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Building Permit # 8/18/2016
t4ORT . BUILDINa PERMIT ,m �' ��' � TOWN OF NORTH ANDOVER M 0 M APPLICATION FOIA LAN EXAMINA,.19 Permit NO: d. DateeceoVol vedp Date Issued: a • oa r CH41�a� 'I'l T a licant must complete all (terns on this page 7717 `r6r�t' Ifi "NE Watt V&t I % MAP lKK w : 1� ,lH tori hAY TYPE OF IMPROVE ENT PROPOSED ED U E -- Residential Non- Residential __._....-_ _1 New wilding 0 One family l Addition I "I Two or more family Industrial Alteration No. of units: Commercial _..I Repair, replacement C7 Assessory Bldg F Others: -1 Demolition I I Other 777 0 S01061, PLA NS immu Interior Renovation of the 2nd floor Annex building & HVAC upgrades . Identification Please Type or Print Clearly) OWNER: (Name: Watts Water Technologies Phone: 978-689-6067 Address: 815 Chestnut Street 771"?,T777_7777777`� Addre'ttll „,. rnI I f Architect - Isgenuity- Martin J. Batt A - 617-4:1.9-4660 ARCH ITT/E J If EE _Engineer - Dx - Chris curn ings Phone, E _ 978-296-6204 Address: A-321 Summar Street, Suite 401, Boston MA Reg. No. A - 11090 E - 200 Br.ickstone Square, Andover MA E - 32298 FFA'SCHEDULE.,BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEL}ON$125.00 PER S.F. � W Total Project Cost: 680 69 33 FEE:: 8268". 32 Check No.: 71125 Receipt No,: I rs I OTE: Persons contracting reit u a st yred contractors do not have access th u arty fund Signature ofAgen, Ignature et contractor Nick euzzupe ncuzzupe0wiseconstruction.com Plans Submitted ❑ ; Stamped Plans ❑ i TYPE OF SEVMRAGE DIS] illYse I Public Sewer CONSTRUCTION siools ❑ Well 21 East Street i E Winchester,MA 01890 T 781.721.1100 m�sales 11� Private(septic tank,etc. C 781,799,1098 I wiseconstruction.com THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED- PLANNING & DEVELOPMENT ❑ �P� u" COMENTS Illlfltlur "0 —? maces "f-D N, e-5 CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionlsi nature & Date Driveway Permit Located at 384 Osgood Street FIRfDPARTIT Temp Dul> ater on'sle yes° =noy ; � r '" r „T "urr°9r' yi✓t Y �� � .,. �7 r � ,,, : a ,� :' `�1./ °�'.: .�,.3^- n 3 '`r.;y.^„ �r'.r- ',„r s^f,.: /'s a � r �rs'y y.�>y.�r y,,,. � ��; �Yy,..�� � .Y.. �.�� � �:r✓' ,.,a� ����i�ted 9E����;.M;�)r�,y�3Lx� �r�'�'�r -.�r �a Y'�'p� r' j..r3 xv '".. �✓ l r�Y'��� ���r� ��Gr^' .,L �"r f,- r . '� x x ;,r'r" �,' „y�s��,yt ✓ � f - /y ,,, ,,..-.r.�'„�q i�'°�`"^" 2 � � -��;%,.,,,>� � �„_ Fire Depar�tif� nt��S��atur�Id�t ;���� � , ., � � � ,� �. X�. ' �.�� �✓ 1 r> +e^,.. -? 1� ✓ r .�,. MEL` �t :a tea?' ..! ''" ,,,, t r afl✓.f a:✓'7�„•y 3 i :c `�.�-'!� ,;a.�„M.?r .Yrc w✓' ,�nh+', ' � _^ sL n � "�,x�a�� v" .✓"ry �� c /` "''"�.f"^,a' - f rz^ � - r rm ra✓: � ... ✓. ;� .,'"5"T, 4 :a s 31 °✓".y �"'✓� � i°,-, r cr✓/„*�'"� .�:"�.``�..G-�".�l-3 �-�- .erd.. ",,T;�,C �u r� r rz r�,� �-�r�- Nom" �� "� ;,� "EV d,;.�� 7' �,�',r�,'> „�„y,W .,�: � NORT1y q Town of o er O �-.- No. i y h ver, Mass, Std' 10 'Q LOCH nlw1C[ 1' S zF U BOARD OF HEALTH d/Kitchen PER F tic System IT LD THIS CERTIFIES THAT �J� L eIPJAN BUILDING INSPECTOR F��ndation has permission to erect .......................... buildings on .,8.14.5....c. .. .. ... ...�....&4"*.,. to be occupied as Zj4d .. Ch,Emney provided that the person accepting this permit shall every respect conform to the terms of the appliclon Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. —HV� y gh PLUMBING INSPECTOR VIOLATION of the Zoningor Building Regulations Voids this Permit. g g Fina[ PERMIT EXPIRES IN 6 MONTHS ELECTRICALINSPECTOR UNLESS CON TI Rough Service Final BUILDING PECLR GAS INSPECTOR - q ilding Rough OccupancyPermit Required to Occupy By Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wail To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. �`� l� �/////�/ �� ���i,%/�f //Di�� %,o// „ "� t L o /i / �1�� ii%!% ' // ,,,,„,,, 4 �� / � ���1 ,�, ;/�;,,. ,� ,,,�,,,, � � j%/1 �� �� ��, �� N� '�� � � ;i �� � � / ��; '� i, �; �,• �, J, i��, �� � �//, � � ��/ y , �� ���i � Oji, ,,,,,/ /�/i�///// i���///�i/ii�//% �///Ja� � �� ti /% �of/� / ////ii/D�/,/�`/ /�/��// /��� /////i/ 'i1 �. � �� ., /// /�//////jriai/%//i /�//�i///i//%/�i�ii��/l” / / � ,,.. ��ii / / / � (���%/ �//// / l% � ///ioii//i//��l// ///i� //; i/� „/�//�, /i /� n � 7'.. ���� � /� i � I �°u �i �v ,, p ����IV�� I � � i ��� � r �� �I t� �� I� � al ,l j/� M ed'x � /, /r„/ yrs ��. %/ ��/�l �, �” ' � r ',� i 1• ti�� i ". '� ' , 1, ,, Q X' �J,%7 i f / � �.i � �, IJ r ��i� �( l;.