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Miscellaneous - 133 MAIN STREET 4/30/2018
133 MAIN STREET 0133 j3 / 2101030.000'1-0000.0 I Date..... .. �. ........... f O�rtORTIy TOWN OF NORTH ANDOVER 9 PERMIT FOR WIRING #;�ss�cau�t4y This certifies that �!.. 1..:...Pn,. ....�.?.C' c ..................... has permission to perform1.Ll ..P..lI C`'!�P.... ....U�-. ...!-.-�... ........................ wiring in the building of..... (Y }Jt'a 6.Yl,.., ...................................... at ... �--'. �.............. ,No Andover,Mass. ............................................. Fee.A25..+..........Lic. No.Qn.Z ............1....l. .... ......... .. L ELECTRICAL INSPECTOR . Check# "1 c n �e/, ' C.onunor 4046 o`Ma66ac1 e1 Official Use Only eLJe�arlmanE o)°�tire Jeradce� Permit No. 1 1�)O1 Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11471 leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.44 (PLFASE PRINT IN INK OR TYPELL INF �TION) Dater 2- City or Town of: �P.2 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) /,33 l MA +�'� s l �`091L- ��r( 5W/ -e. Owner or Tenant LA -P6-45 -TAY- 5(fAV+G t; Telephone No. Owner's Address a Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 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: 11$7- L,[n,t-e.1L Htg-f&L & ptrTl e-1 Completion o the ollowin table.r +be waived b the Inspector o Wires. No.of Recessed Luminaires No.of Cell.-Susp.(Paddle)Fans o,of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA .) No.of Luminaires Swimming Pool nd e ❑ rud. E] Batt= Unitsency tg ng No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners oo etechon an Tot I Initialing Devices No.of Ranges No.of Air Cond. Tons No.of Alerting Devices No.of Waste Disposers eat ump ,Number _. ____�_ o.o - ontaine Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other \` Connection No.of Dryers Heating Appliances KW Securitystems: rt No.of Devices or Equivalent No.of Water KW No.of No.o Data Wiring: Heaters Signs Ballasts No.of Devices or E ulvalent No.Hydromassage Bathtubs No.of Motors Total HP ecommun cations Whingg No.of Devices or uivalent OTHER: i Attach additional detail if desired,or as required by the Inspector of Wires, Estimated Value of Electrical Work: fU (When required by municipal policy.) W ork to Start: 1,23-15 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 Iicensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such cfferage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I cert,under the pains anti penalties of perjury,that the information on tltls application is true and complete FIRM NAMES-"ATEJ,i AI C C—L e:C-Ti2t CAL- .=Nc-- LIC.NO.: 17q � Licensee:V 1 i 1;p =AMWA A'Z7-i Signature LIC.NO.: Jq Y 50 {Ifapplicabl enter"exem in the license,,..��rrr__niber line.) Bus.TeL No.. ' �C6 Address: l l o i(-50" i tit' 2 , 1 -%. - ':� , �� L)d 4� t/ Alt.Tel.No.:9 28 AQ li 7#59 'Per M.G.L.c. 147,s.57-61,security work requires Department of Public 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,l hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Own nt PERMIT FEE; $ Signature ture Telephone No. The ComanonweaTth ofMassachusetfs Department of lndotrkl Accidents Office of°Investigations UqV 600 Washington Street Boston,MA 02.1.11 www.mrrssg ov/dia Workers' Compensation Iaswranoe.Affidavit:Buzlders/Contractors/FIectriciansIPlu mbers applicant wormation Please Print Le�ibl� Name(aiminess/organizat€onandmduai): SATO LJt4E LIPMUtL _W G Address: j1 Q i "Pk C k SC N S-r — I'Z.e m k City/State/Zip: K M V tN K A QI!yY Phone#: 09 ' 68 Z - 5?4.* A xen employer?Check the appropriate box: Type ofproject(required): a employer with(_ 4. ❑I am a general contractor and I 6. ❑New construction loyees(fizli•and/oxpart time):* have hired the sab-contractors a soleproprietor orpartnei- listed on the attaAed sheet t 7. ❑Remodeling . and have no employees These sub contractors have 8. ❑Demolition ing for me is any capacity. workers'comp.insurance. 9. ❑Building addition w0 kers'comp.insurance 5. ❑ We are a corporation and its ed.] officers have exercised their 10.E]Electrical repairs or additions a homeowner doing all work right of exemption per MGL 11.[j Plumbing repairs or additions lf(No workers'comp. c.152,§I(4),andwehaveno 12.❑Roof repairs ance required.]t employees.[No workers' comp.insurance required.] 1311 other ?Any applicant that cheeks box#t must also M outthe section below showing their workers'compensation policy information. Y Homeowners who submitthis affidavit indicating they are doing Q work and then hire outside contractors must snbmit a nevi affidavit indicating such. *'Contractors that check this boxmust attached an additional sheet showing the name of the sub-oonftactors and their workers'comp.policy information. I am an employer that isprovidang workers'compensation huuranceformy employees. Below is thepolicy andjob site information. Insurance Company Name: RhT-Tran ) GG C4 Policy#or Self--ins.Lic.#: 08— W EG -C F 4 3 q%j . Expiration Date: 04/01 f jr JobSite Address: � ` 3 /tOA i-&, G' GSy/StaeZip:�aIR_0X L 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 fie ofc up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations otthe DIA fo insurance coverage verification. I do he eb erti th pains and enalties o that the in ormadon r y fy p p ,j`' }' p evaded ove is a ar�d con-ect. S' e: ate: �- r hone#. q?9" Z• 534 rOther e only. Do not write in this area,to be completed by city or town official wn: PermitUcense# thority(circle one): f Health 2.Betiding Department 3.City/Town Clerk 4.Electrical Inspector 5 Plumbing Inspector rson: Phone P. i Y :'.."'.. ....�,,: ....�:. z;GOMMONWEALTH OF mMSAdHI�SETT ;:_>`><> 1]kyj kg Lai OJNAUUQ • BOAE;[T Of ILEtTRI'CIANS ISSUES .THE FOLLOWING LICENSE A.5 REG(S,TERED MgSTER ELECTR f C I'A'N FSTAT'ELINE ELECTRICAL INC PFI I L I R.: J 1 AM, All I 1 10 Jb'GXSON ST 1. ' MA 0181 ...4 MTHUEN 505 1 4 A 07/. 116' 56940 77 � ORTIy T0VM of over No. L- LAKE O doer, 1Vlass., ��� COCMICHEWICK ADRATED PP��.(� SS BOARD OF HEALTH Food/Kitchen -PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........� vC ....................�,.4'�j�'.g S....................................................................................................... Foundation has permission to erect........................................ buildings on �3 �.....J..l. ........... ................................................ Rough t0 be Occupied.aS .. . .�.."-�v. S��� e..l'cu��.. .... �*�?�c,��= : .. r '. /.'J....���, 'r Chimney provided that the person accepting this permit shall in eve respect conform to g-e terms of the application on file in Final this office, and to the provisions of the Codes and By-Law relating to the Inspection, Alteration and Construction of Buildings in the Town-of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations'Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION ST T�S ELECTRICAL INSPECTOR Rough ' ..,............................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. Burner, Street No. SEE REVERSE SIDE j Smoke Det. NORTH o? Town of North Andover F � A Office of the Planning Department *N1.o� '`' * Community Development and Services Division 9SSACHUSkt Osgood Landing 1600 Osgood Street Building#20,Suite 2-36 North Andover,Massachusetts 01845 P(978)688-9535 F(978)688-9542 To: Gerald Brown From: Judy Tymon Date: October 24, 2011 CC: Curt Bellavance After speaking with David Gulezian on October 24, 2011,the site contractor for The Mediterranean Caf6 , located at 133 Main St., I have determined that the plan for outdoor seating does not require Site Plan Review. The Site Plan Review waiver is granted, based on the following: 1. The current use(restaurant) would be continued and the footprint of the building will not change. 2. The applicant has consulted with the Building Inspector,who has determined that the number of seats for the restaurant has not changed. 3. The plans include some landscaping to delineate the seating area from the abutting sidewalk. 4. The proposed changes do not have a significant impact on the site or adjacent properties and will not impact vehicular or pedestrian traffic, nor will it impact environmental resources. Please let_me know if you have any questions. J-d'y Tymon, AIC Town Planner BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 • REMOVE EXISTING FLAT ROOF, WALLS �e,� aOHrr AND WINDOWS AS MAY BE REQUIRED �cc� �oR`�P. FOR NEW CONSTRUCTION. s DEMOLISH EXISTING STAIRS AND NORTH PORTION OF FLOOR DECK/CEILING mk TO ALLOW FOR NEW STAIR AND _ ----------�— WALLS TO BE BUILT. F1 REMOVE EXISTING SINKS AND ASSOCIATED ' PLUMBING COMPONENTS . AS NECESARY. , LO DEMOLISH EXISTING WALLS AND DOOR N �_ N ti F ; S � � c6 co co ....__ SHOWN DASHED 0 00 c6 co \ N C DN C P i L cD r ix C7 z F LL v.: 2ND FLOOR PLAN Zj SCALE: 1/8" = 1'-0" p U REPAVE AND REPAIR BITUMINOUS PAVING AS NECESARY TO PROVIDE LEVEL ENTRANCE FOR HANDICAP ACCESSIBILITY. REMOVE PORTION OF z EXISTING EXTERIOR N a WALL AND DOOR TO z ALLOW FOR NEW . CONTRUCTION o r w — — — -- — — — --- --- -- — — — -- - -- -- -- -- — — — -- --- REMOVE EXISTING o EXTERIOR STAIRS DEMOLISH EXISTING REMOVE EXISTING Uj Uj ^ STAIRS, HANDRAILS ;, i ,; CLOSET AND EXTEND a F o \L AND BOTTOM LANDING. =_= WALL. INSTALL DOORS IN U z Q rNl.NEW LOCATION AS SHOWN I REMOVE EXISTING Q EXTERIOR STAIRS issue date: 03-31-2011 \ \\ revisions: REMOVE EXISTING — S DOOR TO RESTAURANT. 9 UP DEMOLISH WALL AT A THIS LOCATION S \ SHOWN DASHED dr. chk. \ ''•..., � ® 2011 GSD Associates,LLC �sssa�aassaaa Ka�waar R aaaaras�aaaarlarrro■ ■1111 R t ra Q11rp1 r arl r1101�[>•N yF�a�I rfaalaaara�Ra�R y �1615>•t�lr al�rla Ami d job number' 1 ST FLOOR PLAN GSD-1102014 SCALE.• 1/8" = l'-0" 1 D1. 1 n G)r` -rl '' -- j r _.._................ r L 11 ..... I 1 1 i Ca 0 Z a I i .-.� �. m c CLOSE 1111 � � x li ' $ to 1�` li ---- - D — w i I I D _ FTA w M LOCATION:P.\00 Co VY jmq\173 Yoh%Nath k4o \30-Co La tbn COP tz\P�k F o 3-30-2011— Q project/owner, sheet title: consultant: architect: I N y C PROPOSED FLOOR PLANS GSD Associates,LLC 133 MAIN ST. ?3 �L RNORTH ANDOVER,MA 146 Main St. 1 1C) North Andover,MA 01845 o � j Tel:978-688-5422 a� •1 x Fax:978-688-5717oll 11pp 1�� y �te�e■■r*# Qk, GORY P Sq� E�� c� y MOL ( No.8688 NEC ROOF TO HATCH EXISTING TO - MATCH EXISTING --- 10 _�; ................ ... , cco / - NEC ENTRY J ¢ N ~ f -"----- DOOR U aa) LO ........................- c6 ao - : � ' � f—� NOTE:NEC LAIImNC AND DECK LFLOOR HECJ47 TO MATCH ._i RESTAIRANT FMSH FLOOR U 0 .c rn U) Z H ti Im DECORATIVE TRIM TO ENTRY DOOR TO RESTAURANT AT CLOSELY MATCH EASTNG NEC LOCATION,REFER TO PLAN C RE-CONFIGURE STARS SO AS NOT TO EXCEED T RISER HEIGHT. PROVOE HANDRALS AS REOURED EXISTING MAIN' ST. ELEVATION PROPOSED MAIN ST. ELEVATION 2ZZ- U SCALE: 1/8" = 1'—O- SCALE.- 1/8" l'-0" i z +.. o qj i i LLI j� w r t ! NEC ROOF TO I MATCH EXISTING t 1 I _ nE �wTINf3TCSG - o U'Z - U Za ------------- ---------------------------------- ------------------------- z Q issue dare: 03-31-2011 `� ------------ revisions: 1 It , c5 1 dr. chk. i 2011 GSD Associates,LLC $ mmirnmm mimmNNNINI.2 EXISTING SIDE ELEVATION PROPOSED SIDE ELEVATION _ —•..-.a•�...L.�..., SCALE: 118" = l'—O- SCALE. 118" = 1'-0" ' N:•s�.w�1NN.w.�N{!iQ 3 iw•rrww.wN�ra�LLNL.■ ao�N.w.u.•sNr:� S job number.' GSD-1902014 A2. 1 . A Ano PROVIDE 1:20 MAX. SLOPE P. BUILD OVER THIS PORTION OF EXISTING RAMP FROM EXISTING NO,gig DECK LEVEL TO NEW WOOD DECK AND MATCH DECK LEVEL RAISED DECK AREA WITH RESTAURANT FINISH FLOOR LEVEL. WMA, PROVIDE 41' HIGH GUARD RAIL AS Lik REQUIRED AT DECK NEW WOOD DECK TO MATCH RESTAURANT FINISH FLOOR LEVEL. PROVIDE 42" HIGH GUARD RAIL AS REQUIRED EXISTING DECK RAMP UP OVER-BUILT DECK\���'1 ,• ELEV. 99'-1 3/4" ELEV. 99'-3 1/4' �n� REBUILD EXISTING TRIM AS SHOWN ON • FRONT ELEVATION Nob 00 V O NOTE: NEW DECK ( NEW STEP AT ENTRY 00 FLOOR HEIGHT TO -= -' a a - - - - - DOOR TO BE 6 1/8' L MATCH RESTAURANT ;� TO MATCH STAIR RISERS Z F FINISH FLOOR - - - - is RE-CONFIGURE STAIRS SO AS NOT TO EXCEED 1' RISER HEIGHT. PROVIDE HANDRAILS w: FINISH FLOORt — _ UP NEW BOTH SIDES. LANDING ELEV. 99'-31/4' UP 3"-0II' 3'-0" -9' 3'-3 1/8' z c w p wN `D EW LANDINNEW BRICK PAVERS G a UP-Ln =3(M TO MATCH EXISTING NOTE: NEW LANDING 4EL V. 99'-3 1/4' x z FLOOR HEIGHT TO = g RESTAURANT MATCH RESTAURANT y L 0 FINISH FLOOR w o y„ J FINISH FLOOR ri) o ELEV. 99'-3 1/4' RELOCATE EXISTING RE-SET BRICK PAVERS DOOR TO NEW AT EXISTING WALKWAY TO LOCATION AS SHOWN. BE LEVEL WITH GRANITE REBUILD EXISTING STEP AT SIDEWALK TRIM AS SHOWN ON c FRONT ELEVATION RU z¢ ` � I r --, 4 �Z j�te_ ,1 Issue dare: 03-31-2011 revisions: O 2011 GSD Associates.LLC aoeaaaotom avmasax $ rofrrn K rffrata mnx a ��K•fcoara:rfaaxa rxaarxsrrw<sfs arrfrrafr<:aaf�$ ' �xlrir�fr�fl/f.IFdtli� �rfnrMirrrrsfrmaftrx gaa�a.rcrur[arrx=ra 1ST FLOOR PLAN Ajob n.—beC SCALE.' 1/4" _ -o' 1 GSD-1102014 A 3. 1 • Q�v\ �,aftY P's No.8688 TMs; NEW STAIRS: 15 RISERS TOTAL s 6 1/8' +/- PROVIDE HANDRAILS BOTH SIDES. EXTEND SLOPED ROOF EXTEND HANDRAILS 1'-0' AT TOP . ON 2ND FLOOR OVER AND I'-11" AT BOTTOM OF EACH L THIS AREA. SECTION AS REQUIRED • ` cD I J Q N I� co FLAT EXISTING ROOFI DN �FLATTIROOF—� U 2 > co co o co TO REMAIN I DN I TO REMAIN a c' co cO ° N to x N •� a ° I" o CN7 z li I LJ ( � � � DN ' � c U � - ' f 1 Z CL CL RAMP UP o .nom` J ^W LL w Q n` W y b � O RF-O Z N Z RU z¢ x 9 Q c z issue- 03-31-2011 revisions. 3 g A S dr. chk- 5 z _ © 2011 GSD Associates,LLC wwwwAl m mrox RAiIR RIRIIRa�t i.—mom so BR RRI R{M-R■R RRO l RR R10 R R R .� mma mmmm t•�t01[ROAOf 44 A•RtIRR{RIRI KtR•Am/ RIIiR1i�QR0R f walW{�RR�RIRIIRIR4RSR•RR71R:R:RI■ aRl.ilsui[uu.Rwunarc 2ND FLOOR PLAN Y job number.- SCALE: 1/4- = l'-o" � GSD-9102094 A 3.2 ARo�''/P + mak, GORY P.Ski tc'l y N0.8688 r G ANDOVER MA. : l i ' � E NEW/ "' CL,OSETNEW ' o WINDOW NEW STAIRS: J Q C 15 RISERS TOTAL 9 6 1/8' LOCATIO --- —-- - PROVIDE HANDRAILS BOTH SIDES. > co EXTEND HANDRAILS 1'-0" AT TOP N 0 � ° AND I'-II" AT BOTTOM OF EACH a m SECTION AS REQUIRED u) Z F LL TOP LANDING —..._ ELEV. 108'-4 3/4" 011 — — OLD ENTRY LEVEL - ELEV. 100'-0 cn " o — °O NEW ENTRY LEVEL F-: ELEV. 99'-8 1/2' Z x L NEW STEP AT ENTRY W L DOOR TO BE 6 1/8' TO MATCH STAIR RISERS z EXISTING DECK LANDING t ELEV. 99'-1 3/4' ELEV. 99'-3 1/4' PROPOSED SECTION RE-CONFIGURE STAIRS 7- SCALE: 1/4" l' 0" SO AS NOT TO EXCEED w T RISER HEIGHT. a 000 �. �Z w o' � �z s issue date: 03-31-2011 revisions: g dr. chk. m 2011 GSD Associates,LLC arrau aaaocerr�rasAm wormam sarrrsrtr■ wrur-rr■®.wrmarrs aorwwairRtww rraswr■ rcr. lgmv w wrs �4Rf rwwwiwr�aFwtStR S wwrwiwlwaw�rrawaautt mwmrawrsra=ac g job number- GSD-1102014 umber-GSD-1102014 A4. 1 -? -'0 Date..5:./d................& ......... 10 Th TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING &S CHUS This certifies that . ......r —^ ..................... ........................................... has permission to perform ...... ............. ................................................... wiring in the building of..t....*............. ........ ...... . ......—ell at.../".............................. .........................I. ......... .Nort Andover,Mass. I LA-1 Fee�!!............. Lic.No-4r�-7ZR4r..,,.' ....... 7�Z ELECTRICAL INSPECTOR Check # 691'to Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. Occupancy and Fee Checked ( 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 MR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: a 1WIV 4 City or Town of: A/oliml �Ja✓�/`p To the Insp ctor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) //V Owner or Tenant IqLPI b Je L I Ase A Jk � Telephone No. Owner's Address �jy L Is this permit in conjunction with a,.building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building 0-TAIC 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: /( -7- '_7,1f move f Cetlr,-%9 ?,4llleb^-J Completion of theolio ing table maybe waived b the Inspector of Wires. No.of Total No. of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA Above In- o.of Emergency Lighting No.of Luminaires Swimming Pool rnd. E:i grnd. ❑ 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 No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection Security No.of Dryers Heating Appliances Key Y Systems:* No.of Devices or Equivalent • No.of Water KW No. o No. of Data Wiring: Heaters Signs Ballasts 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 El ctric I Work: (When required by municipal policy.) Work to Start: 0/r, Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE CO ERAGE: 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 p ins and penalties of perjury,that the information on this application is true and complete. FIRM NAME: VZ2.,o t G LIC. NO.: 7--2711 Licensee: _�7, 144"ZZ Signature LIC. NO.: C-3 -27V,3 (If applicable, enter "exenip "rn the_license number line.) Bus.Tel. No. /17 Address: /O Z�o�ylr J7- wctyX,00� ,r �I��` r—Alt. Tel. No.:!2M M2-77f C' *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, 1 hereby waive this requirement. I am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. � 1 Date..... ..-..�.........�. t NpR71� 3?°•';�``°-:'�4,.p4L TOWN OF NORTH ANDOVER p PERMIT FOR WIRING CHUSE� This certifies that ... ....................... 57Ar�2/�t-7- �ZF .............................................................. has permission to perform ��y ... ��_ ............ .... ................. ............... wiring in the building of /rr Ems_ ... ............ �T . ........................................ ......... ........ .......:. at....... ................................. rth Andover,Mass. o� l7�/7L ELE INSPECTOR"7' '*'** Check # e Commonwealth of Massachusetts Official Use Only f Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS 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 PRINTININK OR TYPE ALL INFORMATION) Date: d Z.- Cq - Z,C)11 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) Owner or Tenant Owner's Address Telephone No. Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Boz) Purpose of BuildingC-0 V1'1 Ai ek sl-t.. 6 U j L tUtility Authorization No. Existing Service Amps / Volts Overhead ❑ Und rd g ❑ No.of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity �\AAr� L., n 4 n�NG Location and Nature of Proposed Electrical Wor �n A i-/l. L —L�R►G A(_ "~ Completion of the followin table may be waived b the Ins ector 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- o.o Emergency ig g d• ❑ nd. ❑ Batte Units - No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones n and No.of Switches No.of Gas Burners No.of Detectio InitiatingDevices No.of Ranges No.of Air Cond. oTotal ns No.of Alerting Devices No.of Waste Disposers EMPIiances Number Tons KW _ No.of Self-Contained '' Deteetion/Alertin Devices No.of Dishwashers Heating KW Municipal ! f Local❑ Connection El Other No.of Dryers KW Security Systems:* No.of Water No.of No.of Devices or E uivalent Heaters KW No.of Data Wiring: Si gyns Ballasts . No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total Hp Telecommunications Wiring: OTHER: No.of Devices or Equivalent } c,, Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: I t Z (When required by municipal policy.) Work to Start: 2 — •- )t 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 [f BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties of perjury, that the information on this application is true and complete,. s� FIRMNAME: Tla T �. I N 4 L e e,T lL+ (-A L. � C- A, LIC.NO.: �`rtr/�i� Licensee: ����.� !�lVN�L2_.` Signature LIC.NO.: �y�(.j (If applicable, enter "fin t n the license numb line.) ��p Address: ) IU � t S S- -W eA& 1 � 11�U(�N �/� its.TeL No. '02-�3�? Per M.G.L c. 147,s. 57-61,security work requires Department of Public Safety"S"License:� L cl.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. $ - 'v. ,�. -� � / ��/ ... ;- The Commonwealth of Alassachusetis k; ! Department of Industrial Accidents w Office of Investigations My 1u 600 Washington Street i Boston, MA 02111 {'1 www.mzass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgmization/Individual): ,TA j(_�-- I— L tNC an(•C11L NL Address:_ "� M ( City/State/Zig: p I Auep! H A 0 /eil Phone#: . 928—6 9 2 53,? Are you an employer?Check the appropriate box: 1. am a employer with 3 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2•❑ I am 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. [No workers'comp. insurance 5. ❑ We are a corporation and its 9, ❑Building addition 10.❑Electrical a required.) officers have exercised their repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No-workers'comp, c. 1.52, §1(4),and we have no 3 12❑Roof repairsinsurance required.]t employees. (No workers comp. insurance required.] I3.0.0ther *Any applicant that checks bor!#I must also fin out the section below showing their workets'compensation policy information 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 subcontractors and their workers'comp,policy information. lam an emiployer that is providing:workers'compensation insurance for mV employees: Below is the policy med job site information. Insurance Company Name: NCR L L SS .T-lv.$o n /i NC CC,0 Policy#or Self ins. Lie.#:_VAI C ' 3,5?3/j qGExpiration Date: (J1:14:6�/ .. Job Site Address: I A t N ST L City/State/Zip:/.Ai 1 o 1�& H4 Q/OY/ 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 c nder th ains and penalties of perjury that the information provided above is true and correct Si Lure: _ Date: Phone#:_125 699 - 3 s Fow se only. Do not write in this area,to be completed by city or town officio( on: Permit/License# uthority(circle one): f Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector { Confect Person• Phone#• Information and Instructions •R 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`(either the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation•affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage.. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,nottthe 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 numberlisted 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 appiicanL 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 Industria( Accidents Office of Investigations 600 Washington Street Boston, MA 42111 Tel. # 617-7274900 ext 406 or 1-11.77-MASSAFE Revised 5-26-05 Fax#617-727-7744 www.mass.gov(dia l s 7564 Date.. . ./.� %ORT" TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION . y SSACHUSEtt 000 This certifies that . . . . t t. . . . . . . . /L`. . . . . . . . . . . . . . . . . . . . . . has permission for gayys,,installation �Jbd'e . . . . . . . . .. . in the buildings of . . . . . . . . t Z. . . . . . . . at, J.3.3. . ./1w !? . . . . . . . . . . . orth Andover., Mass. Fe4e. :QO . Lic. No.31.3�a.`{. . . . . .. ,e ? _;.- GAS INSPECTOR Check# 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING _J City/Town:Q &JOy C-< , MA. Date: I '— ( 'J s I 1 Permit# Building Location: 1 � J ! v l A I U 5+ Owners Name: 12& Type of Occupancy: Commercial [� Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ New: Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes❑ No❑ FIXTURES co Cd W Z W N U = W W ~ N m = O W W U N H O = W W O J �- W U) O 2 W w U) > W z m° O a a W W w x tr I-- U W W z _ L o W o �- � WX V W Z O J F- H O Z J 0 LL N W W H W Z W } Q Q m W O Z O ~ H SUB BSMT. BASEMENT 1 FLOOR 2 FLOOR 3 FLOOR 4 FLOOR -5'FLOOR 61HFLOOR 71HFLOOR 8 1HFLOOR Installing Company Name:_ Coc�`f h \c/Zr Check One Only Certificate# 119 r� /� q/J ❑Corporation Address:- 1"t (�JJ &)e) tc� AUf- /City/Town: �� y� State: 14A A Business Tel: q`Z b 32 S (� 55 Fax: ❑ Partnership El Firm/Company Name of Licensed Plumber/Gas Fitter: Cocom �uc'-e'C Pr INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes E�- No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box❑;1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. Ty a of License: By LyjPlumber C�-X Title ❑Gas Fitter Signature of Licen ed Plumber/Gas Fitter ❑Master / City/Town Mourneyman License Number: , APPROVED OFFICE USE ONLY ❑LP Installer Date. . 8856 ONORM TOWN OF NORTH ANDOVER �•..•o .�,ti0 PERMIT FOR PLUMBING 41 ,sSACHUs� This certifies that . . .(V!1 I . . . . . �. . . . . . . . . . . has permission to perform . . . . .Ht} !. , ' (e--. . . . . . plumbing in the f buildings o . . . . . . . . ... . . . . . . . . . . . . . ' / GM at . 3 . . .�� 1!1. . . . ?. . . . . . . . . . ., NorthAndover,jjMaQ�ss. Fe yfi U.Lic. No..31., (?y. . . . . . . PLUMBING INSPECTOR Check # 6 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town: 1 y 4AI JUL)`e <- ,MA. Date: I—� Ll —� � Permit# k_; ! 2 Building Location: j ) 1�1/�I N 5� Owners Name: Type of Occupancy: Commercial© Educational❑ Industrial❑ Institutional❑ Residential❑ New:❑ Alteration: ❑ Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z SYSTEMS LU O Ln w Ln u `y D > Z of Cyt = of iii O cz N z LU F Y Q N - Q W U� ' a a a' W z CL W Q C Z W Z V) O Z N VI W � Q 0 Q W 0 Q W Z W J 7 K Ce LL off! C♦ W L6 F.- 3 p 3 o z Q Y 2 = 0 Q = Z a �' a Y Z V1 H H W p a } H Q a o 0 > > o = o Q a m m o s LL = be g g �, 3 3 3 0 SUB BSMT. BASEMENT 1ST FLOOR 2ND FLOOR 3RD FLOOR 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Check One Only Certificate# Installing Company Name: _�6{�J UC'�'{i G, ,AD F-1 Corporation G Address: 1 & p A City/Town: 1� State: E] Partnership Business Tel: 7 () b�� Fax: ❑ Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes YNo❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy nf, 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: Title n1plumber Signature of Licensed-Plumber City/Town El Master License Number: / 3 APPROVED OFFICE USE ONLY) Journeyman t No eTM V i �'SSACNYbs, CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 250 (10/8/08) Date; November 14, 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 133 Main Street—Mediterranean Villa Restaurant MAY BE OCCUPIED AS Restaurant-- 16 Seats IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Arthur 5kambus 133 Main Street North Andover MA 01845 NORTH T® oAndover No. Z S C% o W yy dover, Mass., O - LAKE �, T COCMICHEWICK ORATED `S BOARD OF HEALTH PERMIT T D Food/Kitt G Septic System { BUILDING.INSPECTOR THIS CERTIFIES THAT........ ...:Al" .........:......... �r. ! .......::................................................................................... Foundation has permission to erect...................................,.... buildings on ...::, :::....................f :............................................. Rough to be occupied as..... .......... .. .: .......... ........ ........: ...... ? Chi n y .m ........ ......... . ................. ............ ; provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final �, this office, and to the provisions of the Codes and By-Laws relating to the Ins pection,,.Alteration and Construction.-, f 1411,� Buildings in the Town of North Andover. } kUMBINP INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Ro aY PERMIT EXPIRES IN b MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ,! ........... ..................... Service .. r - BbALDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR ou ro L� `� Display in a Conspicuous Place on the Premises — Do Not Remove Fq �� y No Lathing or Dry Wall To Be Done FIRE. EPA%01 NT Until Inspected and Approved by the Building Inspector. Burner J;0121� ' Street No. -Smoke'Det. SEE REVIERSE. SIDE , ,` 1� 1(316 Date..`1..........`... t� NORTH °f' °:•�"� TOWN OF NORTH ANDOVER ° PERMIT FOR WIRING HU This certifies that ..... ..f....................... ............a:.. ............ A..:........... has permission to perform ......`.- s.....1.,.......................................... wiring in the building of... ... 1 ..s':. ;•.............. 1. at. �.?....... ... .....................C�CTRi�ICAL Nth Andover,Mass. Fee ...�......... Lic.No/ ' .�!/ ................ 4 ELINSPE R Check # 64 � j float Use M4,. Pwi it No ,.L?rPnrb""'t of _ im- -�sr.t•rca_< .�, Occupancy and tree Qtecke j / BOARD OF FIRE PREVENTION REGULATIONS 1Rev. 0671 f leave hlmi:5 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be prrftxn ed in accordant with the Mm4t h0Wt%plctriaal Cute:MEC) 321 CMR t2 M) !1'L.RASE PRIN7 IN INK OR TYPE AIJ,INI-C71MA110N) Date:_ Clty or Town of: W=kn To the Inspector 4 Wiles By this application the undersigned gives notice of his or her intention to perform the electrical toot k described below Location(Street&Number) 1 , M A 1 LZ) 2 01�� Owner o: Y e:nant t'��t�`i �,;f�r� n t���.I"1� 1/i�•l.t���' ��Tetephoue No 91�:-�°t�--'Zr-t Sc7 Owners Address Is this permit in conjunction with a building perrrlie Yes LNo ❑ (Check Appropriate Box) Purpme of Building mi t,t T i utility Authorization No Existing Service _._= A Amps , l VOits Overhead L_J Undgrdl_! No.of Meters Tlrlw Service Amps ! Volts Overhead❑ Undgrd ❑ No_of Meters Number of Feeders and Airimcity [_ocation and Nature of Proposed FAccuical Work: Inv Completion oI thelollowittx table may be wah ed by the Inspector of Wires. No of Total No.of Recessed Luminaires �No of Ceil-Susp (paddle)Fags KVA No.of Luminaire Outlets INo of Hot I abs iGeMMIDIS KV A �No of Luminaires Swimming Pool ❑ In- 'B ttex L ucoc'Ughting No of Receptacle Outlets No.of Oil Burners FIRE ALARMS lNo of Zones � t..�.. No of Gas BUMCIN No o Detection andNo.Of Stivilches initiating Devices No..of Ranges No.of Air Conti TQC No of Alerting Devices No of Waite Disposers Heat PrunpL__umiiet_ _'I �___.,�W,, o. etf-Contained �itl;:l DaK onj&l 'ngces No of Dishwashers Space/Area Heating KW Local ❑ Chnnectioln Murucrpal ❑ Other a No of Dryers Heating Appliances KWSettrity S 'stents:G v No.of Water o of No-of Data Whin HwLeN KIN' Siam B acts oEguivatent No Hydromassage Bathtubs No of Motors Total Up Tel ecu,nu,unteatrcxrs ,ring: '�( nt 10f HER: Attack additumal detail ifdesfred oras required by the ftttpeaar of Wires mei Estimated Value of Electrical Work- Wolk (When required by municipal policy) Q'�s Work to Strut: inspections to be requested in acmdanc:e:with AMC Rule 14,and upon completion INSURANCE COVERAGE: Unless waived by the owner,no permit for the petforrnancx of electric0l work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage ex 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 0 BOND ❑ OTHER ❑ (Specify:) - I certify,under the pains and penalties of perji,t}.that the tnformidon On this applrcaum f true and complete A1C. NO.:` A Licensee:CRS). hU tai=N 8 Signature LIC NO.: 3 (if amicable.enter "exempt"in the licence ruanher lore j Bus Tel No Address: 1:1 =ago LT neL-dli)ri�, -r-12 ©1 f f c-)a Alt I el "Per M_O L.c 147,s 57-61,security work requires DepsrtmenL of Public Safety"S"L icense: Lic No OWNER'S INSURANCE WADER:I am aware that the Licensee dots not have the liability insurance coverage normally required by law By my signature below,i hereby waive this requirement I am the(cheek one) ❑owner ❑owner's agent. Ovmer/Agent PERAfli FEC-,R ��'% Signature _ — T eleohone No._ . . I R - The Commonwealth of Massachusetts *. y Department of Industrial Accidents _. Office of Investigadom 600 Washington Street �+ Boston,MA 02111 1 'r� www mass gov/dia Workers' Compensation Insurance Affidsvit:Builders/Contractors/Electricians/1'lumbers Alpyh ant Information Please Print Legibly Name(Business/Organization/individual): Address: 1-71 �5 . City/State/Zip:1SG_1, US 4,111pr 019CU 019CPhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with 7 4- ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 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 10. Electrical repairs or additions mqu�] officers have exercised their 3.El I am a homeowner doing all work right of exemption per MGL 1 I.❑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 most also fill oat the suction below slowing 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. ZConftct=that check this box most attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I ain an employer that is pnoviAng workers'codon hmronrefor my employees. Below is thepolicy and job site inforrnation Insurance Company Name: &- 4-\ Policy#or Self-ins.Lic.#: WC- 43R�5 Expiration Date: Job Site Address: I j-,�> Iyl A I N City/State/Zip:Noe:I-j ANL VqP- iMA 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 tint a copy of this statement may be forwarded to the Office of Investigations of the DIA for ulstuanee coverage verification. I do hereby certify ander the pains and penaGdies of perjury that the mfornuom provided above is true and correct Si G4� --y---- Date- -1 Q Phone#: 7f 1 -")si•- 7 Official use only. Do not write in this area,to be completed by city or town Widal. City or Town: Permit/Lkense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: North Andover Board of Assessors Public Access Page 1 of 1 I "ORT61 %ndover Board of Assessors Of tt�ao a'�.y0 SSACH°5e� roperty Record Card Parcel ID :210/030.0-0041-0000.0 FY:2012 Community:North Andover SKETCH PHOTO Click on Sketch to Enlarge Click on Photo to Enlarge j h - • I "i 133 MAIN STREET i Location: 133 MAIN STREET Owner Name: LAPPAS,ALLEN&VRAHLIOTIS,KAREN TR Owner Address: 105 LESLIE ROAD ; City: WALTHAM State: MA Zip: 02451 Neighborhood:35-5 Land Area: 0.18 acres Use Code: 340-GEN-OFFICE Total Finished Area: 3944 sqft Total Value: 450,000 544,700 Building Value: 312,500 407,200 Land Value: 137,500 137,500 ! Market Land Value: 137,500 Chapter Land Value: LATESTSALE Sale Price: 700,000 Sale Date: 09/14/2004 l t Arms Length Sale Code: Y-YES-VALID Grantor: RUBIN,VICENTE Cert Doc: Book: 9052 Page: 164 f I i I http://csc-ma.us/PROPAPP/dis la .do?linkld=18891 — p y 69&town—NandoverPubAcc 2/13/2012 ttORTH O���VED 16 qti p . t °.p coc41F IWICKJOArED �1 ; SSACHU�'��,�y TOWN OF NORTH ANDOVER _ SignTermit Date: October 22. 2008 f Permit Number: 008-09 THIS CERTIFIES THAT ARTHUR SKAMBUS —MEDITERRANEAN VILLA Has permission to erect a GROUND SIGN 4' X 47" POST AND PANEL NON ILLUMINATED On 133 MAIN 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 Town of North Andover. Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit Internally Illuminated Signs are Prohibited Inspector of Buildings �i0RTi1 q 0 1 t ti � �a a�lcr �A COCNIC Mr WKM`� - �s9sS►rea OR���5 AGHU TOWN OF NORTH ANDOVER _ SignT.ermit Date: October 22, 2008 Permit Number: 008-09 THIS CERTIFIES THAT ARTHUR SKAMBUS —MEDITERRANEAN VILLA Has permission to erecta GROUND SIGN 4' X 47" POST AND PANEL NON ILLUNUNATED f On 133 MAIN 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 Town of North Andover. I � Violation of the Zoning of Sign Regulations, Section#6 Voids this Permit I Internally Illuminated Signs are Prohibited 7 Inspector of Buildings i �- I r- r SIGN PERMIT APPLICATION 1600 Osgood!'Street Building 20,Suite 2J6 TOWN OF NORTH ANDOVER Site Owner Applicant Arthur Skambus Tel 978 390-2459 Site Address 133 Allain Street, N. Andover, MA 01845 Size of Proposed Sign Man Parcel Illumination: a)Not.illuminated Flow attached: a)Against the wall b)Internally illummnated b)Roof c)Externally illuminated c)Grouted. x 47 2) 4' d)Other To existing wooden sign. Materials4'H "L 040 Red Aluminum Sign panels to existing sign decorated with; High Performance Vinyl Proposed Calors: Background White and 23 Karat Gold Leaf Vinyl Lettering as shown on drawing. Lettering 23k Gold/Black Outline :border Cost of Sign S1,607.50 i Iteauired AUnchmentss Note: No permanent/temporary sign shall be erected,or enlarged until an. Photographs of building application on the appropriate form furnished by the Sign Office has been filed Material sample with the Sign Officer containing such information including photographs,plans Color sample and scale drawings,as he may require,and a permit for such erection,alteration, Site or blot Plan(Required for all free-standing signs) or enlargement has been issued by him, Such permit shall be issued only of the Dra%vings of proposed sign Sign Officer determines that the si6m complies or will comply with all. Other,specify applicable provisions of the By-Law. Wil'I sign overhang any public road or walkway Yes( ) No(C) If Yes,Name of Agency who will provide liability insurance: AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED I DATE FILED: Receipt# Check# Revised 10.31.2006Form S[Vi Permit Application SIGNATURE OF APPLICANT APPROVED BY �1�i fel vw �1i' � � ` C�� .��:�f. •1 • - *�� �} �, , �e�`' �. MK•'+i�e � 1 • -�, 111} �_ —_ -�_ - - - -- s Ic titCAS 1,1 A t. DINING .1 _ CASUAL DINING 1 � " - & Tae Out /bdR 0 - IZZ A r rrr - r - r . rr THIS DESIGN IS AN ORIGINAL 'T\IL;T NO of r:'=7 Ai',RM ,0R'RAYSrFFRF-By ANY I/F'H'1 v— PtOBOX 1951 7' Bridge 5' Pelham. NI[0337B;1-600-527-74461 Fax K3-635-790? E-Mail Inlo .hamma:andscrls corrin www.l-amma,andscns.con � Date. . ". . . . . . . APO NORT" TOWN OF NORTH ANDOVER 10 PERMIT FOR PLUMBING ; . ,SSACMUS� ` This certifies that . . `�. . . . ..`.'