HomeMy WebLinkAboutBuilding Permit # 10/24/2016Floadplain E7 Wetlands
Non- Residential
❑ Industrial
Commercial
(tethers:
AJ7
DESCRIPTION OF WORK TO BE PERFORMED:
eAfri/ t . frr t`iciec, 4' 12/7E 5 IF--1/11 /0 Me 7:
Identification - Please Type or Print Clearly
OWNER: Name:.. f / S A t% :S T E Phone: t / 7 079/ Z2 k
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Address: /�.�-// s 7`-
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 4;2 2C6 7—
Date Issued: /0 L-` /6
IMPORTANT: Applicant must complete all items on this page
Date Received
TYPE OF IMPROVEMENT
❑ New Building
El Addition
❑ Alteration
❑ Repair, replacement
❑ Demolition
PROPOSED USE
Residential
❑ One family
❑ Two or more family
No. of units:
El Assessory Bldg
❑ Septic gVVell
a er ewer
Contractor Name: ,:p� ,.�2 L12e1,
Email. `4'711..: F .�.
Address::
...........:
...........
fit :P e►visor �: Construction License: `` ;021,41-Home am rovernenfi License:
�` .:. ' Exp` Date
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ARCHITECT/ENGINEER goe (97 Phone: /7)12-3 3
Address: H) L C Crk.6, ( (t1VJtVAJ I4 11- Reg. No. MA Ct.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
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Total Project Cost: $ 2000
FEE: $
Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Check No.: I; 9 56
Signature of Agent/Owner Signature of contras or
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VIOLATION of the Zoning or Building Regulations Voids this Per
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Name of competent operator (If Applicable)
Date Issued -rejected
_ 0
FPs (rev. 3/00)
City or Town
Date
P . Ocyx 1025, ante Road, c , 01775
APPLICATION FOR PERMIT
DIG SAFE NUMBER
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
by
Address
GORHAM FIRE APPLIANCE
288 Willard SI
Quincy, MA 02169
(o / 7 (it 72 S-1 d�
(Full name of person, Firm or Corporation)
eLo
r//-z/)r210/rie4/4,
41.1.
(Street or P.O. Box) (City or Town)
For permission to (state clearly purpose for which permit is requested)
4LfD '.4/. ,(i'cS
Cert. No. S7/7
't/i b 5 7" 4L ,e/ re/ F-/L/ f//2
2a _c r ( / Em s Itzeit)/
ire G6 e/1 404
By PAL grrn
(Signature of Applica
Date of expiration Fee $ Paid 'Due
FP6 (rev. 3/00)
City or Town
Date
di/4 w a 0/o/i
_ wwe oide eta& g_;e6 alc",da
P oa 10,25, & R; &tom, O1775
PERMIT
c .4/1/6-1212/
Permit Number (if applicable)
DIG SAFE NUMBER
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in this permit is granted
GORHAM FIRE APPLIANCE
to z�a Willard st
(Full name of person. Firm or Corporation)
for
Quincy,MA 02169 F/ E S VS r7i1 //VST,4LL_
Restrictions: N F P4 44 1- .#fra? is ? u/L-. 300 ti/Mi
/ 79/ 62_
(Give location by street and no., or describe in such manner as to provide adequate identification of location)
Fee Paid $ This Permit will expire on
Signature of Official Granting Permit Title
This permit must be conspicuously posted upon the premises 4
/660 OS zV) /I ^e .lit7�c h
Engineer and
Architect
Specifications
TO
FUSIBLE
LINKS
28 125
TO DISCHARGE
PIPING
TO REMOTE MANUAL
PULL STATION
13.125
(FRONT)
TO GAS VALVE
SHUT-OFF
• OPTIONAL
MINIATURE
SWITCH
CONNECTION
TO GAS
SHUT-OFF
004062
OQ
10.625
(SIDE)
General
The Kitchen Knights II Restaurant Kitchen Fire Suppression System is
a pre-engineered solution to appliance and ventilating hood and duct
grease fires. The system is designed to maximize hazard protection,
reliability, and installation efficiency. Automatic or manual system
activation releases a throttle discharge of potassium carbonate
solution on the protected area in the form of fine droplets to suppress
the fire and help prevent reignition after the discharge is complete.
System Operation
The Kitchen KnightTM Restaurant Kitchen Fire Suppression System
has been designed for protecting kitchen hood, plenum, exhaust duct,
grease filters, and cooking appliances (such as fryers, griddles,
rangetops, upright broilers, charbroilers and woks) from grease fires.
The versatile state-of-the-art wet chemical distribution technique,
combined with dual, independent activation capability - automatic
fusible link or manual release — provides efficient, reliable protection
the moment a fire is defected. Once initiated, the pressurized wet
chemical extinguishing agent cylinder discharges a potassium
carbonate solution through a pre-engineered piping network and out
the discharge nozzles. The wet chemical discharge pattern is
maintained for a duration of time to ensure suppression and inhibit
One Stanton Street
Marinette, WI 54193
Kitchen Knight II
et Chemical
s u
Model
No.
A
BCD
Flow
Point
Capacity
Weight
Mounting
Bracket
Used
PCL-300
8.00
25.06
30.81
22.75
10
53 lbs.
MB-15
PCL-460
10.00
25.06
30.81
22.75
15
83 lbs.
MB-15
PCL-600
10.00
35.81
41.56
33.50
20
108 lbs.
MB-1
reignition. Expanded capability provides remote manual actuation, gas
equipment shutdown, and electrical system shutdown. This optional
equipment will enhance the basic system functions and be applicable
when designing custom configurations to suit a particular customer's
needs and/or comply with local codes.
