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HomeMy WebLinkAboutMiscellaneous - 1211 OSGOOD STREET 4/30/2018 (5) BUILDING FILE i i i Date.....� .-...� . . f NpRTM 4 3?;•t:�``°;��."�� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUSE� '' This certifies that ................�--�t u.�. �EG� .... .. ..... ... ................................ has permission to perform ......... 6.t(..... .�.N 1V'!^ S ..... ,,QQ .................................... wiring in the building of...............�.�.��?.#F ............................................. at....... .........................`+ �,�.............P ......... .. ,North Andover,Mass. .............. Lic.No. . .......... Fee...�� 59.... ..A. ............:................ ......... .... ELECTRICAL INSPECTOR ' r Check k LI 2- 773 -0 Commonwealth of Massachusetts Official Use Only l� Department of Fire Services Permit No. 77-3 S Oc BOARD OF FIRE PREVENTION REGULATIONS [Rev.l 07]upancy and Fee Checked i eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(ME ),527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFORMATION) Date: d City or Town of: NORTH ANDOVER To the Inspector ofWires:" By this application the undersigned gives notice of his or her intention to perfiboxT the electrical work described below. Location(Street&Number) Owner or Tenant Telephone No.(,,�-&/s" Owner's Address 7 71 Is this permit in conjunc 'on with a buildin�permit? Yes ❑ No (Check Appropriate Boz) Purpose of Building en-e 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: , completion rollowin table may be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Ceil.-Sus o.of Total p.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ Ia- ❑ o.o mergency ig g d. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o.of Wetection an Initiating Devices No.of Ranges No.of Air Cond. Tonsl No,of Alerting Devices No.of Waste Disposers eat Pump Number Tons KW No.o Self-Contained Totals: ...............__..._._._._ . Detection/Alertina Devices No.of Dishwashers Space/Area Heating KW Local Municipal Connection ❑ Other ❑ No.of Dryers Heating Appliances KW Security Systems:* No.of Watero.of No.of Devices or Equivalent Heaters KW Signs Ballasts Data itinNo.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or E uivalent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Val4ofEletrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCEAGE: 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 pegmit issuing office. CHECK ONE: INSURANCE DABOND ❑ OTHER ❑ (Specify:) `� �� /� I certify, under the pains andpen o erjury,that the info► ation on this application is true and complet FIRM NAME: v (/ ( C LIC. Licensee: Signature '�� /� LIC.NO.: (If applicable, en`r` mpt' ,� ��/t� mberline.) % �f� Bus.Tel.No Address: ,/ �(f Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work req ' es Department o ublic Safety"S"License: Lic.No. 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:$ ak CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 345 (11-2-05) Date: .JM@a 12,2006 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1211 Osgood od Street MAY BE OCCUPIED AS Commercial Fit Up IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Diem.Dinners-McLays 12.1.1 Osgood street Notth Andover MA 01845 gilding c or I k NORTH own of _ ..:A = over 4__4o y7LA dover, Mass., ��'o�•at1 COCMICMEWiCK ' A0RA7ED P*' BOARD BOARD HEALTH / PERMIT . T Food/Kitchen,' Septic Sys em' BUILDING INSPECTOR THIS CERTIFIES THAT .•...... ....� .. ...... ...IN...•••.. Foundation C� ..... .................................... ............ .... .... �...................... has permission to erect........................................ buildings on ..