> s` Page 1 of 1 VI'Alse C,'ONSTRUCTION Client: Watts Water Technologies Project: Annex HVAC Upgrades Location: 815 Chestnut Street - North Andover, MA Date of Estimate: 12-May-16 Plan Date: 22-Apr-16 Estimate#: E16-064 Estitnate Summary CSI # Trade Cost 02100 Demolition $10,550 02500 Sitework $1,748 03300 Concrete $3,800 04500 Masonry NIC 05500 Structural Steel/Misc. Metals $24,570 06000 Rough / Finish Carpentry $51,860 07000 Thermal and Moisture Protection $7,480 08100 Doors, Frames and Hardware $5,165 08800 Glass & Glazing NIC 09250 Drywall $20,490 09500 Acoustical Ceilings $25,500 09650 Flooring $37,900 09900 Painting $5,350 10100 Specialties $8,230 11100 Equipment $2,096 12100 Furnishings $3,042 15300 Fire Protection $30,040 15400 Plumbing $54,810 15500 HVAC $262,116 16000 Electrical $87,190 17000 Tel/Data $38,756 Total $680,6011 Owner 0 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water Technology,Annex—Level I Date: Ajjgusj..2,2016 Property Address: 815 Chestnut Street North Andover,Massachusetts Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: Renovations of approximate 4,000 sg ft to Level 1 includina new_cubical/workstations Layout, a revised layout for the perimeter offices and new ceilings and flooring through the space. 1,Martin J. Batt,MA Registration Number: 11098 Expiration date: 8/31/2016, am a registered design proPs.vional, and I Dave prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports (see item 3,)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. ........... .......... UA Enter in the space to the right a "wet"or J. electronic signature and seal: 410 t1t Phone number: 617-419-4660 OF Email: inbattoa isgenuity.corn Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document w To be submitted with the building permit application by a a Registered Design Professional fol-work per the 8t" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water Technology, Annex—Level 1 Date: July 28, 20.1.6 Property Address: 815 Chestnut Street North Andover Massachusetts Project: Check(x) one or both as applicable: New Construction X Existing Construction Project description: Renovations of approximately 4,000..sq ft to Level 1 includin a new cubical/workstation La out a revised layout.for the perimeter offices and new ceilings and flooring through the space. 1,Christopher J. Cummins MA Registration Number: 32298 -Expiration date: 6130/18, am a registered design professional, and that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project [ ] Architectural [ ] Structural [ ] HVAC [X] Fire Suppression—NFPA 13 [ ] Electrical [ ] Fire Alarm -NFPA 72 j ] Plumbing for the above named project and that,to the best of my knowledge, information and belief, such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that 1(or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care and be present on the construction site on a periodic basis to: I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17. (not applicable) 3. Be present at intervals appropriate to the stage of construction to become gencrally familiar with the progress and quality of the work and to determine if the wot-k is being performed in a manner consistent with the approved construction documents and this code. The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. Nothing in this document relieves the Contractor of its responsibilities regarding the provisions of 780 CMR 17. When required by the building official, I shall submit field/progress reports(see item 3.)together with pet inent comments, in a form acceptable to the building official. u B Upon completion of the work, I shall submit to,#wa*id_1 z�i4 official a `Final Construction Control Document'. OF r�-1qS Enter in the "wet" space to the right a p g or electronic signature and seal: C' MECHaNicrL Cad` Phone number: 978-296-6204 % ��L Email: ccumtnings@rdkengineers.cotn Building Official Use Only Building Official Nance: Permit No.: Date: Initial Construction Control Document N To be submitted with the building permit application by a Registered Design Professional for work per the 8'h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water Technology,Annex—Level 1 Date: July 28, 2016 Property Address: 815 Chestnut Street North Andover Massachusetts Project: Check(x) one or both as applicable: New Construction X Existing Construction Project description: Renovations of approximately 4,000 sq ft to level I including a new cubical/workstation Layout,a revised la out for the perimeter offices and new ceilings and flooring through the s ace. I, Christopher J. Cummings, MA Registration Number: 32298 -Expiration date: 6130118, am a registered design professional, and that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Entire Project [ ] Architectural [ ] Structural [X] HVAC [ ] Fire Suppression---NFPA 13 [ ] Electrical [ ] Fire Alarm -NFPA 72 [ ] Plumbing for the above named project and that,to the best of my knowledge, information and belief, such plans,computations and spccifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care and be present on the construction site on a periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17. (not applicable) 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures, and for construction safety. Nothing in this document relieves the Contractor of its responsibilities regarding the provisions of 780 CMR 17. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to[40- ifi1diggfficial a `Final Construction Control Document'. --��A 0 F'1,74 "wet" CHF�IiT'OPHE R J (0, „ Enter in the space to the right a wet CUM MIN G, U or electronic signature and seal: MEE ANtcA_ No.'12298 Ss, Phone number: 978-296-6204 F ~,� Email: ccummingardkengincers.com Building Official Use Only Building Official Name: Permit No.: Date: Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8t" edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water Technology,Annex—Level 1 Date: July 28, 2016 Property Address: 815 Chestnut Street North Andover,..Massachusetts Project: Check(x) one or both as applicable: New Construction X Existing Construction Project description: Renovations of approximately 4,000 sq ft to Level 1 including a new cubical/workstation Layout, a revised layout for the perimeter offices and new ceilings and flooring through the space. I, Christopher J. Cummings,MA Registration Number: 32298 -Expiration date: 6/30/18,am a registered design professional, and that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project [ ] Architectural [ ] Structural [ ] HVAC [ ] Fire Suppression_.NFPA 13 [ ] Electrical [ ] Fire Alarm -NFPA 72 [X] Plumbing for the above named project and that,to the best of my knowledge, information and belief, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care and be present on the construction site on a periodic basis to: I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17. (not applicable) 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code.The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures,and for construction safety. Nothing in this document relieves the Contractor of its responsibilities regarding the provisions of 780 CMR 17. When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to$wbAdi► official a `Final Construction Control Document'. Enter in the space to the right a"wet" HHlsTOPHER J. : CiUMMINGS r1 or electronic signature and seal: ` MECHANICAL N 32293 A} _ 34 e Phone number: 978-296-6204 p ,r, Email: ccummings@rdkengincers.com Building Official Use Only Building Official Name: Permit No,: Date: Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8"' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water TechnQloW — Annex—Level 1 Date: July 28, 2016 Property Address: 815 Chestnut Street,North Andover Massachusetts Project: Check(x)one or both as applicable: New Construction X Existing Construction Project description: Renovations of approximately 4 00 sq ft to Level I including a new cubical/workstation L,avout,a revised layout for the perimeter offices and new ceilings and floorin through the space. 1,Qtlbcrt Martin, r.,MA Registration Number: 333 53 Expiration date: .6/30/18 am a i-egistered(levignpi-ofc,,s,violial, and that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ] Entire Project Architectural Structural HVAC Fire Suppression—NFPA 13 [X] Electrical Fire Alarm -NFPA 72 ] Plumbing for the above named project and that,to the best of my knowledge, information and belief, such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I (or my designee)shall perform the necessary professional set-vices in accordance with the Professional Standard of Care and be present on the construction site on a periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17. (not applicable) 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures,and for construction safety. Nothing in this document relieves the Contractor of its responsibilities regarding the provisions of 780 CMR 17. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. OF—' Enter in the space to the right a"wet" CKRERT E or electronic signature and seal: MARTIN,JR, 0 ELECTRICAL No 33353 Phone number: 978-296-6247 Email: gLnprtiqCa),rdken&incers.com aril cial Use Only , Building Official Name: Permit No.: Date: Initial Construction Control Document W To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the SMOuew Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Watts Water Technology, Annex—Level I Date: July 28,201 Property Address: 815 Chestnut Street,North Andover, Massachusetts Project: Check(x)one or both as applicable: New Construction X.Existing Construction Project description: Renovations of .Level I including a new cubical/workstation Layout,.A revised layout for the perimeter offices and new ceilings and flooring through the space. 1, Gilbert Martin,Jr., MA Registration Number:33353 -Expiration date: 6/30/18, am a registered design professional, and that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: ] Entire Project Architectural Structural HVAC Fire Suppression—NFPA 13 ] Electrical [X] Fire Alarm -NFPA 72 ] Plumbing for the above named project and that,to the best of my knowledge, information and belief, such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services in accordance with the Professional Standard of Care and be present on the construction site on a periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Pet-form the duties for registered design professionals in 780 CMR Chapter 17. (not applicable) 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code.The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures, and for construction safety. Nothing in this document relieves the Contractor of its responsibilities regarding the provisions of 780 CMR 17. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a 'Final Construction Control Document'. Enter in the space to the right a"wet" N or electronic signature and sea]: ARTIN,jp, N 3 A- Phone number: 978-296-6247 Email:griiartiiif)r(fkeyigincers.cotn icial Use Only Building Official Name: Permit No.: Date. COMMONWEALTH OF MASSACHUSETTS STATE BUILDING CODE 780 CMR, 8TH EDITION CHAPTER 9 FIRE PROTECTION SYSTEMS NARRATIVE REPORT 780 CMR—901.2.1 PROJECT NAME: Watts Water Technology Annex, Level 1 Renovation ADDRESS: 815 Chestnut Street North Andover, MA RDK PROJECT##: 20160156.00 DATE OF ISSUE: July 29, 2016 Hoery I. NCalNI,'--k5 Andover Amherst Boston Charlotte Durham x.r„ill:e1oq 780 CMR 901.2.1 Fire Protection Systems Narrative Report—July 29,2016 Project Name:Watts Water Technology -Annex, 2nd Floor Renovations RDK Project Number: 20160156.00 As required by 780 CMR§901.2.1, this narrative report is a written description of the proposed fire protection system features to be installed as part of the Watts Water Technology Annex, Level 1 Renovations project located at 815 Chestnut Street in North Andover, Massachusetts. 901.2,1 (1101— BASIS (METHODOLOGY)-OF DESIGN Section 1 - Building Description A. "Use" Group(s)within Scope of Renovation: "B" Business (office). B. Location &Area of Renovation: 4,000 sgft on the First Floor. C. Existing Building Height&Area 1. Height: One (1) stories above grade; one (1) story below grade, 2. Area: —66,500 sqft total. D. Type(s) of Construction: 1. Existing protected non-combustible. E. Hazardous Material Usage and Storage: None in excess of exempt amounts within scope of renovation. F. High-pile Storage (over 12 ft.) of Commodities: None within scope of renovation. G. Site Access Arrangement for Emergency Response Vehicles: Existing features to remain; not affected by scope of renovation. Section 2 -Applicable taws, Requlations &Standards A. Massachusetts State General Laws (MGL), Chapter 148 1. MGL§148, sections as applicable. B. 780 CMR-- Massachusetts State Building Code, Vh Edition (amended IBC-2009) 1. Chapter 9 "Fire Protection Systems" 2, Chapter 34"Existing Structures" C. Existing Building Code of Massachusetts (amended IEBC-2009) 1. Chapter 7 "Alterations—Level 2" 527 CMR— Massachusetts State Fire Prevention Regulations 2. Chapter 10"Fire Prevention, General Provisions" 3. Chapter 12"2014 Massachusetts Electrical Code Amendments" D. 521 CMR—Massachusetts Architectural Access Board Page 1 of 6 1 i 780 CMR 901.2.1 Fire Protection Systems Narrative Report—July 29,2016 Project Name:Watts Water Technology -Annex, 2"d Floor Renovations RDK Project Number: 20160156.00 1. Section 40 "Visual Alarms" E. National Fire Protection Association (NFPA) Standards: 1. NFPA 13 (2013)—Installation of Sprinkler Systems" 2. NFPA 70 (2014) — "National Electric Code" as amended by 527 CMR Chapter 12 "Massachusetts State Electrical Code" NFPA 72 (2010)--"National Fire Alarm Code" F. Federal Regulations (significant requirements thereof to the extent applicable to RDK scope) 1. 28 CFR Part 36, ADA Standards for Accessible Design 2. 29 CFR Part 1910, Occupational Safety& Health Standards G. Documented Local Ordinances (Voluntary Compliance) 1. local bylaws and ordinances Section 3 - Design Responsibility for Fire Protection Systems A. Engineer of Record: RDK Engineers (RDK) has engineered and specified the fire protection systems to be installed. For each fire protection system designed by RDK, RDK shall review the installing contractor's Tier If shop drawings for conformance to the approved construction documents and be present at the site at intervals appropriate to become generally familiar with the progress and quality of work and to determine if the work is being performed in manner consistent with the construction documents and 780 CMR. RDK shall certify each fire protection system installation to the extent required by 780 CMR§901.5.1(1). B. Architect of Record: Isgenuity LLC has designed and specified the architectural features to be constructed, including means of egress, fire resistance construction and interior finish. Isgenuity LLC shall review the installing contractor's Tier II shop drawings for conformance to the approved construction documents and be present at the site at intervals appropriate to become generally familiar with the progress and quality of work and to determine if the work its being performed in manner consistent with the construction documents and 780 CMR. Section 4 -Fire Protection Systems to be Installed A. Fire Mains& Hydrants: Existing features to remain; not affected by scope of renovation. B. Automatic Sprinkler System: Existing sprinkler system service equipment, pumps, zoning, mains, alarm devices, etc. to remain and are not affected by the scope of renovation. 