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Miscellaneous - 1025 OSGOOD STREET 4/30/2018 (5)
Date..v��.Y °....... TOWN OF NORTH ANDOVER r PERMIT FOR GAS INSTALLATION , is certifies that U .............. . ' has permission for gas installation ..... ...... ........ . in the buildings of ... � ... A;,../a . 9. � /.f . f ........ at a.« . J............�., North Andover, Mass. ,.Fee.. 3Q.....� Lic. No./.Ty.'!. 'GAS INSPECTOR MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Date 7- 1)'1� -/O Building Locations®r� S' �S� n�� Permit # -7/ 5 Z Amount $ 0 Owner's Name S, •L, V New ❑ Renovation Replacement Plans Submitted ❑ (Print or type)/ ` Check one: Certificate Installing Company Name r�: �iizkpr d V tt.•w�?��$ ElCorp Address �Y �i ,�o Y- d 00 Partner. 4z_ --T�� F spa j'+- 0 c ,� uu si ess'Te ep one 9.-7 41 � � S � � � � ® Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ZI No 13 If you have checked }des, please indicate the type coverage by checking the appropriate box. 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 0 11—uy — iy «.aa.l vl ulu uutaiiz) dau unonnau(jn r nave suomiuea for entered) to above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State qhs Cp�e and Chapter 142 of the General Laws. IAPPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 1694 Gas Fitter l7cense Number © Master ciJourneyman w v� Ci w F W z z 0F O U w x z H a O x w z Q x w p w UG U w F a H > F z a w x o x w j 3 0 .4 U a> ° o SUB-BASEM ENT BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR -8T H. F L 0 0 R (Print or type)/ ` Check one: Certificate Installing Company Name r�: �iizkpr d V tt.•w�?��$ ElCorp Address �Y �i ,�o Y- d 00 Partner. 4z_ --T�� F spa j'+- 0 c ,� uu si ess'Te ep one 9.-7 41 � � S � � � � ® Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes ZI No 13 If you have checked }des, please indicate the type coverage by checking the appropriate box. 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 0 11—uy — iy «.aa.l vl ulu uutaiiz) dau unonnau(jn r nave suomiuea for entered) to above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State qhs Cp�e and Chapter 142 of the General Laws. IAPPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 1694 Gas Fitter l7cense Number © Master ciJourneyman I.P The Commonwealth of Massachusetts Department of Industrial Accidents Office of Lnvestigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LegibIV Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. [:11 am a sole proprietor or partner- listed on the attached sheet : ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL C. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. 0 New construction 7. [] Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other csxt 1W Uut me section belloW sn0\i^,n^b their w0lr, rc' compensation policy 'info. WatiCJII. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the. name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below information. is the policy and job site Insurance Company Name: Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Simatare: Date.: Phone #: Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. 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 employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance 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 wire 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 Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5 -26 -OS vmrv,-mass..gov/dia 0.1 A k Date .... /4.-..;?—. . TOWN OF NORTH ANDOVER PERMIT FOR WIRING �—� This certifies that ........... .................... ......%��k71..1�.�;�.%�n.....r.L FC„.. has permission to perform !' S�7,4Q .V ....................... wiring in the building of .....C. .. .e . . '..f_ ........ �..t,??.t- ............................. at ........ . 7 ..............`!z .....s.1 ..' ............ , North Andover, Mass. Fee ..... '..a----Lic. No....�►'? �= .............�!,!.! 1 ELEC�iRICALINSPECTOR / 1 Check # --q/-OT // 7097 it commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only ,Permit No. 7 D� 7 Occupancy and Fee Checked [Rev. 9/051 (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / , j - 7 O (C, City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 1 tJ �� (tj 5 OO CSS 5 Owner or Tenant Owner's Address SSO 3 ivrk ,? 5't r v C fee 5 -/— Is Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service J -(—IQ Amps I Z0/ % `foVolts Number of Feeders and Ampacity Telephone No. Yes Q' No ❑ (Check Appropriate Box) Utility Authorization No. —1-7 7- — � L13f� Overhead ❑ Undgrd ❑ No. of Meters OverheadUndgrd ❑ No. of Meters 1 Location and Nature of Proposed Electrical Work: ''T e P', S �� / Ce—, i GO It .7uucn uuuatunat aerau g aesrrea, or as required by the Inspector of Wires. 4 , Estimated Value of Electrical Work: (When required by municipal policy.) `j Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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:) / certify, under the pains and a alties of perjury, that the information on this application is true and complete. FIRM NAME: �1oC,1 ' ��' C_ ec+ r 5 LIC. NO.: Z! 7 )L 4— Licensee: 1\o r C � , 4PL Signature Z LIC. NO.:(If applicable. enter "exempt" in the license number line. �. Bus. Tel. No.•9 %// �s Address: j �} o,y (� Sc ���'Al✓%� U 311 7 % Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 ._ ��Vcl Signature Telephone No. PERMIT FEE. $ D —.urr u rrrr juituwingmote may ae warvea by the /ns ector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. —of I ota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool ove ❑ n- ❑ No. oEmergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers eat Pump No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal[I Other Connection No. of Dryers Heating Appliances KWSecurity ystems: No. Devices No. o Heaters KW ater o. o o• o of or Equivalent Data Wiring: Signs Ballasts No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicationsfiring: No. of Devices or Eq uivalent OTHER: .7uucn uuuatunat aerau g aesrrea, or as required by the Inspector of Wires. 4 , Estimated Value of Electrical Work: (When required by municipal policy.) `j Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 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:) / certify, under the pains and a alties of perjury, that the information on this application is true and complete. FIRM NAME: �1oC,1 ' ��' C_ ec+ r 5 LIC. NO.: Z! 7 )L 4— Licensee: 1\o r C � , 4PL Signature Z LIC. NO.:(If applicable. enter "exempt" in the license number line. �. Bus. Tel. No.