�� I .................................................. Rough to be occupied a ........... .......... e arson accepting this permit shall in eve nform thebermsof*the*that thry Fina �/ ' ! 05 this / this office, and to the provisions of the Codes and By-Laws relating to the In ection, Alteration and Construction of Buildings in the Town of North Andover. 'PLUMBING INS E R VIOLATION of the Zoning or Building Regulations Voids this Permit. Y oug o � l PERMIT EXPIRES IN 6 MONTHS >. UNLESS CONSTRUCTI STARTS ELECTRICAL INSPECTOR ............. .. .... .. Service .. ........... e UILDIN2- /G INSPECTOR Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. BurnerJ(t0� Street No. SEE REVERSE SIDE Smoke Det. r►ORT1 Ot4 •o •1tio h � Town of North Andover Building Department ` °',••° `�' �ss�caus� 400.Osgood Street North Andover MA 01845 978-688-9545 Fax 978-688-9542 APPLICATION FOR CERTIFICATE OF OCCUPANCYIINSPECTION ADDRESS/LOCATION OF PROPERTY : Nor-R-) A-ncb �� (YI k 01 az S DATE REQUESTED FILED/READY FOR INSPECTION—OJ � '(�,� K)o,-'O(–Re`d+' o Corn�g 10:,?�p� 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 DOLLARD $20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. Signature Cr, bad–__= OFFICIAL USE ONLY ROUTING y/ D.P.W. –WATER METER `((2 � 'CDi DATE D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. s C 6)wt�,� SIGNATURE/DPW AUTHORIZATION APPLICATION CERTIFICATO OF OCCUPANCY revis!11.15.2004 Location No. Date TOWN OF NORTH ANDOVER F p Certificate of Occupancy $ s�cMos t� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ n Check # Building Inspe"6tor v le v NORTH q O �SVt0 6 �IO Or AcK eya O "A .6 �9SSAC HUS��,�y TOWN OF NORTH ANDOVER Sign Permit Date: December 5, 2005 Permit Number: 029-06 THIS CERTIFIES THAT, Dream Dinners Has permission to erect a Wall Sian 3' X 10' non illuminated On 1211 Osgood Street provided that the person accepting this Permit shall in every respect conform to the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Sign Regulations in the d Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit Inspector of Buildings r I/ D � fe � TOWN OF NORTH ANDOVER 400 Osgood Street 0—cC� SIWEE7_ SIGN PERMIT APPLICATI N Site OwnerTel #9A 7&6¢ pplicant M INN �S Site Address�2�� r� bp-> ST'E�T,/� �� . INt4- Size of Proposed Sign Map Parcel Estimated Cost of Sign �?,�� �8 How attached: (a) Against the wall Illumination: ( Not illuminated b) Roof (b) eternally illuminated ( ) c) Ground ( ) (c) ernally illuminated" (d) OtherPo Proposed Colors: Background Materials: ALUIRtM441 Lettering Border V L Required Attachments: No permanent/temporary sign shall be erected, or Photographs of building enlarged until an application on the appropriate form Material sample furnished by the Sign Officer has been filed with the Color samples Sign Officer containing such information including Site or Plot Plan (Required for all free-standing signs)—2,Ci0/q&�5 photographs; plans and scale drawings, as he may d Drawings of proposed sign —?SETS require, a permit for such erection, alteration, Other, specify or enlargement has been issued by him, Such permit shall be issued only if the Sign Officer determines that the sign complies or will comply with all applicable provisions of the By-Law. Will sign overhang any public road or walkway: Yes ( ) No� If Yes, Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED, Date Filed: Signature of Applicant doll TO DATE TIME AM P FROM PHONE( ) H ;CELL( ) OF 1�� I .