1. Existing wet-pipe fire sprinkler system to be modified to accommodate new partition layout. Modifications shall predominantly include new return-bend piping to new sprinklers and new branch piping from existing cross-mains. C. Standpipe System: This building is not equipped with.a standpipe system. D. Fire Alarm System: Existing fire alarm system head-end, back-bone, sequence of operation, etc. to remain and are not affected by the scope of renovation. Page 2 of 6 780 CMR 901.2.1 Fire Protection Systems Narrative Report—July 29, 2016 Project Name: Watts Water Technology -Annex, 2nd Floor Renovations RDK Project Number: 20160156.00 1. Existing initiating circuits (SLC or IDC) within scope of renovated area to be modified to accommodate new or relocated initiating devices. New circuits may be added as dictated by the capacity of the existing circuits as determined by the installing contractor; the style and class of new circuits shall match that of the existing system. The following types of initiating devices shall be added: a. Smoke detector; common area, electrical closet, etc. b. Manual pull box 2. Existing notification appliance circuits (NAC) within scope of renovated area to be modified to accommodate new partition layout. New circuits may be added as dictated by the capacity of the existing circuits as determined by the installing contractor; the style and class of new circuits shall match that of the existing system. 3. Audible notification appliances within scope of renovation shall be UL 464 horn type. 4. Visual notification appliances within scope of renovation shall be UL 1971 strobe type and shall flash in a synchronized manner. E. Emergency Power: Existing generation equipment, feeders, transfer switches, panel boards, etc to remain and are not affected by the scope of renovation. 1. Where required, NAC remote power supplies added to support new circuits shall be provided with standby batteries. 2. Means of egress lighting and exit signs within the scope of renovation shall be provided with emergency power supplied from existing "base building" emergency circuits if available or standby batteries local to the fixtures. F. Smoke Control Systems: Existing features to remain; not affected by scope of renovation. G. Commercial Cooking: Not applicable to the proposed renovation. H. Hazardous Materials Monitoring: Not applicable to the proposed renovation. Section 5 -Features Used in the Design Methodology A. Occupant Notification Procedures: Existing occupant notification via the fire alarm system and subsequent building management personnel procedures shall remain and are not affected by the scope of renovation. 1. The existing fire alarm system treats the building as a single evacuation zone. B. Emergency Response Features: Existing features to remain; not affected by scope of renovation. C. Safeguards: Existing fire protection systems shall be maintained throughout the construction as required by the Authority Having Jurisdiction (AHJ). Impairment to existing fire protection systems shall be approved by the AHJ and Owner prior to commencing work. A fire watch shall be provided during impairments to the fire suppression or fire alarm system in accordance with AHJ requirements. D. Future Testing & Maintenance: Modifications performed as part of the scope of renovation shall be warranted by the installing contractors for a period of one year covering defects in materials and workmanship. NFPA required inspection, maintenance and testing activities associated with Page 3 of 6 780 CMR 901.2.1 Fire Protection Systems Narrative Report—July 29, 2016 Project Name:Watts Water Technology -Annex, 2"d Floor Renovations RDK Project Number: 20160156.00 the building fire protection system are the responsibility of the owner and are to be conducted under existing and/or future maintenance contracts held by the Building Management Company. Section 6 -Special Consideration and Description A. Unless otherwise noted, the design of the fire protection systems does not utilize alternative compliance design methods and is not intended to deviate from the prescriptive requirements of 780 CMR or other applicable codes and standards. 901.2.1 MOO - SEQUENCE OF OPERATION A. The existing "base building" coordinated fire protection system basis of design and sequence of operation shall remain unchanged and shall not be modified under the scope of renovation. The general arrangement of the existing sequence of operation is described below and is subject to confirmation by the installing contractor and fire alarm system control unit technical representative. B. Activation of an existing or new manual pull station, smoke detector, heat detector or sprinkler system waterflow switch shall initiate the predefined fire alarm system "alarm condition" sequence: 1. Display alarm condition at fire alarm control unit and remote annunciator(s). 2. Energize audible (temporal-3 pattern) and visual (UL 1971 synchronized strobe) occupant notification circuits within evacuation zone(s)as designated by pre-established control unit sequence of operations. 3. Perform auxiliary fire safety functions as designated by pre-established control unit sequence of operations such as elevator recall, damper activation, door closure, AHU shutdown, pressurization systems, etc. 4. Transmit alarm condition to central / supervising station and/or local fire department via municipal alarm system. 