. . . . . /. . . . . . . . . . . . . . . . . . . . . . . . has permission to perform -. . ! . . . .. ..�`. . . . . . . . . . . . . . . plumbing in the buildings of . . . . . . . . . . . . . . . . . /a'-' "?�'•"' �-e . . . . . . . . . . . ., North Andover, Mass. at . . . . . . . . . . . . . . . . . . . . d FeA! . . . . .Lic. No`:�.y�2,7 _1. . . . . .�. PLU Bd G INSPECTOR Check # 111 7892 DatP . f NOR7p, TOWN OF NO TH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS� l % This certifies that -.. .-:--^! ". ! . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform�J `-'�.. .. . . -. . .. ... .. . plumbing in the buildings of(. . f'z'. . .. .. . . . ... .%`?`` q . . . . . . . . . . atld ! "' � """`" '�' . . . ... . . . . . . .. North Andover, Mass. Fee�. . ... . . . . .Lic. No . . . . .,, PLU B NG INSPECTOR Check # 79 '14 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building LocationOwners Name OS � -X Y Date i a S - Permit# 7-7 Type of Occupancy Amount New Q Renovation Replacement Plans Submitted Yes ❑ F1No FIXTURES H � v U y co 7S1r IFIUQt M FLOCK 41HI+If�t SIB)N7lJQ2 6M b7IJCIt '/KaOCR - 9M)JXR � (Print or type) Installing Company Name /lf Q 1 o heck one: Certificate ( Corp. Address �� 1' M t ocivrVC, Partner. Business Telephone C/ Y 97 t E] Firm/Co. bA Name of Licensed Plumber. _ IF L iC /'' cL , Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity11three insurance Bond ❑ Insurance Waiver. I, the undersigned,have been made aware that the licensee of this application does not have any one of the above Signature Owner ❑ El 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 under Permit Issued for this application will be in Performed compliance with all pertinent provisions of the Mass chusetts State Plumbing r4ode and Chapter 142 of the General Laws. F,;- APPROVED , SisraLli ui iacens tum er Type o�Plumbing License own kens�umoer (oFTtCE USE orn,r Master ® Journeyman ❑ Date.S.. . . ... .. Of NORTH o? �°� TOWN OF NORTH ANDOVER 49 PERMIT FOR.-GAS INSTALLATION �,SSACMUSEtt - This certifies that . . . . . . . .'t*-e . . . . . has permission for gas installation . . . . . . . . . . . . . . . . . . . in the buildings of . . .' :z.^'. . . .... . ....... . . . . . . . . at �(.' �� .? �'. +� . . . ' , North Andover, Mass. Fee- c TJ. Lic. No/ `Nf. . . . ` .: � , ... . . . . . . . . . GAS I�P TOR Check# r,?d 92 6608 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FPITING (Type or print) date / NORTH ANDOVER, MASSACHUSETTS DB Building Loqations _ / 0 9 /rpt.fo) St ' Permit# Amount owner's �� Owner's Name New❑ Renovation Replacement ❑ Plans Submitted Z c z F d� eo 0 F' w 9 O 0 z 0 z F Gw a z v w 5 v, z dd C m > w G9 EW+ z F z x W W C7 C W F w F O C W O z t C W W z O z W O O SU B -BASET ENT W 3 C C7 J VO C > c BASEM ENT IST. FLOOR 2N D . FLOO R 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . .FLOOR 8TH . FLOOR (Print or type) Name i k Z � L Check one: Certificate Installing Company V ❑ Corp. Address 4 W-�,t t��Q`p C?� ❑ ��4,y 119 1-f ( � 0'a $" Partner. Business a one cam ) cfQ f) L bFi Co. y� Name of Licensed Plumber'or Gas Fitter Z INSURANCE COVERAGE I have a current liability insurance,policy or it's substantial equivalent. Check one: Yes El If you have checked yes,please indicate the type coverage by checking the appropriate box. No❑ Liability insurance policy ® Other type of indemnity ❑ ❑ Lid Bond Owner's Insurance Waiver. I am aware that the licensee does notes the Insurance coverage required by Chapter 14jthe Mass. General Laws,and that my signature on this permit application waives this requirement. Signature of Owner or Owner's Agent Check one: Owner 13 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 and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title Plumber City/Town•. ❑ Gas Fitter S L-/ i • I .�e ivwnuCr Master APPROVED(OFFICE USE ONLY) ❑ Journeyman MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) J A NORTH ANDOVER,MASSACHUSETTS ✓,'%'t �" � Date Building Location 133 �a ,� Owners Name �v�v.� Permits#7�,D- Amount /d T e of Occu anc ��(Vl�e v—c I New 13 Renovation Replacement '1:3 Plans Submitted Yes No El FIXTURES UCC q O V U W v� r 0i O q 1ST KIM �1B I+IAL7t �]6IfJQ2 4IIi PIfJQt 5TH FLOCK 6IH HDD 7IH HOMR - SIH Flf.�t ,.(Print or type) Installing Company Check one: Certificate Nam��� �t l vjy��j>y) j ® Corp. to Addres Partner. usrness Telephone -7 --p UG 5 1 aFirm/Co. Name of Licensed Plumber: 0 Y Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type.of indemnity Bond Insur the undersigned,have been made aware that the licensee of this application does not have any one of the above thre ur I ature Owner ❑ Agent ❑ I hereby certify that all of the details and information I s mitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work tnstalla'ons erfo ed under 't Issued for this application will be in compliance with all pertinent provisions of the M chuse S to Pi mQ and Chapter 142 of the General Laws. By: i Lure o icons um er Title Type of Plumbing License City/Town 9- iceuse um er Master Journeyman F1APPROVED�o�c$usE ONLY I Date OF ,+ORTM o� TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION -�9SSAC14USE� ti This certifies that ',�' . . . . . . has permission for gas installation '�!3 �r� - "�` ' . . . . . . . in the buildings of .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at ' .` �'~" . . . . . . .. North Andover, Mass. Fee�?1..�"'. . Lic. No :� /'�/. /. . . . . . . . . . GAS INSPECTOR Check# 6504 MASSACHUSETTS UNUORM APPLICATON FOR PERMIT TO DO GAS FITITVG (Type or print) Date NORTH ANDOVER, MASSACHUSETTS /R® Z -4D(5 Building Locations 3 3 / `Ci 1,1x1 'S T / p Permit# O`7 Owner's Name Amount Amount$ , New❑ Renovation Replacement ❑ Plans Submitted ❑ a , 9 w w a a o v, x H z ', N C w w Q w w O r., O w F w �I Z V w Z F C D C W G7 F Z F Z W W Cw7 w F w a Z a c z ° z w c SU B -BASEM ENT r. , C BASEMENT IST. FLOOR 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . .FLOOR 8TH .' FLOOR (Print or type Name CJ)E/, _/�� �� N �, t n RcPe+1 n G Check one: Certificate Installing Company �7�— ❑ Corp. _ Addres �� Z-d /Ce S/ C�E/C�s��i/ Ql�i ❑ Partner. Business a ep one '-,�_(0C 3 Z) 'Firm/Co. Name of Licensed Plumber'or Gas Fitter NJSd 'A4SURANCE COVERAGE I have a current liability Insurance,policy or it's substantial equivalent. Yesc� If you have checked Yes please indicate the type coverage by checking the appropriate box. No[] 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. Signature of Owner or Owner's Agent Check one: Owner ❑ Agent ❑ t hereby certify that all of the details and information 1 have s ttte or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and ins ations pe orme oder ermit Issued for this application will be in compliance with all pertinent provisions of the Massac s tts Stat as de apt 142 the General Laws. By: Signature of Licensed Plumber Or Gas Fitter Title 0 Plumber City/Town.: Gas Fitter _hyla ❑ License um er Master _ APPROVED(OFFICE USE ONLY) ❑ Journeyman poRrk Zoning Bylaw Review Form Town Of North Andover Building Department 4s° t 27 Charles St. North Andover, MA. 01845 s"`HUSF Phone 978-688-9545 Fax 978-688-9542 Street: 13 c3 m A 10 S Ma /Lot: 3 4r f e Applicant: 7—.4/V ,q g Request: can�r►��- ., w.�his �• Kr S Date: Please be advised that after review of your Application and Plans that your Application is DENIED for the following Zoning Bylaw reasons: Zoning G -)3 Item Notes Item Notes A Lot Area F Frontage 1 Lot area Insufficient 1 Frontage Insufficient 2 Lot Area Preexisting q -e-5 2 Frontage Complies„ 3 Lot Area Complies 3 Preexisting frontage e S 4 Insufficient Information 4 Insufficient Information B Use 5 No access over Frontage 1 Allowed G Contiguous Building Area 2 Not Allowed 1 Insufficient Area 3 Use Preexisting 2 Complies 4 Special Permit Required �e S 3 Preexisting CBA p S 5 Insufficient Information 4 Insufficient Information C Setback H Building Height 1 All setbacks comply 1 Height Exceeds Maximum 2 Front Insufficient 2 Complies 3 1 Left Side Insufficient 3 Preexisting Height H e S 4 Right Side Insufficient 4 Insufficient Information 5 Rear Insufficient 1 Building Coverage 6 Preexisting setback(s) S 1 Coverage exceeds maximum 7 Insufficient Information 2 Coverage Complies D Watershed 3 Coverage Preexisting ,� S 1 Not in Watershed e S 4 Insufficient Information 2 In Watershed j 1 Sign -4-)LA 3 Lot prior to 10/24/94 1 1 Sign not allowed 4 Zone to be Determined 2 Sign Complies 5 Insufficient Information 3 Insufficient Information E Historic District K Parking 1 In District review required 1 More Parking Required LJ "S 2 Not in district e S 2 Parking Complies 3 Insufficient Information 3 Insufficient Information q e S 4 Pre-existingParkin 'Remedy for the above is checked below. Item # Special Permits Planning Board Item # I Variance Site Plan Review S ecial Permit wlra�u� Setback Variance Access other than Frontage Special Permit jk-F3 Par king Variance. Frontage Exception Lot Special Permit Lot Area Variance Common Driveway Special Permit Height Variance Congregate Housing Special Permit Variance for Sign Continuing Care Retirement Special Permit special Permits Zoning Board Independent Elderly Housing Special Permit S ecial Permit Non-Conforming Use ZBA Large Estate Condo Special Permit Earth Removal Special Permit ZBA Planned Develo ment District Special Permit Special Permit Use not Listed but Similar Planned Residential Special Permit Special Permit for Sign R-6 Density Special Permit Special permit for preexisting - Watershed Special Permit The above review and attached explanation of such is based on the plans and information submitted. No definitive review and or advice shall be based on verbal explanations by the applicant nor shall such verbal explanations by the applicant serve to provide definitive answers to the above reasons for Any inaccuracies,misleading information,or other subsequent changes to the information submitted by the applicant shall be grounds for this review to be voided at the discretion of the Building Department.The attached document titled"Plan Review Narrative"shall be attached hereto and incorporated herein by reference. The building department will retain all plans and documentation for the above file.You must file a new permit application foam and begin the permitting process. O wldmg Department Official Signarfe Application Received Application enied" an Review Narrative z .; Q following narrative is provided to further explain the reasons for DENIAL for the OLICATION for the property indicated on the reverse side: -,R,;, wa,,:, ' i t �� ✓i`A 3E 91 /Pn a.vu�rvlc/' ,8A ke r% I'3-G-S A,--O!; s . a,4 c��c �a � j Referred To: Fire Health Police Zoning Board Conservation De artment of Public Works Planning Historical Commission Other Building Department F t pCGEE AUG 2 5 2004 BUILDING DEPT. Preliminary Report for YASMINE CAFE 133 Main Street, No. Andover MA 01845 30! / By; Taner Gulbas 1 Norwich Lane Methuen MA 01844 Cell: 978-979-0757 Home: 978-683-3629 ,r r YASMINE CAFE Type Caf6/Bakery, Gourmet Sandwiches/Cakes Located: 133 Main Street, North Andover, MA Employee: 2 Full Time, 1 Part Time. Also, plus the owner Serving: Breakfast, (Muffins, Croissants etc.) & Lunch. Parking: OF-Street Menu: Gourmet Mediterranean Salads, Foods Panini Sandwiches, Wraps Variety of Cold Sandwiches in different breads. Baklava, Kataifi, Mediterranean Pastries Birthday Cakes, sweets Gourmet Coffee, Expresso, Shakes, Smoothies Dining Room To be consisted of 5 or 6 round tables with seating 2- 3 the max. Possibly a couch by the outside window with a coffee table besides for people to sit and relax and read their papers/studies. There will a different variety of art effects all around for decoration purposes. There will be a trash counter with condiments bin over it. • Maybe a display to sell packaged coffee and tea from different parts of the world. Kitchen A walk-in possibly 5x8 will be situated at the end of the restaurant, within the kitchen area. There will be an 80,000 BTU conventional oven 32WX72H. 2 refrigerated displays/counter for the front of the store. (these are to be 40" height X59"X35Deep A small prep table, 3 compartment sink, A slicer, a panini machine, food processor Misc. utensils, Bakerware, Shelves for storage. Also residential style an electric range. Expresso and drip coffee machines. • f Menu Display A laminated wood colored board with interchangeable menu items/posters. A light fixture hanging from above it. Also there will be a stand alone erasable board with weekly specials. Restrooms Currently there are 3 restrooms inside the building. As town and landlord permits we will cancel one of the restrooms and make a bigger unisex one to be used by the customers. This is just the preliminary report for Yasmine Cafe to get the necessary approvals to form the business at its location. More information will be available to get necessary permits as it may or may not be necessary. Competition There are many food establishments nearby 133 Main Street. But currently there is no-one serving or having the concept as what Yasmine Cafe is planning to serve. The town of North Andover Main Street really has the foot traffic of customers. There are no parking spaces available, it will solely be off-street parking just like other businesses allowed in downtown area. Ownership/Management Taner Gulbas will be the sole owner of Yasmine's Cafe. A business entity, such as S-Corp to be formed as soon as town OK's the location. Mr. Gulbas has many years of experience running/managing food establishments. He holds a degree in Hotel Restaurant Management from Hesser College, Also a Bachelors degree in business from Southern New Hampshire University. Though he is currently not in the field but is planning to return with Yasmine Cafe. His experience in food, customer service, and a compliments of Yasmine Cafe should really bring a good/professional/neighborhood friendly business to town. WC walk In K-A T c 14 C-nS free C v n sXo� �a1�! 0 0 0 io 0 s I / D / 1 i Rite of May to Second Street Second St Building Olympia Realty Parking Lot V� i }�7 Main St Building 133 Main St Building 1�l r V �/ To Town of North Andover, Planning Board Continued issue of Parking Spaces for 133 Main St Dear Board Members As it was discussed at the last meeting on Sept 7"', parking was an issue that had to be re- visited for a Site Plan Review Waiver Yasmine Cafe on 133 Main Street. I realize parking is always an issue in downtown for area businesses. But findings show we just might have sufficient parking spaces for the business. Findings listed down below adds up to minimum of IP�parking spaces not including the public parking located across from 133 Main Street which is behind the sports shop. 1) 133 Main Street, Should have 13 spaces in the back as it outlined in the drawing. This will be done by clearing and combining the spaces with Olympia Reaalty's existing Buildings (Second St, and 147 Main St.) and maybe re-shaping the current landscaping between all of their buildings. Owner has provided us with a written authorization. 2) There are enough spaces on Second St. for 8 cars for street parking. 3) There are minimum 3 spaces behind our lot available for st parking on the rite of way (see drawing) 4) 147 Main St. also owned by Olympia Realty will allow us to use their existing 6 car parking spaces for our use. ,r 5) Last there is also public parking(at least 30-50) located across from our building, which is behind the sports shop. Not considering the street parking available on Main st. which is in front of 133 Main Street. Under current findings, I would like to ask for your consideration od Site Plan Review Waiver. As I believe Yasmine Cafe will be a very good match to Town of North Andover. ncerely Taner Gulb 978-979-0757 F NORTH own of No. 2• .� -_ 40M `A = dover, Mass.,_ 1 D oft '�•�o' 1 / 2 COCHICHEWICK I ,p \ �� ADRATED PPS 7`S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System �' BUILDING INSPECTOR THISCERTIFIES THAT..... ....................... ............................ ................P...................................��.V..� ........ Foundation has permission to erectACAA �i........... buildings on ... ... ....I.y.).......M. ......5 .. Rough to be occupied as...... . (.6M�......,�0./''`......, /Q!1� i.Y/th. .....P�Z�/�......�,� .....�.. Chimney provided that the person accepting this permit shall in every respect conform to a terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST TS C Rough 44P moo .......... ....... ............................................ ..................... Service BUILDING INSPECTOR Final 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. Burner Street No. SEE REVERSE SIDE Smoke Det. R Date................... :. D ...... y �LORTil TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACMUS� This certifies that has permission to perform ... 0.�-.i--./�..................... wiring in the building of... ��..!�r�� t.v......( o raR/1 ., at 3 3 i`v ST.......................North Andover,Mass. Fee.............._. Lic.No............ ............. 4!