Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Miscellaneous - 733 TURNPIKE STREET 4/30/2018 (12)
r• Commonwealth of Massachusetts Department of Fire Services - BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. ILle Occupancy and Fee Checked tev, 1/071 (1PavPhlnnL-1 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code (MEC) 527 CMR 12 00 WORK (PLEASE PM%TDV 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 perform the electrical work described below. Location (Street & Number) _ % ?, "�-,r , P i `QC– S 7— Commonwealth — Owner or Tenant Owner's Address Is this permit in conjunction with a building permit? Yes R1 Purpose of Building O -(Z; C Existing Service 2-v 0 Amps t r- 0 / 2nkVolts New Service Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: No ❑ (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters --••��•• Estimated�,.,.�—rtui —suu y aesirea, or as required by the Inspector of Wires. Work to to oValue of Electrical Work: . (When required by municipal policy.) 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:) P ff3':) I certify, under the pains and penalties of perjury, that the information on this application is true and complete - FIRM NAME:To L u T LIC. NO.: Licensee: Signature (If applicable, enter "exem t in qqhe license numberLIC. NO.: 17 2 - Ane.) � c� Address: S y G d ;,` k��©� Bus. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: AILL cl No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ 5 4 ei2 ;( Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts 4. [:11 am a general contractor and 1 Department of Industrial Accidents have hired the sub -contractors Office of Investigations listed on the attached sheet. I 600 Washington Street These sub -contractors have Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legiblv Name (Business/Organization/Individual): Address: myself. [No workers' comp. City/State/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. [:11 am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' *G.. ..t2,. at_ _t_ comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other __�_ _.-. -.......v vv a:a� 4:JV 1111 VUl lue Secuon omom, saolkmg 1.^helr work,=' compensation policy .:.form—;on. t Homeowas who submit this a`fidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sienature: Date Phone #: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Issuing Authority (circle one): Permit/License # 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: I . V Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house . or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the perr&L or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business, or commercial venture J (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-72.7-4900 east 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 5-26-05 www.mass.govddia 94 ,.8 Date.. ��..Z....�.........jl..... NORTH (Irso' ``TOWN OF NORTH ANDOVER p PERMIT FOR WIRING This certifies that ....... Jit �/w !l ......................................... has permission to perform ... (� 5174 ( U�� wiring in the building of ...... �Cfi 7 3� / v/Z�/�� .... 5' ................ ,North Andover, Mass. Fee.(......... -f ....... Lic. No.............. .................� ......r, jj ............. 19 ELECTRICAL INSPECMR Check # oq'3 Date ... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........... ............� Lhas permission to perform ............ ........ wiring in the building of at .... 7. 7 --.,North Andover, Mass. Fle"e-12--'.... Lic. No..m'�Txi� ...... k'l� I ELECTRICAL INSPECTOR Check# 111200 (,onunotuaeatih o� l�a3dact' Official Use Only 40 aLJe�artinent o��ire �ervicea Permit No. ` ��0 Occupancy and Fee Checked r BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/07] eave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: / 2 �— City or Town of: 11161 & Olo ti �9 I" To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant n1.) -1;r Owner's Address Telephone No -61Z 3/ez - OI o`er Is this permit in conjunction with a building permit? Yes ❑ No R (Check Appropriate Boa) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ New Service Amps Number of Feeders and Ampacity No. of Meters Volts Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: tip I C'mmnletinn nfthe fnllnwino tnhlo mini ho wniwnd by tho h7mveMr nfWiroc No. of Recessed Luminaires No. of Ced.