5. In addition, the operation of an existing in-duct smoke detector shall initiate the following: a. Operation of an existing or new in-duct smoke detector provided at air handling units (AHU's) shall shut-down the corresponding AHU. b. Operation of an existing or new in-duct smoke detector provided for control of a smoke damper shall close the corresponding damper, C. The operation of an existing sprinkler tamper switch shall initiate the predefined fire alarm system "supervisory"sequence: 1. Display supervisory condition at fire alarm control unit and remote annunciator(s). 2. Transmit supervisory condition to central/remote supervising station. D. Normal power failure to fire alarm system remote power supplies, ground faults, short circuits and open circuit conditions shall initiate the predefined fire alarm system "trouble" sequence. 1. Display supervisory condition at fire alarm control unit and remote annunciator(s). 2. Transmit trouble condition to central /supervising station. 901.2.1 (1)(M) - TESTING CRITERIA Page 4 of 6 780 CMR 901.2.1 Fire Protection Systems Narrative Report—July 29,2016 Project Name:Watts Water Technology -Annex,2nd Floor Renovations RDK Project Number: 20160156.00 Section 1 -Testing Criteria A. Fire Protection System testing shall be scheduled, administered, conducted and overseen by the general contractor, subcontractors and manufacturer's technical representatives. 13. The following fire sprinkler system inspections and testing shall be performed: 1. Visually inspect system installation for completeness, presence of defects or damage, and confirm system is placed into"all normal" operational service. 2. Hydrostatically test system piping for a period of 2-hours. Piping shall be tested to normal system operating pressure where new installed piping cannot be isolated from the existing piping, 3. Functionally operate any new sprinkler waterflow or valve supervisory switches as part the fire alarm testing. C. The following fire alarm system inspections and testing shall be performed: 1. Confirm integrity of new or modified circuits (free of grounds, shorts, opens) prior to the installation of devices, appliances or equipment. 2. Visually inspect system installation for completeness, presence of defects or damage, and confirm system is placed into"all normal" operational service. 3. Confirm correct system supervision of wiring faults, missing devices and status of normal and standby power supplies(for new equipment installed as part of the work). 4. Functionally operate new devices installed as part of the work and confirm correct sequence of operation and address/zone identification at the fire alarm control unit. 5. Confirm audibility 1 intelligibility and visual synchronization of notification appliances. 6. Where fire alarm control unit software is updated as part of the work, functionally operate 10% of existing devices not affected by the work and confirm correct sequence of operation and address/zone identification at the fire alarm control unit. 7. Confirm correct operation of circuits under fault conditions in accordance with installed circuit style and class. D. Documentation, to be submitted to the Engineer of Record and AHJ: 1. Sprinkler System: NFPA 13 "Contractor's Material and Test Certificate", accurately completed and endorsed by installing contractor's signature. 2. Fire Alarm System: NFPA 72 "Fire Alarm System Record of Completion", accurately completed and endorsed by installing contractor's signature. E. Upon completion of the work, and receipt of the appropriate close-out documentation, the Engineer of Record shall certify completion for each fire protection system to the extent required by 780 CMR§901.5.1 F. The general contractor shall then schedule final acceptance demonstration testing with the AHJ in order to obtain approval for a Certificate of Occupancy. Page 5 of 6 780 CMR 901.2.1 Fire Protection Systems Narrative Report--July 29, 2016 Project Name:Watts Water Technology -Annex, 2111 Floor Renovations RDK Project Number: 20160156.00 Section 2 - Equipment and Tools A. The contractor shall provide all required tools and equipment necessary to perform full functional testing as outlined. As a minimum these items shall include: 1. NFPA Forms 2. Manufacturer's Instructions 3. Fire Protection Systems Narrative Report 4. UL smoke candies or aerosol spray 5. Sound meters 6. Voltage Meters 7, Gauges 8. Communication Radios 9. Printer or data transfer device for recording each FACP event Section 3 -Approval Re uirements A. The contractor shall obtain written acceptance of the installed system from the AHJ prior to the owner request for a Certificate of Occupancy. B. The contractor shall replace and/or repair each system or component of a system that fails to pass the Final Acceptance Test satisfactorily. Preliminary and Final Testing shall be rescheduled and testing shall be conducted until compliance is fully demonstrated. The