- ... . .. Y ^D SRICAS;ECT(aR Check # {(�/ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. (O Z Occupancy and Fee Checked 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 INK OR TYPE ALL INFORMATION) Date: 2 06 City or Town of: NO, At4oye R To the Inspe for of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) J33 A1AIN 57 Owner or Tenant MPd U r'y ('m u rn,n- + Telephone No. Owner's Address S'r4me Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building p f,+VL I(, Utility Authorization No. Existing Service , ®p Amps JZ0 / 2 O Volts Overhead R 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: �vQP�N OW�� eo&,e - I'ZO A� "22nv I- 2a Are, 11a EV,4eorP 2 L/$ht �t�//� �qr Completion of the following table may be waived by the Inspector of Wires. r 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 E:1o. o Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switches No.of Gas Burners o. of Detection and Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: 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 KW No.o No.o Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent t Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP 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: 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: v ZLa Fkc,4,r-Tc. LIC. NO.: (Z 771A Licensee: fes-.A0 N J T, �,22_-o Signature LIC. NO.: 3 Z3 (If applicable, enter "exempt"in the license number line.) Bus.Tel. No.: PrJ 317, 5'317 Address: /0 Co/V/7` 5T. Iva ANOove r /ja* Dld/KJ— Alt.Tel. No.:W, 07-"77,f a *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: $ Location A3 3 AA (0 Si— No. LNo. Date a- - D ,* NORT1y TOWN OF NORTH ANDOVER F? • • O9 41 Certificate of Occupancy $ Building/Frame Permit Fee $ 3 s "us Foundation Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 3 y _- Check # l 8 ` o f r 17853 Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAI RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER. DATE ISSUED: SIGNATURE: Building Commissioner/I for of Buildings Date Z SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: Map Number Parcel Number 1 1.3 Zoning Information: 1.4 Property Dimensions: i Zoning District Proposed Use Lot Areas Frontage ft 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40.11 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT Historic District Yes O rn i 2.1 Owner of Record liYM P4.Iced Name'Pritit, Address for Service f � Signature Telephone 2.2 Owner of Record: e Name Print Address for Service: z rn i nature Telephone SECTION 3-CONSTRUCTION SERVICES 90 3.1 Li sed Cons ct on Su rvt r: � Not Applicable ❑ av( - Licensed Construction Su �j sor: ! Dc PG�n,G, J License Number Addresszle ( �v �` '� L Expiration Date `✓ ic Signature Telephone r 3.2 Registered HomeImprCon acttor Not Applicable ❑0 G-4,v 'c(a r Company Name l � I ? % Registration Number r Address q;77 !/ r Expiration b6te �n Si nature Telephone "' SECTION 4-WORKERS COMPENSATION(M.G.L C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check all applicable New Construction 0 Existing Building ❑ Repair(s) Alterations(s) ❑ Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be E)FFICIAI USE ONLY ; Completed by permit applicant 1. Building �l 'T r ®� d (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(e)x (b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 CLQ.Ba Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, ,as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date R, SECTION 7b O N�E�R,//AlUTHORIZED AGENT DECLARATION 1> Wil/" " as Owner/Authorized Agent of subject r property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief L�m_v ' 67d lip-r,I yl Print Narne L) C 1 Si ature of Owner/A ent Date NO. OF STORIES _ SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST2ND 3 SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE NORTH TO" Of Andover `� No.380 0 L..Vo dover, Mass., COCHICHEWICK offArED C7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT..........0-4-14.61.49.14..............9. -r ....... ... ...... ...... ..... .. ...... .... ................................................................................... Foundation has permission to erect...te ........ buildings on....1.3.4.... M.&W........X.. .................... Rough to be occupied as............ ........w.....4 ..&.1..&W W P C.I's I . # to.4 C *. Chimney ....................... ........ .. .......S..........................:.. provided that the person accepting this per shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings In the Town of North Andover. 30fvl PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PEBNffT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTI N ARTS ELECTRICAL INSPECTOR Rough ids Service ...... ....... ....A................... 4 ......6INSPECTOR Final 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. Burner Street No. SEE REVERSE SIDE __Jj Smoke Det. r 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 Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signa ure of Permit Applicant DaK NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector j a f •f ACORD,M CERTIFICATE OF LIABILITY INSURANCE DA1TE 2/01/2 0�) PRODUCER 978-975-4344 THIS CERTIFICATE IS ISSUED ASMATTER OF INFORMATION INTERNET INSURANCE AGENCY, INC ONLY AND CONFERS,, NO RIGH1 UPON 'THE,CERTIFICATE 522 CHICKERING ROAD HOLDER. THIS CERTIFICATE DOES NOT.AMEND, EXTEND OR ALTER THE VERAGE.AFFORt)ED BY TMIE POLICIES BELOW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NORFOLK& DEDHAM D.G. CONTRACTING, INC. INSURER B: NORFOLK& DEDHAM DAVID INSURERc: ARBELLA PROTECTION &NORFOLK& D 428 PLEASANT STREET I NORTH ANDOVER, MA 01845 NsuRERD: AIG INSURANCE I INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'LPOLICYEFFECTIVE POLICYEXPIRATION LTR POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RLN I E A X COMMERCIAL GENERAL LIABILITY R0401723A 07/01/2004 07/01/2005 PREMISES(Ea occur ence $ 100,000 CLAIMS MADE OCCUR MEDEXP(Anyoneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS,COMP/OP AGG $ INCLUDED POLICY PRO' LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 90151692 06/12/2004 06/12/2005 (Ea accident) $ 1,000,000 ALLOWNEDAUTOS BODILY INJURY $ X SCHEDULEDAUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON,OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACHOCCURRENCE $ 1,000,000 C X OCCUR 7 CLAIMS MADE 4600020399 12/10/2003 12/10/2004 AGGREGATE $ 1,000,000 C 0001370 12/10/2004 6/10/2005 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATIONAND WCSTATU> OTH, D EMPLOYERS'LIABILITY WC333-27-74 03/31/2004 03/31/2005 TORYLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE,EA EMPLOYEE $ 100,000 Des,describe under SPECIAL PROVISIONS below E.L.DISEASE)POLICY LIMIT $ 500,000 OTHER i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTAT AUTHORIZED R ESE IV ACORD 25(2001/08) RD CORPORATION 1988 s� �O�OF OU Vi�J�R TRIlC"CIUti Licence 001621 Num/.C9 = BirNid0� 1 a xpi t, IOMV200 Tr.0z: 6242 Gmez*N IPA ;. 428 PLEASANT ST ratoY !d AWOVER• MA 01MS f ' Board of Building Regulations and Standards NOME IMPROVEMENT CONTRACTOR Registration: 120199 4 Expiretioh' /1/2006 Tividual „ DAVID GULEZIAN DAVID GULEZIAN " }: 418 PLE-AUT#6T CG»-+ '�✓�""" i .. .._.r_.. ..—,em. &A6..nip&Fi aa...i..tek►atnr .— t 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 . Y-;Tmg,�j on for Official Use Onl BUILDING PERMIT NUMBER: o?co DATE ISSUED: D S' J O SIGNATURE: Buil din Commissioner or of Buildings Date v1 ,.fM•r •:,:s at .w. 11 Property Address. 1.2 Assessors Map and Parcel Numbs: X63 ,Hain U �! D 1 A" _ av le Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zonin District Proposed Use Lot Area Frontsge(ft) m 1.6 BUILDING SETBACKS(ft) Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided d C 1.7 Water Supply M.G1..C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: J Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal On Site Disposal System ❑ _ .� istoricDistrict: Yes No 2.1 Owner of Record Name(Print) Address for Service: 1-9 k?«vJ dr,;C Z �S 5 m Signature Telephone 2.2 Authorized ent r—� D Name Print Address for Service: Z 7-C )'G/O,S T Q S Signature Telephone z /y 3.1 Licensed Construction Supervisor Not Applicable 0 Address License Number 0 rre robihd-ng1 6-16&n D 'yn� Licensed Construction Supervisor �/ r Expiration Date Signature Telephone P 3.2 Registered Home Improvement Contractor Not Applicable ❑ 0 Company Name Registration Number M Address r Expiration Date ^Z Signature Telephone G SEM a , . I' ..� l4 .. . .. z- . � .v,-.,. _._ t b Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed��(affi�dyavit Attached Yeah..... �yNoo.......❑ I�.L'�Ui= 5,ANO c�rrslca��r+��fl��r���['Mrd ��>_� ��� ��n`�s,+�a�e���. ���►s�� 5.1 Registered Architect: Name: Address Signature Telephone Q S villi &- ej-'! Area of Responsibility Name: _3'1/�3 s�0 dot S�� /��� ic/ /"( a Regisst750/06 'on Number Address: Expiration Date Signatur Total Not applicable ❑ Name: Registration Number Address Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date z Name Area of Responsibility r Address Registration Number Signature Telephone Expiration Date i Not Applicable ❑ Company Name: Responsible in Charge of Construction New Construction ❑ Existing Building ❑ Repair(s) ❑ TAlterations(s) 0 Addition 0 Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Description of Proposed Work: USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 ❑ A-3 0 1A 0 A4 0 A-5 ❑ 113 0 B Business 0 2A ❑ C Educational ❑ 2B ❑ F Factory ❑ F-1 0 F-2 ❑ 2C 0 H High Hazard ❑ 3A ❑ IInstitutional ❑ I-1 0 I-2 ❑ I-3 0 3B ❑ M Mercantile ❑ 4 ❑ R residential 0 R-1 0 R-2 0 R-3 0 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 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: 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 s Total Area s Total Height ft 4 Independent Structural Engineering Structural Peer Review Rapired Yes ❑ No ❑ SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 MR L 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 Signature of Owner/Agent Date Item Estimated Cost(Dollars)to be aWs E Completed by permit applicantsrfi�; i 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from(6) 3 Plumbing Building Permit fee (a)X(b) 4 Mechanical(HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) Check Number : 1 :j l. ' r,. >y.x - t.. Fy Sr..-.y �'"'S.:~:_r..,�4�5s�et"��Y;°;Y�-z-�o��,#r�j4 �Sm 7f r^Y ����u�,�._�''inx�ti'�srr:4 �i�� ��t.��r fix,,P�;��Jsrr r4 `-�` � 1z,r< .f zr tai s` r�}v'�r�,� � .C°&,,�+�v,�•*a t •s � ;o.� .�f..;- Yr;,'2'�r^t...z .��., ..ten.: "�'at ��ti r..D. ,fs�`, �t.,��r'.t..�'�.-'-' NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2ND 3 RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE .ryg � v a 'f u, 23 � t LocationIC2,9'10 A, /*u % 'A No. Date 16 A )ln �aRTh TOWN OF NORTH ANDOVER + i Certificate of Occupancy $ sACNUstt� Building/Frame Permit Fee $ p Foundation Permit Fee $ Other Permit Fee $ rr TOTAL $ Check # MCI � 1 3650 '� Building Inspector AlRestaurant & Ventilation, Inc. Al Restaurant Ventilation Inc, 145, Broadway Everett MA 02149 (617)389=4488 Office(617)387-0042 Fax Customer Information Spec Sheet This Intormation is vital towards the preparation of permits/applications for City 3 State regulations thru Building Inspection & Fire Depts. compliances before the start of Installation. (Please indicate WA where applicable) (Engineering drawings .for mechanical 6 In#IhMon permits where necessa aro p with Info below) CONTACT NAME(S): � JOB NAME: ✓, ., Date Eng.Drawin Comp JOB ADDRESS: l Z A c. tS'J e-4' M Bus.Phone ? 6(r-'6Cell# g g�� Fax chi) 7 3 F" Building Owners Name a Phone#: S" Confirm you will get letter of Authorization to Ild from building owner on fetter heed (Y) (N) check one Conflrrn you need generic letter for Welding authorization from owner...(we will fax to you) (Y) (N) check one Existing Building Work permit S: Ward/: Lot or Parcel# t `(7�\ 8 City Hall Building Dept Name S Phone# t5 cJ `` `�• ` ^�'"'�� > ��5 City Local Fire rtmentlFiro Prevention mrstem o.O _�.(�' 4' �,.� ►•i ca T Cci GIC 9 General Contractor(GC)Name&&phone#CW,6�) Electrician Name&Phons#• V((-. Plumber Name&Phone#: c Engineer Drawing RecifEnginser COMM NT80. / f � 1ar s C 1c ^4 Please use rear of page for additional info space. All labor relating to plumbing,electrical,mechanical carpentry and or existing contractual requirements to prepare and finish the job site are the responsibilities of the buyer of this proposal. (Unless such task is specifically stated) Thank you for considering Al RV for you business needs.We appreciate your Input in making this a success Leaders in Rcommercial rresteurente orxhaust& iation kitchens.Fans 01 In Custom service maintenancertainless agrteel eements avellao bller residential, e W6 shine In what we do beat. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 �, = www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e ra j� Address: /'V.5 rtJc�ca City/State/Zip:FV0-9#-, 1Y7,4 . Phone #: &17 38'7- V yJOS Are y an employer?Check the appropriate box: Type of project(required): I. 1 am a employer with 4. [1 I at a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am 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. q. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §](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 1911 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 emp/oyer that is providing workers'compensation insurance for my employees. Below is the po/icy ant!job site information. Insurance Company Name: Morse— ae-"ce__ Policy#or Self-ins. Lic.#: Jel�O /lzo J S Expiration Date: O b Job Site Address: 1-53 /Y1 f/r7 07' A/d •/401 dM,/, 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 tine 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 certi under the pains nd penalties of perjury that the information provided above is true and correct. Si 7natur : Date: l S DS Phone#: — .3Y - S—_ 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. Plumbing 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-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 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 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 Fax# 617-727-7749 Revised 5-26-05 www.mass.gov/dia DATE(MM/DD/YYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE 09/27/2005 PRODUCER (508)238-0056 FAX (508)230-8367 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Morse Insurance Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 285 Washington Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Easton Village Shoppe North Easton, MA 02356 INSURERS AFFORDING COVERAGE NAIC# INSURED Al RESTAURANT VENTILATION INC INSURER^: Employers' Fire Ins. Co. 20648 145 BROADWAY INSURERS: Associated Employers Insurance EVERETT, MA 02149-2418 INSURERC: OneBeacon America Ins. Co. INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD LIMITS GENERAL LIABILITY FBlU08166 08/18/2005 08/18/2006 EACH OCCURRENCE $ 1,000,000 DAMAGE TO REN I Eff- X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ 300,0001 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 5,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY j LOC AUTOMOBILE LIABILITY CBlES 5008 08/18/2005 08/18/2006 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) C X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR a CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCC 5005 529012005 08/18/2005 08/18/2006 1 TORY LIMITS I X 110ETRH EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ S00,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Empl rl o Restaurant BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 133 Main Street OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Daniel Morse/LMW Thi" ACORD 25(2001/08) ©ACORD CORPORATION 1988 1 Proposal Al Restaurant & Ventilation, Inc. (A i KV) 145,Broadway Everett MA 02146(617)3894488 ph.(617)387-0042 fax We shine in what we do PROPOSAL SUBMITTED TO PHONE/CELL DATE EMPIRIO GOURMET (978)794-3020 09/20/2005 STREET JOB NAME 133 MAIN STREET EMPIRIO CELL(978)884-2458 CITY STATE ZIP CODE JOB LOCATION NORTH ANDOVER MA 01845 NORTH ANDOVER ARCHITECT/ENGINEER DATE OF PLANS . CONTACT FAX PHONE LARRY YOUNG I TBA GABRIEUSTERGIOS _D978)794-3072 A I RV proposes to furnish material and labor—complete in accordance with sped ions be w,for the total sum of: Thirteen Thousand Six Hundred &Two Dollars .......................;(...... ...................77/100 Al RV required(40%)initial deposit$6,801.39.On the day of Delivery and start of work$3, Total Dollars:($13,602.77) On completion of work final payment for Labor+of$3,400.69 Client agrees to all in thi ent in signing this proposal to contract. PYMT:Check Cash NOTES:Client has read&agrees to the disclosures attached.New Hood&Fant bejistal d. ire system&permits by othe incid. Hood installation follows NFPA,req.96,IMC&BOCA compliances.,Eng drawin pe 's eq./I cluded.) Roof Fan openings'and back-wall reration b other........... Final to AIRV minus client's en d wins tem& units.......570,447.77 All material is guaranteed to be as specified.All work to be completed in a workmanlike Authoriz y:I Jo twood GM&Orville Bernard Sales M9111.-1 manner according to standard practices.Any alteration or deviation from specifications SinatUr below involving extra costs will be executed only upon written orders,and will become an 9 extra charge over and above the estimate. All agreements contingent upon strikes, Date: accidents or delays beyond our control.Owner to carry fire,tornado and other necessary Note:This proposal may be withdrawn by us if not accepted wl In insurance.Our workers are fully covered by Workman's Compensation Insurance. 30 days. Al RV hereby submit specification and estimate for EMPIRIO GOURMET to manufacture,deliver,&install products to cover the Equipment 24"—4 burner range,36"Grille, Pis verify final equipments(L to R) MUA Hood 6 $ 1,270.50�Transition $ - Exhaust Canopy 3 $ 375.71 Cleanouts 1 r$ 71.88 MUA Hood $ - Crane Rental (1/2)days 4' $ 517.50 Rear or Front Plenum $ - :Inside Outside corners �$ - 45 Degree Elbow $ - control switch ctr �$ - / 90 Degree Elbow 2 $ 382.80 gall Brackets 1 $ 43.13 Duct 16g 10 to 12 x 12 14 $ 369.60%Shelving(48x20) $ - Duct 16g 14 to 18 x 18 6 $ 198.00 Wall Cap/Moldin Tee-E: 3 �$ 64.69 .Duct 16g 20 to 24 x 24 $ - Fire Sys Cabinet $ - Curb to Fan Adap $ - S/S Sheet 4 x 9-10 w/par 2'p'$ 373.75 Spark Prevent ion.Filt ers $ - ;Exhaust Blower (s) 1 $ 1,185.94 Flat Roof Curl Price by sit $ - MUA Unit I $ 1,140.00 Pitch Roof Curb 2 $ 422.40 ;MUA Louver 11. $ 179.69 Curb Plate 2 $ 158.40 Total Material $ 7,347:97 Off Set (130-Price by sit $ - ;Single Tank Sys.+Perm: 1 $ 1,725.00 Fire Wrap UL 3. $ 594.00 ;Engineering drwg 1 $ 700.00 Rip-Out & Disposal !Tax $ 367.40 Gooseneck $ - !Fire Watch/Mech. Perm 1 730.00 Sub Total $ 39771.41 j Labor 2 2732.4 i Total $ 13,602.77 p �� /may �� � � ��� � �� �� �� Location No. X39 Date 4 NORT1y TOWN OF NORTH ANDOVER O F w a # ; ; Certificate of Occupancy $ . i ''mss CHuf< Building/Frame Permit Fee $ s�cNs ♦4 Foundation Permit Fee $ Other Permit Fee $ w TOTAL $ ? Check # x 17535 _Building Inspector � L TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REP RENOVAT OR DEMOLISH A ONE OR TWO FAMILY DWELLING . z rn BUILDING PERMIT NUMBER: / DATE ISSUED: `C;—) 1(5?(3 Zo SIGNATURE: �. Ad Building Co ner/In or of Buildings Date SECTION 1-SITE INFORMATIW O 1.1 Property Address: 1.2 Assessors Md Parcel Number: l Numb 13-5 � (Ai e SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......❑ No.......0 SECTION 5 Description of Proposed Work check as a Ucable New Construction ❑ Existing Building 0 Repairs) 0 Alterations(s) 0 7 ddition 0 Accessory Bldg. ❑ Demolition 0 Other ❑ Specify Brief Description of Proposed Work: 5 ani s1` d Bv�'�.