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HomeMy WebLinkAboutMiscellaneous - 1593 OSGOOD STREET 4/30/2018 BUILDING FILE 77, - `~'; �• North Andover Health Department Community Development Division April 3,2014 The Cork Stop Frank Stamos, Owner Nick Papantonakis,Owner 1593 Osgood Street North Andover,MA 01845 Dear Establishment Owners, The North Andover Health Department received your application for a new"retail liquor store", 4 located at 1593 Osgood Street and to be known as"The Cork Stop". The application was a complete change from the concept of a food establishment proposal,as was described in your preliminary conversation with the Technical Review Committee meeting on January 22,2014 and with Health Department staff over the past few months. (see documents attached) { The following has been noted in regards to the application submitted. 1) This application is for retail liquor sales only, which indicates that there will be no other food items sold at the store except for liquor items. 2) This application is not a request for a small retail food establishment; which would include sales of prepackaged foods such as chips,candy,milk, soda, lemons/limes etc. 3) The Cork Stop is not proposed as a food establishment; which would include providing foods that are assembled or prepared on site for sale,for customer food samples,gifts or food otherwise free to customers. 4) This establishment does not have kitchen facilities;no food prep or storage area,no ware washing area,no cooking areas are proposed. 5) This establishment does not propose accessible(handicap or otherwise)bathrooms for customers. 6) This establishment is not a place of assembly. There is no ability to support a public gathering; sanitation wise.No wine tastings,charity or other events can occur onsite. Page 1 of 2 North Andover Health Department, 1600 Osgood Street, Suite 2035, North Andover,MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Having completely reviewed your application, it has been determined that"The Cork Stop" does not need a food permit to operate. Therefore,there is no comment to any of the structural elements or to finish elements such as the materials used for the floors walls and ceilings. To reiterate,this is a major change from your initial proposal. The Health Department strives to provide customers with information that will assist with current plans,as well as provide for future plans for the establishment. This application does not allow for any future expansion into operation of any type of food establishment without submission of a new plan and full compliance to the food code. Thank you for your cooperation in this matter. This correspondence is a Health Department review only. Please be advised that other departments may have specific requirements. This does not supersede any other department's request regarding other town or state regulations. san Sa S/RS Public Health Director Cc: Curt Bellavance, Com. Dev. Director Building Department Encl. TRC Minutes,January 22, 1014 TRC Information Form Floor plan submitted March 26,2014 I f North Andover Health Department, 1600 Osgood Street, Building 20, Suite 2-36, Page 2 of 2 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 Location t V-) 1 i @ S�U� SLej No. �� Date 1 I� w TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �' " -w `` Buildi g Inspector NORTH O�,tL�o r6�ti 2 ., N• t 6 OOH a s p TOWN OF NORTH ANDOVER �4A '�"4Aria! . " * SIGN PERMIT gcHu �y DATE: September 24, 2014 PERMIT: 005-15 THIS CERTIFIES THAT Jimmy's Pizza — 1591 Osgood Properties has permission to erect a sign on 1591 Osgood Street - Reface Existing Sign — The Cork Stop and Jimmy's Add 3' Round Sign to building "The Cork building "The Cork Stop" provide that the person accepting this Permit shall in every respect conform to the terms of 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 spector f I Buildings Amount Paid:$30.00 Check# 8289 Receipt# 28055 E APIP]LIftCA' IION 1600(Osgood Street Building 20, Sante 2-36 COQ SIF` NORTH AlNTDOVER Date: �S/ / ' i Name of applicant who is purchasing the sign Site Owner ( `�� O�(, ©O D ? +fro 9C-j�,T tC,(; Phone#of applicant who is purchasing the'sign Site Address �� 1 y 5 Blame of sign company Phone# Map Parcel of Proposed Sim HOW atkaclied: a)Against the.gall �1Q �" f? Illumination: Ot ill gated. b Roof ` T'Nnteraaally illuminated C)ground i c Externally illuminated 7 r{ -e— S .n illu d)Other rTu h S 1=4 Materials_ ]Proposed Colors: Background Lettering ]Forder Cost of Si p O • Reanunure¢ll Aft- cIlnunneim4s^ 1`y�te: o pea�anegat/tean or Photographs of building � c% Np aty sign shall be erected,or a rged until an Material sample applicatioaa on the appropriate form fuanished