contractor shall be liable for all additional charges as a result of retesting. C. Final certification shall be provided from the contractors that the installation is in accordance with the approved construction documents and applicable codes. The Engineer shall certify that the installation complies with the approved construction documents per 780 CMR 941.5.1. D. Operations Manuals and Record as-built drawings shall be submitted with any modifications as a resultant of changes that were dictated from the Final Testing process. E. The Owner shall provide an emergency contact list for use by the AHJ in the event of an emergency at the protected property. END OF NARRATIVE Page 6 of 6 COMcheck Software Version 4.0.0 Interior Lighting Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: WATTS WATER TECHNOLOGIES-ANNEX Project Type: Alteration Construction Site: Owner/Agent: Designer/Contractor: ANDOVER, MA RDK ENGINEERS 200 BRICKSTONE SQ ANDOVER, MA 01.81.0 Allowed Interior Lighting Power A B C D Area Category Floor Area Allowed Allowed Watts (ft2) Watts 1 ft2 (B X C) 1-Common Space Types:Office-Open plan 2578 1 2578 2-Gammon Space Types:Office-Enclosed 719 1 .10 791 3-Common Space Types:Restroom 183 1 183 4-Common Space Types:Conference/Meeting 1 Multipurpose 235 1 _19 282 5-Common Space Types:Corridor I Transition 60 0.70 42 6-kitchenette(Common Space Types:Eood preparation) 94 1 ,19 113 7-TELE DATA CLOSET(Common Space Types:Electrical/mechanical) 19 1 .10 21 Total Allowed Watts= 4010 Proposed Interior Lighting Power A B C D E Fixture ID : Description/Lamp 1 Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Common Space Types:Office-Open plan(2578 sa.ft.) LED 1:LT1:2X2 RECESSED LED:Other: 1 42 50 2100 Common Space T ffi e- Enclosed 718 LED 2:LTi:2X2 RECESSED LED:Other: 1 10 50 500 Q.ommon Space Types:Resfroom (183 sq.ft.) LED 3:LT1:2X2 RECESSED LED:Other: 1 4 50 200 Common Space T es:Co fe Meeting/Multipurpose 235 .ft LED 4:LTi:2X2 RECESSED LED:Other: 1 4 50 200 Common 5 apace Types:Corridor/Transition (60 sa.ft.l LLD 5:LTI:2X2 RECESSED LED:Other: 1 2 50 100 kitchenette T es:F o e r i n 4 .f. LED 6:LT1:2X2 RECESSED LED:Other: 1 2 50 100 TELE DATA CLOSET(Comm-on Space_Types:Electrical/mechanical 19 sq.ft.) LED 7:LT4:1 X4 LED STRIP:Other: 1 1 28 28 Total Proposed Watts= 3228 Project Title: WATTS WATER TECHNOLOGIES -ANNEX Report date: 04/14/16 Data filename: Q:12016120160156-WWT Annex 2nd Floor Renovations10600 Electrical Design1603 Page 1 of 7 Lighting120160156.0 WATTS ANNEX COM CHECK.cck Interior Lighting Compliance Statement Compliance Statement: The proposed interior lighting alteration project represented in this document is consistent with the building plans,specifications, and other calculations submitted with this permit application.The proposed interior lighting systems have been designed to meet the 2012 IECC requirements in COMcheck Version 4.0.0 and to comply with the mandatory requirements listed in the Inspection Checklist. Name-Title Signature t l Project Title: WATTS WATER TECHNOLOGIES-ANNEX Report date: 04/14/16 Data filename: Q:\2016\20160156-WWT Annex 2nd Floor Renovations\0600 Electrical Design\603 Page 2 of 7 Lighting\20160156.0 WATTS ANNEX COM CHECK.cck COMcheck Software Version 4.0.0 Inspection Checklist Energy Code; 2012 IECC Requirements: 94.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. 2012 11CC Plan Review Complies? Comments/Assumptions C103.2 ;Plans, specifications,and/or ❑Complies Requirement will be met. [PR4]1 calculations provide all information ❑Does Not with which compliance can be determined for the interior lighting ❑Not Observable and electrical systems and equipment ❑Not Applicable and document where exceptions to :the standard are claimed. Information :provided should include interior ;lighting power calculations,wattage of :bulbs and ballasts,transformers and control devices, Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: WATTS WATER TECHNOLOGIES-ANNEX Report date: 04/14/16 Data filename: Q:12016120160156-WWT Annex 2nd Floor Renovation s10600 Electrical Design1603 Page 3 of 7 Lighting120160156.0 WATTS ANNEX COM CHECK.cck 2012 IECC Rough-In Electrical.Inspection Complies? Comments/Assumptions C405.2.2.` Automatic controls to shut off all ❑Complies :Requirement will be met. 1 ` building lighting installed in all ❑Does Not [EL22]2 . buildings. ❑Not Observable ❑Not Applicable ----_-----_ __ _--.-._..__ . ..._._...................a.................._...,.,......._._... ......,..,............ C405.2.1. Independent lighting controls installed ❑Complies Requirement will be met. 1 per approved lighting plans and all ❑Does Not [EL23]2. :'. manual controls readily accessible and:❑Not Observable; ;visible to occupants. ❑Not Applicable _ C405.2.1. Lighting controls installed to uniformly.