` it D - Cjl'1 L t�10E. _ !FAX -- E E GSI 4&tf welt s► �► - s -- M _ _ - --- - x----� E A �litW1 ��hAS ,sat G1 ' �v►S�dh � E - T^ u f l Lk O E-MAILADDRESS SIGNED PHONED❑ BAALLCK❑ CALL RNED❑ SEE YOU ❑ TAGAIN ALL[:] WAS IN ❑ URGENT❑ P' W y�4p � E t x � y - Y /. r �v. r 6210 Date.......I.." f HOR7q, .,e'` "oar TOWN OF NORTH ANDOVER r o . PERMIT FOR WIRING i ,SSACMUS� I � This certifies that ... - S ....e.4.A:5 r....4�L..... ... �- . has permission to perform ...... ... r../...... .................................................. wiring in the building of..... ............. .. ...... ....................... .......................... ....,North Andover,Mass. y z�- -� `Y Fee........... ...... Lic.No. � �7� .... ...... �t-!.�! ,:;�!!C. ............. .... ............. . i ELECTRICAL INSP'ECTOis Check # � 7 .�--\ a, . �omnmrtruaat o`///adJa..1Lud41L1 For Office Use Only (Rev.iI 2 D c� �c]� Permitt Number� mbep JaPart'nrsrsl o`..tira arvitaA BOARD OF FRE PREVENTION REGULATIONS Occupancy&Fee APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK V VV (ALL WORK TO BE PERFORMED WrrH THE MASSACHUSETTS ELECTRICAL CGDE 527 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATION Date: l-- (S -CSS City or Town of: o P t �-. �-�J pcTe('— 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) (Z « �S S 0OG Owner or Tenant: #Jtt—S Owner's Address: S A-o l Is this permit in conjunction with a Building Permit? Yes No ❑ (Check Appropriate Box) Purpose of Building:ee)AA:R- ue Utility/Authorization Existing Service: _ZC?0 Amps L ZO/ ZO Volts Overhead ❑ Underground.❑ TM of Meters New Service: Amps / Volts Overhead ❑ Underground.❑ "of Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work: srtit�4 U - e..4Q� �`; �. �j� ,qv,.� �,,,JA.)e ri, No.of Recessed Fixtures I No.of Cell:Susp.(Paddle)Fans I No. of Transformers Total KVA No.Of Lighting Outlets e LS t I No. of Hot Tubs I Generators KVA No. of Lighting Fixtures e t 'It n�a I Swimming Pool: Above ground ❑ In Ground ❑ I #of Emergency Lighting BatteryUnits No.of Receptacle Outlets Z I No. of Oil Burners Fire Alarms #of Zones #of Detection&Initiating Devices No.of Switches / I No.of Gas Burners #of Sounding Devices: C� #of Self Contained No.of Ranges No. of Air Conditioners TOTAL TONS: Detection/Sounding Devices L 6—it N Local❑ Municioal Connection o Other ❑ No. of Waste Disposals I Heat Pump Totals: Security Systems: Number. TONS: KW: I No.of Devices or Equivalent r� No.of Dishwashers I Space/Area Heating: KW I Data Wiring,No.of Devices or Equivalent r No.of Dryers I Heating Appliances KW ( Telecommunications Wiring:No of Devices or - -Equivalent No. of Water Heaters KW I No. of Signs: #of Ballasts: I OTHER-, #of Hydro Massage Tubs ( No. of Motors Total HP 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 ❑ Please specify: Estimated Value of Electrical Work$ (When required by municipal policy) Work to StartInspections to be requested in accordance with MEC Rule 10,and upon completion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Firm Name: CA,5 \ C„ LIC.# Licensee O F} Q Signature: LIC.# 171-74 /T (if applicable,enter"exempt'in the license number line) ►�} Address I�A� �rt ut (� ( 1 ��� ]�J� Bus.Tel.#/?P-922-323L Alt.Tel.# lOWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the Lability insurance average no.^maliv reowreo by iaw. By my signature Delow,I nereny 1 waive this requirement. I am the(check one) Owner❑ OR Agont❑ Signature of Owner/Agent: Telephone# PERMIT I LE:S S • "-� a COnLJtOn7LQQt�lJl o` //a»ar1«a[� For Office Use Only (Rev. 11/99) i Permit Number. _:.Jiaar[nunl o�}irr �arvicad BOARD OF riRE PREVENTION REGULATIONS Occupancy&Fee APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK (Ail WORT:TO BE PERFORMED WITH 7,HZ MASSACHUSETTS—c-I RICAL CGDE:27 CMR 12:00) PLEASE PRINT IN INK OR TYPE ALL INFORMATIONDate: I t— (�— �A,)11 .,� City or Town of: IO t Air r pcTe-C ' 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) s�� �Z �� �S S ® Owner or Tenant: b tr,'y tV 2r-S Owners Address: SA-0t Is this permit in conjunction with a Building Permit? Yes y`9- No o (Check Appropriate Box) Purpose of Building:2nga,� ��i ilp UtilityAuthorization Bxisting Service: _ZjnD AmpsLz0/ ?