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Miscellaneous - 350 WINTHROP AVENUE 4/30/2018
Date ..... TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that ...................................................... has permission for as ins allation ...1 in the buildings of 4 > C-50 \,) at ....................................... ... .. .. . ..... ........... Fee.),I.Q . ...... Lic. NI—io.N .. ... "a /5� F'r1 , North Andover, Mass. I GAS INSPECTOR Check # G TYPE OR PRINT CLEARLY 41161- G 116, - 3oa 5 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK JOBSITE ADDRESSI --- — OWNER'S NAME OWNER ADDRESS I Same.)t?�D TEI� FAX OCCUPANCYTYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL❑ NEW: ❑ RENOVATION: ❑ REPLACEMENT: ❑ APPLIANCES 1 FLOORS BSM BOILER BOOSTER f CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ,ROOM /SPACE HEATER ROOF TOP UNIT TEST +UNIT HEATER UNVENTED ROOM HEATER WATER HEATER PLANS SUBMITTED: YES❑ NO[] 10 1 11 1 12 1 13 1 14 INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 YES ❑ NO ❑ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYFJ OTHER TYPE 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 AGENT I 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 withAl Perti t vision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME I Robert Josey LICENSE #L9185 MP Q MGF [j JP [jJGF [jLPGI ❑ CORPORATION [3#3788C PARTNERSHIP❑#LLC ❑#� COMPANY NAME: RH White Construction Co ADDRESS 141 Central St CITY I Auburn STATE MA ZIP 01501 TEL 508 832-2195 FAX 508-926-4347 CELL 508-245-7431 EMAIL t\n \ ROUGH GAS INSPECTION NOTES THIS PAGE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES Yes No THIS APPLICATION SERVES AS THE PERMIT ❑ ❑ FEE: $ PERMIT # PLAN REVIEW NOTES Location „No. a G - G�°a`� Date 1 y'+ f "O"'" TOWN OF NORTH ANDOVER O'tt��o F ? • • 0? 9 + s Certificate of Occupancy $ ,r Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee -4,j,--' TOTAL $ 24(J Check # 17005 (J 'Building Inspector U) c� z D c m 0 D r n D z O D m In F m O D z n .D r m -i m .n r D z r r O -1 co m 0 m m O T (D U) z DO O_ D m 0 't7 O S..L. v' 0 CD i O0 Cf) poa ? C 0 C D m�fDoc 0 cD �n. in o 0 -0� N a- v 0•�c� m a5 (o LD c= Q ` CO O CL) T;T T(D (D �n r— LO U) cn i. z (' c S CD = C0. :3 n O CD W c O = -0 tD, 0 0 n to ='O rn =rCD-0 (D 3rn c w z o (D ^" N �. O 0 N to J O Q Q O 1 n% Cr a) c ?= _CD in cz- o�o�CD (D cn. < o m = 0 3 -) OD �• O O O CDC O =ou) d�3 �00��.3� ��cn �• co'�- v oo rn — co rn O�m � cn � T w ? (D CD tn3 am --t O CDCT W or < " cD� oK CD (n' C CD ,. n E5- CD O CD 3 J CD o -0v CD to " cn 0 3 = 0 - o o CD Q :3 (D N 6 = 00 -_+ =`G c _ W J Sll G n CD CD CD M 4 II. CD 3 Z) N i. _r C0. v/ '0 (D (D o v. Q O CL n (D cn. o rn a 00 co r- 0 ° w --t = 0 -, O O ill O (n II. Vi nyj ZZ �o s m� D 3 cD 0 0. m -p v ° o cD 0- O w e m z r o cn Ti D' CD C Q C v r i. w � � O N A, CO (D �. O 0;;oo 6 co,6-7o 3 �p Ncp iUc� W r2 (D 33 o? �ID IDn�� n ° m cn ch 3 C O ID N co (D co 0) cr C (D ,e flo r l (AII 30' e� y � OlwShowirp - .- Fine ' w lndtan c`Uis►ne- �„ w Ik stars -orange 151 Z`�� W CA. silver metalic- big letters 2,0 a 0 a Z letters on swooch- pms 286 blue $ _ } N swooch-123 yellow 0) Q n actul sign dimensions are 3 a Z 0 20' long x 9' high =180 s. f. (� <ui ao ao rame dimensions are9' x 26'.5" = 238.5 s. f. U)� � 0 30' x 40' total storefront area =1200 x 20% = 240 s. f. W LO wl. 5 En �-d � CD �. �. ?; w a o'o.GQ Ln �. o it CD 0 H o. rn 0 rp:r 0 CD 0°,CD a 46V (CD o w bd CD CD Ln t o En MH jCD O F.o�.