HomeMy WebLinkAboutMiscellaneous - 19 High Street �\
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5/31/2016
Date: May 31, 2016
20478
This is an e-permit.To learn more,scan this barcode or visit north andoverma.viewpointcloud.com/#/records/20478
ITrm•
TOWN OF NORTH ANDOVER 1 '
PERMIT FOR WIRING
Car
This certifies that Joseph V Camilo
has permission to perform iNSTALL (4) 4" CONDUIT UNDERGROUND FROM BUILDING TO FUTURE COOLING
TOWER
wiring in the buildings of WEST MILL
at 18 HIGH STREET , North Andover, Mass.
Lic. No. 21659
1/1
Datev
TOWN OF NORTH ANDOVER
,4
PERMIT FOR WIRING
This certifies that .!�.! CtJ►'�. . . lh-.? . . . .
has permission to perform �.� �.. �'t . �v C-ems . . . . . . . . .
wiring in the building of . �?4. . �� " �. . . . . _ . . . . . .
/ 4
at . . /.C1 .�'! h . .SY . . . orth Andover M S.
Fee .1Lic. No. ,/ . . . . . . . . . . . . .
.
ELECTRICAL INSPECT
i;
0,ieck
11236
/2012 10:28 FAX 7813375152 2002/008
C6mnwo&woa&o f ftidackudatb Official Use Only
.lJopartiraanE o��tlro Jervlced Permit No.
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] IeflVCblank,
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachuseuq Elcctrical Code(MEQ.527 CMR 12.00
(PLE,4 PRINT IN!NK OR TYPE ALL INFORW TION) Date:
City or Town of: /-A AggloyeTo the Inspector of Wire.v:
By this application the undersigned gives notice of his or her intention to perform the electrical work described below.
Location(Stroet&Number)
Owner or Tenant Telephone No.278-19 660G
Owner's Address 941 A
Is this permit in conjunction with a building permit? Yes No ❑ (Check Appropriate Box)
Purpose of Building Utility Authorization No.
IAO Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampocity
Location and Nature of Proposed Electrical Work: g _/�T�d g`�wt�t". o4 �9& td��pr
Coln letlon ofthefollowing table mg be waived by the ins actor 6f Wires.
No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans IN o.of Total
Transformers KVA
No.of Luminaire Outlets No,of Hot Tubs Generators INA
No.of Luminaires Swimming Pool Above ❑ n- o-o❑ mergency Lighting
rnd. rnd. Battery Units
No,of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones
No.of Switches No.of Cas Burners o.of Detection an
Initiating Devices
i No,or Ranges No.of Air Cond. Total No,of Alerting Devices
Tons g
No.of Waste Disposers eatum um er ons o.oSelf--Contained
•J
Totals ....................... Detection/Alertlng Devices
No.of Dishwashers Space/Area Heating KW Local❑ MunicipmElConnneecttion
Other
No.of Dryers Heating Appliances RWSecurity ys ems:
No.of Devices or Equivalent
No.o Water KW o.o al o Data Wiring:
Heaters Signs Ballasts No.of Devices or E uivalent
No.Hydromnssnge Bathtubs No.of Motors 2 Total HP a ecommun cat onsirmg:
No.of Devices or E uivalent
OTHER:
Arraeh additional detail(f desired,or as required by the Inspector of Wires.
Estimated Value of Elcotrical Work: 12,OD. (When required by municipal policy.)
Work to Start; 2 Inspections to be requested in accordance with MEC Rule 10,and upon completion.
INSURANCE C V CE: Unless waived by the owner,no permit for tho 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 overage is in force,and has exhibited proof of same to the permit issuing office.
CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)
!certljy,under l/te �1Rs and at es ojperJury,that the information on this application is true and complete
FIRM NAME: C, LIC.NO.: �'� �� A
Licensee:Mrynall mullam'-, Signature LIC.NO.:
((/'upplicahle,en er,'•ex tnpt"In the liccna'e i ether line.) BU9.Tei.N0.•1-787-347-02-2-7-
Alt
� �� -O�LZ
Address: / a GJ Alt.Tel.No.:/_?iP/—M.7 Y�8
9.
*Per M.G.L.c. 147,s.57-61,security work requires Department of ublic Safety"S"License: Lie,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)Qowner F1 ow es a crit.