-Susp. (Paddle) Fans No. of otal Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- Swimming Pool d. ❑ d. El No. o. o Emergency g Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Tod No. of Alerting Devices No. of Waste Disposers Heat Pump Totals:I Number Tons KW No. of Self -Contained Detection/Alerting Devices I 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 Heaters of No. of Si Ballasts Signs Data Wiring. No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total IIP Telecommunications Wiringg• No. of Devices or uivalent o?? f� OTHER: �Q A s7--t-� Ae IGC�� / :t )e Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of FIec "cal Work: O, ?o (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with NEC 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 andpenalties ofperjury, thatt the information on this application is true and complete FIRM NAME: ,7 r! C' LIC. NO.: /lp/ryxr Licensee: ." ',,, Signatu LIC. NO.: L' (If applicable, enter "exempt" in the license manber line.) Bus. Tel. No.• 9-03�-V/Ej` 7 Address: 3%/ W� i fes° Liv O. // �i� vokS(�7T /Ufi 12,6 Alt. Tel. No.:40.3 5 -'P -7a 9 *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'sent. Owner/Agent Signature Telephone No. PERMIT FEE: $ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigations ky 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/organiration/Individuai): I Address: 321 k- City/State/Zip: 46c, k5 0104 Phone #: 6 Q3 - 46`3 - d-0-13 Are you an employer? Check the appropriate box: 1. ( I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required-] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box # 1 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 worker;' 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: L14 A9 r` S ,Volicy # or Self -ins. Lic. #: U A —/// Expiration Date: /d a /oZ Job Site Address: ���� l^ vt r K l �T City/State/Zip:/VO /f n ©'over— 0 144 A. `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 cerft)T_xnder the pains and penalties of perjury that the information provided above is true and correct %, Phone #: 403' V 3 92 V(/3 Official use only. Do not write in this area, to be completed by city or town offkiaL -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 M 9 4 17 �-- z /o Date.................................. TOWN OF NORTH ANDOVER p PERMIT FOR WIRING '— -W This certifies that ....... 7 ..................... ............... has permission to perform ........ .............. wiringin the building of ...................... I ............................................................ at ...... 7 ...... 3.. .......5. x' :. ...... North Andover, Mass. Fee —��&7!;A� .... Lic. No. 12A44� ................ ........ P ALERIC L INSPE R Check # 0��3 Commonwealth of Massachusetts MEN=Official Use Only F0ec=cuPa t No. — 7 41 % Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS ncy and Fee Checked ' [Rev. 1 /07] APPLICATION (leave blank FOR PERMIT TO PERFORM RM ELECTRICAL All work to be performed in WORK P accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT WINK OR TYPE ALL INFO&MT1O19 Date: B City or Town of: NORTH ANDOVER To .the Inspector of Wires: BY this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number)7 `3 3'y,� Owner or Tenant Telephone Noc? 7�3 -true 7 Owner's Address _ (7 Q (_ .t : - Z 0 Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. Exis tin Service ervice Am s P / Volts Overhead ❑ Und rd g ❑ 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 ollowin table may be waived by the Inspector of Wires. FNo. of Recessed Luminaires No. of CeiL-Susp. (Paddle) Fans o. of Total Transformers KVA of Luminaire Outlets No. of Hot Tubs Generators KVA of