (Ea accident) S • ALL OWNED AUTOS — OODILY IN.1l1HY $ ( sL'Hw7Ul FU AUTOS (PrI palevn)—--- HIRED AUTOS BODILY INJl114Y S NON•OWNI-I)AU'1'Uti (Por accident) —•------- PROPERTY DAMAGE --- (Per eccidunq GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO CITHER THAN At110ONIJ AGO S EXCESS LIABILITY CACTI OCCURRENCE- E 1 OCCUR EJ CLAIMS MADE RETENTION I --- g WORKERS COMPENSATION ANI) X ORY L M17S kH_ A EMPLOY ERS'LIABILITY CER'IIFICATEOFAPPROVAL 3/31/07 3/39/08 - F L EACH ACCIDENT -- S — 1 000 000 I C.L.DI:a L-!ti L•:Fn EMHI.f)YFF E •I,OUO.000 F 1. DISEASE-POLICY LIMIT ,S 1,000,000 OTHER I I DESCRIPTION OF OPERATION SILOCATIONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENVSPECIAL PROVISIONS i EVIDENCE OF WORKERS COMPENSATION INSURANCE I I CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LOVYER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 6LFORE THE EXPIRATION DATE YHERLOP,THII ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN ST. M I GHAEL PARISH NOTICE TO THE CERTIFICATE HOLDER NAMFD TO THE LEFT,BUT FAILURE TO DO SO SHALL 196 MAIN STREET IMPOSENO BLIGATION OR LIABILITY OF ANY KIND UPON YHE INSURER.ITS AGENTS OR NORTH ANDOVER, MA 01845 HEPRE TA VEs. AUT H IID R PRESENTA IVE ACORD 25-S(7197) co ACORD CORPORATION 14813