} FD �o CIO o. CD CD CD con CD CD O a o d �• o CD � Abd CD CD 0 0 0 w. CD c� 9, o H Ln �. o it CD 0 CD CD 46V w 01 Date .... ?-o9-03 t NORTI1 TOWN OF NORTH ANDOVER p PERMIT FOR WIRING EmuSES This certifies that.E df wiN Chu/ ................ / has permission to perform ��`�' s 4 j r ) (,ti �..... a 011 Y Lv 0 0 .......................................... ............. wiring in the building of.n �.! I�Jo � ✓` .....((-- ...... n.....�............. .............................. at ... . �....... `v .�i. u �' �...../ ! u. North Andover, Mass. `Fee.... ..: Lic. No. 19 OU .... - .:J.`.E't ELECTRICAL INSPECTOR 'iheck # 4650; Official Use Only Permit No.t�',�o 7�5 eM)PW .F, Z?W 09SS SS S ae�aeKt °d Sam Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS.5 CMR 12:00 APPLICATION 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 information) Date_ To the Ind P ctor ofWires: Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number A-) Owner or Tenant Owner's Address ,e Jar ,. Is this permit in conjunction with a building permit Yes fy' No ❑ (Check Appropriate Box) Purpose of Building �� s'1 Cl�+t ✓ A w� Utility Authorization No. Existing Service Amps D t, Voits Overhead 9-'y Undgmd ❑ No. of Meters New Service S� Amps Voi s Overhead ❑ Undgmd ❑ No. of Meters Number of Feeders and Ampacity, Location and Nature of Proposed Electrical Work 1 . OTHER: 0 1 W lai.(,C- ( ti )d / ERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws �ity Insurance Policy including Completed Operations Coverage or its substantial equival valid goof of same to the Office YES = NO = if you have checked YES please indicate the BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Work to Start Signed under the FIRM NAME ' NO = rage by checking the appropriate box. U v' Date Resquested Rough Final LIC. NO. LIC. NO. n A,11-, W7Bus. Tel No. b 7-X ! -u .� Z L— W,4 A Ar S O / a 6 o S�i7, Alt Tel. No. OWNER'S -1 S RANC WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Gerippi Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) Total No. of Lighting Outlets No. of Hot fuse No. of Transformers KVA Above ❑ In ❑ No. of Lighting Fixtures Swimming Pool grnd ❑ grnd ❑ 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 No. of Detection and Total No. of Ranges No of Air Cord Tons Initiating Devices Heat Total Total No. of Di osal No. Pumps Tons KW No. of Sounding Devices Nod of Self Contained No!G Dishwashers S ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No.'bf Dryers Heating Devices KW Local Connection a No. of No. of Low Voltage No. of ater Heaters KW Signs Bailases Wiring i No. Hydro Massage Tuds No. of Motors Total HP 1 . OTHER: 0 1 W lai.(,C- ( ti )d / ERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws �ity Insurance Policy including Completed Operations Coverage or its substantial equival valid goof of same to the Office YES = NO = if you have checked YES please indicate the BOND = OTHER = (Please Specify) (Expiration Date) Estimated Value of Work to Start Signed under the FIRM NAME ' NO = rage by checking the appropriate box. U v' Date Resquested Rough Final LIC. NO. LIC. NO. n A,11-, W7Bus. Tel No. b 7-X ! -u .� Z L— W,4 A Ar S O / a 6 o S�i7, Alt Tel. No. OWNER'S -1 S RANC WAIVER: I am aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts Gerippi Laws. And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) i 30. N 92 Date... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that .. .... ............ .......... .......... has permission to perform.. ..... .................................................................... wiring in the building of ...... .......... 7t ....... ............ ( ......... .................. at .........5.K.'............................ ................... .' North Andover, Mass. 01 .............. ................. Fee,/// ... ....... ....... "" Lic. No./ ELECTRICAL INSPECTOR Check # WHITE: Applicant CANARY: Building Dept. PINK: Treasurer THE COMMONTMALTHOFMASSACHUSETTS Office Use only DEPARTA1hM0FPUX1CS4FM Permit No. 131/ BOAROOFFIREPREVEMONRF.GUTATIONS527CMR12010 1976 � Occupancy &Fees Checked APPLICATTONFOR 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 The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 3 ro ' Owner or Tenant U• Owner's Address Is this permit in conjunction with a building permit: Yes 13 No Purpose of Building I VAV441✓ To the Inspector of Wires: (Check Appropriate Box) Utility Authorization No. Existing Service T Amps�Volts Overhead ID Underground �' No. of Meters New Service Amps olts Overhead r-1 Underground No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work /,g 7777o,11447 7 No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total 3,0 KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets n V No. of Gas Burners ALARMS No. of zones No. of Ranges No. of Air Cond. TotalFIRE Tons No. of Detection and No. of Disposals No. of Heat Total Total _ Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW No. of Self Contained Detection/Sounding Devices Local Municipal Other if lio. of Dryers Heating Devices KW E Connections No. of Water Heaters KW No. of No. of Signs ' Bailasis No. Hydro Massage Tubs No. of Motors Total HP I v OTHER• kW1anMCoverage. PMuanttDftmqurtenlenisofMassdnsettsG=xWLaws Illaw awnetillabillyhmz=PbhcymkxkgCmipleu,-QpwaftmCowrWoritswbsWtia mpvaleM YES NO �. IbavesubmittedvandploofofsametatheOffim YES ET IfywhaveducicedYES, pleaseindc& the Mmofooverageby drddngthe box 11�� / ,p INS[ a� CE� BOND � OTHER � tPlease Specify) L //r, ! 0 / Woik{oStart /„) — / / — 0 1 lnTcc6mDa1eRMjesrod SigtledunderTrapbraltiesofP2W* -L HRMNAME ��_5 Estirrla>edValwofEcftJalWork$ tf„s-&v Rough / CA G C— FM L mseNo. lige / Signal ue Lic wNo 17 S BusumTelNo. Ate_._. �gg rl/1 �e /L l.So,� �r✓�' /3QtTrn/ ��y 1 / Alt Tel No. j 3 OWNER'S INSURANCE WANE;; I am aware that the License does not have the insure= coverage orits strbslantial egitivalent as regtmed by Ma%admselts Garal Laws and d-atmysignahueon duspemmapphc abm waives this iequ*ffmial (Please check one) Owner 1:3 Agent ® Telephone No. PERMIT FEE $ /�� Signature of Owner or Agent f Location -No. / Date TOWN OF NORTH ANDOVER .. 9 • ; Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ 9 Foundation Permit Fee $ Other Permit Fee� $ TOTAL $ Check # 413 � � Building Insp � r p D cn --i O C --4 Z (D= O D to C Q m z 0 D o .- r: v �- CD o ) CD S v tD •• 0 m (7 O z (�CD 0 CD r. �, 0�-10= C() r ED O Hi. ca p z m -0 0 p (. < V) c� a r ° c,o°-avS -m-1 D v `�-a�o�oD rn 0= cu"� D ( v o^ �� r cn Q E3 -a CD n cn c o s cn' cn 0 = ° O 0 Z -0 w v ° 0 -� r m CCD z O g m ca D cn N U) n G• n v ^ m :3 ,' n CD z ° m o cn cn -0 o n cn o m c M S a o o -5 cD m S �. �3�II�vZ CD' m cn � o' ° n - 0 U) cn _= O O -' O ,, O �.Cry cn m �v =m —a, C/) CD m O ' cn CD OO 0-0 SCG a pmt _ O J 111 S ♦D 0 � 1 O �G o (n z S to O N - CD D _0mLoo•3a C " _.