Luminaires SwimmingAbove In- o. o. merger cY 19 Pool d• ❑ d. 0 Batte Units g No. of Receptacle Outlets Na. of On Burners FIRE ALA MS, No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No, HZiste es No. of Air Cord. °� Tons No. of Alerting Devices No. Dis osers eat Pump Number Tons P Totals: ""' -_-- _.... o. of Self -Contained �' Detection/Ale Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal Connection ❑ Other No. of Dryers Heating Appliances KW Security S terns: No. N ys of Water o of o. of Devices or E uivalent Heaters KW No. of Data Wiring: signs Ballasts . No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total gp Telecommunications Wiring: nTUr,D. No. of Devices or Equivalent 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 ofperjury, that the information on this application is true and complete. FIRM NAME: � � . %�; GjCc LIC. NO.: f%2G a Licensee: Signature y. (If applicable, enter "ex� " in t license number li LIC. NO.: Address: I AL{ �a Bus. Tel. No.: *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Alt L cl. No. ER OWN'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement I am the (check one) ❑ owner ❑owner's agent Owner/Agent Signature Telephone No. PERMIT FEE. S " The Commonwealth of Massachusetts Department o f Industrial Accidents Office of investigations 600 Washington Street B ostor", M4 62111 ww►v.mass.gor1&a Workers' Compensation Insurance Affidavit: Builders/Contractors/ElectrieianS/Plumbers Applicant Information Please Print Leaibl, Name (Business/Orymi*zabon/Individual): Ad&ess: City/Sate/Zip: Phone #: Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. 111 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet $ ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a co orad and ' required.] ❑ I am a homeowner doing all work myself: [No workers' comp. insurance required.] t rP on its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required ] Type of project (required): 6. ❑ Nev, construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10 Z Electrical repairs or additions 11.❑ Plumbing repairs -or additions 12.❑ Roof repairs 13.❑ Other `: WSJ zPPh---t that check,: box #1 mu -S! also uu cat pec_ ' Romeowners who submit this affidavit indicating a , �- A or, --T, nal do;,- aL wct's and thea hire outside conTMacta {hist submit a new aindavit indicating such. Contractors that check this box must attached as additional sheet showing the name of the sub contractors and their workers' coma. poiicy informadoinformation. I am an employer that &Providing workers' compensation insurance for my employees. pout Below is thep andjob site n. 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 c. 152 can lead to the imposition of fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties criminal penalties of a in the form of a STOP WORK ORDER 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 a Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct lone #: Official use only. Do not write in this area, to be completed by city or town ooi i,,L Cita, or Town: Permitucense # Issuing Authority (circle one): 1. Board of Healtb 2. Building Department 3. Citv/Town Clerk 6. Other 4. EiectricaI Inspector Piirmn;... s., ..._4__ con`,,act Person: Phone #: v Location 7 33 Tv No. ek D Y: Date t NGRTh TOWN OF NORTH ANDOVER #io , Certificate of Occupancy $ AC MUS E Building/Frame Permit Fee $ Foundation Permit Fee $ r Other Permit Fee $ TOTAL $ Check # 'i 7540' t t AA ,fit-.� Building Inspector • TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING Secti6n for Official Use Onl LLr y ' P3 ,O BUILDING PERINUT NUMBER: DATE ISSUED: ©. SIGNATURE: Buildin Commisdoner/i or of Buildings Date Y Property Address: 1.2 .Assessors Map and Parcel Number X1.11 l33 tk,c, j V4 51' kf If" . UA tT # Z "I 6 ; l N• � • . `� ' o1 -8 Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Wag* Lot Area Fronts ft 1.6 BUILDING SETBACKS (ft) EXIST(.1Cr CAM 01a•rU Front Yard Side Yard Rear Yard Required Provide RequireE= Required=Provided Reqwred Provided 1.7 Water S 1y M.G.L.C.40. 