�iyy X q 16)W 4�__ div i �� a , TX rd- X t2 Inc [ V�y��e �r�1 V rs SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OMCIAI.USE ONLY Completed by permit applicant , 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of 3 q D o �— Construction 3 Plumbing Building Permit fee(a)x tb> 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 d Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I. as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION OWNER/AUTHO'J ED AGENT DECLARATION I, v- ` ��v/ as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are Lyre and accurate,to the best of my knowledge and belief Print Name G Signature of er/A ent Date NO. OF STORIES SIZE BASEIVIENT OR SLAB SIZE OF FLOOR TIMBERS 1' 2' 3 RD SPAN DIMENSIONS OF SILLS D20ENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CBDANEY 1S BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE ACORDTM CERTIFICATE OF LIABILITY INSURANCE DA1TE 2/01/2004 ' PRODUCER 978-975-4344 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION INTERNET INSURANCE AGENCY, INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 522 CHICKERING ROAD HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. NORTH ANDOVER, MA 01845 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: NORFOLK& DEDHAM D.G. CONTRACTING, INC. INSURER B: NORFOLK&DEDHAM DAVID GULEZIAN INSURERc: ARBELLA PROTECTION & NORFOLK& D 428 PLEASANT STREET INSURERD: AIG INSURANCE NORTH ANDOVER, MA 01845 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'LPOLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS LTR INSRD TYPE OF INSURANCE E_MIYYL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIALGENERAL LIABILITY R0401723A 07/01/2004 07/01/2005 PREMISES EaocCurence $ 100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS,COMP/OP AGG $ INCLUDED POLICY PRO' LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 90151692 06/12/2004 06/12/2005 (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY X SCHEDULEDAUTOS (Per person) $ HIREDAUTOS BODILY INJURY $ NON,OWNEDAUTOS (Per accident) [FIR PERTYDAMAGE $Per accident) GAR AGE LIABILITY AUTO ONLY,EA ACCIDENT $ ANY AUTO OTHERTHAN EAACC $ AUTOONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACHOCCURRENCE $ 1,000,000 C X OCCUR F—I CLAIMS MADE 4600020399 12/10/2003 12/10/2004 AGGREGATE $ 1,000,000 C 0001370 12/10/2004 6/10/2005 $ DEDUCTIBLE $ RETENTION $ $ TATUWORKERS COMPENSATION AND WCSLIMIT R E D EMPLOYE RS'LIABILITY WC333-27-74 03/31/2004 03/31/2005 TORY LIMITS ER E.L.EACH ACCIDENT $ 100,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE,EA EMPLOYEE $ 100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE,POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENT ES. AUTHORIZEDPR�5��41,C�.Rlll ACORD25(2001/08) CORPORATION 1988 North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, S150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector y� ulnw� 1 _� NORTH Town of : _ 19Andover A13 C/ qft 30 E dover, Mass., /4/.2 3 /wood Yr I� COCHICKEWICK V Ids RATED 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System Q '� BUILDING INSPECTOR THIS CERTIFIES THAT .... Y. Foundation ...0.... Y P a has permission to erect..Q...0V"....wiaildings on .....1.34...... ........6*..*.............. Rough to be occupied as... 1 .^ v { �r ................................... . Chimney . . . ! .......... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. a0 � q 1 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUSTJIRTS ELECTRICAL INSPECTOR Rough ....... .............................. Service BUILDING 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. 4 t s Date.........`... ... `.?. .... Ot NORTN 1M TOWN OF NORTH ANDOVER o ' PERMIT FOR WIRING ACHUs� This certifies that .......`..:.:. ` ` ` ........ ....:................................ ................................ has permission to perform ....- ........ .............................................. wiring in the building t`!........................ at./2-.3.- . ............ ..s. -t ................................. .North Andover,Mass. Fee..................... Lic.No. ............. ............................................................... ELECTRICAL INSPECTOR Check # G 4i 7 u Official Use p�a Permit No. Dyea�xurr°d pub Sa�cty BOARD?/OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy& Fee Chec PLICTION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all rZformation) Date &61u E� To the Inspector of Wires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number /33 /la j.1 Owner or Tenant /4)rIU.n6 P/-j n. A nc 1 1JW11)1! 0"1=4 i Owner's Address Is this permit in conjunction with a building permit Yes 0 No X (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps Volts Overhead 0 Undgmd 0 No.of Met( New Service Amps Voits Overhead 0 Undgmd a No.of Met( Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work � � Oro n- 94:1414 Total No.of Lighting Outlets No.of Hot fuse No.of Transformers KVA Above 0 In 0 No.of Lighting Fixtures Swimming Pool gmd 0 gmd 0 Generators KVA No.of Emergency Lighting No.of Receptacles Outlets No.of Oil Burners Battery Units No.of Switch Outlets No of Gas Burners FIRE ALARMS No.of Zone _ Total No.of Detection and i No.of Ranges No of Air Cond Tons Initiating Devices _ Heat Total Total No.of Diposal No. Pumps Tons KW No.of Sounding Devices _ NoJ of Self Contained No.of Dishwashers Space/Area Heating KW Detection/Sounding Devices _ 0 Municipal 0 Other No.of Dryers Heating Devices KW Local Connection No.of No.of Low Voltage No.of Water Heaters KW Signs Bailases Wiring No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent YES= NO have submitted id proof of same to the Office YES= NO - If you have checked YES please indicate the type of coverage by checking the appropriate box. INSURANCE BOND - OTHER - (Please Specify) Y (Expiration Date) Estimated Value of.Ele ric i Work$ Work to Start ( Inspection Date Resquested Rou Final Signed under the Pe alties o perjury: FIRM NAME LIC.NO. Licensee_ Jf<r"(41414 / Signature `l-� rr LIC.NO.aF6� f - _ / Bu Te o. 7 T-3 7 Address LIR.d kt f l /�ew(�mGt MI. 6/111 r Ak_ .No. OWNER'S INSURANCE WAIVER: I am aware that the Licenses does not have the insurance coverage or its substanti I equivalent as required by Mass General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMIT FEE (Signature of Owner or Agent) u ` The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation.tnsurance Affidavit Mame Please Print Name: Location: City Phone # I am a homeowner performing all work myself. Q 1 am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees woridng on,this jot Company name. Address Cfy Phone#. Insurance.Co. Policy Company name: r Address . ` Phrme# Insurance Go. PONcv# Falkwe tD secure coverage as required under Sedion 25A or MGL 152 canie.ad torew iriaposrtiorr 441.crwri;!'IW. penalties cf`.arTri ardlor one years'bnprisonment-as AM understand that a copy of this statement may be'forwarded to the Office-of hrmstigations of the DIA for coverage verification. !ab hereby cffW muter tl)s pains and penaltieses of perjury bW the kA m obwprovidled above is true and t ornect Signature Date Print name Phone-# official use only do not write in this area to be completed by city or town ofriciar CRY or �Check if im nedbte response is required LiL1 ❑ Ser contact person: Phone#: ❑ )He; F! ou 04E TotnlltIIlCllilP 10 of Massac4use##s Office use Only Department of Public Safety �Ql Permit No. BOARD OF FIRE PREVENTION REGULATIONS 5 1 CMR 12:00 Occupancy & Fee ked _'� "' • W�L 3/90 (leave blank) APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK All work to be performed in accordance with th Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) /1)Date � c2 It f City or Town of VQ V 14 To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work d s ribed below. Location (Street & Number) )N 5T- �II'' Owner or Tenant IT'tP �e V/�)� /����`� SND TfyS7_ Owner's Address 5 g Is this permit in conjunction with a building permit: Yes D No ❑ (Check Appropriate Box) Purpose of Building ,J Utility Authorization No. Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters .rvice Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters of Feeders and Ampacity rr''r I-�l� S C / and Nature of Proposed Electrical Work �VC'� 1�1 TAT���-�'E/ ✓� T(_tfE 5 �"[���' TOTAL .ighting Outlets No. of Hot Tubs No. of Transformers KVA a Above in- i htin Fixtures Swimming Pool grnd. ❑ grnd. ❑ Generators KVA No. of Emergency Lighting ece tacle Outlets v No. of Oil Burners Battery Units witch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and Ranges No. of Air Conditioners Tons Initiating Devices Heat Total Tota I No. of Sounding Devices. Disposals No. of Pumps Tons KW No. of Self Contained Dishwashers Space/Area Heating KW Detection/Sounding Devices Municipal Dryers Heating Devices KW Local❑• Connection ❑Other No. of No. of Low Voltage ater Heaters KW Signs Ballasts Wiring ro Massae Tubs No. of Motors Total HP INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES O NO O !have submitted valid proof of same to this office. YES 0 NO 0 If you have checkke ES, please indicate the type of coverage by checking the appropriate box. G _ INSURANCE LJ BOND ❑ OTHER❑ (Please Specify) Estimated Value of Elect ical Work $ ado (E iratio Date) Work to Start `� D Inspection Date Requested: Rough Final UJ LL G'ALI- Signed under the pe alties of perjury: FIRM NAME L� - L C �� LIC. NO, J-y063yr 1. Licenseer�IL Signature f LIC. NO. S0 D 631- Address r '�'V d Bus. Tel. No. a �0�� 6 d� Alt. Tel. No. .OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws, and thatmy ure on this permit application waives this requirement.. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) B"� . rvrrm,�. F.dzP Commonwealth of Massachusetts Oficial I Ise 0111N Permit No. (/3 ,? Department of Fire Services Occupancy Occupancy and Fee(Checked � 9, (!ea�,e blank) BOARD OF FIRE PREVENTION REGULATIONS [Rev. 051 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK ince\\itli the kiassachUSCUS Electrical Cotle(%IEC'). 52 7 l'% IR stork to be pertbrilied in accord, I C IR 12.00 (PLEASE PRINT LV INK OR TYPE.-1 LL INTOR,11-1 TION) Date: 1z z-)/, � City or Town of: w: ox P L, kite R To the hmpelbor oj'Wire.v: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) AI)411V <77—- Owner orTenant (3 c u r rt-0 rl'� Telephone No. Owner's Address 0 2 Is this permit in conjunction with a building permit? Yes No E] (Check Appropriate Box) Purpose of Building Pe T-1A-I'(- 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: Uj1V2 1 0 F ljeL,,j jhA 14 1/ — FZ4 P--' ('ons lotion ty the lolloiring table inav be waived by the his pector of'11'i 11'ires. Recessed Luminaires No of Ctil.-Susp.(Paddle)Fans No.of Total No.of Reces I - Transformers KVA No. of Luminaire Outlets lNo.of-Hot Tubs Generators KVA Above Ei In- No. of Emergency Lighting No.of Luminaires Swimming Pool grnd. ❑ grnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Detection and No.of Switches No.of Gas Burners Initiating Devices Total No.of Ranges No.of Air Cond. Tons No.of Alerting Devices "eat Pump I.N.Pm, he.17, Tons ..K.W.- No.of Self-Contained No.of Waste Disposers Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local Fj Municipal El Other Connection Security Systems:* No.of Dryers Heating Appliances KW No.of Cices or EquivOent -No.of-WaterNo.of No.of Data Wiring: Heaters KW Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs No.of Motors Total HP No.of Devices or EQuivalent Welch idditiOW11 detail If,lesired, or(is ruquired by the 111vector 0/ I'll-es, Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 11:72 inspections to be requested in accordance with N,1EC Rule 10. and upon completion. INSURANCE CaERi, GE: Unless ,vaiv ed by the owner, nopermit for the performance of electrical work may issue unless the licensee provides proof of liability ilISLIM11CC including"completed operation"coverille Or Its Substantial equivalent. The undersi-ned certifies that Such CO'VCI'a,,e is in force,and has c0ibited proof of same to the permit issuing ollice. CHECKONE: INSURANCE [�KBOND El OFHER n (Specify:) I certify.ander the pains(nndpentiftiev of perjury, thin the hifin-mation on this application is true and complefe. FIRM NANIE: zj() oe - --- — LIC. NO.: U" -2 LIC. NO.: Signature �7 -;,z 3 Licensee: "'y In the liccasc millibc]-line.) Bus. Tel. No.- 222"J,2 L� ot P y f Address: /W t,4 Alt. Tel. No.: 7 7 *Security System Contractor License NqUirccl for this work. if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I ani aware that the Licensee does not have the liability insurance covJ'age normally required by law. By my signature below, I hereby waive this requirement. I arnthe(check one)[:] owner 0owner's agent. Owner/AgentF P 4� - Signature Telephone No. M1 T FES': TOWN OF NORTH ANDOVER BUILDING DEPARTMENT 1 APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING T OTHER THAN A ONE OR TWO FAMILY DWELLING sv ERNE S SCCt10n for OfIClal Use OnI w' � �.,.: .: . BUILDING PERNIITER: DATE ISSUED:0 • 0L a I j zi /;, W mr W I Z SIGNATURE: Buildin,g Commissioner or of Buildinfs Date 1.1 Property Address:Y 1.2 Assessors Map and Parcel Number: � 30 Number arcel Number '..3 Zoning Information: 1.4 Property Dimeusions: v Zonin Distrid Proposed Use Lot Area Fronts ftm 1.6 BURDING SETBACKS(ft) Front Yard Side Yard Rear Yard t Required Provide ReqWred Provided ReqWrW Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal on Site Disposal System ❑ v a 4 -1 1130.J[ ftt it t. �o v M 2.1 Owner of Record ( A 94, RM vt Name(Print) I Address for Service: �l m Signature Telephone 2.2 Authorized Agent Name Print Address for Service: Z O Signature Telephone 3.1icensed Construction pupervisor Not Applicable ❑ Address License Number Licensed Constru ' Supervisor. Expiration to ic Signature Telephone t ! r< 3.2 Registered Home Improvement Contractor Not Applicable ❑ v Company Name Registration Number M r Address r Expiration Date /Z Signature Telephone GI Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the-buildingrmit. Signed affidavit Attached Yea.......❑ No.......❑ SEC l�f@N S 'PR4�I41 ) r C13' C° ICiSM, V RTCS,l+# 3 �Alb G`E3NS1kIIC CtA M- 35� FbC'l�1t 'A Y.. 5.1 Register Architect: �U Name: Address -Signature Telephone m Lay Y p u Y l Area of Respo ibility Name: —ice Registration Number 4ddress: 0 ♦ Expiration Date Signature Total Not applicable ❑ Maine: Registration Number Address 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 1a .eu Ay,(Q V1 Not Applicable ❑ Company Name: Responsible in Charge of Construction WOO New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) Addition 0 Accessory Bldg. 0 Demolition ❑ Other 0 Specify Brief Description of Proposed Work: 4 Za Y' tiyerz T11 5)VI e hU orC'm ao-7-n cryo-X4 otY u 1 read y�1I�f�%��r``►���,�,�`� �e►�hd�dg� !/7 �93�6,�� � �'w�'II �v5��,� to USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 ❑ IA 0 A4 ❑ A-5 0 IB 0 B Business 2A ❑ C Educational fEl 2B 0 F Factory 0 F-1 ❑ F-2 0 2C ❑ H High Hazard ❑ 3A 0 IInstitutional ❑ I-1 ❑ 1-2 0 I-3 ❑ 3B ❑ i M Mercantile 0 4 ❑ R residential ❑ R-I 0 R-2 ❑ R-3 0 5A 0 S Storage 0 S-1 ❑ S-2 0 5B ❑ U Utility ❑ 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: 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 s Total Area s Total Height ft 731-1 'Wo --Mffiqllx Independent Structural Engineering Structural Peer Review Required Yes 0 No 0 SECTION 10a Owner Authorization- TO BE COMPLETED WHEN OWNERS AGENT OJR CONTRACTOR APPLIES FOR BUILDING PERMIT I, 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 61 1�02�ao - nerlAuthorized 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 Ole Print Name /.*// Signature r/Agent Date 112 Item Estimated Cost(Dollars)to be <s xn �" y " Completed by permit applicant ` w � 1. Building rx m f rql �00, ©0 f (a) Building Permit Fee V Multiplier 2 Electrical /4 ('� - (b) Estimated Total Cost of Q (i Construction from(6) 3 Plumbing j o'dam - Building Permit fee (a)X(b) 4 Mechanical(HVAC) ' 3 ✓� - �2 5 Fire Protection I!C M mf-chav ct 6 Total (1+2+3+4+5) 0 "7 7 Check Number �ft1}=5$.7 sil.��[ .. �.y...ya;;,�j r• S1a}�,b {u.y't ydti F'v s { .. 1:.. r u r a ,L `'� l4. `f�, k #i,S'71's 6 ';y;...h �?l� :..�'.;,;.qJ�w 41.-1 µ.ry Y:j`,,kj fir` ;:, el .�i. a y ,C1fi5 �tJeYi�,''.,:..:R c$ �,y r,zs.: ' ,6§wy'4 s+.p- yA �t d ff Y ,.S 4 'ri Sxl t C y J Ylz 7 n NO.OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1ST 2 ° 3RD SPAN DEMENSIONS OF SILLS DEMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE �. i.^ '``k,i t,�z:?` ya�,c,��`2>5 's+. ��-x�,� �,''7.try 5`e 4���C'�� rs3.- '�.i_.. �,� ✓r E ,c�wi �i�,xh�.