•9 %// �s Address: j �} o,y (� Sc ���'Al✓%� U 311 7 % Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 ._ ��Vcl Signature Telephone No. PERMIT FEE. $ D MAUGEL ARCHITECTS FIELD REPORT AIA DOCUMENT G711 CLIENT: Great Pond Crossing, LLC TENANT: N/A PROJECT: 1025 Osgood Street — Retail Building ARCHITECT'S PROJECT NUMBER: 06122 FIELD REPORT NO: #3 DATE: March 15, 2007 TIME: 11:30 A.M CONFORMANCE WITH SCHEDULE: on time EST. % OF COMPLETION: 40% ARCHITECT: Maugel Architects, Inc CONTRACTOR: Grasso Construction Co. PRESENT AT SITE: N/A — Grasso Construction Co. Jonathan Cocker — Maugel Architects INSPECTED BY: Jonathan Cocker WEATHER: Rain TEMP: 40 (F) OBSERVATIONS: • Steel o Steel was erected. o Temporary bracing was still in place. o Metal decking was 95% Complete. Gaps at deck to columns and deck to foundation need to be filled prior to concrete pour. o Studs for composite decking were installed. • Framing o Wall framing was complete and appears in conformance with the drawings. o Roof truss installation was underway and 5% complete. INFORMATION OR ACTION REQUIRED: This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way; relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. rj REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA ®,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 MAUGEL ARCHITECTS FIELD REPORT AIA DOCUMENT G711 CLIENT: Great Pond Crossing, LLC TENANT: N/A PROJECT: 1025 Osgood Street — Retail Building ARCHITECT'S PROJECT NUMBER: 06122 ARCHITECT: Maugel Architects, Inc CONTRACTOR: Grasso Construction Co. FIELD REPORT NO: #3 DATE: February 8, 2007 TIME: 10:30 A.M. CONFORMANCE WITH SCHEDULE: on time EST. % OF COMPLETION: 25% PRESENT AT SITE: N/A — Grasso Construction Co. Jonathan Cocker — Maugel Architects INSPECTED BY: Jonathan Cocker WEATHER: Sunny TEMP: 15 (F) OBSERVATIONS: • Sitework o Rough grading is complete. • Foundations o Footings and Foundations are complete and appear ion conformance with the drawings o Damp proofing was installed. • Steel o Steel was erected. o Temporary bracing was still in place. o Metal decking was 95% Complete. Steel angles at slab connection to foundation wall were not installed. o Studs for composite decking were not yet installed. o Leveling grout under all columns was in installed. • Framing o Wall framing was just beginning. INFORMATION OR ACTION REQUIRED: This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA ®,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 e Jan R 16 0'l U5:04p n�vtn,MooK, l•+�.s kzvermoor Engineering ltil-544-'7 "l�?J RI;VERMOOR ENGINEERING LCC. PROFESSIONAL ENGINEERS p.1 SITE OBSERVATION REPORT Date: January 16, 2007 Project: Treadwells — Osgood St. N. Andover, MA Report Date & 1/16/06 10.00am Attendees: Peter J. Palk Jon Cocker -MAI Time: By: Peter J. Palk, P.E. Weather: Cloudy 30 degrees Site: 1025 Osgood St. N. Andover, MA General Comment: Rivennoor Engineering has completed a site review of the structure at the above referenced site. This report is limited to the portion of the structure identified in the scope of work. Observations and comments are _based on exposed to view surfaces on the day of the report. The Iffects of uncovered conditions are not addressed in this report. Rivermoor Engineering has completed the site review of existing conditions of the exposed areas at the referenced site and presents the following: • Foundation and footings complete. No stair framed to the basement so the I' floor framing, posts, sts, slab & concrete walls were not accessible. • Floor & Walls are framed. Windows installed. interior posts for beam support to the ceiling level not complete. Contractor to provide Simpson beam to post connections per plans. • Roof trusses set & roofing installed. Although the truss & roof were designed by others, Rivemioor Engineering recommends hurricane clips be provided at all rafter / truss ends. • Plate connection required at the valley beams and ridge point per plans. • Posts missing at gable ends under ridge beams. Posts missing down from ridge in the interior to LVL beams — both sides. Add connectors top & bottom of posts. FAX Jon Cocker—MAI 978 456 2801 10 New Driftway SCIT'UATE, MA 02066 TEL. (781) 545-2848 --FAX (781) 544-7729 MAUGEL ARCHITECTS FIELD REPORT AIA DOCUMENT G711 This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA (D,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 MAUGEL ARCHITECTS FIELD REPORT AIA DOCUMENT G711 CLIENT: Great Pond Crossing, LLC ARCHITECT: Maugel Architects, Inc TENANT: N/A CONTRACTOR: Grasso Construction Co. PROJECT: 1025 Osgood Street — Treadwell's ARCHITECT'S PROJECT NUMBER: 06121 FIELD REPORT NO: #1 DATE: December 6, 2006 TIME: 9:00 A.M. CONFORMANCE WITH SCHEDULE: on time EST. % OF COMPLETION: 5% PRESENT AT SITE: John Grasso — Grasso Construction Co. Jonathan Cocker — Maugel Architects INSPECTED BY: Jonathan Cocker OBSERVATIONS: • Sitework o Rough grading is underway. • Foundations o Foundations and footings have been poured. o Damp proofing was installed INFORMATION OR ACTION REQUIRED: WEATHER: Sunny TEMP: 30 (F) This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA ®,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 q.....i" .........:. This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA ®,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 �j MAUGEL ARCHITECTS FIELD REPORT AIA DOCUMENT G711 CLIENT: Great Pond Crossing, LLC TENANT: N/A PROJECT: 1025 Osgood Street — Treadwell's ARCHITECT'S PROJECT NUMBER: 06121 FIELD REPORT NO: #2 DATE: January 16, 2007 TIME: 10:15 A.M ARCHITECT: Maugel Architects, Inc CONTRACTOR: Grasso Construction Co. CONFORMANCE WITH SCHEDULE: on time EST. % OF COMPLETION: 40% PRESENT AT SITE: N/A — Grasso Construction Co. Jonathan Cocker — Maugel Architects INSPECTED BY: Jonathan Cocker WEATHER: Sunny TEMP: 30 (F) OBSERVATIONS: • Sitework o Rough grading is complete. • Framing o Framing is 95% complete (see action items below). o Exterior posts to support the roof are not in yet installed. o No access was provided to the basement. Bridging could not be reviewed. • Windows o Window installation is complete. • Roofing o Roofing installation is complete and appears in conformance with the drawings. INFORMATION OR ACTION REQUIRED: 1. Install post from LVL ridge to LVL beam below at (2) structural ridge locations per plans. 