� o•c m cn cc m v ca S 0 O m rn cn -� — O m0Sm0J� 70 a M m D _• 0 CD(D (D m. n CD a m 3 S m -t-,' cn U) o o Z _ cn o o m J a- r•-' a _ D m m CD m (a a] J CDcn 0 0 cn cD a. 0 0 o rn w �. = 0 CD m .Co 0 C Q c' 3 v o' 0 v mz X —0 CD — D 3 E lV 3 ^` w ^m` Y\V `VmW O_ a cn --i O z m z O z C/) (DD D o D O 0 T 0 r _ D 0 D Z O CD� Q �n p z m I o r a �rn � z f z � I I I� I� I� II I I� I I Io�u,oi m �um3oi m M r s -+ z In z 7U z i 'mo z 0 M I Gl�,a p m p w z cs� o o =' cs� m J) 2: `V p rnS m c z z � ip a rn rn a N 70 O n I 11 �D�II -K D i ■ II rn o c z` cs) = m p p W W ID 0 WN X 3 < N I com�� W`_< Q 4 OD 9 vND(fl 0 � y4 W (p co 0 ��tAW 0) I0) m N gi �a 5W C_ 0 N D CD N N W O -1 6 / 9 y \ / 3 C) O O m 3 w C) O � � � � � KD / / u @ y \ S C)- /o$ >f>7= m --I mM z>mz mm 7)�M� I$m A ) >.az� 4mm(-)® = =g% ±//° 0gmp> R§±w4 ® -Tl =4 c) =G}§7 m7Z«a4 mo7- $&$g2 //\\\ \ --A m /f/\\ 713%7cn $\9\\ g_\¥/m z �PJ ) \; > 73k/) §)w$® \/G @\ b�%? -nƒa)o ■0 CDN x:3<m » o@m3 %®- 1 } « \ \ ��\0\o\� oj000 §E±2�; $®2 q � �� lR O m ° o. '+ o y . CD ~h CD O CD fp CD ... ti CD c: N IN .. u, CD CD ° in N Q a b 1-1 N C ��� n °� CD CD CD all C)N ►� O� O CD b �71 CD CDa � O N O a o C) d C CD w � 0 0 � O Date. ./ ?. -. / Z.. n/ TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING. -%k. This certifies that ..... has pe::=;-ai�ion to ....... plumbing in the buildings of at ....6 ..... North Andover, Mass. Fee/ Lic. No.......... .... L U 1� INSPECTOR r Check # k's �/ 9 5059 f� MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING r r" (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Location Owners Name�et Type of Occupancy VA- Date /.? - // " O / VA - / Permit # Amount /:d d' i New Renovation 13-11" Replacement El Plans Submitted Yes No FFXT'J'RES .J (Print or type) pp / Check orCertificate Installing Company Name ElCp Address l /�y 2 2 ! C d �✓ ✓t� ✓ty �0 Ni1�' !� L! l� ❑ Partner. Business Telephone 9 (T f• S',� _ 1 Firm/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the t o insurance coverage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond ❑ Insurance Wai wr: the undersigned, have been made aware that the licensee of this application does not have any one of the above three insurance Ignature Owner Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installatio perfor under'Permit Issued for this application will be in compliance with all pertinent provisions of the Massachuse to Ply i ";apter 142 of the General Laws. By Signature ot Licensectum er Type of Plumbing License Title Z City/Town icenL� uum er Master01 Journeyman ❑ APPROVED (OFFICE USE ONLY Location No. e Date NORph TOWN OF NORTH ANDOVER " A 41 Certificate Occupancy $ of TACH Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL G� $ Check # 2% Building7�"ctor a��Location No. 6�� Date NORTH TOWN OF NORTH ANDOVER Of ��4•n ,•,h0 U OL Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL G $ Check # -��/ d 14162 � wilding I for Date TOWN OF NORTHANDOVER 27 CHARLES ST APPLICATIONFOR-ERTIFICATE OF INSPECTION � , 20 -moo () Fee Required (Amount), O No Fee Required Accordance with the provisions of the Massachusetts State Building code, Section 108,1 S, 1 hereby apply fog Certificate of Insr110 -add ��amsao�ress: Street and Number Name of Premises �c"S k� Purpose for which Premises is, Used -.rw'� Licenses (s) or Permit{s) Required for Me Premises bY-01her-Governmental Agencies: Age Certificate to be issued to Address 350 Vii a� �P �J�. A3jKr Telephone Owner of