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HomeMy WebLinkAboutMiscellaneous - 127 QUAIL RUN LANE 4/30/2018 127 QUAIL RUN LANE 210/060.0-0131-0000.0 ` ' 942 Date...��...?....�0.......... NORTp °ft"`° '•�"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING SSACHUS This certifies that .............. !... ..... °.� ... D................ ;. has permission to perform .......... t wiring in the building of........... ............................... at.......Z. ........... ,North Andover,Mass. f Fee...{5.. .t .... Lic.No. .�?�W. ................ ...� . ...r. ........ Lw,,RiEAL INSPEe%R 1 Check # f Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No.- '?y`/Z„ BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked [Rev. 1/07] (leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL All work to be performed in accordance with the Massachusetts Electrical Code M WORK (PLEASE PRINT IN INK OR TYPE ALL INFOR MTIO ( )�5 7 CMR 12.00 City or Town of: NORTH ANDOVER 2/6 To the Date: By this application the undersigned gives notice of his or her in ntion to erform the el�electrical ector ofees described below. Location(Street&Number) Z Ql Owner or Tenant �G / Telephone No. Owner's Address Is this permit in conjunction with a building ermit? Yes ❑ No Purpose of Building_ (Check Appropriate Bog) 1 ry , � Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Und d �' ❑ No,of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and.Ampacity Location and Nature of Proposed Electrical Work: ��� ✓ Com letion o the ollowin table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total No.of Luminaire Outlets Transformers I1A No.of Hot Tubs c Generators KVA Swimming No.of Luminaires SwiiPAbove ernd• In-d• Battery Units o.o mergency tg g ❑ — 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. Total Tons No.of Alerting Devices FNof Waste Disposers eat Pump Number Tons KVV__ o.of Self-Contained Totals: Detection/Alerting Devices Dishwashers Space/Area Heating KW Local❑ Municipal Connection Other No.of Dryers Heating Appliances KW Security Systems:* No.of WaterNo.of No.of Devices or Equivalent 1 Heaters No.of Data Wiring; signs Ballasts . No.of Devices or E uivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equivalent t 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 Stark 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 cove g e is in force,and has exhibited proof of s e t the rmit issu' o ce. CHECK ONE: INSURANCE 2' BOND ❑ OTHER ❑ (Spec' �J/ � �� 2 I certify, under the pains a Wallies per.0 ,that th orm n ) �(J'� lic* I�/ �0 FIRM N' I� le f �n this applccation is true a d complet LIC.NO Licensee: � kj Signature ((( (If applicable, e r " empt' n he lic ns nu er ine.) LIC.NO.: Address: / Bus.Tel.No.: *Per M.G.L c. 147,s.57-61,security work req es D „ „ Alt.Tel.No.: epar�nent of Pu lic Safety S License: Lic.No. 00 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: S V . Jt1 Dater, :. :.l!. ..... . . Of.NORTH TOWN OF NORTH ANDOVER O F PERMIT FOR GAS INSTALLATION h SACMUSEt� ' This certifies that . . .�n . . ,�. '. /. ��. ! . . . . . . . . . . . has permission for gas installation . . . .lT. , . . . . . . . . . . . . . . . . . . . in the buildings of . . ,��11t.!.<�.' . . . . . . . . . . . . . . . . . . . . . . at . . �,?.?. . . .0 2.,. A. .L . . . . ,, North Andover, Mass. Fee. Lic. No.. . . . . . . . fGAS INSPECTOR Check# / t 4 3 7 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING )0 (Print or Type) �J02TN �f7AJEK , Mass. Date 6 - �f- 003 Permit # 7� Building Location_.. Owners Name_T01J)� hC LL I LLO iJ O i2TH ANJ Dov EK 1'j A Type of Occupancy kCS I060Tl A t, New ❑ Renovation ❑ Replacements Plans'Submitted: Yes[] No ❑ cn N � 5LW N • � N c9 V z OC N a o M N }' a w W a o z X v m �' z n a o a r W M H o w 4 = W H N ° a 0 4 N cc W Z V W N W 4 a O' Q ' W cc X 4 W J