Owner/Agent
Signature Telephone No. P+c,RMIT FEE. $
/2012 10:29 FAX 7813375152 1a004/008
The Commonwealth of Massachusetts
Department of.1ndustrial Accidents
Office of levestigalions
kv 600 Washh"n&reel
Boston,MA 02111
www.mws gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Ayelicant Wormation Please Print Leeibly
Name(Businois/OMmizationgndividual): Aldon Electric, Inc.
Address: 38 Greenwood Avenue
city/State/Zip: Weymouth, MA 02189 Phone#: 781-337-0222
Are you an employer?Check the appropriate box: Type of project(required):
l.® I am a employer with 52 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors
2.3 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling
ship and have no employees These sub-conductors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
[No workers'comp.insurance comp, insurance. 9. E]Building addition
required.] 5. ❑ We are a corporation and its 10.R] Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11.E] Plumbing repairs or additions
myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs
insurance required.] t c. 152,X1(4),and we have no 13.[]Other
employees, [No workers'
comp. insurance required.)
'My applicant that checks box#1 must also fill out the section below showing their worlot:ts'oompensation policy Infbnnation.
I Homeowner&who sttbrnit this affidavit Indicating they are doing All work and thea him outside eontraetofs must submit a new affidavit indicating such.
=ConbWers that chock this box roust attached an additional sheet showing the name of the sub-contractors and state whether or not the=entities have
employee$. lithe SA-contractus have amployam.they must provide their workers'comp.policy number.
I am an employer that Is providing workers'compensdion b arrranee for my employees: Below Is rhe policy and Job site
ln/orrrltation:
Insurance Company Name: Guard Insurance
Policy N or Self ins.Lie.#: ALWC348449 Expiration Date: 05/31/2013
Job Site Address: City/State/Zip-
Attach a copy of the workers'Compensation polity declaration page.(showing the policy number and expiration date).
Failuro to serum 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 cert fy under the pains and penaMfes ojperJrrry that the injornwtioa provided above is true and correct
Simiat=CIIAit2,� I AA Date,
..1
grid use only. Do not write in this area,to be completed by city or town off daL
City or Town: Permit/License 0
Inuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact person: Phone#.
x
Location ��/ � �iP��
0/0
No. Date
NOR,h TOWN OF NORTH ANDOVER
O
F A
A
Certificate of Occupancy $
cwus to Building/Frame Permit Fee $
Foundation Permit Fee $
Oth Permit Fee $ lD,Oa
TOTAL $
---7&JC&eck #
236 .; 6
Building Inspector
NORTH
0tE° !6'qyO
6 0�
TOWN OF NORTH ANDOVER .
T y
0403coccIwac SIGN PERMIT
°RATE° #t'
9SSACHUs�� TEMPORARY
DATE: November 4, 2010
PERMIT: S018-2011
THIS CERTIFIES THAT Good Day Cafe John & Kathy Santoro
has permission to erect. outside and window sign 2' x 3'
on 19 High Street, North Andover, MA 01845
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
Inspector of Buildings
Receipt: 23656
Paid: 40.00
r 4 SIGN PERMIT APPLICATION
1600 Osgood Street Building 20, Suite 2-36
TOWN OF NORTH ANDOVER
Site Owner � �k'�n
A licant �,K4 Sin Tel
pp
Site Address
Size of Proposed Sign
Map Parcel
Illumination: a) of illuminated
How attached: a) Against the wall ) Internally illuminated
b) Roof c) Externally illuminated
c) Ground
COP d) Other I h Materials: e
Proposed olors: Background W46
Lettering
Border Cost of Sign
Required Attachments: 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 i
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 Plot Plan(Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the
Drawings of proposed sign Sign Officer determines that the sign complies or will comply with all
Other, specify applicable provisions of the By-Law.
Will sign overhang any public road or walkway Yes ( ) No (N
If Yes, Name of Agency who will provide liability insurance:
AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED
DATE FILED: �� �DY,
Receipt# Check#
Revised 10.31.2006Form Sign Permit Application SIGNATU OF APPLICANT APPROVED BY
i
0
O
O
now hiring. call (978)688-6006 .