2. Install post in exterior wall to support structural ridge (2) locations at gables per plans. 3. See Structural Engineers report regarding hurricane clips. 4. Install Simpson connectors at post to Ivl connections per plans. 5. Install missing post from floor to LVL beam per plans. 6. Install plate connection at hip to ridge connection per plans This report is based on observations and information obtained the day of this report and is limit to those observations, and in no way relieves the contractor, subcontractors, engineers to adhere to the plans and specifications for this project. REPORT BY: Maugel Architects, Inc AIA DOCUMENT G711. ARCHITECT'S FIELD REPORT. OCTOBER 1972 EDITION. AIA ®,©1972 THE AMERICAN INSTITUTE OF ARCHITECTS, 1735 NEW YORK AVE., NW, WASHINGTON, D.C. 20006 Date. . 7 ....... . TOWN OF NORTH ANDOVER At •• PERMIT FOR GAS INSTALLATH V.-.'. This certifies that ...?.��t.. � : !?.?................. has permission for gas installation A e.� ` . P. ' in the buildings of ..n0 G at ©° c ............... North Andover, Mass. Fee.... U.... Lic. No.. .. ... GAS INSPECT0h Check # 6019 i MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations Date 6 0 P 5-- P # O is Owner's Name New ® Renovation ❑ Replacement ❑ SUB-BASEM ENT BASEMENT 1ST. 2ND. 3RD. FLOOR FLOOR FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. ITH. FLOOR FLOOR (Print or type) Name ermtt / Amount $ �Up -�01-t Cv A!1LA-0 Plans Submitted ❑ n 2Q 1"M 7-17 C « i z o W Name of Licensed Plumber or Gas Fitter / �'_ _/0 0 i A Ck one: Certificate Installing Company Cff Corp. ❑ Partner. E]Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes If you have checked es please indicate the type coverage by checking the appropriate box. No❑ Liability insurance policy 14 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent 13I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work apd installations performed under Pcrmit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts jtat�pas Code and Chapter 142 of the General Lawc_ By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber / 3 6-- Gas Fitter License vurnder u Master Joumeyman w Name of Licensed Plumber or Gas Fitter / �'_ _/0 0 i A Ck one: Certificate Installing Company Cff Corp. ❑ Partner. E]Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes If you have checked es please indicate the type coverage by checking the appropriate box. No❑ Liability insurance policy 14 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent 13I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work apd installations performed under Pcrmit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts jtat�pas Code and Chapter 142 of the General Lawc_ By: Title City/Town APPROVED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber / 3 6-- Gas Fitter License vurnder u Master Joumeyman Date. V. X-19 HORTM .o.1ti, TOWN OF NORTH ANDO PERMIT FON(PLP.VSfNG This certifies that C A ................... has permission to perform ................. plumbing in the buildings of - !A- e? A .................... at. 1 O. j ............ North Andover, Mass. Fee. ... Lic. No.. ...... ........ PLUMBING INSPeCTOR Check # 7405 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS _ / LL Date Building Location `0 2 5 D�' q R®d T Owners Name -3a 44R.A-O Permit # `? Amount !f 1b,"Type of Occupancy n)/y] �J„�� j•_� New Q Renovation [:] Replacement 11 Plans Submitted Yes [] No El (Print o type) Check Installing ComP Y Nam ❑ Corp. UPartner.' © Firm/Co. Name of Licensed Plumber _� `�a / elge Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy ® Other type of indemnity Bond Certificate Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature 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 under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts a umbin Code anA Chapter 142 of the General Laws. By:4 Signaulm of Eicenseaum Title er �sCf lf�� r Type of Plumbing License City/Town APR APPROVED (OFFICE USE ONLY icesumer Master rj Journeyman Date W.- . ? . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .... �J- ....f .R.� v � -� P R has permission to perform .... t `.0 !` ` `' I/' plumbing in the buildings of/.�.n �." . ��t"` �. !•�..`" at : �C..Z .1�.. �! �5. �.. ................. North Andover, Mass. Fee... Lic. No..1`7.4 !. . ......... -^-a� ......... . PLUMBING INSP C - R Check # L( F 7402 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building New ba Renovation [] Replacement FYYTiTR F C Date�� (� Permit #.— - `leo L Amount i j -,;- Plans Submitted Yes 1:1 No ❑ (Print or InstalllingtyCompanyName Rc jft � ��O 1 �'� Um6„! �e�i--Check Cnorp Certificate Address K2 Ck Le 6�\ Je- 2�� �r���l „�%�„ ❑ Partner.' Business Telephone — Firm/Co. n � Name ofLicensed Plumber. Insurance CoveMe• Indicate Liability insurance policy ff bo)c Bond Insurance Waiver I, the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Signature Owner I hereby certify that all of the details and information I have best of my knowledge and that all plumbing work and insta compliancewith all pertinent provisions of the Massach By: Title City/Town APPROVED (OFFICE USE ONLY ❑ Agent ❑ or entered) in above application are true and accurate to the der Permit Issued for this application will be in ��g de and Chapter 142 of the General Laws. r Type of Plumb' g License License Numoer Master ❑ Journeyman 18 I Date. y 7 TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that ..)/.� ...... el �.. !..n D has permission to perform ....V. ?? ................... ...... plumbing in the buildings of ... at ..l D..2 .j ...Q.£ �; .................... . North Andover, Mass. . �l.. j Fee. 3U....Lic. No../.74.C7 /�'````��. ....... % PLUMBING INSPECT( Check # �� Z 85uj MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location /6 s- 0 34 oy d S7 - Owner f Owner Ve— New f—I . Renovation E] Replacement FTY93 TO i+c Date Permit --p- -p- 3 Amount 3 y — Plans Submitted Yes [] No (Print or type) Installing Company Name -5-41 Address—(C2--A, iC ;too 6 M Check one: Certificate 1-3 Corp. 11 Partner. 