-69-Volts Overhead ❑ Underground.:] TM of Meters New Service: Amps / Volts Overhead ❑ Underground.❑ Uof Meters: Number of Feeders and Ampacity: Location and Nature of Proposed Electrical Work:,5r-t,+U e•a9-r r; ���- �. ��� ,,��„L �,�A)CrC, No.of Recessed Fixtures I No.of Cell.-Susp.(Paddle)Fans ( No. of Transformers Total KVA No.Of Lighting Outlets e t S t I No. of Hot Tubs I Generators I(yA No. of Lighting Fixtures e t ;A3 C, I Swimming Pool: Above ground o In Ground 0 I #of Emergency Lighting Battery Units e j(.4 S 4;,.J �I No.of Receptacle Outlets I No. of 011 Burners Fire Alarms f;of Zones of Detection&Initiating Devices No.of Switches / I No.of Gas Burners #of Sounding Devices: c :of Self Contained No,of Ranges No. of Air Conditioners TOTAL TONS: DetectionlSounding Devices L Sit N Local p Municipal Connection 0 Other o No. of Waste Disposals I Heat Pump Totals: Security Svstems: Number TONS: KW: I No.of Devices or Equivalent No.of Dishwashers I Soace(Area Heating: KW I Data Wiring,No.of Devices or Equivalent No.of Dryers I Heating Appliances KW I Telecommunications Wiring:No of Devices or Equivalent No. of Water Heaters KW I No. of Signs:—#of Ballasts: I OTHER: #of Hydro Massage Tubs I No. of MotorsTotal HP ( 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 I issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER 0 Please specifv: 1 Estimated Value of Electrical Work.$ (When required by municipal policy) Lwork to Star.: inspections to be requested,n acccroan:e with MEC Rule 10,and upon:cmptetion. I certify,under the pains and penalties of perjury,that the information on this application is true and complete. Firm Name: 0+45 t i I Licensee: tJ _ ioi,- V-e-r— Signature: LIC r 1 7b til (lf�a-p-plicanle,enter"exempt"in 2h license number line) 4 AcCreSs:_ L A r�1 �t-t J C- ( r-Q C(AA Bus.Tel. �; 8=6 52-323?—,32 Z Alt.Tel. OWNER'S INSURANCE WAIVER:I am aware tnat the a:ensee does not have the hat;ltty ir.;uran:e coverage ncrmaiiy reau,rec cy iaw. By my signature oeiow, nereoy waive this requirement. I am tree(check one) Owner p OR Agent❑ Signature of OwnerlAgent: Telephone# rLttMtT rLr•.:s l Z S f� ���z-LL �`'7�f�,� _ l � jiUl�� ��T79.0 y `�� ,h � �1 U � 1 _� Date. .. . . . . . . . . 4, TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING : � : . o ,SSACNUS� - This certifies that . . !.. *. . . !.`�`�. . . . . . . . . . . . . . . . . . . . . . has permission to perform. ". : . . . . . . .-. '. :. . -.Z'.. . . . . . . . . . . . plumbing in the buildings of . . : . . . . . . . . . . .: :. . . . . . .`. . . . . . . . . . at /. . . . ... . . . . . . . . . . . . North Andover, Mass. FeeLic. No—,--7i. .i . . . . . . . . . . . . . . . . 1z( PLUMBING INSPECTOR Check # i1. 6673 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Date /0"-- Building Location /'- 0✓G 004 6tOwnersName % AJ � � G/ CR5ei Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes No FIXTURES SLBffm HAg1VIIVI' ls>c>HIOCR � au i�oQt 31 HDM 41H NJ" SII ]HIDLR 6Il3 Rfm 7MK DM gul Kfm (Print or type) , Check Certificate //InstallingComP Company Name e c Y { Corp.❑ A" Address �J ®x nyo Partner. usrness Telephone rm/Co. Name of Licensed Plumber. Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy !i� Other type of indemnity D Bond 11Insurance 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 0 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 Massachuset mbing Code and Chapter 142 of the General Laws. BYSignature i ns Type of Plumbing License Title 41 ?7 y— City/Town 1.1cense Numver Master Journeyman ❑ APPROVED(OFFICE USE ONLY Location No. ���5� U � i Date �oRT� TOWN OF NORTH ANDOVER � 9 ` Certificate of Occupancy $ s ♦ e� .w,.::.. 