CAloss� Gcaf� �Dav� �✓e-
�le
Location 9 �`C (`( &c7
No. Date
NORT1y TOWN OF NORTH ANDOVER
F �
Certificate of Occupancy $
Building/Frame Permit Fee $
J�cMU
Foundation Permit Fee $
th Permit Fee $
TOTAL $
Check # ��d7
2365
Buildin /In pector
NORTH w
-' TOWN OF NORTH ANDOVER
C•C ��w�•,,° SIGN PERMIT
7 �pAtEo
DATE: November 4, 2010
PERMIT: S019-2011
THIS CERTIFIES THAT Good Day Cafe John &Kathy Santoro R7y 31W I
has permission to erect. Permanent awnings, front door 50" x 54", and lobby door 76"x36
on 19 High Street, North Andover, MA 01845
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
/_lnsp6_cfor of Buildings
Receipt: 23657
Paid: 40.00
,
54-7297-2114
GOOD DAY CAFE 1004 .
19 HIGH STREET / ' '! '/
NORTH ANDOVER,MA 01845 ! !f- -6
.. oCa. e WidPli aFF Y
'gilt
0
O SALEM
CO-OPERATIVE BANK
SALEM,NEW HAMPSHIRE
IVP
2114729 ? ?,: 5 271706 ll■ X 00 4 —__--_—
Location
i
No. Datey.
NORTh TOWN OF NORTH ANDOVER
Fn,
�ose ; : Certificate of Occupancy $
s�CMus t� Building/Frame Permit Fee $
Foundation Permit Fee $
the Permit Fee $ Oa
TOTAL $
Check # 00
23657
Build in In pector
I �
I
- 1
h� SIGN PERMIT APPLICATION
1600 Osgood Street Building 20, Suite 2-36
TOWN OF NORTH ANDOVER
Site Owner h�j ,p
I�
Applicant SM6 Tel
Pp �
Site Address Lip Sit 9b , r 1 1�,,, �� Y-,q,�''u
Size of Proposed Sign U"�'�^•�Ol PU O 1' "t
Map Parcel 1 / -4L k N 7
��� " Illumination: a of illuminated
How attached: a) Against the wall #i W e Internally illuminated
b)Roof U c) Externally illuminated
c) Ground
d) Other Materials: /�61c
Proposed Colors: Background
Lettering 3b4.M
Border f. Cost of Sign TYLE b `YI,�
Required Attachments: 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 Plot Plan(Required for all free-standing signs) or enlargement has been issued by him. Such permit shall be issued only of the
Drawings of proposed sign Sign Officer determines that the sign complies or will comply with all
Other, specify applicable provisions of the By-Law.
Will sign overhang any public road or walkway Yes ( ) No `I1J1
If Yes, Name of Agency who will provide liability insurance:
AN INCOMPLETE APPLICATION WILL NOT BE ACCEPTED
DATE FILED:
l"A
Receipt# Check#
Revised 10.31.2006Form Sign Permit Application SIGNATURE OF APPLICANT APPROVED BY
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Fire Retardant — FIRESIST'"delivers a state-of-the-art combination of flame retardant performance and UV resistance
that exceeds industry standards.
Weather Resistance — With over 100 years of outdoor awning experience, Glen Raven has engineered new coatings and
finishes to maximize water repellency,sunlight resistance,and ease of cleaning.
Color Retention &Strength —The deep,rich colors and robust durability of FIRESIST deliver long lasting good looks to
any application.Plus,workability improvements make cutting,sewing and welding easier than ever.
Styling —The new FIRESIST color palette focuses on popular solids and fresh tweeds.
TECHNICAL DATA
WEIGHT 8.75 oz. per square yard
WIDTH 60"/152.4 cm
COLOR Solution dyed to resist color loss from UV exposure and weathering.
Resistant to most chemicals, including bleach.
WARRANTY 5 years against loss of color or strength.
SURFACE Plain weave- Highly water repellent and soil/stain release finish.
UNDERSIDE Urethane/acrylic coating
TRANSPARENCY LEVEL Lighter shades translucent for back-lighting applications.
ABRASION RESISTANCE Excellent
FLEXIBILITY Excellent in both hot and very cold conditions.
FLAME RESISTANCE California State Fire Marshal Title 19
(PASSES ALL,BUT NOT LIMITED,BELOW) NFPA 701-99,test method II
CPAI-84;Tent walls and roof
FMVSS 302
FAA 25.853(Aviation)
UFAC Upholstered Furniture, Class 1
MILDEW RESISTANCE Excellent(with proper maintenance and cleaning)
CHEMICAL RESISTANCE Excellent
WATER REPELLENCY Excellent
OIL RESISTANCE Very good
SEWABILITY Excellent
Heat sealing Can be heat sealed using sealing tape and heat source
such as wedge, hot air,radio frequency welding,etc.