Q a ~ f' yW, y 0 > u. N W J N WQ W ? a W Z, 4 a Q m Z O W O 4z C tl x w O 3 c t3 J U a y c a F- o SUB—BSMT. BASEMENT 1ST FLOOR A 2ND FLOOR 3RD FLOOR _ 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR STH FLOOR Installing Company Name BAY STATE GAS COMPANY Check one: Certificate # Address 55 MARSTON STREET �O Corporation 1862 LAWRENCE, MA 01840 ❑ Partnership Business Telephone -68.7-1105 Q Firm/Co. Name of Licensed Plumber or Gas Fitter Francis X. Corkery INSURANCE COVERAGE: I have a currenntt liability InsuranceEl policy or its substantial equivalent which meets the requirements of MGI_Ch. 142_ YesNo If you have checked ve, please indicate the type coverage by checking the appropriate box. A liability insurance y / dY policy f$( Other type of indemn'dy❑ gond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner❑ Agent ❑ hereby certify that all of the details and information I have submitted(or entered)in abo plication are true and accu%e to the best of my . ,nowledge and that all plumbing work and installations performed under the permit issu f r this applicatron will n mpliance with all >ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Gene Type of Ucense: Plumber Signature of Ucensed Plumber or Gas itle Gasfitter Al 4 5 Master Ucense Number aty/Town Journeyman TPP VED O FIC E VST—ONLY . I• BELOW FOR OFFICE USE. ONLY FINAL INSPECTION SKETCHES PROGRESS INSPECTION i FEE N0. APPLICATION FOR PERMIT TO DO OASFITTING < ' ' NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER LIG NO. PERMIT GRANTED DATE ...�`� GAS INSPECTOR Location h No. Date NORTFj TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ AC MUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # J 18 l / � � Building Inspe_tpf 1 TOWN OF NORTH ANDOVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR.RENOVATF, OR DEMOLISH A ONE OR TWO FAMILY DWELLING il 1$. [CI8)E to - BUE DING PERMIT NUMBER: DATE ISSUED: m SIGNATURE: Building Commissionefflnq.3EW of Buildings Date 3 ?Y P1 SECTION 1-SITE INFORMATION O 1.1 Property Address: 1.2 Assessors Map and Parcel Number: 6 60 IN Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Areas Fronts ft 1.6 BUILDING SETBACKS 00 Front Yard Side Yard Rear Yard Required Provide Required Provided Required Provided 1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public ❑ Private ❑ Zone Outside Flood Zone ❑ Municipal ❑ On Site Disposal System ❑ J SECTION 2-PROPERTY OWNERSHIP/AUTHORIZEDAGENT "'"" it: 1�`'fi!Gt; 1!? r,10 1„ 2.1 Owner of Record Z-7 a d. Name(Print) Address for Service ,nature Telephone 2.2 Owner of Record: 0 Name Print Address for Service: z M Signature Tele hone 90 SECTION 3-CONSTRUCTION SERVICES 3.1 Licensed Construction Supery or: Not Applicable ❑ c t, "t,",f 7 Licensed Construction Supervisor: oklF 0 /� �� ;(� License Number � a c/ qq�� k.. Add ( C , 9 — o y is Y7�ZE s-7�s� Expiration Date � Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name M 17� 4--lr Registration Number r Address Expiration Date Si re Tele hone r r SECTION 4-WORKERS COMPENSATION(NVLG.L. C 152 § 25c(6) 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 buiJ46 permit. Signed affidavit Attached Yes... ...0 No.......0 SECTION 5 Description of Proposed Work check a0 A ucable New Construction 0 Existing Building ❑ Repair(s) X-lAlterations(s) 0 Addition ❑ Accessory Bldg. 0 Demolition 0 Other ❑ Specify Brief Description of Proposed Work: SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant 1. Building ��Z j 0. (a) Building Permit Fee k Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a) x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 - Z 6- "' Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 7T I, as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b O/�WNERJAUTHORIZED AGENT DECLARATION 1, 5� T/ /hl as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are L*ue and accurate,to the best of my knowledge and belief Print Name '� -2 e/_0 5 ignatiie of Owner/Agent Date NO. OF STORIES SIZE rV BASEMENT OR SLAB SIZE OF FLOOR TINIBERS 15 2' 3 SPAN ..� DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION _ THICKNESS SIZE OF FOOTING X MATERIAL OF CHININEY _ IS BUILDING ON SOLID OR FILLED I:AND IS BUII DING CONNECTED TO NATURAL GAS LINE a � ✓>rie �c n2�yu»uueaG� u`, r�aa.;atfiuoe%�s .y .: 1 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR _ - Number: CS 089839 -1 Birthdate: 06/19/1972 ' Expires: 06/19/2008 Tr.no: 89839 Restricted: 00 SCOTT P HOUSE 854 BROADWAY#1 HAVERHILL, MA 01832 Commissioner ✓r'ie Vr a�na�uuecze'l� c f, i!{z:;acireeaetl6 - Board of Building Regul.:icns and Standards - HOME IMPROVEMENT CONTRACTOR Registration: 129774 Expiration: 11/2/2005 Type: Supplement Card PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. HAVERHILL, MA 01832 � � Administrator \� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations >� ,f,� 600 Washington Street Boston MA 02111 Workers' Compensation Insurance Affidavit Ap licant Infoimation: Property Owner Name: Job Location: 12 -7 City: Z/t A., l Phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity. am.an•:: :• employer providing work:>r>: •s•• ' compensation on f•o••r•• - :Y: employees Y s workt' rg on this job. Company Name: Address: S I O►'t City: {-- �r�1,tl' Phone# 26 Insurance Co."I l a,4--; 4 6ro UP Policy# 02-W B KL yZ 613 1 am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: Company Name: Address: City: Phone# Insurance Co. Policy# Na:.:. Company me. Address: City: Phone# Insurance Co. Policy# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition 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 hereby certify under the pains and enalties of perjury that the information provided above is true and correct. Signature 11 nn A Date Print Name —7t--+4 � lIV f C i 14 LQ ✓l Ol W 1 Phone# 9 Y'Z 6•S^`�Z5 Official use only. Do not write in this area,to be completed by city or town official ❑Building Department City or Town: Permit/license# ❑Licensing Board 11 Selectmen's Office ElCheck if immediate rrcnonse is required ❑Health Department Contact person: _ Phone#: 13Other C C N0RTH '9 Town of _ Andover 0 100 �? y •�?oo S• o A o dover, Mass., COCMICMEWICK �7S RATED pPa��y 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT , ' BUILDING INSPECTOR ... .......................... ............... ..... ... �'�•.�t..o..l .�..... Foundation has permission to erect. �. .e'. 4... buildings on lo? . R0...!�......P. Rough ..... ... ... ........ .......... t0 be Occupied 8s....... .......4.t~. ` , ��.9 r Chimney ...... ...........qt.............. ........................................................................... y provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relatin o the Inspection, Alteration and Construction of Buildings in the Town of North Andover. & O ;3, PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR F Rough ............................... ... . .......................... ................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. <, k4e-r HIC Registration#129774 Federal ID#04-3277886 Pella Windows & Doors Pella Windows & Doors of Boston 45 Fondi Road "Viewed to be the Best" Haverhill, MA 01832 PH: (800) 866-9886 Service: Ext. 124 Fax: (978) 373-7274 DOOR CONTRACT Sales: (866) Pella06 Sold To:,.Lr'"/'(' fly' <l r1z2r Date: Address: IQ/, Cit :_ /Li�!