Record of Building Address Name of Present Holder of Certificate Name., of Agency,\if any TURF OF PERSONS TO WHOM IS ISSUED OR HIS A-UTHOIRIZED A INSTRUCTIONS: _ E, TIFICATE TITLE �" 20 ^C) U IVT DATE 1) Make check payable to • Town of North Andover 2) Return this amUcation with your check to: Ru� Dept 27 Charles Street, North Andover MA 01845 PLEASE NOTE: Application form with accompanying FEE must be submitted for each building or structure or part thereof to be cert 3) Application and fee must be received before -the -cerci fiw4te will -be -issued. 4) The building officials shall be notified within ten (10) days of any change in the above information. CERTIFICATE # EAPIRATIONDATE: FORM SBCC-3-74 REMED 2199 jme TOWN OF NORTH ANDOVER INSPECTOR'S NAME 3 OFFICE OF THE INSPECTOR OF BUILDINGS MICHAEL MCGUIRE INSPECT40N-REPORT FORM 9 CLASSIFICATION PASSES INSPECTION yes 0 no 0 OWNER - � �I`� �C� \ ( \CU\C BUILDING NAME DATED A- 7 -0 t STREET LOCATION TYPE OF OCCUPANCY Day -Carte Center A. 0 -Cafb -0 -6ym D Apt. 0 School 0 Common Victualer's Liquor U/ Place of Assembly 0 Other OCCUPANCY NUMBER {+ncludesAories # aid-ocoupancy iw4loor - use4everse-side EXISTINGS EXIST SIGN yes nu 0 LIGHTED EXIT SIGNS -operable - fires -V �e -0 EMERGENCY LIGHTING SYSTE M operable 0 dry cell 0 wet cell 0 SPRINKLER SYSTEM operable 0 gage pressure yes 9/ no 0 SMOKE DETECTOR operable 0 yes 0 no FIRE ALARM SYSTEM -expiration-date -yes 0' -no ANSUL SYSTEM yes no 0 FIRE ALARM SYSTEM operable 0 municipal 0 yes 0 no 0 ELECTRIC EQUIPMENT PROPERLY PROTECTED yes 0 no 0 EGRESSES LAWFULLY -DESIGNATE unobstructed 0 yes -fl -no 0 STAIRS PROPERLY RAILED yes no' HALLS AND STAIRWAYS LIGHTED yes Ek no 0 RADIATOR GUARDS yes 0 no fl COMPLIES HANDICAPPED PERSONS LAWS -yes 0 -no FIRE RESISTANT CURTAINS OR DRAPFRIES HOW HEATED �aF �� F� � �v �.iY. NO. FIREPLACES �i yes 0 no BOILER ROOM CONDITION VENTILATION UTILITY ROOM - CLOSETS NUMBER OF GRADE FLOOR MEANS OF EGRESS DOORWAYS NUMBER OF SEPARATE STAIRWAYS ACCESSIBLE PER STORY SHOPS FOR INSPECTOR USE ONLY Revised 2/99 JMC Location vS O vo r P C),7—, No. Lq I ES Date L ` oa NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ ''+S'••°''�c�' scHusE Building/Frame Permit Fee $ FoundatiGn Pe mit Fee $ Other Permit Fee $ TOTAL $ Check # 15354 Ar1if �Y� Building Inspector TOWN OF NORTH ANDOVER BUII.DING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING �"' sedion for Vaa icial Use MORE, G BUILDING PERMIT NUMBER: � j � DATE ISSUED: SIGNATURE: L Builft Comnu erfl or of Buildings Date 1.1 Property Address: 1.2 Assessors Map and Parcel Number: I P Z al �/�l !�(��l o AtOz.- 0 ,� 7- 00-3I,gc-32 . Map Number Parcel Number r 1.3 Zoning Information: 1.4" Property Dimensions: Zoning District Proposed Use Lot Area Frontage ft 1.6 BURDING SETBACKS (ft) Front Yard Side Yard Rear Yard Required Provide Required Provided R red Provided 1.7 WaterE71y M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System Zone Outside Flood Zone ❑ Public Y Private ❑ Municipal On Site Disposal System ❑ 4.,t , 3AS+F.3• • i s N" - . s i:+b to � �rnpy ti �' .• 2.1 Owner of Record -CJs/3viet WIJ ame (P Address for Service t -I k�� i— �2�ar� Signature Telephone 2.2 Authorized Agent iJ C, 140 I 9g 9A,621S&J 1/l%� 1��S7ejAi il,4 Name Print Address for Service: / _S a ' Signature Telephone 3.1 Liceenssed Construction Supervisor Not Applicable ic / l��/� 1� (S (� /J /E% " (j j3o s7�c/ �- d L� r/ Q �0 4 � 1/0 /S , Addi License Number a 0 z O14c) ( 1 s J / v Licensed Supervisor: I / ! 