�..,.z 5 �� .g � 4}�T�.F Location No. �'�� Date ti of 40WTh TOWN OF NORTH ANDOVER � F 9 i Certificate of Occupancy $ s i # 'SJ,cMusE` Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ G5 . . Check # 1 89U7 6olml) Building Inspector r+� . I i r p4m � 5 � 2 3ozo s,C . f l i) All open areas, exclusive of areas to remain in an existing natural state shall be landscaped in an appropriate manner, utilizing both natural and man-made materials such as indigenous grasses, trees, shrubs, and attractive paving materials and outdoor furniture. ii) Deciduous trees shall be placed along new and existing streets and ways. Street Trees (defined as trees which typically grow to no more than 30 feet in height) shall be located every fifty feet (50') on center along both sides of the major arterial roadways within the District. Outdoor lighting shall be considered in the landscaping plan, and shall be designed to complement both t man-made and natural elements of the site and adjacent areas. Appropriate methods (such as cutoff shields) shall be used to minimize glare and light spillover onto abutting property. iii) Intensive landscaping or preservation of existing vegetation shall be provided within the OSGOD where it abuts streets and along internal drives. iv) Preservation of existing vegetation or tree-lined areas shall be maintained. f. Parking areas and lots shall use landscaping and terracing to break up large areas + - ' of pavement and to enhance residential flavor and appearance, with such Osgood Smart Growth Overlay District—Draft of 8.21.05 10 of 104,4 , ' RC2 ` 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 Mel�(id Gov(► t (oI HONE4 j O; LOCATION: Assessor's Map Number ARCEL SUBDIVISION 2 LOT(S) STREET I J �� T. NUMBER �l Jam. OFFICIAL USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS D INSPECTOR- LT DATE APPROVED Z - Z q,p-5- DATE DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS -SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT es'RECEIVED BY BUILDING INSPECT R - DATE Revised 9197 Jm ACTIVITY REPORT TIME 12116/2005 16:07 NAME HEALTH FAX 9786888476 TEL 9786888476 SER. # 000B4J120960 NO. DATE TIME FAX NO./NAME DURATION PAGE{S} RESULT COMMENT 12105 09:09 21 01 OK RX ECM 12105 09:27 978 887 2340 02:04 01 NG RX ECM #243 12105 10:24 819786238320 54 02 OK TX ECM #244 12105 10:32 816179834305 01:01 05 OK TX ECM #245 12105 10:34 816179834305 52 05 OK TX ECM #246 12105 10:38 816179834305 01: 52 09 OK TX ECM #247 12105 10:43 816179834305 54 04 OK TX ECM #248 12105 10:45 816179834305 01:34 08 OK TX ECM #249 12105 10: 47 816179834305 54 04 OK TX ECM 12105 13:24 33 01 OK RX ECM 12105 13:26 33 01 OK RX ECM 12107 12:04 9783276827 41 02 OK RX ECM #250 12107 14:33 89786889522 02:02 07 OK TX ECM #251 12108 14:04 816179834305 29 04 OK TX ECM #252 12108 14:06 816179834305 01:25 08 OK TX ECM #253 12108 15:09 89786851099 44 02 OK TX ECM 12109 11:08 16035958753 59 02 OK RX ECM #254 12109 11:50 817817413032 24 02 OK TX ECM 12109 13:55 10 01 OK RX ECM 12109 13:56 15 01 OK RX ECM #255 12112 10:46 89786888476 00 00 BUSY TX #256 12112 11:09 89786851268 30 03 OK TX ECM 12/12 12:25 17 01 OK RX ECM 0257 12112 13:36 819786643241 15 01 OK TX ECM #258 12112 13:43 816179834305 01:05 06 OK TX ECM 12112 13:52 9784701017 40 05 OK RX ECM 12112 16:04 1 978 475 6531 16 02 OK RX ECM 12112 16:15 1 978 475 6531 11 01 OK RX ECM #259 12112 16: 18 816179834305 02:20 10 OK TX ECM #260 12112 16:26 816179834305 04:12 17 OK TX ECM 12113 10:26 9786890007 39 02 OK RX ECM #261 12113 11:07 89786811188 37 02 OK TX ECM 12113 11:56 17812709406 20 02 OK RX ECM #262 12114 09:40 818663894400 14 01 OK TX ECM 12114 11:19 9788375046 02:20 05 OK RX ECM #263 12/15 09:45 89786851099 33 02 OK TX ECM #264 12/15 10:13 816179834305 38 03 OK TX ECM #265 12/15 10:58 816176245587 32 03 OK TX ECM 12/15 11:35 +15088807232 01:13 04 OK RX ECM 12/15 13:51 41 04 OK RX ECM #266 12115 16:33 819784091269 01:08 03 OK TX #267 12/16 09:51 89784754575 41 03 OK TX ECM 12116 12:09 800 976 6608 20 01 OK RX ECM #269 12116 16:04 819782589041 28 01 OK TX ECM #270 12/16 16:06 89787943072 28 01 OK TX ECM BUSY: BUSY/NO RESPONSE NG POOR LINE CONDITION / OUT OF MEMORY CV COVERPAGE POL POLLING RET RETRIEVAL PC PC-FAX OilThe Commonwealth of Massachusetts Department of Industrial Accidents Olflce of Investigations Boston, Mass. 02111 ' Workers'Compensation Insurance Alffdavit Nems 'baA 640Y�ray) Please Print Location: I Yna( r) (7+ City Y N ky 1, fm q�79 Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity I am an employer providing workers'compensation for my employees working on this job. Comparn/name: �a U i`c 'g J lie--c t a h ' AMms q, Cily: �( Y I ooe V, M# y�j o/ Phone Q ?89 Instirance.Co. -T G p C '333-.9- 7-7Y Company name: Address City: Phone tlf� Insurance Co. Poilm! Failure to seams coverage as requlned under section 26A or MOL 152 can Iced to the k4mbon d aiminal penallias d.e fine up to$1,500.00 and/oronsyeas'ImpdooiN.on-asrsed.ae.cbdMeoakimjnlwfcmdAZMPVVDRKORDMIAnd.afloed.(;1110. M-aAWapaioat.ma. I understand that a copy of this statement may bs forwarded to the Offbe of Investlgedons of the DIA for coverage verdkAdon. 1 do hereby cer't/y under the pats ne!!bs of penury that the kdbrmabon provided above is true and correct. Signature / / Print name �j¢V;d- G�0-�lah Otfidal use only do net write In,this ares to be completed by dty or town offider City or Town PamtUcensina ❑ Building Dept ❑check N immediate response is requked 0 L kerWng Board Contest person: ❑ Selectman's office Phoma ❑ Health Department Cl other I TOWN OF NORTH ANDOVER AFFIDAVIT Home Improvement Contractor Law Supplement to Permit Application MGL c. 142 A requires that the"reconstruction, alteration, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units...or to structures which are adjacent to such residence or building" be done by registered contractors, with certain exception, along with other requirements. Type of Work: Est. Cost Address of Work Owner Name: Date of Permit Application: hereby certify that: Registration is not required for the following reason(s): For office Use Only Work excluded by law Pemit No. Job under $1,000 Date Building not owner-occupied Owner pulling own permit Other (specify) Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FIND UNER MGL c. 142A. Signed under penalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the above property: Date Owner Name 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 of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. T Also, note Permits are required under Fire Prevention laws Chapter 148 Section • 10A. The debris will be disposed of in: LL (Location of Facility) Signature of Permit Applicant Fire Department Sign off: Dumpster Permit Date Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. 2. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [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: 2 V06 City or Town of: NO, AtaD00e R To the Inspe for of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street& Number) j33 N9//U ST Owner or Tenant JF mfou r'U 0 v + Telephone No. Owner's.Address S14 M f Is this permit in conjunction with a building permit? Yes ❑ No � (Check Appropriate Box) Purpose of Building s+aI C. Utility Authorization No. Existing Service 6-LOO Amps (ZU / 2y0 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: 5'�P?f� mRk+ '-7"0 (A,I AUZ- IAS - 1-20 ArT --L?--v 1- La Ar` IZ*w V 19,0("O Completion of the followingtable ma be waivedby the lns ector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans o.of Total Transformers KVA No. of Luminaire Outlets No.of Hot Tubs Generators KVA ove n- o. o Emergency ig in No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers eat Pump um er I TonsI o. oSelf-Contained Totals: Detection/Alerting Devices 1 No.of Dishwashers Space/Area Heating KW Local❑ untctpa ❑ Other Connection j No.of Dryers Heating Appliances KW Security Systems: No.of Devices or Equivalent No.of Water KW o. o o.o Data Wiring: Heaters Signs Ballasts � No.of Devices or Equivalent No. Hydromassage Bathtubs No.of Motors Total HP a ecommunications iring: 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: 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:) I certify,under the pains and penalties of perjury,that the information on this application is true and complete. FIRM NAME: U GLa F1-eC fr; c LIC. NO.: 11.1 Licensee: 'S-t �,Z'2—u Signature LIC. NO.: /%at7 3 Z3 (If applicable, enter "exempt"in the license number line.) Bus.Tel. No.: lAY,3i 7, %3/ 7 Address: &7 fi✓/1` ST /a), ver D/dyf Alt.Tel. No.:'272,P• 692- '72J�C) *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, 1 hereby waive this requirement. 1 am the(check one)❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 6135 Date.................................. f NORTH 1 3?;.,W o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING �,SSACMUS� This certifies that ............................................................'. ZEL �T Z ................................ has permission to perform . G!pyT� t �TI,E`73 wiring in the building of................E...Is-=. �w .... .......... 3 �✓t ./.� -57— at .............. . .North Andover,Mass. .. .......S.�........... ........127?..�� � ao Fee.!............... Lic.No.............. .........................................,�...... '......... y / ELECTRICAL INSPECTOR J Check � I �� \\Ii DEFAWNWOFPUB[IMMY Pernd.t No. BOARDOFFMPREVF1VlMRBOULA1Xa 527adR ao �up�&Fees Checked ��•� APPUCAITONFOR PERMIT TO PERFORM ELECTRICAL WORK NAu WORK TO BE PERFORMED IN ACCORDANCE wrrH THE MASSACHUSSTS ELEMICAL CODE,527 CMB 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Dg ( ( a 2 o s Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) 13S W10 S • peso . r)n,b,e(L Owner or Tenant <o Tip,e-e L mP oy r Owner's Address --9Ano-e Is this permit in conjunction with a building permit: Yes No (Check Appropriate Box) Purpose of Building Re4-a�L / co�P-ec .rlo,10 Utility Authorization No. Existing Service 0>7 Amps2o �Voita OverheadUnderground a No.of Meters New Servis� Ampa�Volta Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed®ectrical Wort S'�PP y 1 210 A rP e-,r U Cr a r s 0 ,o _ ©v„�c 7Vf4 0,#q No.of Ughdm Outlets No.Of Hat Tubs A.of Translbrtmars Total No.of Uandry Fi:tmes Swimming Pod" Above Below aaI in KVA m KVA around 173 Vomw No of RecaptacM Oudgs No of OB Butmers No.of Emergency Ughting Battery Uniti No.of Switch Outlets No.of Oa Buxom No.of Ramgaa No.of Air Cond. TOW FIRE ALARMS No.of Z xws Toms No.of Disposals No.of Hoe TOW TOW No.of Debcdon and Pumps Ton KW No.of Dishwuhspace Ara Hesdmg Kw No.� ee dua�� Sounding Devlca NO.of SOK Cootabted No.of Dryer Heating Davina KW t�° O i Devlca No.of Wats Heater Kw Na of No.of o o sive Bailesis No.Hydro Mawep Tabs No.of Motor Told HP v* OTHER �t?C� fJi� �^�Stifl /NS��4( 2,t�( pit,P_ ,AJ S ' I�sanaeCotettge Plraretblterac}�ireninbeflrinsdsr�Cklmllaw� ]hateacwt3tLish Yhata>oeFbiYirri�dr�Cbr{>it* absuba�nti upw o YES No C3 Ihmes hTftdvMpmfc( amebhef]�YM 1<)athsredtaioDdYl39,p�;�9e4pd MRANET� t3 BaV Q on= WodruSM /1'Z 7 os- 1att�e�tionl]dleRer}ssbd ROM (f f 2a o E arebdVa zdEb WW*S Sagrndurad� Pa�albafpajuiy. p - rind i-u zoo i,le c ��c. 717 9 f9 LiotnreNn 12 L;crft�e 64/�-1�oNy T. P� 2-2cp � 4A!*J ,7 .�.� I�oeneNo E a 7 3 Z 3 �,ii,ar /D Cod v�f f7"" Ain. .41uoouer IK4 pi J Mh=TdNn 5i J',3)7. 5 3l 7 ° OWMR'SMRANKEWAM,Ianawmtud eljo wdmmt tz ratalae AlT�1Na �7� G�z 77�C1arddtetrtp�9grdaetnlHs�euritrQplort3mwal�firegiitanert ����e��me4Wb!'MwdseetbGalailLsrla (Please check one) Owner C3 Age Telephone No. pgR119•l.FEE S D11OVrOMMWSUEIY Permit No. � BOAWOFFREPRUSVHONRBG(1lAlM527a2j2'W � 1f Occupancy&Fees Checked APPLICATTONFOR PERMITTO PERFORM FT.ECI IC,AL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the4spector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street dt Number) 13 3 W lP S7- Fm 100r(') t J UY 61e�e'J"t, 7M Owner or Tenant &q(er, r4NC(rt a t-,A P PA-f Owner's Address /o5 Le Silt toxlAd M-4 a 2 ySt Is this permit in conjunction with a building permit: Yes MrNo a (Check Appropriate Boa) Purpose of Building f c" a' ( Utility Authorization No. Existing Service Amps .LL.72 QVolts Overhead Eff Underground No.of Meters j New Service AmpVolts Overhead EM Underground EM No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work NJ W Z OV ityA l W i oa ,�vtcl�+N e 12-0,J &wt.'r 6-eA,. No.of Lighting Outlets No.of Hat Tubs No.of lronsrbmmers Total KVA No.of Lighting Fixtom Swimming Poon Above Bebw Oemerators KVA ground No.of Receptacle Outlets No.of On Rumors No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Homers No.of Ranges No.of Air Cad. Tota FIRE ALARMS No.of Zones Tau No.of Disposals No.of Had Total Tata No.of Detection and Pumps Tons KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No,of Self C=uoi W DelxdailSoanding Devices No.of DM n Hosting Devices KW Local Municipal odw Connections No.of Water Heaters KW No.al No.of Sizes Bahule No.Hydro Massage Tubs No.of Motor Taal HP O'T'HER' 1rz9ti�iaeCbvea�Ar®uartb�erar}iere�afMe®da�ed�C�lLawa Ihateaataetliabiftylnar�iael�icy��$ YES No 0 Iharesutrrioadvaidpioafa(srmeblieQlgoa Y14 g'yatelia`edia�dYES,pism' Qiet)'Peafaotit�gl�' d,edorgh � 1L��� INSURANCE BCTip O'mm E3 ?Am**) E Die bSlell � � Estimebdvatieef119cdcal Wade S Wadc ��� � Alla) S@,rd mda l k=&s pQ1uY v zea �4 EWMNANIE l I;otrtaeNo. /2 77�,-I' i;�, fzQYU 4 2zy S"tgbae Iio=No 92-2 ,32--3 14.Ad*m ' '2- dNa owt, 'SP6URANMWAIVER,Ianawaethr dzLimmddpmwtdreivaloecmwporifssbmtdaglivaislta9m* adbyMmKknoGffndLawa arddietmydgne mcndispcum'i-ppicrdonvmvealisreq MMI (Please check one) Owner Agent Telephone No. illillilillillillimm� FEE S t { `1'O'WN OF NORTH ANDOVER f NoerH 7 Office of CONLN,11;N1TY DEVELOPMENT AND SERVICES HEALTH DER-kRTNIEN' * ^ r -100 OSGOOD STREET * ",�'\\.-:-__-�-.. 1' NORTH ANDOVER, BIAS SAC HI;S ETTS 01845 'SSAC14uSE� Nlichele E. Grant 978.688.9-540—Phone Public Ilealth Inspector 978.688.9512 -FAX healthdept_'(r`toNN-nofnorthandover.coin i%NN N�,.toNvnofnort ha ndover.com Alexandra Lappas,Owner Emprorio Gourmet Coffee Tea and More 133 Main Street North Andover,MA. 01845 December 29,2005 Re: Upgrade of Food Permit Dear Mr.Papadopulos,Manager, This letter is in response to your revised application for the changes to your existing Food Establishment that was received by the Health Department on December 23,2005. The status of the following items previously listed has been identified in red. 1) Speak to The Building Department regarding seating. Since the last application was submitted the seating has increased. ok- 2) k2) Please fill in the section with the maximum amount of meals served per day. 600 3) Hot/Cold Holding E-11 -during Service a. Hot Items—How will you be holding items such as Meatballs,chicken items at the correct hot temperatures? Please list the holding process. N/A b. Cold Items-Where will cold items be held for service,such as cold cuts, shaved steak, condiments and vegetables?WaIk-in c. Where will French fries,onion rings etc be stored during service. freezer 4) Cooling Section E-11 -Please fill this section in—Items like meatballs,chicken etc.,what will be the method of cooling at the end of the day. As required by code 5) Preparation Section E-11-Please fill in#1 and#8 8 -ok 6) Preparation Section E-12 Please answer#6 and#8 ok 7) Finish Schedule Section E-13—Please list Covering for the floors,walls and baseboards for the Prep Area. ok 8) Garbage and Refuse C-E-14—Where will you be storing your garbage. Where is the dumpster. +es 9) E—18 Please complete#54 and 67(What is the frequency of deliveries) 10) Where will you cleaning vegetables. Prep sink 11) Where is the hand sink in the prep area. Ok front Ai ca? li:uzdsink to,,tm in Kitchencte 12) In the prep area place all sinks as well as equipment in there perspective areas on the drawing. ok 13) Bath doors—Apply springs that automatically close the bathroom doors,-k 14) Will you be preparing any raw products? If so,you will need a cutting board for raw products only. 15) Do you have slicer,and if so where will it go and could you submit a cut sheet for it?ok 16) Are you selling whole pizzas'as well as slices? Y,-�s, thermal to.x f' r ILoldin4 17) Who will your linens be laundered by?C h u rc h i i l ok Thank you for,responding to the outstanding health concerns noted on the review. The health department has approved your plan. A copy of this approval will be forwarded to the building department. As you mentioned, if any substantial changes in the plans occur during construction you are expected to advise the health department. The Health Department is aware that this establishment owner wants to continue operating while the changes are being made.Please note that is it your responsibility to be sure that all foods are kept safe from contamination during the construction. At no time shall construction workers be allowed to enter food preparation areas while the operation is running. If work is being done in the evenings,be advised that all food surfaces must be given extra attention in the mornings. All food contacts surfaces must be sanitized properly prior to use each day. Once basic construction is complete and the equipment is in place,please contact the office for a construction inspection to verify that you have built it to plan. At that time we will sign off the building permit. Prior to utilizing the newer areas note the following. 1) The establishment shall be clean of all construction materials 2) All handsinks and bathrooms will be stocked with a wall mounted paper towel and soap dispensers 3) Handsinks should be labeled"hand wash only" 4) If potentially hazardous foods are being offered undercooked,such as hamburgers to order,a disclaimer regarding foodborne illness must be posted,as the code requires. This is a Health Department plan approval only. Please be advised that other departments may have specific requirements. This approval does not supersede any other department's request regarding other town or state regulations. If you have any questions regarding this approval,please contact the health office. Sincerely, ,sn-a� san Sawyer,RE /RS Public Health Director Ce: Building Dept Plumbing Dept. Susan Sawyer,Public Health Director Curt Bellavance,Community Development Director Alexandra Lappas Date. G':atBa7. t NORTI{, 3?;.<;�``°.:•_:"�o� TOWN OF NORTH ANDOVER p PERMIT FOR WIRING .�A ,SSACMUSEt This certifies that .. 11�f .s ..................................... . has permission to perform ... l�� ....:.... .....,I��X.�1'..'.� 1 ................ �A& ✓ 46,64A54 �s i wiring in the building/of..........�...........................,................I.�.......�...,:...... at.....�4AII.....� . l.!?!.....57.7.................................... .North Andover,,Mass. ELECTRICAL MpECTOR Check # 55L0 �\ o4E TIImmunli ratt4 of Mnss lC4nnetts Office Use Only Department of Public Safety Permit No. BOARD OF FIRE PREVENTION REGULATIONS 5 7 CMR 12:00 fi 4& 3 Occupancy Fee ked 3/90 (leave blank) t;L f APPLICATION FOR PERMIT TO ERFORM ELECTRICAL WORK All work to be performed in accordance with th Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date City or Town of 0 ,oQ V To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work d's ribed below. Location (Street & Number) /33 ,Q,�,.f4) 5T- Owner ` / �✓ Owner or Tenant frLP 1 tie yt I)#'5e lteq-Ay qlj-0Tfys/ Owner's Address S 9 me OF Is this permit in conjunction with a building permit: Yes ID No ❑ (Check Appropriate Box) Purpose of Building � a 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 rr II �Y J� / C S C Location and Nature of Proposed Electrical Work fMDV�`� l��i P—R MU J 5w)TCOES L/ t17-5' TOTAL No. of Lighting Outlets , , No. of Hot Tubs No. of Transformers KVA Above In- No. of Lighting Fixtures a SwimmingPool rnd. [:] rnd. ❑ Generators KVA No. of Emergency Lighting ,No. of Receptacle Outlets U No. of Oil Burners Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Conditioners Tons Heat Tota Tota Initiating Devices No. of Sounding Devices. No. of Disposals ' No. of Pumps Tons KW No. of Self Contained No. of Dishwashers Space/Area Heating KW Detection/Sounding Devices. Municipal No. of Dryers Heating Devices KW Local❑ Connection ❑Other No. or No. ot Low Voltage No. of Water Heaters KW Signs Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP OTHER: INSURANCE COVERAGE: Pursuant to the requirements of Massachusttes General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent.YES❑ NO❑ ! have submitted valid proof of same to this office. YES ❑ NO ❑ if you have chFZBOND ES, please indicate the type of coverage by checking the appropriate box. INSURANCE ElOTHER❑ (Please Specify) 0. 