Suggested Architect's Specifications
The fire suppression system should be of the stored pressure, wet
chemical pre-engineered fixed nozzle type manufactured by
Pyro-Chem. A carbon dioxide cartridge is designed in compliance with
Military Specification "MIL-C-601 G", and shall be used as the
pneumatic releasing device for the system. The cartridge shall be an
integral part of the control head assembly. The wet chemical storage
cylinder shall be D.O.T.-rated for stored pressure of 225 psig, and a
pressure gage shall be provided on the cylinder valve for visual
inspection. The system shall be capable of automatic and manual
actuation. Automatic actuation shall be provided by an appropriate
number of fuse link detectors mounted in series on a stainless steel
wire input line to the control head. Manual actuation shall be provided
by turning a handle on the primary head and/or by an optional remote
pull station with a dedicated stainless steel input line to the control
head.
PC2004192..
0��nya „
Install Dale: 8/2.2/10
Bellas Roast Beef
1211 Osgood Si
No
Harry
t31';'27c.::31-8282
Untitled System
Untitled Layout
Duct
16 x16111,
22
r
Gorham Fire App112aluu Cu
288 Wiliz-trii
Quincy, MA 021
Eia!„!
t517 412-5785
IIlLtOII
16 x 16 he.
11,1F
Rttrr,
Install Date: 8/22/16
Belles Roast Beef
1211 Osgood St
No Andover, MA x
Harry
617-791-8282
Notes
Gorham Fire Appliance Co
288 Willard St
Quincy, MA 02169
Bob Gorham
617-472-5785
gorhamfire@hotmail.com
MACC#54
Fusible Links:
=> To determine actual fusible link ratings, temperature readings must be taken during peak cooking time.
Untitled Layout:
Note I > Nozzle: 1H x 2: (I-Tood: Single Bank) nozzle position: 2 in, from back edge of filter, I/3rd down from vertical height, 0-6 in. of end of plenum (or
module), aimed down the length of the plenum.
Note 2 => Nozzle: 2H x 3: (Fryer: 3 vats) nozzle position: 24-48 in., anywhere within perimeter of hazard area, 24-48 in. above cooking surface, aimed at.
center of cooking area
Note 3 => Nozzle: 2H x 2: (Griddle) nozzle position: 24-48 in., 0 to 6 in. from short side of hazard area, 24-48 in. above cooking surface, aimed at center of
hazard area.
I•Z6tc; N6z-47:1c: ZIT 7: 1. (Chsa:: as -oiler) nozzle position: 36-18 in., a-bovs:: any corner of hazard arca, 36-48 in. above the cooking surface and aimed at center
of broiler surface
.Note 5 rr".;. Psnge: 6 burners: Additional nozzle combinations are possible for this range. Please refer to the manual.
Note 6 > -Nozzlo: 2L x 2: (Rang::: 6 burnosa) .1132;;;;.: 31 it in., 34 .1!1 al;;;;:, within
on hazard size. Aimed straight down anywhere within a undefined in. r2dio. r‘f hazard. area ceriter.line. NOTE: when raring high. preximit;
rang. e..t7.^7 Virn71.,,7:17
Fly) 3 of .5
A
The Commonwealth of.MMassachusetts
.Department of IndustrialAecidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation insurance Affidavit: Builders/CtractoIt7.7 ectxiciaxts/Plnmbers.
TO BE FILED WITH T:PER PERMITTING
P,le•seI'rint Le
licant7n#ormation /
Name (Businessioiganizaiion/Individual):
Address:
City/State/Zip:
Axe you an employer? C7;eerthe approp rate box:
I. am a employer with ._employees (full and/or part-time).*
2.0 I am a sole proprietor or partnership and have no employees Working for me in
any capacity. No workers' comp. insurance required.]
3. :II am a homeowner doing aft workmyseli [Ho workers' comp. insurance required] t
4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no emplbyees.
5 ❑I am a general contractor Ihavehired the sub -contractors listed on the attached sheet.
These sub-entractors haandve empIoyees and have workers' comp. insurance #
We are a corporation and iis, of cershave exercised their right of bxemption per MGL G.
152, §1(4), and `we'have no employees. No workers' comp. insurance required.]
affidavit indicating ssreh.
i Homeowners who submittlias afustatt and€d. iiadditional
arenal dosheng all et
teontractors that check this flax must attaclied'an additional sheet showing the name of the sub -contractors and state whether o� not (hose entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
am an employer that is providing -workers' compensation insurance for my employees. below is the policy androb site
Ic Gi1 / CL �
Type of project (required);
7. I I NeiVidOnstrdetion
g. n Remodeling
9. Demolition
10 ❑ Building addition
11. Electrical repairs or additions
1_2. $ :p]imi hig repairs or additions
1.3.. [ Roof repairs
14.1I dthet
* ny applicant that checks 7bVil must also fill out the section bel work ing ndthetheir
ire outside contractors oos must submitn policy ia new affi
'bl
information.
Insurance Company Name: //0
CJ ExpixatioxtDate; j/ t* Policy # ar Self ins. Lic_ #:^T�f�j p44 4
o` City/State/Zip:1 ldf ,� 7
lob Site Address: �-� ��
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
on
e by a fine up to
0.00
Failure to secure coverage as required under 2m 25A is a criminal the form of Op WORD ORDEIZIand a fine of p to $2�0.00 a
and/or one-year imprisonment, as well as civilpenalties
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
1- do hereby certin, under tliepains and penalties ofpedury that the information provided above is True and correct:
Date: I
11
11
Sigiatom:
Phone #: l
Official Ilse only. Do not -write in tins area, to be completed by city or town official.
• Pern it/License #
City or Town: __---------
Jsuing Authority (circle one):
1. Board of Health. 2. Building Pepartment 3. City/Town. Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Phone #:
Contact Person:,
State Fire Marshal
a
Fire
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