4 i Building/Frame Permit Fee $ Mwu Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # l..�`� >' 8745 —Building Insp&-tor TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 22rffiffla���� :T6is Section for Official Use OnlyffifflIM-41" BUILDING PERMIT NUMBER: q< DATE ISSUED: SIGNATURE: 0 Buildi N Commissioner/I or ofBuilDate Ri E�W 1.1 Property Address:il Assessors Map and Parcel Number Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sf) Frontage(ft) 1.6 BUILDING SETBACKS(ft) M Front Yard Side Yard Ren Yard Re red Provide —Reqdred Provided R red Provided 1.7 Water Supply M-G.L.C.40. 1.5. Flood Zone Information: 1.9 Sewerage Disposal System: Public 0 Private 0 zone Outside Flood Zone 0 Municipal On Site Disposal System 0 2.1 Owner of Record 0181rict: Y—es—NO Name(Print) Address for Service: X M Signature Telephone 2.2 Authorized Agent 3: Name Print Address for.Service: z 0 Signature Telephone z M 90 3.1 L_ sed Construction Su nvisorN Not Applicable 0 Address License Number 0 Licen nstruction Syfervisor. 00 >45 J5 00 jj> Expiration to Sigriature Telephone 3.2 Registered Home Improvement Contractor Not Applicable 0 Company Name Registration Number M r Address Expiration Date Signature Telephone G) - J Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in th.a denial of thcw issuance of the building permit. Signed affidavit Attached Yea.......Cd— No.......❑ s 5ECTI4N S P.R© I A , C CMS RC"l U R 'IC,ES 1�"f t: i3 U ltt 5MU T+1E? k 5.1 Registered Architect: Name: Address Signature Telephone 3.2 RegllsEet�c�Pt �+a>4� � �j� \� Area of Responsibility Name: y j A L Registration Number Address: Expiration Date Signature Total Not applicable ❑ Name: Registration Number Address r 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 Repaur(s) 0Alterations(s) ❑-7�ition ❑ Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: kk&-v%.A uT -7� a'arfo�f e-CK USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 0 A-1 0 A-2 0 A-3 0 IA 11 A4 0 A-5 0 1 B 0 B Business 0 2A 0 C Educational 0 2B 0 F Factory 0 F-I D F-2 0 2C 0 H High Hazard 0 3A 0 1 histitutional 0 1-1 0 1-2 0 1-3 0 3B 0 M Mercantile 0 4 0 R residential 0 R-I 0 R-2 0 R-3 0 5A 0 S Storage 0 S-1 0 S-2 0 5B 0 U utility 0 Specify: M Mixed Use 0 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: -A Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor(st) Total Area(sf) Total Height(ft) 5— 7 HIM 1ri ndent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR"PLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize to act on My behalf,in all matters relative two work authorized by this building permit application Signature of Owner Date r 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 4-IL Signature of Owner/Agent Date . l Item Estimated Cost(Dollars)to be Ala_ s Completed by permit applicant ,. z 1. Building (a) Building Permit Fee boo Multiplier 2 Electrical (b) Estimated Total Cost of boo Construction from(6) 3 Plumbing Dt:�o Building Permit fee (a)x(b) 4 Mechanical(HVAC) 7c"sr� 5 Fire Protection av 6 Total (1+2+3+4+5) cCheck Number .. INW{fit... >:..�,,�, >'�z��Sdt. ; �q t,,tgstF�_}$�,,?��',����� .�,�a.� S.�t .'�� �<s �� `a:�Y�'a F `�i p �, �.��•,;'3r .f'' .�.�ati.'x�'�'.s�fi jr r 4� yf;rug ��' �s nor.�< �,�•£. *r; .v.....:..5 t.....'ii+.. f .a.+"fa z,y.:�'.rE; H.:.,�"",, 4., :F>:�.�2� .� .