60 PLC S 0 '5D a 0� O`�s Estimated Value of Electrical Work $ a)l (E iratio Date) Work to StartApeaas D Inspection Date Requested: Rough Final Signed under thes of perjury: r FIRM NAME L� L L �6 LIC. NO. %5W 63, Licensee L SiSigrnature LIC. NQQO�SOD 631- Address �d• ,�'✓ 0 Bus. Tel. No. L� Alt. Tel. No. ,OWNER'S INSURANCE WAIVER:I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as required by Massachusetts .General Laws, and that my signature on this permit application waives this requirement, Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent) 5926 Date...... ~..$�.5 f f NOR7M 1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING � - ,SSACMUS� p This certifies that ,2. Jv. ................ ............ .-........................... has permission to perform 4,�/?pt.-7 ©U/4ET„S ............................. „ 7 .......� Pp wiring in the building of�r���....... ......... ..r...�a..................................... at /.��..............'`-' �?'...........................,North Andover,Mass. ................ ............ • Fee..................... Lic.No.............. ............... .:".... .�-/ ts. .. .......... ELECTRICAL INSPE&OR 4 Check # 770 DEPAJUMENTOFPURKSUM permit No. 0 BOARDOFFIREPREVFvimRDGuLAT 115527am,a, Occupancy&Fees Checked APPLICATTONFOR PERMITTO PERFORMELECTRi WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Datef lO S Town of North Andover To the spector of Wires: The undersigned applies for a permit to perform �the `�electrical work described below. /� Location(Street&Number) 3 3 l�Int I P 'ST- �'�tor(,) UYj� cd/�ee /- 72 et Owner or Tenant ('e ��'�rt t-.AP Owner's Address 105 Le silr. t2-0,4d On(, -Inc,m MIt ° 2 Y s/ Is this permit in conjunction with a building permit: Yes[�No E3 (Check Appropriate Box) Purpose of Building f t'VkL Utility Authorization No. Existing Service Amps ('Z' / 2 DVolts Overhead Underground No.of Meters S New Service Ampa_. Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work tiJ W 2zvy tb""- W.y-foe, MAJAime. tLov fo wCr No.of Lighting Outlets No.of Hot Tube No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generator KVA around M ground No.of Receptacle Outlets No.of OU Burner No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Hem Total Total No.of Deoxtion and. Pumps Tons KW Initiating Devices No.of Dishwasher Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW Local E3Municipal other Connections No.of Water Neaten KW No.of No.of Signs allasis No.Hydro Massage Tube No.of Mown Total HP OTHER- A >�taataeCa�Altager!<b111eafMeB®cfil9ellaCBlsellswg ]h=aanetliel*lia =F0rl,YndudrgU tft— arka nswa tivaknt YES NO ItNmsubrrftdve1dpioafofsmzlD*rcOlBm YM Sycuhav drd1rdYE%pk=it3cateQtet)Peafarnt by . . 19the bac ET IIVS'URA� BOND M tPleeaeSpedfy) BFWMDoe &Of /*/Pfr Es=*dVakzdEhcoEdWhk$ WodcbStat 7 ���� lttiactiorrD*ReQire W Ra* FkW Sgrdur� PaNkksofpeijWjr vl2v e��n FtitMNAME LioertseNo. /2 77 M1 I� �y>t��ill�l ZZo StBmnie Lio�eNo 92-232--3 976° 317 S3/ ;7 Ce pa Al<T»Na OWI�WSP6UAICEWA1VIIt;lamawanet udrLia w esmtltateihemmmta mWcrtsatonalegivalmtastapWbyNbmwfi>.smCoiaalLaws e andthecmydgaWeonftpmtT cappidonaiimpk rat (Please check one) Owner 1:3 Agentoi uwner or Agent a Telephone No. PERMIT FEE S � Signature Date. . NORTH TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING SSACHUS This certifies that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . has permission to perform--< . . . . . . . . . . . . . . . . . . . . plumbing in the buildings of at/—'--U. . . . . . . . . . . . . . . . . . . North Andover, Mass. . . . . . . . . t Fee Lic. No.. . . . . . . . . PLU ZN6I . . . . . . . . . . . . *' Z INNSPECTOR Check # 6P; 3 3 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS ti Date Building Location 13�3 Owners Name �•�P� Permit �?-3 Amount Type of Occupancy New Renovation Replacement Plans Submitted Yes ❑ No ❑ FIXTURES >> fx W o z z 3 z a o U SCBM WEVEvr IS:FLOOR Zn>FLOCIz 3MFLOOR 4MIt" 51H HAC)CR slHHADOR 7IH HfM:F SMHJ00R (Print or type) Check one: Certificate Installing Cony Name7T--) r(-N- 1 -Fj E] Corp. Address p Partner. �• -== .4:yJ , - Busmess Telephone �—� -z 9—y yy f, r/C0. Name of Licensed Plumber: Insurance Coverage: Indicate the type otinsurance coverage by checking the appropriate box: Liability insurance policy 0-� Other type of indemnity ❑ 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 ❑ Agent ❑ I hereby certify that all of the details and informa 'on I have sub itted(or en d)in above application are e and accurate to the best of my knowledge and that all Is wor and installatio s performed u r Perini d fort ' pplication will be in compliance with all pertinent provisions of the M sac is ate Plu ing d Ch er 14 the General Laws. By: igna ure-o Icenscu rju. er Title Type of Plumbing License City/Town ge pice se Numoer Master Journeyman ❑ APPROVED(OFFICE USE ONLY Date...z70`✓ .3, TOWN OF NORTH ANDOVER PERMIT FOR WIRING JqCHU This certifies that ................ . .. ......../Z .7..,rj.... ........................... 4 :-, 46 has permission to perform ..... . ....x....... .'77...:5 ...• wiring in the building of. Pf"0'404.55. ..........*'Ln/.elo 7 ................. at...... ......MAAM.1..... .......................... .North Andover,Mass. cr Fee Lic.No.IA,..775 ........... /SY ELECTRICAL ispEcrOR Check # Commonwealth of Massachusetts Official t'�`"nly 2,,= -- Permit No. (03 2 G = Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 9%05] (Dave blank) � APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All\Mork to be performed in accordance\Nith the Massachusetts Electrical Code(MEC). 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: //Z 34 6 City or Town of: No, 0gAJ To the hmpec•tor of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street& Number) Owner or Tenantyyl lD!Y r u Coa(.lt^,iyV4,7f Y4l eX N�(r-a ,4#,4I Telephone No. Owner's Address 61441W 404- �Z$1d-11 Is this permit in conjunction with a building permit? Yes E4-- No ❑ (Check Appropriate Box) Purpose of Buildintg. #Qe T-�t L — Coyrt e- S—L,,,4 Utility Authorization No. Existing Service VO° Amps /20 / 7,y0 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: (Kxtyifir p 7 e2-I ,IJ%-FIX/V i�A v -rGt r✓ (Tom lotion o'the.Jollowing table nury be waived by the fns)ector o/'ll'ires. No.of Recessed Luminaires No.of Ceil: No.of Total Susp.(Paddle) Fans Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No. of Zones No.of Gas Burners No.of Detection and [, No.of Switches InitiatingDevices No.of Ranges Tons No.of Air Cond. Total No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained P Totals: Detection/Alerting Devices al No.of Dishwashers Space/Area Heating KW Local El ConnectMunicipion ElOther Heating Appliances KW Security Systems:* No.of Dryers No.of Devices or Equivalent No.of WaterKms, No.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or Equivalent Telecommunications Wiring: No. Hydromassage Bathtubs --JNo-of Motors Total HP No.of Devices or Equivalent OTHER: tttach adclitional detail 1/(Iesired. or(is re(Iuirett hl%the Inspector 1171-es. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: 111-,21"( Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE CO ER GE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insw ince 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 and penulties ojperjury,that the information on this application is true and complete. �. FIRM NAME: LIC. NO.: �Z7?rl P 7w e,4- c Licensee: A72-0 Signature f LIC. NO.: C 2732 3 (lrapplicable, anter 'exemp(."in the license numbc>r line.) Bus. Tel. No.: -3175'317 Address: k fI ,06,je a/yYfAlt.Tel. No.: 91 612-77-o *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 PER�b11T FEE: .14 Signature Telephone No. Date. :'7�. .12 D�... .. HORTM 1 pf �,•o 1'1. TOWN OF NORTH ANDOVER PO PERMIT FOR GAS INSTALLATION �9SSAC HUSEt'C This certifies that . . '""`^ P. . . .fir-. �.. .. . . . . . . . . • . has permission for gas instlallation, -��^ �.. .� �.: -� • • • • • in the buildings of . . . .L. c:J . . . . . . . . . . . . . . . . . at North Andover, Mass. Fee! . . Lic. No.S?9'�_�! . . . 4 . . . ;-e. . . . . . . . . . . GASINSPE TOR Y Check# 51.47 N ASSACHUSyM UNIFORM APPUCATON FOR PERNIIT TO DO GASG (Type or print) Date /�7� o NORTH ANDOVER,MASSACHU TT"�j— 7 Building Locations `� �l"� Permit# Dunt$ , Owner's Name POP 45 New Renovation Replacement13 Plans Submitted c c N , P SUB -BASEM ENT ! ✓ BASEM ENT 1ST. FLOOR a 2ND . FLOOR 3RD . FLOOR 4TH . FLOOR STH . F L O O R 6TH . FLOOR 7TH . FLOOR 8TH . FLOOR (Print or type) C e one: Certificate Installing Company Name uv ' Corp. Address 6 O Partner. rrr usmess a ep one .{—QSt—a'n 9 —9-ey 9 Co. 9 Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes U�— NoO If you have checked Vis,please indicate the type coverage by checking the appropriate box. Liability insurance policy �''� Other type of indemnity 13 Bond 13 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 13 Agent 13 t hereby certify that all of the details and information ve sub)teor entered)in above application are t and accurate to the best of my knowledge and that all plumbing work a installatiormed un Permit Issued f r thi p ication will be in compliance with all pertinent provisions of the;fila, achusetts StCode mpter hd the n al Laws. Sigfnature of Lice Plumber Or Gas Fitter Title ELPlumber =5'4l:� City/Town Gas FittertieNurrArer Master APPROVED,OFMCE USE ONLY) Journeyman ` MASSACHUSETTS U141FORM APPLICATION-FOR RM1T TO:pp°pLU f4Bj Q (Type or Print) :i:..,• rNORTH ANDOVER ,Mass. .:�- ; . Date:, � -9s , Building Location /33 ^,/q,ill Permit u?6,, "r Owners Name,Of/�, '7-0 I!C S i tib• ei New Renovation j] ' Replacement Q Plans Sybmitted lIXTURES `i. ' z z at ;,fir N m O 2 z y W W • W Y J o' ••' � V h H ? t7 � tt N Z m a CC Z p = W 0. a , .j a w of x a: w ar z ¢ a C < < 3 1{ Z* o a a w ¢ Q w Cl 4 Wz a a aG w it W m v, a: a p O J 01 1- 116 Ac 4 x W IL. YC W > 1- O CL 7 N 1- x 0. O 44 •i O N N 2 O 0 07 �' Y W i- O V Y iL J to W O O J = H N W O :30 O < Ac a O ! Sua—+BS MT. • BASEMENT IST FLOOR 2ND FLOOR , 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR ' LITH FLOOR t (Print or Type) Check one: Certificate Installing Company Name Corp. Address ,C?k /s'8ecl Partner. Firm/Co. Business Telephone Asa 0— Name of Licensed Plumber: Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy © Other type of indemnity E] Bond E] Insurance Waiver: I, the undersigned, have been made aware- that the licensee of i this application does not have any one of the above three insurance coverages. Signature of owner/agent of property Owner AgeneN II beorbr Certify Ilial allot die details and in(ornralion 1 ha•c wtsiniticd(ot en(ercd)in alw,••e appliolion ire lint anj�irrale to an bell r a" knowkdp and lbal all plumbing work and insullaliinnt lice formcd under rerwoit issued(or this applieatiow will bilk all rallnem pit.14 I v1sia"o(lbe Maw dimietls Stale Plumbiag Code and Ctupter 142 of clic Gcnual Last I Y ` Title . Signature of Licensed Plumber I City/Town: ��pe of Plumbing License / , ( + ! r-1 ria _ Date. '` . . = ` 3632 �aORT" �,<.•�� •otic TOWN OF NORTH ANDOVER49 p PERMIT FOR PLUMBING41 A ,SSACHUs� p ' This certifies that . . . . . . . . . . . . . . . . . has permission to perform . . . . . plumb,ing in t�uilf�,: . . . . . . . . . . . . . .T�4+--:�:Q. . . . . ^o at. . . . . . . . . . . . . . . .—56;�.. . . ., North Andover, Mass. o -� 9 17 . . . . . .Lic. No A. '* . PLUMBING INSPECTOR 0 WHITE:Applicant CANARY: Building Dept. PINK:Treasurer Date..�// .... NORTH N TOWN OF NORTH ANDOVER PERMIT FOR WIRING SS CHuS This certifies that .—. —)/0(-/***/""A-:�... . .................... has permission to pef/farm .......I............................... wiring in the building of Xg, .......... ;y........................ ......... .North Andover,Mass. Lic. zl/z/... A 'ELEcrRIC-AL INSPECT9I� Check # 5 7 /"- Lim WIVIAlul y YI r fi"[1 Ur 1nr1a,arxt.n v.1[..i 1 LJ -- DEPAR73fNW0FPUBIICS4FFEIY Permit No. `` 7 BOARDOFFMPREVFIMONRPGAT70NSM7aM12W Occupancy&Fees Checked APPLICATION FOR PERMIT TO PERFO ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHU S ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work scribed below. Location(Street&Number) Owner or Tenant X -, ��.��J.o 0 5 Owner's Address /a S /- /i r A-1.9 / ,-, -`--- Is this permit in conjunction with a building permit: Yes o No M (Check Appropriate Box) Purpose of Building Xt S Utility Authorization No. Existing Service Amps_ �Volts Overhead Underground 1:3 No.of Meters New Service Amps Volts Overhead Underground Q No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work " W /-.,v r 4A"T X,,Ile Z" No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures ? Swimming Pool Above Below Generators KVA V round ground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pumps . Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices _ No.of Dryers Heating Devices KW Local Municipal Othe Connections No.of Water Heaters KW No.of No.of Signs Bailasis No.Hydro Massage Tubs No.of Motors Total HP OTHER• � hssirnioeCo�aga PL>tsaattbthetaquuanaiSdMasad»1tsGalaalLaws IhaNeacu=tlitatyhmaa=Fbfryirrb*gConpl* aitsstl &MWeWdlat YES NO -aIha-,esubfrmedvddpedofwmlodrOfc>~YES rT lfyouhawchadodYES,pk=n1raletxMrofoDmaWby �ap¢o bo>< Bono o Few © B#mticnD* Estim*dVafueofEla=cal Wodc$ WorklDSatt -�- a - hEpacfionDWeReWmbd Rough Final Suledtn derTrePftkiesofP*ly.. �— FIRMNAME ° G' K �' Lioe wNb. A14-3 7 /P / LiXrwe J 19 s2 Sigf>ahae Lmisel b BUSmesSTeLNa i-G.7-777- 72 ;dless7 �i sr ���„ mit .� ��v �� y /"zvr. . Alt Tel Na VWTMCSINSURANCEWAIVER IartawarethattheLioerlsedriesnothavedieinsurd=c�oritssulisi dWogivaintastegtriledfryMassadinmCaimWLaws andthatniysgnakncndtispeunilq#cab' iwanesthism*ummlt (ease check one) Owner Agent Telephone No. PERMIT FEE$ signature of Owner or Agent Date.41 A ot "0RT:�M TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 0 -9 a s ,SSACMUS(c� This certifies that .. . . . . .�./. . . . . . . . . . . . . . . . . . . . . . . has permission to perform . . r/�5,.�a- �4.�- ! . . '�'` . . . . . . . . . . . . plumbing in the buildings of ✓. . . .t� r jr ...� .� �.. . . . . . . . . . ' at. / 7-7 . . . . . . . . , North Andover, Mass. 4 Fee.;9-57. . . .Lic. No.. 1/ PLUMBIX SPECTOR Check y 909 f� 6513 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER,MASSACHUSETTS Building Location /1/ /i✓ Owners Name Al—,z ,Jeo �sj�Pir�S t Arno unt Type of Occupancy �,i1?�,��,t ;5�pitle_ New Gj/Renovation 0 Replacement 1:1 Plans Submitted Yes ❑ No ❑ FIXTURES d v stsagvlC R4SE FNr ISS FUM 6 210 FUM �M Fl" 4IH It" 5M FIDM 6IR HIM 7IH FIDCIt SIH HDM (Print or type) �\ ( c Check one: Certificate Installing Company Name 1 Jy�1�. `�.J t l El Corp. Address ? Partner. Business Telephone Firm/Co. Name of Licensed Plumber: 3i�H?ig- Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity 0 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 Agent A I hereby certify that all of the details and inform tion I ha a submitted(or entered)in above appli i are true and accurate to the best of my knowledge and that all plumbing wor and ins llations p o e under Pe Iss d for is application will be in compliance with all pertinent provisions of the sach etts Stat lu h r 14 of the General Laws. By: Signature o ice a er Type of Plumbing icense Titleyy City/Town License Numver Master 8 –Ioumeyman ❑ APPROVED(OFFICE USE ONLY d � ,l N° 2 Un 003 Date.... �............... 7 NORTH °�<�``°;• '"° TOWN OF NORTH ANDOVER 3r �-='� .'e OC p PERMIT FOR WIRING �,SSACMUSE� This certifies that ......... ............. ........�::..�..�:...............`�....... / � �r �� Fi has permission to perform .....��.:...�............ .....................�........................ wiring in the building of......�r.` .<.. ..?...................................................... i at............................................................................... .North'Andover Fee... J......( Lic.No. . �� �.................. ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK:Treasurer ME 09WONWE4LTHOFMA.3-"M1 EM Office Use only DEPARTARMOFPUBLICSAFM Permit No. BOARDOFFIREPREVEM ONRWUTATIONSS27CMR12.(l0 T U9A4 Occupancy&Fees Checked PPLICATIONFOR PERMIT TO PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL CODE,527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date / Town of North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location(Street&Number) /33 /*f;t/ Owner or Tenant �d.S 2 �//L/ Owner's Address cSpf-/IP— Is this permit in conjunction with a building permit: Yes a No EET (Check Appropriate Box) Purpose of Building Cpj;:-I t°- S(71 Q— Utility Authorization No. Existing Service Amps Volts Overhead Underground No.of Meters New Service Amps / Volts Overhead Underground No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work C✓�r% /vG�✓ "�r Z C�lCJr�C U i �2�-- No.of Lighting Outlets No.of Hot Tubs No.of Transformers Total KVA No.of Lighting Fixtures Swimming Pool Above Below Generators KVA groundground No.of Receptacle Outlets No.of Oil Burners No.of Emergency Lighting Battery Units 8 No.of Switch Outlets No.of Gas Burners No.of Ranges No.of Air Cond. Total FIRE ALARMS No.of Zones Tons No.of Disposals No.of Heat Total Total No.of Detection and Pum s Tons KW Initiating Devices No.of Dishwashers Space Area Heating KW No.of Sounding Devices No.of Self Contained Detection/Sounding Devices No.of Dryers Heating Devices KW LocalMunicipal Other Connections No.of Water Heaters KW No.of No.of Signs Bailasis o- No.Hydro Massage Tubs No.of Motors Total HP OTHER h1sL=oeCmaage PtrsuirtbthetaWmmotsdNbmdmsftC>ialLam Iha%eaomotLxb*h-&==PohtyaidudagCaTVW CovmaWcrits!abstwMe4dvakrt YES [ITNO Ihaw%hnfadW1idprp0f0fsane10the011i=YES rJ NO a If}puha%edmdWYFS,pl mmdc ethetmxcfoovwwbydnkzrgthe INSURANCE El' BOND o MHER o omse ) a_ �a —� / E��iat Dtate / F&rgtedvakxdEk±xalWak$ WakbStait _ ( kgxciMD*Rawe*d Rotgh Final Sygnadunda�iePenaltiessv GrJ P L�`�C7�' FIRMNAME liar�seNa Lioaism fff^OLI fd&-wer Lioa>seNo �d�3�v /? Y` Busi=Td.No. 7V .C--,�-d'77 AddtesZ .