by the Sign Office has been filed. Color sample with the Sign Officer containing such information including photographs,plans Site or Plot Plana(Required for.all free-standing signs) and scale.drawings, as he may require,dnd a permit for such.erection,alteration, Drawings.of proposed sign or enlargement has been issued by him. Stich permit shall be issued only of the Other,specify Sign Officer determines that the sign complies or will comply with all applicable provisions of the By-Law. Wi11 sign overhang any public road or walkway Yes N16 . if Yes,Name of Agency who will provide:liability insurance: AN T IQVCOM1A ,TETE APPLICATION WILL NOT BE ACCEPT I ED DATE lFI.,]ED: Receipt#2. Check# `1 Revised 10.31.2®06Form sign Permit Application SIGN OFAPPILffCANT :APPROVED BY ' I i x ' = CORKSTOP ...�... FINE WINES CRAFT BEERS ••� ': IMMY1 PIZZA BAR • GRILL r -- t y > l4.r T _ u'.S.Y! 9•d�a�:v:3(�iqaft� � � W ` _ � Y � � � ,3•.e_ <°•;. z max} �� t i.. "P.Y a�1 �'Sr:� •drz _ye aal••hn., �•�" F � - •/Tam. .. r � � � /,n+c � 4 Date.... V............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING HU This certifies that)............................................el�� ................... .......... ........................................................... has permission to perform ......060^' ova:7�4� wiring in the building of VI/ X�2 I z ev- -.1............................................................... at J ............................................./.44orth Andover,Mass. Fee... ......Lic.No.21095 /1 ............. ....... ,, Check# LLJ . 0 7/3 I Commonwealth of Massachusetts Official Use Only Permit No. 2� Department of Fire Services Occupancy and Fee Checked a a, BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(NEC),527 CMR 12.00 (PLEASE PRINTW INK OR TYPE ALL INFORMATION) Date: MAAj 2" - 10/y City or Town of: NORTH ANDOVER To theInsp�f Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location(Street&Number) /-1-23 ps5 o o f) S7` Owner or Tenant JIn7 - N/GL(. ��i-(r CG12* P79� Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ® No ❑ (Check Appropriate Box) Purpose of Building 57UA2. 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 / i Location and Nature of Proposed Electrical Work: /�4a Ct, /ot T RG M cve- lv>' lutTV ;7,)// Alt 4/ 191v, - sw `f Completion of thefollowing table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In ❑ o.o Emergency Lighting rnd. rnd. Battery Units l No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No, of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices 2 No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump Number I Tons I KW No.of Self-Contained Totals: Detection/Ale ting 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.of 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 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 perj ry,that the information on this application is true and complete. FIRM NAME: . N �1ti L C It 17— LIC.NO.: � I �5 C 4- Licensee: J ap/o ! Signature f)4,,,// -j�� LIC.NO.: r l` (If applicable,enter "exempt" 'n the license number line.) Bus.Tel.No - Address: 3Q�t, /114— /) 1-- 11113 per' Alt.Tel.No.: 9 S- °A' x �' *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,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent [PERWTFEE.- $ 1 Z� Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed 6 on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166,§32,an /J electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the s notification of completion of the work as required in M.G.L.c.143,§3L. .R Permits shall.be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass IN Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed Re-Inspection Required($.) ❑ Inspectors Comments: r f Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INS ECTION: Pass 0 Failed Re-Inspection Required($.) ❑ Inspectors Comments; Inspectors Signature: Date: FINAL INSP TION: Pass 0 Failed ❑' Re-Inspection Required($.) ❑ Inspectors Com en : I, Iq Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. .......dweinhold@townofinerrimac.com The Commonwealth of Massachusetts Department ofIndustrigl Accidents 149 Office of Investigations UT 600 Washington Street Boston,MA.02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): JC2 °`{-- Address: 3 F M � k A City/State/Zip: ��' n^�/> , Ol 9T U Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with�_ 4. ❑ I am a general contractor and I 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.# 7• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] ME]'other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they aie 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. Iain an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify under the pains and pens ties of perjury that the information provided above is true and correct Si ature: �// c����_- Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.