1 O - 7 2, � / Expiratio Date Signature Telcphont " 3.2 Registered Home Improvement Contractor Not Applicable Company Name �- Registration Number Address Expiration Date Signature Telephone W 1 V O M Z C I, 011 t iJ ,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 15— it) IAj Print Name Signature of Owner/Agent Date Item Estimated Cost (Dollars) to be r `� y-h U ( = a 1 Completed by permit applicant 1. Building (a) Building Permit Fee Multiplier 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee tat X (b) 4 Mechanical (HVAC) V 0 5 Fire Protection D a D 6 Total (1+2+3+4+5) Check Number 40 } 31 L �: 74: f •+ L� .C�.� iti y Ste(`- l} +mss` t ,�,txv"''[ % 5 t�rk ,� 2 ^c.)u3.P a*#r . i3 rt „' 7 p r`a �v H . d^ rr,'�� e ti,�`"YK}=Y flit G�S�i> :rc.%i.Y.i�h 'N'_�r 7 v 4 j.,� tw $ S'aS4. ✓'b S6{+y, 5.... y4'' f,.�sP 1{�i.. b i L:_.. '� t ;PIy 1 -j '. "+F �, fi• 1'✓rY..° r Q%yJ ayl r`, t"y...2. '^r t'. {� �^`, u14 l 1 f': r. f 1 'i . ��t'...0 1�t .T "rJ' %5t.. S..�fX+1G�t�- %?" l,.y 'u : y r' (y fk{Tr } f ✓ 4:,+ 1 ? w�i Ly - f &� g? y' ✓�Pi � f V S fi�jl8 ; A �; stri 'C,�,«C:s i h�� �'y x �� s��j .�Fyy fk xi�.c,'�s?ti f � S <:f v.kn. niS � v5 ; C'��r:-0� 1S�i.i,�i^3 "'R �41<'1� b ;�� }��.. 4 5 �,. m'+rV,��..i�1 x�' f f 7 jtt�'i�4r i�'?�jt n5 t' W„�4 NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS lsr 2ND 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 � �",.s�' �-z.,s �.��. � �*5 �gags= .z,'u, i}r1x ��s '>?ka �4i`.�1 tAyi Name: Name: Area of Responsibility Registration Number Expiration Date Address: Signature Total Not applicable ❑ Registration Number — - Expiration Date Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date Name Address Signature Telephone t , . • .. Area of Responsibility Registration Number Expiration Date Name Address T "� Signature Telephone J 4. ' "eR���ff�:1 \ S l'4..! wxYvr§3.VPF4 •, 1�� S (� �t! S� t 1 C'(� n Lti1 C. • ,,Company Name: tyaWInl rN1)I Not Applicable ❑ Responsible in Charge of Construction 1 New Construction ❑ Existing Building V Repair(s) ❑ Alterations(s) V Addition ❑ Accessory Bldg. ❑ Demolition 11 Other 0 Specify Brief Description of Proposed Work: T ,- /le BUILDING AREA EXISTING if applicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area s Total Heieht (ft) USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A4 ❑ A-2 A-5 0 A-3 0 0 ]A IB 0 0 B Business ❑ 2A 2B 2C 0 0 ❑ C Educational ❑ F Factory 0 F-1 ❑ F-2 0 H High Hazard ❑ 3A 3B 0 ❑ IInstitutional 0 14 ❑ I-2 0 I-3 0 M Mercantile ❑ 4 0 R residential 0 R -I 0 R-2 ❑ R-3 0 5A 5B 0 ❑ S Storage 0 S-1 0 S-2 ❑ U Utility M Mixed Use S Special Use 0 0 ❑ Specify: Specify: Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND OR CHANGE IN USE Existing Use Group: Existing Hazard Index 780 CMR 34: Proposed Use Group: 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 Heieht (ft) 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 c G PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) �r STREET //I%In �r�� �f" x ST. NUMBER 3-5 USE ONLY****************************** LRECOMMENDATIONS OF TOWN AGENTS: N ADMINISTRATOR DATE APPROVED DATE REJECTED COMMS TOWN PLANNER COMMENTS /1 FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS I DATE APPROVED ----- -- ---- --- _ DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DA?F E REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT 1 �iFIR.E :DEPARTMENT � L/,Ircj