- FR10-798
FIRESIST"IS A TRADEMARK OF GLEN RAVEN,INC.
Location a,1mow{
No. �• Date -- v
�ORTM TOWN OF NORTH ANDOVER
O
F R
o ## Certificate of Occupancy $
• i ; #
s�CNUSE<�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 3 r
23766
Building Inspector
BLJRT9HILL
December 6, 2010
Mr. Gerald Brown
Inspector of Buildings
TowR of North Andover
16013KOsd`Street
North Andover, MA 01845
Re: `Good Day Caf6
W High Street
East Mills, North Andover
Burt Hill Project 07804.17
Dear Mr. Brown:
The tenant improvements for Good Day Cafe on the first floor of Building One, at 19 High Street, East
Mills in North Andover, MA, were to the best of my knowledge, belief, and understanding, constructed
in conformance with the construction documents issued for building permit dated October 8, 2010,
Permit#295-2011 in accordance with 780 CMR Commonwealth of Massachusetts building code.
During the course of construction, representatives of our office made periodic visits to the site to
observe the progress of the work.
Sincerely,
4
BURT HILL
Linda S. Smiley,AIA
Senior Associate
Phone: 617.654.6003
cc: Kieran Whelan
Dave$teinbergh
Architecture Engineering Interior Design Landscape Master Planning
Z(14 r .. Ca., 4 A4L r-1--- R a AAA flT)1() 1()1 7
1
S 7 FjJ Date.
t
NpRTq TOWNsO� TH ANDOVER
3i �a',r •. . pL
PERMIT FOR PLUMBING
,SSACMUSE�
This certifies that . . . . . . ���' Q. . . . . �. �. . .
�AaAAO. (j
has permission to perform . ...??. . j�;!
plumbing in the buildin sof . . . ./.� . . . .�!. . . . . . . . . . . .
1/
ate,. . . ./9 . . . . ?':'1.1.G. . . . . . .S1 . . . . . . . . . .. North Andover,/Mass.
:W.Lic. No.
Check # _� D— PLUMBING INSPECTOR
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
City/Town: N� ANOy'r,Q, .MA. Date: Permit#
Building Location: ` � �`���'� � Owners Name: & 6,- 4,4 C
Ell 19
M AV Type of Occupancy: Commercial A] Educational D Industrial❑ Institutional F-1 Residential❑
l
New: Alteration: Renovation:❑ Replacement:❑ Plans Submitted: Yes❑ No
FIXTURES
DEDICATED
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z SYSTEMS
LU z
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z a w Z OC Z V1 z Q a N z :3 N fan W. �cc W
a 3 Ln x 4 Q W N P. W a H Vl ii: Q ►- Q
cc o a' W' o a z z � z u a u _ a 3
d LL H 3 0 W 3 = C ® W !A J oc ots p y
a ae x x a p z Q 3 a' Y a H ►�- W >
W u �- Uj
of of p ~ �. �.. >. p. p t].. Z Q. Q.. Q F V.,. �, Q
a m m c o L x Y 5' S n 3 3 3 o a 0 t, > 3
SUB BSMT.
BASEMENT
1sTFLOOR
2ND FLOOR
3RD FLOOR
e FLOOR
5r"FLOOR
6T"FLOOR
FLOOR
$'FLOOR
Check One Only Certificate#
Installing Company Name: ��A/►?1'��f Z/QF��!l ��
Corporation
Address: ��e J City/Town: /ems State: �Tl
� ElPartnership
Business Telk ��''���� Fax:(663 �93� ���
Firm/Company
Name of Licensed Plumber: i �k�7e-N
INSURANCE COVERAGE:
I have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes, ] No❑
If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 11
A liability insurance policy X Other type of indemnity Q 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 Q Agent El
Signature of Owner or Owner's Agent
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.