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 ofhire,• express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint.enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships( LP)with no employees other than the members or partners,are not required to ca mworkers'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 p which will be used as a reference number. In addition an applicant that must submit multiple permit/license applications . � pp p p man given ear,need pp y g y only submit one affidavit indicating current policy information(ifnecessary)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: Tho CoRuAonwealthofMsssachusotts Dopartment of Industrial Accidonts Office of Intvestigations 600 Washington Street Boston,MA,02111 Tel.#617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax#617-727-7749 Www.zuass.govldia P::-oOMMONWEALTH OF MASSACHUSETTlam S:. BOARWOF LE`.0<TR I El ANS ISSUES T'HE FOLLOWING LICENSE `� AS A REG JOURNEYMAN ELECTR;I;C I AN , a QAN I EL J::.DONAHUE ,\� "' a 10 STOREY BROOKE 1 :Ei .EURYP;QR ;: '1 'A 01950 34og::`:: 921 `: o7/3:t1 l5 <� oy �a COMMONWEALTH OF MASSACHUSETTS B�3ARtti�F ,.I!,.� TNS.-;FOL'_OWING LICENSE AS A ,rSTE €FO MAST ER ELECTR`I Ctl AN DONAHUE SR h;Z •OR! YBR00KE DR ,PORT h1A 01950-34.... North Andover Health Department (ommunity Development Division April 9, 2014 The Cork Stop Frank Stamos, Owner Nick Papantonakis, Owner 1593 Osgood Street North Andover, MA 01845 Re: Request for information regarding a change of application from retail liquor to a small retail food establishment Dear Establishment Owners, This letter is in response to an email request received on April 4, 2014, in an interest of changing the application by adding prepackaged items; ie chips and nuts. The previous application did not need a food permit; however this addition will require change in the application and proposed plan. If after reviewing the correspondence you chose to move forward with the food establishment, be sure that the contractor who applies for a building permit waits for the Health approval to be issued and has the final and approved plan to avoid confusion between town departments. If you chose the"no permit needed"path,the April 3rd letter still applies in full. You indicate that there will be no direct food handling and that all items will arrive prepackaged; however the location is still considered a food establishment. Food items still must be protected during storage and handling on premise. After review of the codes and the proposal,the following items were found of concern. Once these items are addressed the Health Department will approve the application. Once approved, if any substantial changes in the plans occur during construction you are expected to advise the Health Department. If in the future any change in the proposed use exceeds the approval of a small retail establishment, you must first inquire to the Health Department for procedures to change your use. Page 1 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 The Cork Stop April 9, 2014 For instance, a change may be one that will require handling of potentially hazardous foods such as cheeses, fresh breads or include items needing refrigeration. In such cases,you would need approval of any equipment considered for purchase for this application and/or you may need the placement of new washing facilities as required by the code. Sincerely, Susan Sawyer, REHS/RS Public Health Director Items to address noted from application and plan 'Action needed I 5-203.11 No Hand Sink. One at minimum is required. Change page Place hand sink on plan in 18. On Handwashing facilities back kitchen/storage area. Submit specification sheets for hand sink Identify walls that may _ 6-101.11 Splash zones around the hand sink and slop sink must have need frp due to this or FRP wall covering or other durable washable surface. (Fiberglass other splash zones. Make reinforced panels).Note: mop must be hanging. Cleaners must have note on plan a storage location. ' Page 5 notes no food supplies Please change section on food supplies Page 10 Finish schedule—blank. Must fill in kitchen on page 11 Complete page 10 and Floors must be durable/washable; non porous etc. what kind of tile? correct where needed. There must be curved coving on the baseboards in bathroom, slop Identify on the plan what 1 sink and back storage area. ` floors are where in the t Toilet room notes no coving; establishment Walk in refrigerator shows no finish schedule; floors, walls Shelving not shown on plan for walk