10 Firm/Co. Name of Licensed Plumber: Y/1-1 -[ 6 " A0 Insurance Coveram- Indicate the thi-aype of insurance coverage by checking the appropriate box: Liability insurance policy I Other type of indemnity ❑ Bond Insurance Waiver: I, the unders three insurance igned, have been made aware that the licensee of this application does not have any one of the above Signature Owner ❑ Age ❑ 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 under Permit Issued for this application will bein compliance with all pertinent provisions of the Massachusetts Stat ��bthg Code and Chapter 142 of the General Laws. D (OFFICE USE ONLT Type of Plumbing License 136 4y rcense Number Master 10 Journeyman � The Commonwealth of Massachuse&s Department of Industrial Accidents Office of Investigations ..600 TT"ashington Street Boston, MA 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers nnfivnnf Infnrmai- __ Name (Business/Organization/Individual): Sj�j I C✓j f OC ���� Address: City/State/Zip: 1���✓ hII�- YY Phone #: �ff �'% Are you an employer? Check the appropriate boa: 1. ❑ I am a employer with 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet I ship and have no employees working for me in any capacity. [No workers' comp. insurance 5. required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required ] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. [] Demolition 9. ❑ Building addition 10. [] Electrical repairs or additions 11 Z Plumbing repairs or additions 12.❑ Roof repairs 13. ❑ Other '.Any applicant that checks box rl must also fill out the section below E;, =xa„ I info_ T Homeovme s who submit this affidavit indicating they are doing all work and then hire outside contractors mulicyst submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I an employer information. that isproviding workers' compensation insurance for my employees. Below is the policy and job site Insurance Company Name: Policy # or Self -ins. Lic. Expiration Date: Job Site Address: 10 2 S S �, p ,City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct: Official use only. Do not write in this area, to be completed by city or town offrcial City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town 6. Other Contact Person: r Clerk 4. Electrical Inspector 5. Plumbing Inspector 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 employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of coxnpliance 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 incmnmce 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) 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 stere 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 Massachusetts Department of Industrial Accidents Oce of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 vcru,.mass._gov/dia MTM �cw CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 806(6/6/07Date: August 13, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED AS Flourishes - retail tenant fit uD IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Cneat Pond crossing ri.c. 865 noj ike Street North Andover Ma 01845 Building Inspector *.too, 40 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 806 Date: August 13, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED AS Flourishes - retail tenant fit uD IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Great Pond cmigngLLLC. 865 Tumike Street North Andover Ma 01845 Building Inspector w O O E004 s. TS os m c e� N W o N est: N m 3 CD m J,--* W v •�" N . m 0 N m m _,,, O cm 0 c c vQyZ 1O o co a o CD HCD c = m m=.. O CL- H H rr N C:I s W c Ws== IK H O W � r 1_ y �_ : c W 'E �m�cm y d. CD CDam--- O � _ cE = F- t Sa=m 8 `VA goil a, O E ai ■ L O Z CL. O H o c cm C C N2 O y O O ■E cc m CL �3 0 Q O C � oaQ c ev d O CD c * Z co CL C.3 t/p) R C C C _c C. 0 LLI 0 Y/ ce W 19 uj N O O u_ 0• n ��� m C 0 c ' v O = c` O y S °� �� a a w 0 w :j o Q w G o c� cq cn cn TS os m c e� N W o N est: N m 3 CD m J,--* W v •�" N . m 0 N m m _,,, O cm 0 c c vQyZ 1O o co a o CD HCD c = m m=.. O CL- H H rr N C:I s W c Ws== IK H O W � r 1_ y �_ : c W 'E �m�cm y d. CD CDam--- O � _ cE = F- t Sa=m 8 `VA goil a, O E ai ■ L O Z CL. O H o c cm C C N2 O y O O ■E cc m CL �3 0 Q O C � oaQ c ev d O CD c * Z co CL C.3 t/p) R C C C _c C. 0 LLI 0 Y/ ce W 19 uj N c a o u_ 0• ��� m C y3 W I 4 LUCD c ' v O = c` O y C O m h y U CLo A O g� :oma TS os m c e� N W o N est: N m 3 CD m J,--* W v •�" N . m 0 N m m _,,, O cm 0 c c vQyZ 1O o co a o CD HCD c = m m=.. O CL- H H rr N C:I s W c Ws== IK H O W � r 1_ y �_ : c W 'E �m�cm y d. CD CDam--- O � _ cE = F- t Sa=m 8 `VA goil a, O E ai ■ L O Z CL. O H o c cm C C N2 O y O O ■E cc m CL �3 0 Q O C � oaQ c ev d O CD c * Z co CL C.3 t/p) R C C C _c C. 0 LLI 0 Y/ ce W 19 uj N u_ 0• ��� m C y3 W I 4 LUCD �.. • ' v Z c N E c O m h TS os m c e� N W o N est: N m 3 CD m J,--* W v •�" N . m 0 N m m _,,, O cm 0 c c vQyZ 1O o co a o CD HCD c = m m=.. O CL- H H rr N C:I s W c Ws== IK H O W � r 1_ y �_ : c W 'E �m�cm y d. CD CDam--- O � _ cE = F- t Sa=m 8 `VA goil a, O E ai ■ L O Z CL. O H o c cm C C N2 O y O O ■E cc m CL �3 0 Q O C � oaQ c ev d O CD c * Z co CL C.3 t/p) R C C C _c C. 0 LLI 0 Y/ ce W 19 uj N APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # D � ADDRESS/LOCATION OF PROPERTY: Map Parcel Lot Number SUBDIVISION kz V R is t4 e s sr DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: PO ri O kL Address 4/V2 14() SIGNED •UTING CONSERVATION PLANNING DPW - WATER METER SEWERIWATER CONNECTION ®Zsl 7 /U`7 NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST r DPW___ Signature File: Application for OC form revised Jan 2007 W V O W J Town of North Andoveroa ,,a o=" Ail Office of the Planning Department:'- ,cisme Community Development and Services Division 1600 Osgood Street �; .