By Type of License:
TtJe Plumber Ti 9.- of Licensed Mum
City/Town Mauer License Nttrmbea:
APPROVED(OFFICE USE ONLY) Cliourney€nan
Cc����ti7NWEAL.Tii-tJF MASSAGHt18ETTS�,.��
. - Ti.='y
LICENSED AS A MASTERpL UMBER
ISSUES THE ABOVE LICENSE TO: I
f
JAMES P GREENEl 74 BRIDGE ST
SALEM NH 03079-32
15Y52
05/01/12 7864
r
Y
the Com,"10mveal'th of Hassachtesetts
Depaitinent of£radnsfi al_4ccidents
Office of Iivestcgations
' 600 WaNkinbaton Street
$ostara, 1(U 02-7II
wwMv Mas'�_-go-p dna
Workers' COMPen.safiOn InS:Uran.ce Affidlavit:BnUclers/ContracforsXXect zc-arzs/P'Irimbez s
ApplicantInformation '
Please Print Leuxbly
Name(Business/Ora uization/individual): S11 M2!5 C_ �F576/r 07L
Address:
City/state/Zip: 07 2 Phone#: 7
•Are you an employer?Checks.the appropriate box:
1. I am a employer with 4. ❑I am a� rM�bm
roject(required):
beneral contractor and 1u,construction
employees(fall and/orpart-time).* have hired-the sub-contractors
r ?
ETI an a sole proprietor orpartner- •listed on Ahe atthched sheet.# modeling
ship andhaveno employees These sub-•contractors have molition
working for me in any capacity: workers' comp.insurance.
(No workers'comp.insurance �. ilding addition
p ❑ We are a corporaiion and its
reiluired.] officers have exercised their cirical'repairs or additions
3.Q.I am a homeowner doing all work right of ex_empiion per MGL mbing repairs or additions
myself:[No workers'comp, c. 152,§I(4),and we have zzo f rinnira cerequired.] t employees. [No•workers' ��comp. rnsrt•ranc@required_] er
T,
n;'= Tic_;t at ch-.cks bo,tg msi&?sG zu?eet i ye Be en eeeat
I,z 2Wners who submit'ihis affidavit indicating tkcy��d _ u" ,"•cries'cou �•�n
o.^:_2 aI W�-anEl them hire�outside coar�ato*s y{�A su uit a new amaavic indicafing such.
+Contractors thatebecTiffi s bG*m• ta'ocuLad an addinoIIai sbeetshowiugthe
na-e'of the sub-contractors and theirworkem'comp,policy inform t!,,
-ram an employer that is providing workers'corrapensaiian"7`37"ance for my employees B'eloh)is the polig and job site.
information,
Insurance Company Dame:
Policy#or Self--ins.Lic.#: a-piration Date:
Job Site Address: City/State/Zip:
Attach a copyof the workers'compensation policy declarat%an pave(suwing the policy ttumber.a)ad expiration date).
Failure to secure coverage as required under Section 25A of MCrL c. 152 can lead to the imposition of c ' in a7 P=alfi a of a
zine up to$1,500.00 and/or one-yearimprisQnment;as we]I as civil penalises in the form oz a STOP WORK ORDER and a rine
of up to$250;00 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of
lnvestigaiions of the DIA for insurance coverage verification. _
I do here$y cern under the pat lies ofperjur3'thrx--the informaizon provided above'is true and correct:
Siauature: _
�/ - __ Date- •. �Q _,,l d
Phone 4: 76
Official zcse only. Do not wHtdin this area to be completed by citj,or torn,,offaciaZ
t
City or'Iovcni• `ermitlt,icease#
lssTiYDg "so
(circle one);
lr.Board of Health 2,Builaiub Department 3. City/Town Cleric 4.Electrical Inspector 5.??lambin_-I nspectar
G.Other
Conta.et Per•soM. Phone'#:
97UJ
Date...
.......... .. ....... . ...
NORTI{
°f'"�� :•�"� TOWN OF NORTH ANDOVER
Wr
PERMIT FOR WIRING
qLL
SSACMUS t�
This certifies that ..........Y.�.�l..Wl .��.... .....................................
has permission to perform / !. . v
.
.. .. ... .............................................
wiring inthe building of..........66b....I) .V...'/"G ..............
f ' r f��� sr ,North Andover,Mass.
v ��
Fee...�S."�.. Lic.No.............. 2�........... .. . .... ................... ... ... ...
ELECTR(CALINSPECTOR
Check #
�'� �-� 61V!!I!1'/Vtl1QM1C'87tlddB QlB B'B¢Bg��BI.BBdB��db� ----- -�
4Y�. Permit No. 7 4 S�
Depa 'Ement of Fire ServiCes Occupancy and Fee Checked
tea„
BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/071 (leaveblank
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL. WORK
ed in accordance with the Massachusetts Electrical Code(MEC,527 CMR 12.00
All work to be perform ) ��
(PLEASE PRINTW INK OR TYPE ALL INFORMATION Date:
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the undersigned gives notice of his or her intention to pe
rform the electrical work described below.