in or in rear for any storage of Submit spec sheets for any kind. Cannot be wooden structures. Must be a washable and shelving in the walk in durable surface such as coated metal Locate if applicable; Note: front and rear doors must be kept closed or have screens change page 11 if needed Page 13 Plumbing connections incomplete; sinks present(page 14) Complete as needed; responsible party is to initial section applicable Page 2 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 The Cork Stop April 9, 2014 Page 14 no information on water supply fill out information on water supply that may be applicable; write N/A where not applicable complete Page 15 Dressing rooms N/A employees have personal items; coats Identify location for etc. personal items. Remove N/A Page 16#34 MSDS sheets not submitted Please submit MSDS sheets for all toxics ie. Floor cleaner, window cleaner. Indicate storage area as well. To restate from the April 3, 2014 letter, if the application is changed to small retail; 1) The Cork Stop is not proposed as a food establishment; which would include providing foods that are assembled or prepared on site for sale, foods requiring refrigeration, for customer food samples, gifts or food otherwise free to customers. 2) This establishment does not have kitchen facilities; no food prep or storage area, no ware washing area, no cooking areas are proposed. 3) This establishment does not propose accessible (handicap or otherwise)bathrooms for customers. 4) This establishment is not a place of assembly. There is no ability to support a public gathering; sanitation wise.No wine tastings, charity or other events can be onsite. Thank you for your cooperation in this matter. This correspondence is a Health Department review only. Please be advised that other departments may have specific requirements. This does not supersede any other department's request regarding other town or state regulations. San Sa r, �3TK Public Health D' ector Cc: Curt Bellavance, Com. Dev. Director Building Department Encl. copy of application needing changes Page 3 of 3 North Andover Health Department, 1600 Osgood Street, Suite 2035 North Andover, MA 01845 Phone: 978.688.9540 Fax: 978.688.8476 30'-10" — � I Z �REFRIDGERATED \ DISPLAY SPL Y WINE RACKS — J to 6 REFRIDGERATED I DISPLAY CASE 04 s d' rn 12'-0" in I E:l O N 69-l" 10'-0" 14'-9" o POINT I OF SALE COUNTER REFRIDGERATED DISPLAY/WALK-IN I COOLER s O 1 i IN 16'-1" s O MO SIN r THE CORK STOP 1 OFFICE TOILET o 1593 OSGOOD ST 00 NORTH ANDOVER, MA 01845 FLOOR PLAN SCALE: 3/16"=1 '-0" L) 4 0 4' 8' 12' GRAPHIC SCALE 3/16"=1'-0" TOWN OF NORTH ANDOVER BOARD OF SELECTMEN GENERAL APPLICATION This is a general application for a license that the Board of Selectmen may grant. All license applications to the North Andover Board of Selectmen must be accompanied by the following information. Indicate if license is: new X transfer. ❑ change of dba❑ j Other I Lis�pe of license(s)applying for: ' Common Victualler ❑ Package Store All Alcohol Class I N o.of vehicles for display: ❑ Restaurant All Alcohol ® Package Store Wine&Malt ❑Class II No.of vehicles for display:i ❑ Restaurant Wine&Malt ❑Fortune Teller ❑ Club All Alcohol ❑Vehicle for Hire/Taxi No of Vehicles: ® Annual Entertainment ® Sunday Entertainment 0 Electronic Games-list below: i ❑ Jukebox i ❑ Billiard Table'No.of tables: Business Name(legal): The Cork Stop, Inc. dba: Please attach copy of business certificate if applying as dba or individual. If business is a corporation or LLC, please attach: 1. Certificate of Good Standing from the Secretary of State's Office, 2. Corporate Vote authorizing business at the location. I Address of licensed premises (include zip code): 1593 Osgood St, N And. MA 01845 mailing address (if different than above address): Name of individual/applicant authorized to apply for license: Fotios Stamos Business tel.no.of applicant: 617-293-8557 Business email: F.E.I.N:(F.I.N.). 46-3884684 I Please check one of the following:❑own premises a lease premises property under P&S I Name and address of property owner if different from license holder: j 1591 Osizood Properties LLC 1595 Osgood St NA MA ame Address E If applicable,please attach copy of lease and/or Purchase and Sales Agreement. Do you currently hold a similar license? What type? Restaurant Have you previously applied for a license? (Yes) X❑ (No)F] Have you ever had a license revolted? (Yes)❑ (No)❑ If yes,please indicate why: 1 ! -E I i i I If there is a building or structure associated with the license, please submit the following (preferably on 81/2 x I V paper-no larger than 8112 x 14 1.Floor plan (include seating area), and 2. Site plan indicating parking areas and access to town ways. If applying for