•''g' Bldg. 20, Suite 2-36, Planning Dept. y'ss►chusgsa North Andover, Massachusetts 01845 Town Planner http://www.townofnorthandover.com P (978) 688-9535 L. Daley P (978) 688-9542 TO THE LAWRENCE EAGLE TRIBUNE LEGAL AD FOR PUBLICATION TUESDAY, JULY 4 & 11, 2006. CLIPPINGS TO BE MAILED TO THE PLANNING DEPARTMENT AS ADDRESSED ABOVE TOWN OF NORTH ANDOVER PLANNING BOARD NOTICE OF PUBLIC HEARING, TUESDAY, JULY 18, 2006 & 7:30 P.M In accordance with the provisions of M.G.L. Chapter 40-A, Section 11, the North Andover Planning Board will hold a public hearing as follows: Purpose of Public Hearing: Application for a Modification for a Site Plan Review Special Permit under Section 8.3 & 10.3 and fora Modification for a Watershed Special Permit under Section 4.136, c.ii (1), (2, (5) of the North Andover Zoning Bylaw. The proposed project includes construction of a two floor -retail building approximately 15,228.s.f and a 25' drive aisle surrounding the building and appropriate parking facilities, located within the Non -Discharge Zone of the Watershed within the General Business zoning district. Applicant/Petitioner: Hearthstone Realty Corp. 28 Andover Street Andover, M 01810 Owner: Goodwin Trust, c/o Russell Treadwell 3667 Huntington Place, Sarasota, Florida 34237 Address of Premises Affected 1025 Oagood Street, North Andover, MA 01845 Assessors Map and Lot: Map 35, Lot 20 Public Hearing Date & Time Tuesday, July 18, 2006 & 7:30 p.m. Location of Public Hearin North Andover Town Hall, 120 Main Street, 2nd floor All interested persons may appear and be heard. Persons needing special accommodations and / or those interested in viewing the application materials should contact the North Andover Planning Department at (978) 688-9535. O C �. O Q1 m Qii 'O �/1 0 0)w ' 2 _. m "'• m pl Y i Q H'O cO U C w m CDN � C c Oc o£'�o�oo m �mcN;E 10(0 or -a d Tii=vnm0al c >._ Caccyo49 rM- ttlmc o QinaM: tv o ov«•- v, m m«>� m mcv m� m m ai-`C^p aCD rn Cc.So a�a�o _ t-3—NNpo. aom o :6o nA am 2��o OCz ate! 3�Uc n.o $ c,c v Nycrn-o N Ca: cva ,E 9 aop� ac mcym o �'�pmmc0 O yoy Q rn o� °� =QF c o.OLO'M=19N o c `m m C m d� c mcg Qo . am c m a� Z �aF �o¢�`o`_�_°�$,mmE°rt, �, NF1 Qo move 4 bac 6 - a y cavo2 zU U. Qo m �`m nc �� `co3mC >>28..0rn�y accDc F-�'000r `�'� Q°5.-801`moEa,mo�°' > n OOCO OlN NO O O N m O;� mM �, 0--m C Q m mr C 0-11 w L O W C CaZ�L yg'•-.C, .Q ma�Z >,O U« 2. 2C,C, �� C �NQ C7 y2L 0, O yc`�= CI •` OZ m'fl d G'yQ� _ Z m r� . ao o io'S Z5 4 m Ca p�m v 0 y d t p uj c O C+- $' m N �V O C10 m•O r' i0 Oar N E� p/• O m �r ,.� m C2Q 12"7 CDC a c v1 W VJ C- d O C.�. NCCON.-- to CDNGO �S dl6« d�Q Q �$ ZmZc�o�ca cwQ�as _'moo-cycoomcoN p gCL Q=ypm'r.-rmm� °tJo`c�t� �`o3cop�� t� r�vip vco- 3�amtm'- v°��y�pui Q adz f Z =�—�L� aoamomzooa ,�oocoa onmo.2a�mQdo«`r 22cW< << 0- ��omam� �'Siamcm O aUr u. m— =ia E_: cncbSN n.ow m m =z«c9'v M0000 uwm V52 3 Hw 21-cA Et m m c E�'cco Z w Date........ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ........ �!vvs/ ...... has permission to perform ........ 9z. ...... -5. wiring in the building of ... r-j..R" 7.—. &V6 ..... Cj?.e,,Ejv7 .. .. at .... -15 ...... ..... .. ..................... . rt Andover, Mass, 40 .... ; Fee.'/ Lic. No. ....... ........................ ..... 00, 302 ELE I [CAL I. -Si INSPECTOR 0 Check # 7500 a Commonwealth of Massachusetts OfficialUseOnly Department of Fire Services Permit No. /5 V0 Occupancy and Fee Checked I` BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9/05] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN WK OR TYPE ALL INFORMA TION) Date: June 29, 2007 City or Town of: North Andover To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) 1 Og s monad gtreet Owner or Tenant (;rPat Pond (rnGsi ng T,T.( Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building CetRrCi;RI Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Comnletion of the following, table may he waived by tho tnsnortnr nfWiroe No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ElIn- Ela nd. nd. o mergency i ng Batter Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: Number 1---- Tons ........ IKW ....................... No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KWLocal ❑ Municipal [jOther Connection No. of Dryers Heating Appliances KW e curi Systems:* No. f Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Dat Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: aft f2gZC7 : -Inspections to be requested in accordance with NEC Rule 10, and upon completion. 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:) I certify, under the pains andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME: SOS Se LIC. NO.: 1 19AC'. Licensee: H. P. Smith Signature LIC. NO.: 89OT) (Ifapplicable, enter "exempt" in the license number line) 41Bus. Tel. No.: 978-887-8341 Address: 10 Srntt-h Main St -rapt TrinCfi -1 d -,—MA nl Q123 Alt. Tel. No.: *Security System Contractor License required for this work; if applicable, enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee 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 Signature Telephone No. PERMIT FEE. $ b f R L BOARD OF ELECTRICIANS EA REGISTERED SYSTEM CONTRACTOR TYPE S 0 S SECURITY CONSULTANTS INC H PRESCOTT SMITH —C 10 SOUTH MAIN STREET SUITE 205 TOPSFIELD MA 01983-1833 295483 1199 C 07/31/10 295483 FA REGISTERED REGIOF EELECTRICIANS ECHNICIAN TYPE H PRESCOTT SMITH —D 10 SOUTH MAIN ST TOPSFIELD MA 01983-1832 295482 390 D 07/31/10 295482 77 - DEPARTMENT OF PUBLIC SAFETY x S - LICENSE Number: SS CO 000302 Birthdate: 05/16/1960 Expires: 05/16/2009 Tr. no: 334.0 S -License: SOS SECURITY SYSTEMS HORACE P SMITH 10 S MAIN ST #205 TOPSFIELD, MAA 01983 DIG SAFE CALL CENTER: (888) 344-7233 Commissioner fc Date.... `� :. d% ................. "`° '• '"� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING Thie n-rtifirc that Wil. _ n r ( has permission to perform -.i .....................:`::..:::..................................... wiring in the building ..- . ....... _) Lr =.„.- at .... -...._.,... �:-r.-'?v..--..... ,North Andover, Mass. Fee.,............... :::.............. Lic. No ... Y?