R1411 Re( 94-f (r rih 14ers - •i,iT AWm F It 2— RECEIVED BY BUILDING INSPECTOR _ DATE Revised 9197 jm FORM__U LOT RELEASE FORM r INSTRUCTIONS: This form is used to verify that all necessary approva;. `er`ln.its 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 .c I APPLICANT PHONE LOCATION: Assessor's Map Number 0 as PARCEL` SUBDIVISION LOT (S) STREEST. NUMBER 7S USE RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR COMM TOWN PLANNER COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS 16 q6l;-:-Qtn DATE APPROV91) DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED 6� �[� Alt i r�UBLIC WORKS - SEWER ATER CONNECTIONS I DRIVEWAY PER IT iU IRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR Revised 9\97 jm rred its( Word _ 1 DATE Sandra Starr Public Health Director TO: FROM: DATE: RE: TOWN OF NORTH ANDOVER HEALTH DEPARTMENT 27 CHARLES STREET NORTH ANDOVER, MASSACHUSETTS 01845 MEMORANDUM Building Inspector Health Director February 25, 2002 Bollywood Grill, 350 Winthrop Street Telephone (978) 688-9540 FAX (978) 688-9542 I have been reviewing the proposed changes to the previous Pasta Pallazzi at the North Andover Mall. Although we still have some items to work out about the proposed new food establishment, it appears that most of the structural and equipment placement is acceptable in public health terms. The Health Department, therefore, has no objection to the start of the construction. Should you have any questions, please let me know. BOARD OF BUILDING REGULATIONS i I License: CONSTRUCTION SUPERVISOR Number. CS 044710 w i Birthdate: 05/01/1955 !kLi% Expires: 05/01/2002 Tr. no: 23574 Restricted To: • 00 EDWIN W CNUI _ ! 49 SPRING RD WESTON, MA 02193 Administrator The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Please Print Name: Location: City Phone am a homeowner performing all work myself. F -1I 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. Company name:LAS COINS S. ,TION Z- C - Com: Phone* 617 - 3 3 8 - M KICI-,3/ S-2AV-74k- Comoanv name: Address City: Phone # Insurance Co. Policy # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the irrposition of criminal penalties.of a fine up to $1,500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of ($100.00) a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. i do herby certify unde he pains and penalties of perjury that the information provided above is true and correct. l 9 ..- Date Print name OL, w uo \l Phone # iii --S,722.. Official use only do not write in this area to be completed by city or town official' Building Dept []Check if immediate response is required Building Dept [] Licensing Board E] Selectman's Office Contact person: Phone #. n Health Department Other FORM WORKMAN'S COMPENSATION C/) M DD C/) Cn m CO2 'C CD az � O� O p.� CL n� .o o p CD Q co CD O av o to CD 0 CO) CSD 0 w Mo d d CO) CA C9. O CA d CD O CD CD a, CA CD CA 0 CD 0 c bid I C c?�O m _ O —�h0Q H dO m H =0§4 M MCL O C) O m O Zai' O ._.►� •O►O y T �a-*a m Or+�• O =.- O Oco � �� ;'Kv Cal rCR =t cnCD cn ,om8 1 a n y O� go zcn -fi -f a a Cn 0 O �NIZIi C, 0 3 (v CO Iff; cn� y9��.� tom z cn o cna : n �o ''d c o `I►e C4 O � � W �• C �, °^x° rte'' N G �. 'ti r N �0°r a ai O n• °�' d ° rp w rr r c ►yid C)rz p 7d � 0 c 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: / 4 (Location of Facility) ell - 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 v T c Q 0 0 0 .y , * * to ! Z l I 0 oLIr 1°jA�i J Z s O s� Cp CD m m a O C.) n m a a: m -n w cc c > > " - o m ° Z O 0 ° m m CD 3 -00 O 'T1 CD -n wCD -n 3 -0 ' Z m m CD ': m _ . fig E:i 69 69 69 fA 69 m w CD 0 0 \ Z P, 4 . ,-.4 W m r Y y v y z ? 