a Class I or Class II license, please submit a plot plan that shows: 1.The number of the vehicles on display 2.The exact location of the vehicles 3.Customer parking 4.Office area Proposed hours of operation: Monday 7-11 Thursday 7-11 Tuesday 7-11 Friday 7-11 ` Wednesday 7-11 Saturday 7-11 Sunday 7-11 (Specify liquor sale hours if different than regular establishment hours): t Mon-Sat Sam-llpm; Sun 12pm-11pm Has the applicant operated a similar business? (If applicable) Name of Business: Jimmy's Famous Pizza (Triplets, Inc.) Address: 1591 Osgood Street, N Andover MA Federal Tax No. (If applicable): 04-3551952 I certify that the North Andover Police Department may run a criminal records check for any prior offenses and that this information may be transmitted to the Local Licensing Authority at their ( request.! Date:� Z1t / 4 Signature. I certify under the penalties of perjury that I,to the best of my knowledge and belief, have filed all state tax returns and paid all state a al taxes quired by law. Date:? `l-I 1Signature: I certify that I have read through the conditions included with this license and agree to comply with any further stipulations that the Licensing Authority may from time to time approve. I also hereby authorize the Licensing Authority or the' agent to conduct whatever investigation or inquiry is necessary to verify the information ined in this application. Date:Z- 2l 4 Signature: Please contact the Town Clerks Office at(978)688-9501 if you have any questions regarding this application form. Reviewed and amended:2011 2 I 1 44 �eu xl(VQ v No Q3Sf1 ST)61d3 1 1 17M S2 0 i S-B, 2 1+ah + Q2 �c l ! i f I �k461r" 4 i 30'-10" �REFRIDGERATED DISPLAY WINE RACKS CASE J ,n ,REFRIDGERATEDMR DISPLAY I CASE -J 596+/- SF REFRIDGERATED 12'-0" in DISPLAY CASE 0 o lV { 10'-0" HAND o POINT SINK OF SALE COUNTER REFRIDGERATED j DISPLAY/WALK—IN COOLER 0 N 1SF+/- 0 MOP 3 BAY e. SINK SINK 3 e +/- s THE CORK STOP OFFICE TOILET co ROOM a 1593 OSGOOD ST SSFP- NORTH ANDOVER, MA 01845 FLOOR PLAN SCALE: 3/191=1'-0° 4' 0 4' 8' 12' GRAPHIC SCALE 3/16 1-0 The Commonwealth of Massachusetts j Alcoholic Beverages Control Commission ,Ult 239 Causeway Street Boston,MA 02114 www.mass.gov/abcc MANAGER APPLICATION All proposed managers are required to complete a Personal Information Form and attach a copy of the corporate vote authorizing this action and appointing a manager. i 1.LICENSEE INFORMATION: { Legal Name of Licensee: The Cork Stop Inc. Business Name(dba): The Cork Stop Address: 1593 Osgood Street City/Town; JNorth Andover State: MA Zip Code: 101845 ABCC License Number: Phone Number of Premise: 617 ( )293-8557 (If existing licensee) i 2. MANAGER INFORMATION: i A.Name: Fotios Stamos B.Cell Phone Number: (617)293-8557 -� C.List the number of hours per week you will spend on the licensed premises: 30-40 i 3. CITIZENSHIP INFORMATION: j A.Are you a U.S.Citizen: Yes QX No n B•Date of Naturalization: C.Court of Naturalizatlon: (Submit proof of citizenship and/or naturalization such as US Passport,Voter's Certificate,Birth Certificate or Naturalization Papers) 4. BACKGROUND INFORMATION: A.Do you now,or have you ever,held any direct or indirect,beneficial or financial interest in a license to sell alcoholic beverages? Yes ❑X No If yes,please describe: Co-Owner of Triplets,Inc.,d/b/a Jimmy's Famous Pizza,current holder of§12 Restaurant License i B.Have you ever been the Manager of Record of a license to sell alcoholic beverages that has been suspended,revoked or cancelled? Yes n No❑X If yes,please describe: C.Have you ever been the Manager of Record of a license that was issued by this Commission? Yes Nof a If yes,please describe: D.Please list your employment for the past ten years(Dates,Position,Employer,Address and Telephone): i 2009 to Present:Jimmy's Famous Pizza(self-employed,co-owner);1591 Osgood Street,North Andover,MA;(978)685.7776 i { i I I hereby swear under the pa enalties of perjury that the Information I have provided in this application is true and accurat Signature Date r� �7/ 30'-10" 5 O" r, WINE RACKS^ � I 04 ti I1I41117� � WINE RACKS ti i REFROGERATE D DISPLAY I. COOLER \ M' POINT OF SALE COUNTER i t 14'-3" �f WINE RACKS I i ii iV STORAGE ROOM THE CORK STOP ~ OFFICE TOILET ROOM 1593 OSGOOD ST i� NORTH ANDOVER, MA 01845 --_= FLOOR PLAN /t SCALE: 4' 0 .41 $' 12' GRAPHIC SCALE ' 3/161=1'-0" i 30'-10" EFRIDGERATED DISPLAY WINE RACKS � CASE I - J Lo 1 � I REFRIDGERATED DISPLAY Hm CASE - J r a d' 12'-0" Lo 0 I N 6'-1" 10'-0" 14'-9" o POINT OF SALE d COUNTER REFRIDGERATED DISPLAY/WALK-IN COOLER d- 0 N ' 0 MOI i SIN THE CORK STOP of OFFICE Roo 1593 O S G O O D STco o NORTH ANDOVER, MA 01845 FLOOR PLAN SCALE: 3/16"=1 '-0" 4' 0 4' 8' 12' i GRAPHIC SCALE 3/16"=1 '-0" I l �