� .................. ELECTRICAL INSkcTor Check # !VJ// 7369 n 4 fflu, I In N J Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. Z-- e , Occupancy and Fee Checked. [Rev. 1/071 (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: n q— d % City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inten . n to perform the electrical work described below,. Location (Street & Number) j (� 6S, (� JT _ Owner or Tenant 6-1-c I,S S O C -U r - Owner's Address 6 L -F✓ ry, >p ; E $ T U Is this permit in conjunction with a building permit? Yes Purpose of Building 0 Telephone N I 0 Vt /Z- APPLICATION Z No ❑ (Check Appropriate Box) Utility Authorization No. Existing Service �1 Amps / c! Volts Overhead [:]Undgrd ❑ No. of Meters New Service z()d Amps 12,0l 2 I dolts Overhead ❑ Undgrd No. of Meters a Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: �1 C e C fk rt Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In -No. rnd. rnd. o mergeney Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges r No. of Air Cond. Tonal No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number Tons I KW No. of Self- ontamed Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water Kms, Heaters No. o No. of Signs Ballasts Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wir Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unl( the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. Th undersigned certifies that such cov rage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) 1 certify, under the pains and enalties of perjury, that the information on this application is true and complete. FIRM NAME: C >° C `�`r LIC. NO.: Z % Licensee: C Signature LIC. NO.: 2 g 7 i (If applicable, enter "exy�{�zpt" in the license number line.) jj�� c} Bus. Tel. No.: Address: 1 Gl 'ye $c t�E Y /y 3 tJ 7 l Alt. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: l am aware that the Licensee does not have the liability insurance coverage n required by law. By my signature below, 1 hereby waive this requirement. l am the (check one) ❑ owner ❑ own Owner/Agent PERMIT FEE. $ Signature Telephone No. ro�,-j VVOT?�Po 7 - 3) '- d -7 [?A( 3 - (-� -> 6--� `?,- 2 -0-7 A, t Date. . .� : Or�....... o? TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION G n J This certifies that ..� .. ��� : f .............. has permission for gas installation .:- p'�..... in the buildings of � at .% / : - !a ....... North Andover, Mass. Fee.?/.°Lic. No.%�l'�.. (I/ - INSPE Check # g$2 / 6077 MASSACHUSETTS UNIFORM AppucATON (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations J-V�� I�r j �� \%� -�Z Owner's Name TO DO GAS FITTING Date 7 �) Permit # r/oG %% Amount $ c� 0Qr1QC1n/(1 I I r Newq Renovation ❑ Replacement ❑ Plans Submitted ❑ v w W z U OU a x W5 F .a 0 p v, o c � o z H w U w x w a O a w z W F d z x x �, W W v > w w v x x d w w > a H z' F d �. O Ov z W o x SUB-BASEM ENT x o x 3 A a a> A a H O BASEMENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7TH. FLOOR 8TH. FLOOR (Print or type)( �— Check one: Certificate Installing Company Name 1i EYJ��.�� �(�I('v�t i, fr �Z ��y�M N -% W- 0M �M \ Corp. Add essr9jl.' Zo J \ ❑Partner. 13usiness Telephone -WIg01� ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter , `F1 „ /" 1 A ✓.'7n, m u r I. o -, INSURANCE COVERAGE Chenm k o : 1 have a current liability Insurance policy or it's substantial equivalent. Yes If you have checked rtes, please ndicate the type coverage by checking the appropriate bo . No❑ Liability insurance policy Other type of indemnity ❑ Bond ❑ Owner's Insurance Waiver: �Iam 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 ❑ 1 hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installatio�Ge er Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts taChapter 142 of the General Laws. Title City/Town VED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter ❑ Plumber ❑ Gas Fitter License Number b ❑ Master Z Journeyman Location 10rk-' 6w� No. G; -e-26,00 Date -L TOWN OF NORTH ANDOVER Check # ') 204Va 9_ "building CInspect6r/ Certificate of Occupancy $ s�CHus Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee,dJr $ r7' TOTAL $ Check # ') 204Va 9_ "building CInspect6r/ 0 a ' ~IN O Cd N o O N +a t� O .y > a �Q C. CA A a x a . m T WX a A .L U cl O _� U •0 - 4; cCd O vi Q O p p,M 0 to 0b b 0 t4 °_u-°� �. th "a 0 0.— c. N U C w x C own- bp3 ' cr I--1 w°cd Q 'rA Q+ N 2 ^° ' N Id U vi n O p a� > a� O o U� Z'-�N��w� a� Z c 3 r &0— 3 C �o i a� i� w Q) to LE,�a,�a ° °° o ° 3 as u'nQo 3 fit' �"�i 6/11/07 Madmaggies.Fs Burgandy Background N" Carved 23 K Gold Leaf Lettering - ice crean cone is raised on a recessed background Black Outline/pin Stripe - Gold Leaf Camphored Sides - Recessed Black Edges Additional Mouldings Should Install & Painted by land lord Prior To Sign Installation Addifi-MpW K TO WAdd%By Imdlo d NJ A 101 al Mold;K To & AWN By Led o -d xtM MAD MAGGIE'S ICE CREAM florescent light INTERIOR/ EXTERIOR SIGNAGE FABRICATION • SERVICE • INSTALLATION 30 OSGOOD ST. METHUEN, MA 01844 E-MAIL: info@harveysigninc.com 978.794-2071 • FAX 978-686-1841 CUSTOMERS: Please proofread carefully and sign only if all is correct. Additional charges will be added if any changes or corrections are requested after customer signs off. This must be signed and faxed back before start of job. X Signature/Date ALL DRAWINGS/DESIGNS/DERIVATIVES:Q 2006-2007 HARVEY SIGN-Aii Rights Reserved. N - . N fills-� till i p01[TM TEMPORARY �Rr CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 713 5-3-2007) Date: August 3, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED FOR THIRTY (30) DAYS AS: Mad Maggie's Ice Cream (Retail Store) IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Great Pond Crossing. LLc 1025 Osgood Street North Andover, MA 01845 Buildlbg Inspector 4 , APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION Building Permit # 7/3 ADDRESS/LOCATION OF PROPERTY: Map Parcel Lot Number SUBDIVISION MAT) P'IA GrI F S 1 Def 4S962r\ST DATE REQUESTED FILED/READY FOR INSPECTION CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Permit Issued to: 6(?AA Tt ' P-0 (j () C passi A] a 4.4. L Address SIGNED RO TING CONSERVATION PLANNING F1 (o) 4J�o7 DPW - WATER METER SEWERIWATER CONNECTION NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL. OF THE OCCUPANCYIINSPECTION REQUEST DPW Signature Fite: Application for OC form revised Jan 2007 NORT/, � b X1.95 ..ho �.rJ sA�ptl$ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER d, Building Permit Number 804 6/6/07) Date: July 23, 2007 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED AS Bella Vita. Salon & Day Spa IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Bella Vita Salon & Day Spa 1025 Osgood Street North Andover MA 01845 Building Ins ector 0 Location �n' �'- No. 7 v Date�U TOWN OF NORTH ANDOVER Check # 53 C,' Building Inspq r Certificate of Occupancy $ '� s'••°' t�� ACMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ by TOTAL $ Check # 53 C,' Building Inspq r pOMN pE, .ars. '1y0 Y CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 804 6/6/07) Date: July 10, 2007 30 Temporary Permit THIS CERTIFIES THAT THE BUILDING LOCATED ON 1025 Osgood Street MAY BE OCCUPIED AS Bella Vita Salon & Day Spa IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Bella Vita Salon & Day Spa 1025 Osgood Street North Andover MA 01845 .