��s� 3 r��Y„ ..2{-t i�s t:, t' t.Y,'. ^'4txf 1• .r+Stb+, -S�'J ? } 5 t ,: NO.OF STORIES i SIZE BASEMENT OR SLAB I - SIZE OF FLOOR TIMBERS ]ST 2ND 3 R SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X t MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE MOM -34 RU • FORM U - LOT RELEASE FORM 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 yja H Lt � ��r���c IN`�H r�(S PHONE -cV Cf- Jf b LOCATION: Assessor's Map Number ��CS� D PARCEL QOa SUBDIVISION LOT (S) STREET ST. NUMBER USE ONLY******** ********** RE OMMENDATIONS OF TOWN AGENTS: ' CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS :F:O?XODCTOR-HEA DATE APPROVED DATE REJECTED SO EALT DATE APPROVED DATE REJECTED rutsLIG WORKS -SEWER/WATER CONNECTIONS DRIVE Y PER IT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECT fR. DATE Revised 9197 jm r • 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: is that the debris resulting from this work shall be disposed o in a properly licensed solid waste disposal facility as defined by NIGL 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section I OA. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date c,',� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ii u y 600 Washington Street r=, Boston,MA 02111 www.mass.g ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name ([3usiness/Organization/Individual): Iruvt, Address: 6 r✓lScy-\ 4t City/State/Zip: C %'CIF 15 LI-A, M k Phone#: q 7j 01 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. Etl ew construction employees(full and/or part-time).* have hired the sub-contractors 2.[ ram a sole proprietor or partner- listed on the attached sheet. * 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. 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 is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif order tate pa' s and penalties of perjury that the information provided above is true and correct. Si nature: GG,, ��''`— b// Date: o Phone#: 0'? A�g `) k� 3 Official use only. Do not write in tris area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employges. 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 perfonnance 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-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 sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be tilled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The 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 Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia � �fye �o��r�rwouuea� a�✓��ucaP.lt4 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 079093 Birthdate: 08/05/1968 Expires: 08/05/2006 Tr.no: 4405.0 Restricted: 00 FRANK C ST PETER 17 JENSEN AVE MA 01824 CHELMSFORD, Commissioner 1 I k I TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT NUMBER: 01F20G©5� PROJECT TITLE: PROJECT LOCATION: 2-i L De�D ✓�. T5t,)^I. T 3A , NAME OF BUILDING: NATURE OF PROJECT: Te PANT P (.T"v P f=09 'D 2EfYnm Dt N N IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, _ ��E(?o(�-`( }�. SM �T11 REGISTRATION NO. 0&a6 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT 0 ARCHITECTURAL STRUCTURAL D MECHANICAL FIRE PROTECTION 0 ELECTRICAL OTHER(SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT,TO THE BEST OF MY KNOWLEGE. SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE.ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR.THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the contractor in accordance with the requirements of the constriction documents. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Be present at intervals appropriate to the stage of construction tb become, generally familiar with6the progress and quality of the work and fib determine, in general, if the work is being performed in a irmu er consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT�fQR OCCUP 4� V. SI NATURE SUBSCRIBED AND SWORM TO BEFORE ME THIS C DAY OF -r 7/ v. 20c _ NOTARY PUBLIC r �A+rr-IPPOLIT91Y COMMISSION EXPIRES a .. Notary Public t�mmonwealth of Massachusetts W MY Commission Expires tune?.?007 NpRTM o of _ 4Andover O i. v.