54) 1.5. Flood Zone Information: Public Private ❑ zone Outside Flood Zone ❑ 1.8 Sewerage Disposal System: Municipal 4 rJ On Site Disposal System ❑ r 2.1 Owner of Record Actmoi Mwx al \Y LLA bec PfM -731 TU.tt~ b ike - S E-., N. �9ntido VL(- M A . Name (Print Address for Service: I �P— X110 --33 If Signature Telephone 2.2. Authorized Agent Maw, ftmyk-A 7S3 1W 14 bi Ice S (-, Name Print Address for Service: Signature Telephone x .f, 'I :..A+ ,.� �. ..+ 'G. :T •.. :FKµ, h.- 3.1 Licensed Construction Supervisor rl`'i ly Not Applicable ❑ uaN 1J .b 0�?9 f Address License Number • \ 1 Licen nstruction Supervisor: 9'lao 1171 (0�m Expiration Date Signature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name Registration Number Address Expiration Date ` Signature Telephone fient [7—vw6e-e AfJ7 V MUdJAL ft t�P N 044%I"� ! as Owner/Authorized Agent Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury Print Name Signature of Owner/Agent bate y( Item Estimated Cost (Dollars) to be k - . �rabI�: Completed by permit applicant ' 1. Building 6� .Vf je L,, (a) , Building Permit Fee Multi ier.:. 2 Electrical (b) Estimated Total Cost of Construction from (6) 3 Plumbing Building Permit fee (a) x (b) 4 Mechanical (HVAC) 5 Fire Protection 6 Total (1+2+3+4+5) (J11f,'� Check Number �i ;� i` 4 y .. ri `�1t•v u�yry•..r, r if'y-t`�ifi' . 5F r' .r ^� 17' L�t}�...s l*ti - 4 . .. 41. '4 - '71n"� }:.. ,5� 44dh'. M y k yl.s :.4 �✓ ' �£•,%'ry Yl,°' : a' JfY F mp. NO. OF STORIES R;, u C l ve � �� l.'� 7L COW -3r BASEMENT OR SLAB SIZE OF FLOOR TIMBERS 1 ST 2 No 3 RD SPAN DEMENSIONS OF SILLS DEESNSIONS 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 5 F't:i b! y 1 j474• F </',� Y��„ f1 [ L"Y"!"f 'J 5 Y rt ✓k Ile, `. ✓s �4--• )'� C y.J T a'., I@ . %�• '2 ..-.�, k$ t .+ri41..�iCtd rt v1- yn 3. _ V1 Y 1..: ..t•i" < },?[`•�lo ,..�..�yS} } ..1.,, f Jy V. n?i y' �..;..;a di. �•F.s^ .F.. .i - � tJ+} 1� T f Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yea .......❑ No ....... ❑ 3ECTgOATS P.)®FSIt1A.1ffES� C#INS'£'�€�t1T$Ri+fllt �U3Il�Sy'`RB SUiU"' T3 iCONSTRUCTIGM�� ft, 5-1 Fistered Architect: F Name: Addre Signa a Telephone S.2 RegsE�et�ed; : esu ag1 L�s� j Area of Responsibility Registration Number Expiration Date Name: Address: Signature Total Not applicable ❑ Registration Number Expiration Date 1 Name: Address Signature Telephone Area of Responsibility Registration Number Expiration Date & 3 f Name A Address Signature ' Telephone I I Area of Responsibility Registration Number Expiration Date i Name Address Signature Telephone �ompany Name: tesponsible in Charge of Construction y Not Applicable ❑ • r , ��1� �.�������:' �I� ��O1EIi ��D 'iii 1c11r afil a►srstxralilp� .: "` New Construction ElExisting Building Repair(s) ❑ ----[Alterations(s) 0 TAddition ❑ Accessory Bldg. ❑ Demolition ❑ Other 0 Specify Brief Description of Proposed Work: Me:)V ❑ USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly p A-1 ❑ A-2 ❑ A-3 ❑ ]A ❑ A4 ❑ A-5 0 113 ❑ B Business 2A 2B 2C 0 0 0 C Educational ❑ F Factory 0 F-1 ❑ F-2 ❑ H High Hazard ❑ 3A 3B ❑ ❑ IInstitutional ❑ 1-1 ❑ I-2 ❑ 1-3 ❑ M Mercantile ❑ 4 0_ R residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A 5B ❑ �C S Storage ❑ S-1 ❑ S-2 ❑ U Utility ❑ Specify: M Mixed Use 0 Specify: S Special Use ❑ 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: J%' AL" Proposed Hazard Index 780 CMR 34: I CESS BUILDING AREA Number of Floors or Stories Include Basement levels Floor Area per Floor s Total Area (sf) Total Height (ft) EXISTINGi"applicable) PROPOSED C- era 9 a -o 4. 20T7 NL t "7'e.2 I Independent Structural Engineering Structural Peer Review Required Yes ❑ No SECTION 10a Owner Authorization - TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 3 I, AJ 1 YUA, Owner of the subject property Hereby authorize A7 My behalf, in all matters relative two work authorized by this building permit application �2 o Y Signature of Owneru Date to act on YI m m m m y m v m d CA C) 10 0 CD Ca ZCD y C36 o �, � O CL y .