-40ma-ela- &C.On Building Inspector M7 N Zs W W Cd /a, in w O O F=4 O z m c o m c O o � C H O w z O v i.i CL c M o p m c iy L o N L a 0 C O +-� LO CD G. VVEE �3 O m co c OCv ts 'COL. c O _� .. N A Cm o �; 3 ©`ti o w o c U w" o _m o o ova c� �m o aw w cA U)cn w O O F=4 O z m U E � H � U M Cf s Cf) zH 0 O �r1 m cm rC/T) C W w U 0 O v w (4 i7 2 V O O O O v Z a" O CO) D O cm Cos O �_ H m m CD O co CLQ_ = O� O O O Cc o oma-„ CL CMa c CO) c ev cv v J .� CL. O CO2 Z C CD 0 CL C3 CO) c C — C ■ C _cc 0. CA D • uj LLI U) 19 W uj 19 W U) c o m c o � C H O C 'r O v i.i CL c M o p m c iy L o N L 0 C O +-� LO CD G. VVEE �3 O m co c o ts 'COL. c O _� .. N A Cm o �; 3 ca cm _m N W H O �m o aw � O O ©: Vr dCL � y O ' C � O H d N O C = O m O to W C CD O= -oZ O •N� O � M .� dL C o� ci m_ W3 C O� O� L 20 = W 0 h H L •.., d r m U E � H � U M Cf s Cf) zH 0 O �r1 m cm rC/T) C W w U 0 O v w (4 i7 2 V O O O O v Z a" O CO) D O cm Cos O �_ H m m CD O co CLQ_ = O� O O O Cc o oma-„ CL CMa c CO) c ev cv v J .� CL. O CO2 Z C CD 0 CL C3 CO) c C — C ■ C _cc 0. CA D • uj LLI U) 19 W uj 19 W U) I l �9 a3 NsSq�. 5�� - oil PUBLIC HEALTH DEPARTMENT Community Development Division Mad Maggies lee Cream Stephen and Maggie Reppucci 1 Delphi Circle Andover, MA 01810 March 30, 2007 Re: Plan review "Mad Maggie's Ice Cream" Dear Mr. And Mrs. ReppuccL The Health Department has received your application submitted on March 20, 2007 for a new food establishment, but unfortunately cannot approve the plan at this time. Please see the list below of items that need to be addressed prior to plan approval. Please submit changes, or explanations as needed, as soon as possible so we may assist you in moving forward in this process. The Health Department looks forward to working with you towards a common goal of providing safe food to the citizens that live and work in the Town of North Andover. Once the items below are addressed satisfactorily, a plan approval letter will be provided to you and forwarded to the Building Department. 1) Please provide the proposed menu. Proposal shows no thin meats, soups etc. Previous discussion indicates that was the direction of the business. The equipment shows a panni grill, salad unit etc. If you know what you are going to do in the future, but may not be implementing it just yet, it is recommended to get our input at an early stage. For example, if you are thinking breakfast i.e. Egg and bacon sandwiches, there is no place to cook an egg on the proposed plan. Please comment 2) Specification sheets were not correlated with the plan, therefore the following assumptions of where each item goes may not be correct. Please respond as needed a. 2 types of chest cabinets (please clarify which type is being used where) b. Cut sheets received for #3,7,29,10,38,36,1425,39 (please supply all other missing cut sheets for 4,8,8A., 9,22,24,28,31,37,40,41,42,43,46,_5 l) Please number each cut sheet. c. Indicate the type of shelving. Is it all stainless/ or epoxy coated? 1600 Osgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com 3) Are there floor drains as was discussed withlumbin ? p g Grease trap in floor. Where will the lower level cooler compressors drain? (Pis comment) 4) Disposable Gloves - Please note that the Health Department does not recommend the use of latex gloves due to the segment of the public that is allergic to latex. (No action needed) 5) Coving — All areas of this establishment should have curved coving for easy cleaning. 6) Note: No screen doors or air curtains are proposed. Please be advised that fines are levied against establishments who keep their doors open. 7) Linens — No indication of aprons being utilized for the staff. How are you planning to keep the food protected from the clothing of the employees? Comments 8) What type of head covering are you requiring? 9) 3 -bay has only one drain board. What is the single drain board used for; (clean or dirty), and what provisions are made for the other. (Please comment) 10) Slop sink. What type of sink is it and how will the food contact surfaces will be protected from splashes; wall mount/4 inch floor unit 11) Handsinks — for the amount of activity in a business such as ice cream, it is important to have enough handsinks. Three handsinks that are proposed appear to be adequate. Note that the front service area is the farthest from any handsink. 12) Discussion was had concerning the placement of the dip wells and ice cream scoop freezers. Please be sure the final plan accurately depicts the proposal. 13)Please note that any freestanding equipment, which is not on rollers, shall be sealed to the floor with caulking or other material to assist in cleaning. We would be happy to meet with you regarding any of the above-mentioned items. Otherwise please submit the needed information and plan changes as soon as possible. Also, thank you for attending the Technical Review Committee meeting. I hope it will assist you through the process of opening your new establishment. ISincer y, S san Sawyer, S/RS Public Health Director Cc: Building Dept. file Thank you, Susan Sawyer, REHS/RS Public Health Director 1 bUU Usgood Street, North Andover, Massachusetts 01845 Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com ,,/- '�)'3- 0 9 Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ... ......................................... has permission to perform ................. ................ ................................ wiring in the building of ........................ . . at.h? ................... : North Andover, Mass. .......................................... Lic. No .�W ........ ELECTRICAL IN Check # 8209 THECOMMOAWEALTHOFMASSACHUSEM Office Us-eon� DFT4R7711ZM0FP[MUCS9FE7Y nna . BOARDOFFIREPREVEN170NRF.