�r , 4� , t ... oo dover, Mass.LA , COCMICMEWICK y1. 7,9 A0RATEO S BOARD OF HEALTH PERMIT T Food/Kitchen Septic System JA -6 BUILDING INSPECTOR THISCERTIFIES THAT..... ................................... ........................... .... .... ...... .................. Foundation has permission to erect........................................ buildings on ...1 /I....................... ............................... Rough • to be occupied a .. .. ............... ......................................... Chimney provided that the person accepting this permit shall in every sped conform the arms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the In action, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough ............... ...... ...... .. ......................... Service UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — 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. 11/4' S'-0' 13'-0' STOREROOM svI X L EF ,4 CUSTOMER SERVICE sV2 +--- H/G KATER SVI ->L<--SV2 101 *SEE FURNISHING PLANS FOR SV2-><-SV1 EA AND SINK ADDITIONAL EQUIPMENT INFORMATION in ! - Ta) sv2 C.W n-}tv� tt / I A,, I C SFtvtiov� �wsp, SVI A H/G I I� K171 ATER ��4'-0'HI&H i ,AND SINK i ! �L l/8' 9'-0 I/2' �'—`3/8' L'—II 1/8' G'-10 I/8' 8'-0' 9'-8 5/8' ` CLR. CLR i D C _ l I X WRAP COUNTER Wtz.-q p Cour WRAP C.UNTER H/G H/G WATER KATM 3 SIDES OF j K TO 4'-0" HIGH I PLAN-NEW LAYOUT Ll 114 _0" l I :5 In, A�s 2" 4 jj�—j. TOWN OF NORTH ANDOVER NOR7y Office of COMMUNITY DEVELOPMENT AND SERVICES F?�'Af�.o'�'°� HEALTH DEPARTMENT Y � 400 OSGOOD STREET NORTH ANDOVER, MASSACHUSETTS 01845 'SSACHUSEt Michele E.Grant 978.688.9540—Phone Public Health Inspector 978.688.9542—FAX healthdept@townofilorthandover.com www.townofnorthandover.com Ms.Catherine Hebert 6 Beacon St. Andover,MA.01810 September 7,2005 Re: Dream Dinners 1211 Osgood St North Andover,MA.01845 Dear Ms.Hebert, This letter is in response to your application for a New Food Establishment that was received by the Health Department on April 8,2005. Following that application a meeting was held between you and me regarding the application requirements.At that meeting the following items were discussed;food code requirements,New Food Establishment application requirements,concerns with regard to the type of food service proposed,forms and applications that were needed for submission etc.Since that time the Health Department has not received any additional information regarding this application.Without a completed application,a formal review cannot be made and subsequently your application for"Dream Dinners"has been denied. In conclusion,it has become known to this office that you are advertising"coming soon"to North Andover on a web site.This statement is being made without the approval of the Health Department.If you choose to move forward in this endeavor we will meet with you once a completed application is received and addresses all aspects of the food code. Please be advised that any and or all applications need to be submitted in full to the Health Department prior to opening. In some cases,variances need to be obtained.Due to the nature of this operation,we feel that there should be some consideration of variances by the applicant. Our next Board Meeting is on Thursday October 27, 2005.Please make a formal request in writing,one week in advance.October 20,2005 would be the dead line. Please make a formal request to the Health Department if you would like to attend.Also,please apprise us in writing prior to the meeting and variances that are being requested.The safety of our citizens is our highest priority. Sincerely, c ke, Mich a E.Grant Public Health Inspector Cc: Susan Sawyer Public Health Director Michael McGuire Building Inspector