� CD o p CD o �rt CL c�=r d CD CD CD G O CA n v c) -• o cc CD CD CA O' CD Z o � CD O C CD O C N C EcKm H CL 10 0 CD to Cl m LO Z ymrtC 3' _.0 N 7 = a .. n o m O N •-► O O --1 bN O =O m = 7 7 m N O_ < O1 0 O N A C � ca :• !� aMCC a C2 •-_�4 170 /f V m O N J CD n CD OO O1 N z cn a �� cn _ %y '� O f o �j N � CD 0 0 moo � n • Z � '�Q pr C=O d C=L -00 I y c m �o MA cn O cnto � � �n w x, G � � v OQ .,� w 0O � z b ►� z 0 0 9 , 0 c Town of North Andover Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 hU://www.townofnorthandover.com Town Planner. jparrino@townofnortharndover.com Julie Vondrak August 4, 2004 Gregory P. Smith GSD Associates 148 Main Street, Building A North Andover, MA 01845 RE: Site Plan Review Waiver 733 Turnpike Street LaBoom Tanning Salon Dear Mr. Smith: P (978)688-9535 F (978) 688-9542 At the regularly scheduled North Andover Planning Board meeting held on August 3, 2004, the Board voted to waive Site Plan Review for the proposed tanning salon business. The business will consist of three employees and is an allowed use in the zoning district. Only internal alterations will be made to accommodate the business. The proposed use will not require additional parking from the previous use. If you have any questions, please feel free to contact me. Wk, Town Planner cc: Planning Board Robert Nicetta, Building Commissioner BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 ft://www.townofiiorthandover.com Town Planner.iparrino@townofiiortharldover.com Julie Vondrak August 4, 2004 Mohammad Yamin 32 Palomino Drive North Andover, MA 01845 RE: Site Plan Review Waiver 733 Turnpike Street Oriental Rug Store Dear Mr. Yamin: P (978) 688-9535 F (978)688-9542 At the regularly scheduled North Andover Planning Board meeting held on August 3, 2004, the Board voted to waive Site Plan Review for the proposed oriental rug/antique store. The business will consist of three employees and is an allowed use in the zoning district. Only internal alterations will be made to accommodate the business. The proposed use will not require additional parking from the previous use. If you have any questions, please feel free to contact me. Sincerely, Julie ondrak, Town Planner cc: Planning Board Robert Nicetta, Building Commissioner BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Town of North Andover Office of the Planning Department Community Development and Services Division 27 Charles Street North Andover, Massachusetts 01845 ft:// townofnorthandover.com Town Planner. jparrino@townofnorthandover.com Julie Vondrak August 4, 2004 Mohammad Yamin 32 Palomino Drive North Andover, MA 01845 RE: Site Plan Review Waiver 733 Turnpike Street Oriental Rug Store Dear Mr. Yamin: P (978) 688-9535 F (978) 688-9542 At the regularly scheduled North Andover Planning Board meeting held on August 3, 2004, the Board voted to waive Site Plan Review for the proposed oriental rug/antique store. The business will consist of three employees and is an allowed use in the zoning district. Only internal alterations will be made to accommodate the business. The proposed use will not require additional parking from the previous use. If you have any questions, please feel free to contact me. Sincerely, Julieondrak, Town Planner cc: Planning Board Robert Nicetta, Building Commissioner BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 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 ADA) �` w I :SXIle PHONE LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONLY**"****************************** RECOMMENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS ` O- W"LANNER DATE APPROVED 0 `� DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH SEPTIC INSPECTOR -HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT, RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm GSD Associates 148 Main Street, Building A, North Andover MA 01845 1' Tel: 978 688 5422 Fax: 978 688 5717 Web: www.gsd-assoc.com Computer Aided Design • Architecture 9 Planning • Interiors • Development