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CIO N CA rl lf1ujQ � ri � 1 0 Q)N - Q►- 00 0 1 �a +1 M "UL '-I 07tri S 5 0 8 9c 7 26CS F'.0' Ad ILU � ly LLQ _-IA 92 0, `3 001 K,., 50°4Sr'-2 0 P ©1 r x� 0 Ak 1 ti� I � r �r 0 Ak 1 TUL 13 92 07 54 CIO KJS50t_,9c ,3.260 F.02 Ik- t r ttl 47 r r z 1 Cz 'op 0 sm n C rt� Ma a. cr rt OR z r rn V) m m z m co w ?t m T cn m m T Ci am C N " o z z y -4 Tel T Rt T en 'i "+ 0 00 0 0 c c� 0 z cn malls ft 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 local or state law, regulations or requirements. ****************Applicant fills out this section***************** APPLICANT: (� G�,C E Phone LOCATION: Assessor's Map Number Parcel Subdivision Lot(s) Street St. Number ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: A Conservation Administrator Comments /v lAliq Town Planner Comments �v 1 Health Agent Comments Public Works - sewer/water connections Date Approved Date Rejected Date Approved Date Rejected Date Approved Date Rejected driveway permit /Fire Department %dao �. Sv ,�c�J'iQ.� ��•� ��- — ED /?, dJT e11410 7// Received by Building Inspector Date I S Location P 2£' TFi 1 :yr'tiz+ N& Date A /J J 9 2 TOWN OF NORTH ANDOVER fez. q : • pL Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ �VEDrjj��mit Fee $ . %-� Sewer rbnTection Fee $ 7 "0;" JUN 0 ypier, connection Fee $ No, q7dVer TOTAL t $ -�-� • r" �, °Rector ` Building Inspector' Div. 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O� uuOma azvo3aa>"w 0 z Q x 13 z °u i 0 d N � LL d 0 xivz Z ¢ W cZc S 0u 0" W Z -0 u Sz > "ALL W v'S v W <O 00 _� O"a - m o � m J a a W�� � m W J 0 N QQaNOaQO tp O f�0 p C�C�LLa3o w 3 ra3 i I 3NI". ONoiv wo z 0 M > c 2 N 'Tl -n x > A 0 Cc -4 M c 0 <M CA oz rM 0 rzz 2* z Z rn ). 0 ZS M C w m M 0 ?5 oz Mcft z M M :cm N Z5 0 M 3Db c) E: dc >z Z> c r w 30 0 z ch M 1 o 0 b T 0 r 14 S ca ON z A CA M M IMMV 0101 o x0 M M "A M 0 M X WN x X z F)(A M G; x c o 0 0%% z A z l 0 z r 0 > --I ion a x x 0 A I x ra a) 0 C) 41". �00 x`WOR2 RIL4 am it A * rzn %ft CK 0 XM, 0 M;K .& OZ r c M M c No 0 Z'* >z 60ow z"M I 3NI". ONoiv wo z 0 M > c 2 N 'Tl -n x > A 0 Cc -4 M c 0 <M CA oz rM 0 rzz 2* z Z rn ). 0 ZS M C w m M 0 ?5 oz Mcft z M M :cm N Z5 0 M 3Db c) E: dc >z Z> c r w 30 0 z ch M 1 o 0 b T 0 r 14 S ca ON z A CA M M IMMV 0101 via 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 local or state law, regulations or requirements. VAPPLICANT: ****************Applicant fills out this section***************c** �V n f iC0 G� Phone L170 r I US0 VII'LOCATION: Assessor's Map Number Parcel Subdivision Lots) Street w✓✓� ��� S+ I Al _ St . Number 35U ************************Official Use Only************************ RECOMMENDATIONS OF TOWN AGENTS: W l ± Conservation Administrator Comments 1V l Town Planner Comments Date Approved Date Rejected Date Approved Date Rejected r Date Approved j PP Health Agent Date Refected Comments .i Public Works - sewer/water connections —T - driveway permit t�Z V X Fire Department117 , Received bY Buildin Inspector Date g id N f JUN 41997 ,A Z O R z < w S v C -1 Cl) -n > s A o r.r 3 0 fp y o w 0 V� 3(D 0 d< cto 0 O A A cr m A 0 Z y A � O O m� s C O4• = O v n 1 CLh fD w O rt A O. > O a ' rri lw A H a m -,o uq tv Ma 3 v,A W! 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