� WD3C/1�1� /vYtR d�lJ AItTeLNa�� 1�3 S-�J OWNER'SINSLR WAIVER;I.arnawatethattheLioam"mt heiiutra�oeeo earilss taitiialecgrivalettastegtmedbyM�sadxsel�Gai�alLaws and dvtmysVn�aeonthepamitappywainthis te#wlie t (Please check one) Owner Agent Q js— Telephone No. PERMIT FEE$ December 7, 2004 Mr. Michael McGuire, RECEIVED Inspector 480 Osgood Street North Andover, Ma. 01845 DEC 2 a 2004 RE: Application for Retail Use BUILDING DEPT. 133 Main Street. North Andover 01845 Dear Mr. McGuire, Thank you for your time and the opportunity to discuss with you my request to open a new retail store at 133 Main Street, North Andover. Our intention is to open a new retail store specializing in International and Gourmet products. These products would be made available through our retail store; we would carry such items as Coffee from around the world, Tea, Imported chocolates, Spices and more. Our goal is to provide the highest quality international products to the community. By focusing on this unique market and the proximity to surrounding communities, we hope to attract a loyal cliental. The store would keep typical business hours throughout the week, and respond to customer needs for special occasions and holiday periods. It is our hope to provide an appropriate number of customer sales associates, plus a store manager to run the day-to- day operations. We look forward to opening our store within the next few weeks, with your support and that of the other town merchants, we feel we will continue in the rich tradition of providing the highest serve for many customers and support for our locate the downtown commercial area. Since lyg r f` r. Gabriel Gualteros, Business Manager 133 Main Street North Andover, Ma. 01845 978-884-2458 1 FOWN OF NORTH ANDOVER Office of(1()tillUNi'i'V 1)EVILOP1tENT .L°yD SERVICES 12 400 OSGOOD STREET NORTH AN DOVER. NIASSACHUS ETTS 018,15 k,RSSRC14 nth 4lichele E. Grant 978.688.9540 -Phone Public health Inspector 978.688.9542 _ FAX hcalthdc�;drto«nofnorthandcn cr.com nofnorthandov er.corn Alexandra Lappas,Owner Emprorio Gourmet Coffee Tea and More 133 Main Street North Andover,MA. 01845 December 29,2005 Re: Upgrade of Food Permit Dear Mr.Papadopulos,Manager, This letter is in response to your revised application for the changes to your existing Food Establishment that was received by the Health Department on December 23,2005.The status of the following items previously listed has been identified in red. 1) Speak to The Building Department regarding seating. Since the last application was submitted the seating has increased. ok 2) Please fill in the section with the maximum amount of meals served per day. 600 3) Hot/Cold Holding E-11 -during Service a. Hot Items—How will you be holding items such as Meatballs,chicken items at the correct hot temperatures? Please list the holding process. \'/,k b. Cold Items-Where will cold items be held for service,such as cold cuts,shaved steak, condiments and vegetables? Walk-in c. Where will French fries,onion rings etc be stored during service. freecr 4) Cooling Section E-11 -Please fill this section in—Items like meatballs,chicken etc.,what will be the method of cooling at the end of the day. As required by code 5) Preparation Section E-11-Please fill in#1 and#8 8 -ok 6) Preparation Section E-12 Please answer#6 and#8 ok 7) Finish Schedule Section E-13—Please list Covering for the floors,walls and baseboards for the Prep Area. ok 8) Garbage and Refuse C-E-14—Where will you be storing your garbage. Where is the dumpster. ,es 9) E—18 Please complete#54 and 67(What is the frequency of deliveries) 10) Where will you cleaning vegetables. Prcp;ink 11) Where is the hand sink in the prep area. Ok front arca" !-landsink io ra` in K itchenctie 12) In the prep area place all sinks as well as equipment in there perspective areas on the drawing. 4 13) Bath doors—Apply springs that automatically close the bathroom doors ok 14) Will you be preparing any raw products? If so,you will need a cutting board for raw products only. 15) Do you have slicer,and if so where will it go and could you submit a cut sheet for it?4 k 16) Are you selling whole pizzas' as well as slices? Y,,s, therwal bo.\ (m- holdiil�', 17) Who will your linens be laundered by?Churchill ol< " Thank you for responding to the outstanding health concerns noted on the review. The health department has approved your plan. A copy of this approval will be forwarded to the building department. As you mentioned,if any substantial changes in the plans occur during construction you are expected to advise the health department. The Health Department is aware that this establishment owner wants to continue operating while the changes are being made.Please note that is it your responsibility to be sure that all foods are kept safe from contamination during the construction. At no time shall construction workers be allowed to enter food preparation areas while the operation is running. If work is being done in the evenings,be advised that all food surfaces must be given extra attention in the mornings. All food contacts surfaces must be sanitized properly prior to use each day. Once basic construction is complete and the equipment is in place,please contact the office for a construction inspection to verify that you have built it to plan. At that time we will sign off the building permit. Prior to utilizing the newer areas note the following. 1) The establishment shall be clean of all construction materials 2) All handsinks and bathrooms will be stocked with a wall mounted paper towel and soap dispensers 3) Handsinks should be labeled"hand wash only" 4) If potentially hazardous foods are being offered undercooked,such as hamburgers to order,a disclaimer regarding foodborne illness must be posted,as the code requires. This is a Health Department plan approval only.Please be advised that other departments may have specific requirements. This approval does not supersede any other department's request regarding other town or state regulations. If you have any questions regarding this approval,please contact the health office. Since,rely, � 'jLan Sawyer,RE /R �' -'` Public Health Director Cc: Building Dept. Plumbing Dept. Susan Sawyer, Public Health Director Curt Bellavance, Community Development Director Alexandra Lappas 6exA 4_1 RECEIVED - - - -- - - UCT i 4 TAUS � BUILDING XV�e,20byf-e Brenna Gorgon 46 Arlington St. Lowell, MA 617-970-1477 October 11,2005 To whom it may concern, This letter is to inform the Town of North Andover of a new business proposal at 133 Main Street. The business name will be Rub:Muscular Therapy and Therapeutic Massage. The business hours will be from 11 a.m.to 8 p.m.by appointment. A typical appointment will consist of a consultation with the client to find out and discuss what areas of the body they want to focus on and establishing client relations,then ending with setting up sessions from there on forth. The sessions can be 30-90 minutes and some different massage methods are Swedish massage,deep tissue massage,sports related massage, and hot stone therapy. Thank You, Brenna Gorgone RECEIVED OCT 14 2005 BUILDING DEPT. Z0 39dd 3d A31d00 Z89099UT9 6T:ST 500Z/ZZ/0Z Closet 20'1-- �, I I -----up- i4 Exit - —{--- a Office Space � f Closet Phase N U N Bathroom Office Space ,-Nn Bathroom -- — - -- 13'10 L! ------13'10— I� Conference Room u Office Space r, I I Closet 47 10, o li' Office zo --- ''i --- - 13'10-1- OP 3'10-1 uP f II Office --UP L l Jam+ 1 -- -- 14'5P--- == -- L7 - , Exit LIVING AREA 1803 sq ft Location / 1A) f ' No. d Date / � 10RTry TOWN OF NORTH ANDOVER f aa_DD F °9 Certificate of Occupancy $ Building/Frame Permit Feed` S•�S' ttt' Foundation Permit Fee $ sAcmus Other Permit Fee $ g Sewer.Connection Fee $ Water Connection Fee $ TOTALMI Building Inspdctor Div. Public Works 4 Location I! " No. Date NOR,h TOWN OF NORTH ANDOVER C?O:`t � n Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s�cMus Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ N s } s Building Inspector Div. Public Works 311T xo. APPLICATION FOR PERMIT TO BUILD— NORTH ANDOVER, MASS. PAGE . MAP 4J0.(a 3 d,Q LOT NO. s RECORD OF OWNERSHIP JDATE BOOK jPAGE ZONE SUB DIV. LOT NO. u ,' GQ)6y, / I — I f I LOCATION / PURPOSE OF BUILDING NT��pvvb OWNER'S NAME ,o,lV^/ SCE&-/ Nd /vT NO. Of STORIES SIZE OWNER'S ADDR&S8 /33 MA N Y. 0 Cvy'1 /1 i� BASEMENT OR SLAB ARCHITECT'S NAME ��`L ' ,1 SIZE OF FLOOR TIMBERS 191 2ND !RD BUILDER'S NAME sSDCJhTcS _2:�1/e SPAN DISTANCE TO NEAREST BUILDING!, DIMENSIONS OF SILLS ujln DISTANCE FROM STREET N POSTS (JL DISTANCE FROM LOT LINES—SIDES REAR GIRDERS 11��77 AREA OF LOT ) 4 FRONTAGE HEIGHT OF FOUNDATION ON . /�' {�„ THICKNESS AJ//1 IS BUILDING NEW SIZE OF FOOTING �p/ja x IS BUILDING ADDITION MATERIAL OF CHIMNEY r• N IS BUILDING ALTERATION �G5 IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /�s 18 BUILDING CONNECTED TO TOWN WATER \/C BOARD OF APPEALS ACTION. IF ANY )� Yl D� IS BUILDING CONNECTED TO TOWN SEWER /� li BUILDING CONNECTED TO NATURAL GAB LINE y INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST BEE BOTH SIDES EST. BLDG. COST G D DD•&D PAGE 1 FILL OUT SECVIONS 1 - 3 EST. BLDG. COST PER SQ. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING y 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE Fi 1/ BUILDING INSPECTOR SIGNATOR OF OWNS AUTHORIZED AGENT F E EOWNER TEL# )6&? -y7 I PERMIT GRANTED CONTR.TEL JI �� tfa CONTR.LIC.Y 100 H.I.C.r BUILDING RECORD t OCCUPANCY 12 SINGLE FAMILYS;0R1ES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS I RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION B INTERIOR FINISH CONCRETE a 1 2 I3 CONCRETE BL'K. PINE BRICK OR STONE HARDW D PIERS PLASTER _ _ ORY WALL UNf IN. 3 BASEMENT AREA FULL I FIN. B M t' AREA _ 1/1 % FIN. ATTIC AREA _ NO B M FIRE PLACES HEAD ROOM MODERN KITCHEN -- 4 WAILS I 9 FLOORS CLAPBOARDS B 1 2 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH _ ASPHALT SIDING HARDW'D ASBESTOS SIDING COMMCN VERT. SIDING ASPH.TILE STUCCO ON MASONRY _ STUCCO ON FRAME _ ATTIC STRS. & FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I� POOR _ ADEQUATE NONE S ROOF 10 PLUMBING GABLE I HIP BATH 13 FIX.1 _ GAMBRELMANSARD TOILET RM. 12TOILET RM. 12 FIX.1 ib�T-ll SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING _ TAR &GRAVEL STALL SHOWER _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR Hl TILE DADO 0 FRAMING 11 HEATING •1000 JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. &COLS. STEAM STEEL M. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT.HEATERS 7 NO. OF ROOMS GAS B'M'T ( 2 d _ ELECTRIC lot d 11 NO HEATING -71 , MIT NO. APPLICATION FOR PERMIT TO BUILD- NORTH ANDOVER, MASS. �r � LL PAGE MAP 4-40. l LOT NO. 2 RECORD OF OWNERSHIP JDATEL BOOK 'PAGE ZONE = —I SUB DIV. LOT NO. LOCATION 73= m( PURPOSE OF BUILDING OWNER'S NAME NO. OF STORIES SIZE OWNER'S ADDQESS � • r BASEMENT OR SLAB ARCHITECT'S NAME K < < SIZE OF FLOOR TIMBERS IST 2NO 3RD BUILDER'S NAME - - j"� SPAN DISTANCE TO NEAREST BUILDING DIMENSION! OF BILLS DISTANCE FROM STREET POSTS - DISTANCE FROM LOT LINES-SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION - THICKNESS IS BUILDING NEW _ SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION �, 16 BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE � If BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER If BUILDING CONNECTED TO NATURAL GAB LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST BEE BOTH SIDES EST. BLDG. COST PAGE 1 FILL OUT SECTIONS I - 3 EST. BLDG. COST PER SQ. FT. • PAGE 2 FILL OUT SECTIONS 1 - 12+ EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS f PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED i �:� l � � �� :/�. _ -'•t.r'�� _ ��t.,�" BUILDING INSPECTOR SIGNATURE OF OWNER OR AUTHORIZED AGENT FEE / OWNER TEL/� � �r ( ; % (_ ' % I l -3 PERMIT GRANTED CONTR.TEL r // 1si CONTR.LIC.t H.I.C.d BUILDING RECORD 1 OCCUPANCY 12; t AMITY S;o IES THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM MULTI. FAMILY �= OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. CONSTRUCTION 2 FOUNDATION 6 INTERIOR FINISH CONCRETE _ d 1 7 13 CONCRETE BL'K. PINE BRICK OR STONE HARDW O PIERS PLASTER - _ ORY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B M'T' AREA _ /4 Vt % FIN, ATTIC AREA _ NO B M FIRE PLACES _ HEAD ROOM MODERN KITCHEN 4 WAILS ( 9 FLOORS CLAPBOARDS B 1 7 3 DROP SIDING CONCRETE WOOD SHINGLES EARTH ASPHALT SIDING HARDW'D ASBESTOS SIDING COMMCN _ VERT. SIDING ASPH. TILE STUCCO ON MASONRY _ STUCCO ON FRAME IONRY ATTIC STRS. b FLOOR I_ BRICK ON FRAME CONC.OR CINDER BLK. STONE ON MASONRY WIRING STONE ON FRAME SUPERIOR I I POOR _ ADEQUATE NONE 5 ROOT 11 10 PLUMBING GABLE HIP BATH 13BATHI3 FIX.1 GAMBREL MANSARD TOILET RM. 12 FIX.) FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY WOOD SHINGES KITCHEN SINK $IATE NO PLUMBING _ TAR i GRAVEL STALL SHOWER _ ROLL ROOFING I MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. 6 COLS. STEAM STEEL BMS. &COLS. HOT W'T'R OR VAPOR WOOD RAFTERS AIR CONDITIONING RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL B'M'T 2nd _ I ELECTRIC lot 13rd11 NO HEATING ' j FORM U - LOT RELEASE FORM INSTRUCTIONS: This form is used to verify that all necessary approvals/permits m Boards and_r'-partments having jurisdiction have been obtained. This does not eliev the applicant and/or landowner from compliance with any applicable or requirements. e . **APPLICANT FILLS OUT THIS SECTION APPLICANT r PHONE j6 ?,93 LOCATION: Assessor's Map Number—6 3(3 . Q , PARCEL SUBDIVISION I LOT(S) b / . STREET ST. NUMBER 133 hjj f1Aj S f', USE ONLY i RECOMMENDATIONS OF TOWN AGENTS: • CONSERVATION ADMINISTRATOR DATE APPROVED 1 DATE REJECTED COMMENTS i . TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED I SEPTIC INSPECTOR-HEALTH DATE APPROVED ( DATE REJECTED 1 COMMENTS PUBLIC WORKS -SEWER/WATER CONNECTIONS i { DRIVEWAY PERMIT ' �IREEPARTMENT rs' r , RECEIVED BY BUILDING INSPEC OR ;. DATE tAORT Town of _ _ over No. ; m dover, Mass., 1 9 19 `� 8 9 COCNICNE WICK lY'�• E �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............(%Z)bN. . ./?/1�'..,L.�1�...�4&elq. ..........�'.K�.y........�!!�.��D.�.....�.I Foundation has permission to we&.....4.,C., A ........ buildings on ........(.Z.3........./..A./............. .................. Rough to be occupied as ,s. ,! .� �i1 -!. ...........1�� .................................. Chimney .............................................................. provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION SELECTRICAL INSPECTOR TART Rough .................................... .... ...... .... Service .... . ..... .. . ..... ..... . ........ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Fi ugh Fnal No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. DEPARTMENT Burner Street No. Smoke Det. ` �11T Na. APPLICATION FOR PERMIT TO BUILD— NO �N NOOVER, MASS. PAGR MAP 440.0 3 d Q LOT NO. e Z RECO D OWNERSHIP JDATE (BOOK PAGE ZONE I SUB DIV. LOT NO. u y - / / LOCATION PURPOSE OF BUILDING AN 7*1 OWNER'S NAM[ N^ _Z* eUBIN Pea- yM NDC NT. NO. 01STORIES SIZE OWNER'S ADDR t .133 H,4 I/V Px. t, BASEMENT OR SLAB NJ A ARCHITECT'S NAMC PDX- A.46L t 8129 OF FLOOR TIMBERS IS 2ND 3RD BUILDER'• NAME s S ocihrCs �NC. SPAN DISTANCE TO NEAREST BUILQIN6/�t, D1141ENSIONS OF*ILLS LAW - DISTANCE FROM STREET POST& DISTANCE FROM LOT LINES-SIDE* REAR - GIRDER* MIR , AREA OF LOT ,✓y/, 4 FRONTAGE HEIGHT OF FOUNDATION /�f y,� THICKNESS A) A IS BUILDING NEW SIZE OF FOOTING V14 X K IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND �• WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IGS IS BUILDING CONNECTED TO TOWN WATER G BOARD OF APPEALS ACTION. IF ANY A21N Y IS BUILDING CONNECTED TO TOWN SEWER y� M IS BUILDING CONNECTED TO NATURAL GAS LIN[ 3 PROPERTY INFORMATION. INSTRUCTIONS LAND COST SEE BOTH SIDE* EST. BLDG. COST / o D0•� . PAGE 1 FILL OUT 6tC710N8 / - 3 EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM PAGE 2 FILL OUT SECTIONS I - I2 SEPTIC PERMIT NO. ELECTRIC MET[PS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS PLANS MUST B[FILED AND APPROVED BY BUILDING INSPECTOR DATE FI 8 11J BUILDING INBKCTOR SIGNATOR OF OWN[ AUTHORIZED AGENT 1 F E E OWNER TEL/ (tea f-) PERMIT GRANTED CONTR.TELI I>i CONTR.UC.1 690 4 7;] 5. ° H.I.C.0 pORTH O:T.■° .1h0 h0 A NORTH ANDOVER BUILDING DEPARTMENT °••.� `�9 27 CHARLES STREET ,SSACHUS�t Tel: 978-688-9545 Fax: 978-688-9542 DATE: NAME ___I Glc(iye/,"i)e lye,(:p 6-;54" ADDRESS Af C 00 ZONING DISTRICT: TYPE OF BUSINESS: BUILDING LAYOUT PROVIDED: YES NO,; AVAILABLE PARKING SPACES: I( S ZONING BY LAW USAGE: r' YES i NO BUILDING INSPECTOR SIGNATURE 2.40 Home Occupation (1989/32) An accessory use conducted within a dwelling by a resident who resides in the dwelling as his principal address, which is clearly secondary to the use of the building for living purposes. Home occupations shall included, but not limited to the to the following uses: personal services such as furnished by an artist or instructor, but not occupation involved with motor vehicle repairs, beauty parlors, animal kennels, or the conduct of retail business, or the manufacturing of goods, which impacts the residential nature of the neighborhood. Sec 4—4.4 Permitted uses by Special Permit included: A. Existing residential uses: B. Multi-family dwelling: C. Uses which involve historic materials or relate to the attraction provided by an historic atmosphere, such as museums, local arts and crafts ships, antique shops, woodworking, furniture repair or restaurants: D. Enterprises whose principal use is the sale or agricultural products, such as greenhouses, orchards, nurseries, food co-ops, or farm products stores. E. Enterprises who principal use is the sale of products produced in North Andover such as local agricultural products or crafts; F. Personal service offices: G. Professional offices; I� Business offices; I. Medical offices; J. Community resources such as banks, churches, schools, or libraries; K. Interior storage uses such as for boats or furniture; and L. Any appropriate combination as determined by the ZBA of the uses stated above. APPLICANT SIGNATURt / DATE