Consulting July 22, 2004 Mr. Robert Nicetta Building Commissioner North Andover Building Department 27 Charles St. North Andover, MA 01845 RE: Building Permit Application for renovations to Unit #2 at Jasmine Plaza 733 Turnpike St. Dear Bob, Attached are architectural tenant fit -up plans for the proposed tenant fit -up of an existing retail space at Jasmine Plaza. The previous tenant of the space was Master Shin's Martial Arts. The proposed construction will subdivide the existing space into two tenant spaces. One tenant is proposed to be a carpet showroom, the other space is proposed to be a Tanning Salon. Our review of the North Andover Zoning Bylaw indicates that the proposed uses of the space as a tanning salon and as a carpet showroom does not require a site plan review. Furthermore, the proposed subdivision of space and renovation of the space does not require a review of the entire Jasmine Plaza Site plan and parking analysis as you suggested in our meeting earlier this week.. The proposed work does not fall under the types of projects or developments that require site plan review as outlined in 8.3.2. i) The proposed construction is not a new building or construction that contains two thousand square feet or results in more than 5 or more additional parking spaces. The proposed construction is in an existing tenant space that was previously permitted. ii.) The proposed construction is not an addition of more than two thousand square feet to an existing structure, or results in the requirement of 5 or more new additional parking spaces. iii.) The proposed construction/tenants in the existing construction is not a change in the use or processes that are typical of a retail shopping center for which the project and tenant space has been previously permitted. There is no exterior work that will effect the traffic or storm drainage, or require additional parking requirements based upon the parking standards of Section 8. 1, or require any additional parking spaces. Mr. Robert Nicetta July 22, 2004, Page 2 iv.) The proposed construction is not a wireless service facility. Additionally, 1. The proposed use/renovation is not changing the siteplan. 2. The proposed renovation is not expanding the envelope of the building. 3. The use of the space will not result in an increased nuisance to the neighbors. 4. The proposed use of the space will not increase the parking requirements for the space as previously permitted. 5spaces per 1000 for each use. 5. There will not be an increase of noise from the proposed uses. 6. The proposed use does not impact storm water drainage onto or off the site. Jasmine Plaza is located in a GB zone and the tenants include a mixture of restaurant and retail uses. The existing tenants at Jasmine Plaza have previously permitted uses. The prior tenant "Master Shin's Martial Arts" was in the Tenant space under consideration here for a building permit was issued a waiver of site plan review on May 4, 1999 as noted in the attached memorandum letter to Robert Nicetta from Heidi Griffm, Town Planner. The proposed uses are all within the requirements of Section 8.1 parking table for Retail stores and Service establishments that require 5 spaces per 1,000 sf of GFA in a GB zone. If you have any questions or require additional information, please contact me at 978-688-5422 x 203. I will be on Vacation from July 23`d to August 2' and may not be able to respond until after I return. Sincerely, GSD Associates Gregory P. ; AIA Architect Town of North Andover f 40RTty OF CF.'