�l�%s�r Phone (Home) ) y St te:�_ Zip: Phone (Work) ( i f - Job site Address (If different):_ Phone (Cell) ( ) Approx. Start Date: f'r y;�,�..lc� Approx. Completion Date: -0,4ys I] Painted ( u Fella vvrnte or L.J LIfICII vvnne 13 Stained ❑ Natural ❑ Provincial ❑Cherry ❑ Early American ❑Clear Polyurethane ❑ Golden Pecan ❑Golden Oak 24. ❑ Attach Sliding Door or Hinged Door Drawing 25. Clean up and vacuum nightly and remove all debris at completion of job site 26. ❑ Remove and dispose of door in existing opening 27• Q ❑ All workman's compensation and liability insurance maintained 28. © ❑ Warranty mailed to customer upon completip wheDJ"ppayment is received. _ 29. (�'` C1 Total Project Amount$ ��,-& r 30. ❑ Financed If Yes:Amount Financed$ (Reference# ) 31. ® ❑ Deposit Received$ / 74>2 `'� 32. ❑ Balance on Substantial Completion$ �/'7FT rj �'L (Payment is payable to installer at completion of job) 33. ❑ ❑ Additional Comments: �:rJiib «` ,=C:ISi?LS FOR ,ANY EXISTING SECURITY SYSTEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE .ALL HADES.VERTICALS.BLINDS.CURTAINS,DRAPES ANY REPRESENTATIONS OTHERTHAN CONTAINED INTHIS AGREEMENT :"I tOt;1•T��"AIR CONDITICNERS,PRIORTOTHE INSTALLATION AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO I R ARE NOT RESPONSIBLE FORTHE RELIED UPON BY "OWNER".YOU ARE ENTITLED TO A COMPLETc.L',1 _ ? LdSi LL, TIOAJ CF T HESETYPES OF ITEMS. FILLED IN DUPLICATE OF THIS AGREEMENT. -C-70FINAL 1"JSPECTION BY PELLA CONSTRUCTION DEPARTMENT. `IDI T:OiJS T:iAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document.Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OR CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID BY SIGNING BELOW,YOU ARE ACKNIDWLEDGINGTH9h1HE ABOVE SPECIFICATIONS FOR THE PELLA PRODUCTS YOU ARE ORDERING ARE CORRECT Peila Rep. Signature: c �/f'( E (✓�' � Jj Date: i Ju to er 5iananne�lA Nr�: � Date: /hite-Criainal Yellow-Customer Pink-Store HIC Registration#129774 Federal ID#04-3277886 Pella Windows & Doors of Boston Pella Windows & Doors 45 Fondi Road "Viewed to be the Best" Haverhill, MA 01832 PH: (800) 866-9886 I Service: Ext. 124 ax: (978) 373-7274 DOOR CONTRACT Sales: (866) Pe la06 � / Sold To: Qtr%fsey ,����yl'd�' 1��' /�it�i� �'EJ�r�i) ��<1Date: Address: 427 ( 141-� kl Phone (Home) City: j- ��i�'�li't St (e:�_ - Zi P: Phone (Work) Job site Address (If different): Phone (Cell) Approx. Start Date:.- ) Approx. Completion Date: ❑ Painted ( u retia vvnite or LJ urren canna! �..., Stained ❑ Natural ❑ Provincial ❑Cherry ❑ Early American ❑Clear Polyurethane 11 Golden Pecan 11 Golden Oak 24. ❑ Attach Sliding Door or Hinged Door Drawing 25. ' Clean up and vacuum nightly and remove all debris at completion of job site 26. ❑ Remove and dispose of door in existing opening 27. d Cl All workman's compensation and liability insurance maintained 22. Cl Warranty mailed to customer upon completign wheD.UApl yment is received. 29. (J 171Total Project Amount$ �, F; 30. ❑ Financed If Yes:Amount Financed$ (Reference# ) 31. 1 ❑ Deposit Received$ f 74.12 32. 0 ❑ Balance on Substantial $Completion 5/'7ET P � � `� (Payment is payable to installer at completion of job) 33. ❑ ❑ Additional Comments:1-7 ' =C:lSI LE FOR ANY EXISTING SECURITY SYSTEMS. SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAK_ -::10V+=.;LL�HADES.VERTICALS,BLINDS,CURTAINS,DRAPES ANY REPRESENTATIONS OTHERTHAN CONTAINED INTHIS AGRE0JEi lT Al CONDITIONERS.PRIOR TO THE INSTALLATION AND "OWNER" REPRESENTS THAT NONE HAVE BEEN MADE TO OR _. Y-VS.i.ISTAL! ERS ARE NOT RESPONSIBLE FOR THE RELIED UPON BY "OWNER".YOU ARE ENTITLED TO A COMPLETEL:' TION OF THESE TYPES OF ITEMS. FILLED IN DUPLICATE OFTHIS AGREEMENT. —.,"70 FINAL!NSPECTION BY PELLA CONSTRUCTION DEPARTMENT. T:-lAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document.Your Pella products will be specially made-to-order for you. UNDER NO CIRCUMSTANCES WILL REVISIONS OR CANCELLATION BE POSSIBLE BEYOND THE THIRD BUSINESS DAY AFTER THE CONTRACT HAS BEEN SIGNED AND DEPOSIT PAID. BY SIGNING SELCY'V YOU ARE ACI<NbWLEDGIN THAR H ABOVE SPECIFICATIONS FOR THE PELLA PRODUCTS Y RE ORDERING ARE CORRECT. °eila Rep. Signature: Date: ;ustcmer SicnatIIr6`. Date: = �• Vhite-Original Yellow-Customer Pink-Store