Location(Street&Number)
Owner or Tenant goo�r7 �/�T Y �%(/� Telephone No.
Owner's Address
Owner's
permit in conjunction with a building permit? Yes � No ❑ (Check Appropriate Box)
Is Purpose of Building �i�i� Utility Authorization No.
ov
Existing Service Amps Volts Overhead ❑ Undgrd❑ No.of Meters
New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:'
Completion of the following table may be waived by 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 �A'
Above In- o.o Emergency Lighting f
No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Batter Units
No.of Receptacle Outlets 7/� 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 Alerting Devices /
No. of Ranges No.of Air Co d. Tons
Heat Pump Number Tons KW ,...., No.ofSelf-Contained
No. of Waste Disposers Totals: Detection/Alerting i Devices
.i Municipal El Other
No. of Dishwashers Space/Area Heating KW Local❑ Connection
Security Systems:
No.of Dryers Heating Appliances KW No.of Devices or Equivalent
No. of Water .
No.of No.of Data Wiring:
Heaters
KW Si ns Ballasts No.of Devices or Equivalent
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 a d penalties of peY ury,that the inf tlon on application is true and complete. t
FIRM NAME: ///I LIC.NO.:
Signature ' LIC.NO.:
Licensee: 3
(If applicable,ente, xem t' Zi a nu ber i L�f j�%�N/� Bus.Tel.No.:
Address: Alt.Tel.No.:
*Per M.G.L c. 147,s.57-61,security work requires Department ofP611C Safety"S"License: Lie.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
Owner/Agent PERMIT FEE. $
Signature Telephone No.
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6
4�
The Commonwealth of Massachusetts
Department ofIndustrial Accidents
Office of Investigations
600 Washington Street
Boston,MA. 02111
�.., 5�•` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leibl
Name(Business/Organization/Individual): w' 'v v
Address: (p ✓/�� /x /�� ���
City/State/Zip: /'jf �� v /t' Phone#: 0 /�✓ i'���
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 1 6. ❑New construction
employees(full and/or part-time).* have hired the sub-contractors 7. ❑Remodeling
2. 1 am a sole proprietor or partner- listed on the attached sheet.
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 S. ❑ We are a corporation and its 10.❑Electrical repairs or additions
required.] officers have exercised their
ht of exemption per MGL 11.❑Plumbing repairs or additions
right 3.❑ I am a homeowner doing all work g p p
myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs
insurance required.]i employees. [No workers' 13.0 Other
comp.insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
� information.
Insurance Company Name: /
�1 Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: //l pl/9- e ' 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 herebycertify unde a ai s alties of perjury that the information provide abo is true and correct.
.fY P
Signature:
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#:
J
N ,A
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cHus
CERTIFICATE OF USE & OCCUPANCY
TOWN OF NORTH ANDOVER
Building Permit Number 295-2011 Date: December 6, 2010
THIS CERTIFIES THAT
THE BUILDING LOCATED ON Good DaY Hi Cafe 19 h Street
�
North Andover, MA 01845 John Santoro
MAY BE OCCUPIED AS a cafe IN ACCORDANCE WITH THE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY
APPLY.
Certificate Issued to: John Santoro
19 High Street
North Andover,MA 01845
Building Inspector
Fee: 100.00
Receipt: 23766
ORT11
Tovm of Andover `
\'
0
No. -
=. o dower, Mass.,
LAKE
COC MIC ME WIC K�\�
,9 °RATE D
`SS BOARD OF HE r`
PERMIT T D Food/Kitch��
_ tt ,_�
Septic System
BUILDING INSPECTOR
THISCERTIFIES THAT............! +. ...............a , ::. ' ' ..f '......:: .................................................................. Foundation
has permission to erect. buildings on ..Z..2....t��.i '.�"/.....: ...................................................
to be occupied as......(.,27 ?K� .Z)nl
.E�l. .. ................... ':: %, %, ..... . 1' zi..,n/� ��...... Chi ey
provided that the person accepting this pe `mit shall in every respect conform to the terms df 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 ofy2 -
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
UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTO;
Service
. �1�:c:. ............ .....�
i BUILDING INSPECTOR
Occupancy Permit Required to Occupy Building GAS Rough INSPECTOR
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. 1
SEE REVERSE SIDE Smoke Det. 1 ) -30- t c3