.OF tI?O�,t�ao COMMUNITY DEVELOPMENT AND SERVICES p 27 Charles Street" t _ •° a North Andover, Massachusetts 01845 �'yq =�° •''`t<`h WILLIAM J. SCOTT SSACHUS� Director (978)688-9531 Fax(978)688-954? Memorandum To: Robert Nicetta, Building Commissioner From: Heidi Griffin, Town Planner Date: May 4, 1999 Re: 733 Turnpike Street, Suite #9 (Jasmine Plaza) At their meeting on April 29, 1999, the Planning Board voted to waive the site plan review for the Master Shin's Martial Art School located at 733 Tumpike Street, Suite #9. Please see the attached letter from Don Kwon Shin dated April 7, 1999 outlining their plans for the site. Cc: R. Rowen, Chairman, Planning Board Michael McGuire, Building Inspector Don Kwon Shin BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Master Shin's Martial Art School RECEIVED 70 Woodland Street, APR 13 1999 Lawrence, MA 01845 PLANNQ DEARTMENT Mr. William J. Scott Director of Community Development North Andover Planning Board 27 Charles Street, North Andover, Mass 01845 April 7, 1999 RE: Jasmine Plaza Suite # 9, 733 Turnpike Street, North Andover, Mass 01845- Request for waiver from Site Plan Review Dear Mr. Scott: I am writing to request a waiver from site plan review. I am intending to occupy the vacant space as shown in plan attached. My business is a Martial Arts studio. Master Shins believes that a waiver of site plan review is appropriate for the following reasons: 1. I am not changing the site plan; 2. I am not expanding the envelope of the building; 3. My planned use of the space will not result in an increased nuisance to the neighbors. 4. My planned use of the space will minimally increase traffic in the area. (Hours of operation are mainly in the evenings after 4.30 p.m. & on Saturday morning The majority of the other -Business within Jasmine Plaza operate during normal business hours Monday through Friday) 5. My planned use of the space will not increase noise in the area because there will be no machinery or external venting which would cause noise outside the building; & 6. My planned use of the space will not impact stormwater drainage onto or off the site. I understand that Charm Sciences, Inc located at 15 Charles Street, North Andover, plass was granted a similar waiver in 1997. 1 would greatly appreciate if you could please review my request for a waiver in a similar manner and alio,.v me to start ruy business as soots as possible. If you have any questions or require additional ir•.formation please contact me at (978)63! .1001. 1 appreciate your time and look fonvard to working with you. Sincerely. ban 'wu►i Shin OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER .ff ;k • CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE:Lao IZE A Lu eapeT S=e i mAri"It% !�PA44h1 xnOV%S • PROJECT LOCATION: 133 'TU2NPIK6 ST, N.AN00,jt 2.. LVN IT 2a 42 5 NAME OF BUILDING: .jA,9 l,Mj Ije R.A?.^ NATURE OF PROJECT: 50 f5121 V I SIO N OF a5PAGE F 7'ENAI""T E17 (WP. IN.,ACCORDANCE THhRTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, �(LE"60�24,p? /771 REGISTRATION NO. 8%B$ BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF F COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT • E HITECTURAL STRUCTURAL • FIRE PROTECTION • ELECTRICAL • OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR9G5UPANCY. CG/v6� SIGNA SUB CRIBED AND SWORM TO BEFORE ME THIS 3 DAY OF U L 20 0 NIMARY PUBLIC MY COMMISSION P DONNA M. WE GE NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS MY Comm Expires Aug. 7, 2009 0 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�N CZ�T�i PHONE LOCATION: Assessor's Map Number 1 D PARCEL SUBDIVISION LOT (S) STREET lW(j i lLE ST ST. NUMBER 3 OFFICIAL USE ONLY *********** 1 RECOMMENDATIONS OF TOWN AGENTS: —1 CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR -HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR -HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS - SEWER/WATER CONNECTIONS A FIRE DEPARTMENT RECEIVED BY BUILI Revised 9197 jm 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: (RAs (k (Location of acility) Signature of Permit Applicant z3 2, Da e NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector _ ✓lze l�anv�azauuea�i o���waaclauaelta s BOARD OF BUILDING REGULATIONS E License: CONSTRUCTION SUPERVISOR i Number: CS 077915 Birthdate: 03/16/1971 Expires: 03/16/2006 Tr. no: 20658 Restricted: 00 PATRICK J LARKIN 674 TURNPIKE ST NO ANDOVER, MA 01845 Acting Cc mis oner t V- Z -6d c spq na- S'Ac�� wp„� CV - Ai