('Uj1A770NS527CW-,2.W Permit No. Occupancy &Fees Checked " APPLICARONFOR PERMIT TO PERFORMELECTRICAL WO RKALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date C�i3 Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work descri ed below. Location (Street & Number) /0 P► o Owner or Tenant VX A . i i _ Owner's Address Is this permit in conjunction with a building permit: Purpose of Building f2zJ Existing Service Amps / Volts New Service Amps Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work No. of Lighting Outlets No. of Lighting Fixtures No. of Receptacle Outlets No. of Switch Outlets No. of Ranges No. of Disposals No. of Dishwashers To. of Dryers No. of Water Heaters KW No. FffIro Massage Tubs t No. of Hot Tubs IYes 1:1No Swimming Pool Above No. of Oil Burners yl - (Check Appropriate Box) Utility Authorization No. Overhead Underground No. of Meters Overhead Underground No. of Meters No. of Transformers Total Below KVA Generators KVA >round No. of Emergency Lighting Battery Units No. of Gas Burners No. of Air Cond. Total FIRE ALARMS Tons No. of Heat Total Total No. of Detection and _ Pumps Tons KW Initiating Devices Space Area Heating KW No. of Sounding Devices No. of Self Contained Detection/Sounding Devices Heating Devices KW Local Municipal No. of No. of Connections Signs Bailasis No. of Motors Total HP Pt • i �� tri i ..:.r�: ..r • :� :.•;:� w1valut YES Lo NO ffymhavedrekEdYES,ple wnx thetypeofco ftmspoffy) No. of Zones ElOther�' ..u,cui,ry �uucuiIunspzm111app)1 ftrequiten-ent, lease check one) Owner Agent Igna re or Uwner or Agent �-1 MC Alt Tel. No m6ralbyMas�m tkGerier 1'r Telephone No. PERMIT FEE TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: 6 IMPORTANT: Applicant must complete all items on this pate LOCATION Print PROPERTY OWNER ("r % "f �� ; ! IlI Print MAP NO.: PARCEL: TYPE AND USE OF BUILDING ZONING DISTRICT: NISTCIRIC iIIRTRI(T VTC n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial ❑ Repair, replacement Demolition ❑ Assessory Bldg ❑ Moving (relocation) I ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION Or WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name:CR KA=T 200 C QOS ST k�- C Phone: 00 Address: '0 R4 ft K CONTRACTOR Name: J,r-h ! A) C Phone• R i P, j�;N� ��y,j Address: J Supervisor's Construction License: o��'i Exp. v Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No FEE SCHEDULE. BULDINC PER T: 12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost :$_�_ FEE:$ %S• Oa Check No.: _ �% A? Receipt No.: / �90 Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art E]Public Swimming Pools ❑ Sewer ❑ Tobacco Sales El Food Packaging/Sales ❑ Well ❑ El❑ Permanent Dumpster on Site Private (septic tank, etc. Electric Meter location to proj ect NOTE: Persons contracting w- registerea contractors ao nut nuve ucce33 tfic guu,us�yr.. Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Wa- ed ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH N COMMENTS G DATE REJECTED 0 DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED Q DATE APPROVED FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date 4". jzk S ,__� //',/ V— D 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 Drivewav Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA — (For department use) Page 3 of 4 Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created 1MC. Jan.2006 TYPE OF SEWERAGE DISPOSAL Tanning/Massage/Body Art ❑ Swimming Pools 11❑ Public Sewer Tobacco Sales ❑ Food Packaging/Sales ❑ Well ❑ Permanent Dumpster on Site ❑ Private (septic tank, etc. ❑ Electric Meter location to project NOTE: Persons contracting w" registered contractors ao not nave access io ine guu.unayi—tu Signature of Agent/OwnerLSignature of contractor Plans Submitted 11 Plans Wa' ed ❑ Certif0�ied Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH N COMMENTS 4 DATE REJECTED Q DATE APPROVED DATE REJECTED DATE APPROVED ❑ ❑ DATE REJECTED FIRE DEPARTMENT - Temp Dumpster on site yes 11 DATE APPROVED no ✓� Fire Department signature/date ��// �� S_� ��—�4. COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer. Connection/Signature & Date Driveway Permit 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location l t%Q.- Vf 5�0 a/ `f No. Date - 7" °RTq TOWN OF NORTH ANDOVER �41 s Certificate of Occupancy $ sACMus <�' BuildinglFrame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s Check # - 0/ 19GO4 Building Inspector 0 �I 0 6 z � ,P% a o r W 0 QJV W = R UO �IVQO` r o� a a f� w C/)v c� w aG U � X0 a rx .� w w w rx w oao C2 w" w ° cn E cn y4 �> �d ,P% r W 0 QJV W = R UO �IVQO` r o� SNL I m W IIO LU Y+ U) 09 W LLI ag W N /re foa�a�rreoouueal� o� .�/�ira�u�c�nf,Za BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 022988 Birthdate: 10/31/1943 Expires: 10/31/2007 Tr. no: 7373.0 Restricted: 00 JOHN GRASSO 865 TURNPIKE ST NO ANDOVER, MA 01845 Commissioner ,p� ✓iie "Vam�no�uue[r.�li o�✓l�Gcra6[tCiuc6e�d '\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 113130 Expiration: 5/18/2007 Type: Private Corporation GRASSO CONSTRUCTION CO., INC. JOHN GRASSO 865 TURNPIKE ST�� N. ANDOVER, MA 01845 Administrator 4 Town of North Andover o "° pT "q,� Building Department6 ° 1600 Osgood Street Building 20, Suite 2-36 North Andover MA 01845- _ a Tel: 978-688-9545 Fax: 978-688-9542 c McHown. / DEMOLITION OF BUILDING AFFIDAVIT 31D OWNER'S NAME & ADDRESS R?I r f eQIJ �, GQo SS l N :Z4dAZE LT LOCATION OF PROPERTY TO DEMOLISH f 0 D S D S y DESCRIPTIONf A CONTRACTOR'S NAME & ADDRESS r=Ef/ --SS-0 e 'nleztsrl rb , M r 6S DEPA RTMENT /S�,,IGN-OFFS DEPT. OF PUBLIC WORKS -WATER: /�/ I 3SEWER- GAS ELECTRIC 5c IF R f- i! =EK TELEPHONE DIG SAFE NUMBER X00 4- / D Vtq �O DATE RECD Building of Building Affidavit: revised 8.2006 BLDG. INSPECTOR I Robert C. Pendrake Supervisor of Support Services November 14, 2006 Re: Removal of electrical service for demolition. Dear Mr.Grasso This letter is to confirm that the electrical services and meter(s) were removed from 1025 Osgood St North Andover on Friday November 3 2006.If you have any questions or need further assistance, please feel free to contact me at 978-725-1320. Sincerely, Robert C. Pendrake Supervisor of Support Services RCP/cmc 1101 Turnpike Street North Andover, MA 01845 978-725-1320 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 at: 1G,t 0s';o4 �) S'V 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. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I 0A. The debris will be disposed of in: Fire Department Sign off: Dumpster Permit 11 acy, RETUAid cz0A 1 " (Location of Facility] Si Permit Applicant