❑Complies Requirement will be met. — 2 reduce the lighting load by at least ❑Does Not [EL15]1 50%. :[]Not Observable'. ❑Not Applicable C405.2.2. '.Daylight zones provided with ❑Complies Requirement will be met. 3 individual controls that control the E]Does Not [EL16]2 lights independent of general area `❑Not Observable lighting. ❑Not Applicable C405.2.3 :Sleeping units have at least one ❑Complies—'Exception: Requirement does not apply. [EL17]3 master switch at the main entry door ❑Does Not :that controls wired luminaires and switched receptacles. ❑Not Observable ❑Not Applicable C405.2.2. :Occupancy sensors installed in ❑Complies Requirement will be met. 2 required spaces. ❑Does Not [EL-1811 ❑Not Observable' ❑Not Applicable _ 0405,2.2, :Primary sidelighted areas are ❑Complies Exception: Requirement does not apply. 3 equipped with required lighting ❑Does Not [EL20]1 controls, ❑Not Observable', ❑Not Applicable C405.2.2. :Enclosed spaces with daylight area ❑Complies Exception: Requirement does not apply, 3 under skylights and rooftop monitors ❑Does Not [EL21]1 are equipped with required lighting controls. ❑Not Observable ❑Not Applicable C405.2.3 Separate lighting control devices for ❑Complies :Requirement will be met. [EL4]1 ;specific uses installed per approved ❑Does Not lighting plans. ❑Not Observable []Not Applicable _ 0405.3 Fluorescent luminaires with odd ❑Complies sException, Requirement does not apply. [EL19]3 numbered lamp configurations that ❑Does Not are with 10 feet center to center(if recess mounted)or are within 1 foot ;❑Nat Observable edge to edge (if pendant or surface '❑Not Applicable mounted)shall be tandem wired, C405.4 'Exit signs do not exceed 5 watts per ❑Complies Requirement will be met. [EL611 face. ❑Does Not []Not Observable' ❑Not Applicable 0405.2.3 Additional interior lighting power ❑Complies Requirement will be met. [EI-811 allowed for special functions per the ❑Does Not approved lighting plans and is ❑Not Observable .automatically controlled and 'separated from general lighting. ❑Not Applicable Additional Comments/Assumptions: 1 E High Impact(Tier 1) 2 jMedium Impact(Tier 2) 3 'Low Impact(Tier 3) Project Title: WATTS WATER TECHNOLOGIES-ANNEX Report date: 04/14/16 Data filename: (?:12016120160156-WWT Annex 2nd Floor Renovations10600 Electrical Design1603 Page 4 of 7 Lighting120160156.0 WATTS ANNEX COM CHECK.cck 2012 IFCC .....-._ _�. Final,inspection Complies? Comments/Assumptions ...._._ ..,..,._ ..-....... ._....... ----_-.. ---- C406 2.5. :'Furnished as-built drawings for ❑Complies Requirement will be met, 1 electric power systems within 30 days 171 Does Not [F11613 of system acceptance. ,-]Not Observable' ❑Not Applicable C303.3,C4Furnished O&M instructions for ❑Complies Requirement will be met. 08.2.5.2 'systems and equipment to the ❑Does Not [F11713 -building owner or designated representative. ❑Not Observable ❑Not Applicable _....__..__..._. _ ..... ................................ .......__..._..._......_....__. _.-_.._-._._ C405.5.2 Interior installed lamp and fixture ❑Complies See the Interior Lighting fixture schedule for values. [F11BIl :lighting power is consistent with what ❑Does Not is shown on the approved lighting plans, demonstrating proposed watts ❑Not Observable are less than or equal to allowed ❑Not Applicable watts. C408.3—m;Lighting systems have been tested to ❑Complies Requirement will be mete [F13311 :ensure proper calibration, adjustment, ❑Does Not programming, and operation. []Not Observable: ❑Not Applicable C406 — 7 Efficient HVAC performance, efficient ;❑Complies — [F13411 lighting system, or on-site supply of ❑Does Not renewable energy consistent with :what is shown the approved plans. []Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 1 3 ;Low Impact(Tier 3) Project Title: WATTS WATER TECHNOLOGIES-ANNEX Report date: 04/14/16 Data filename: 4:12016120160156-WWT Annex 2nd Floor Renovations10600 Electrical Design1603 Page 6 of 7 Lighting120160156.0 WATTS ANNEX COM CHECK,cck WISEC-1 OP ID: LO DATE / Y) CERTIFICATE OF LIABILITY INSURANCE 08/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemenk s. PRODUCER CONTACT -NAME:_ DeSanctis Insurance Agcy,Inc. PHONE _ _.._-....... ...._.. FAX _--. ___._. ....._... 100 Unicorn Park Drive Arc No.Ex :781-935.8480 IAIC No), 781-933-5645 Woburn,MA 01801 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# _....._.._.....___�._._.____. _.__. INSURERA:Llberty Mutual Insurance Cos. 23043 INSURED Wise Construction Corp. INSURERB_Associated.Employers _ 11104 21 East St. INSURER C:Nautilus Insurance Company 17370 Winchester, MA 01890-1127 _..... ....__.____ _...._....._. INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR A6151 SUB-A— ..,_.._...... _..__,_ .._. ......._._... POLICY EFF POLICY EXP_.__... _.. ..._.... ...........�___�_ _._._ ��._.._....._...._. LTR TYPE OF INSURANCE INSD WO POLICY NUMBER MWDDIYYYY) (MMIODfYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR TB2Z11261323026 06/27/2016 06/2712017 UAMA"SEs 300,00 X Per Project Agg MED EXP(Any one person) $ _..._._..10,00 _.._..._.._.... .............._...,.__._._w-__ PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ..I JECT 1 LOC PRODUCTS-COMPIOP AGG $ 2,000,00 )( PRO- OTHER: AUTOMOBILE LIABILITY CBINED SINGLE LIMIT $ 1,000000 EOMa accidenta A ANY AUTO AS2Z11261323016 06/27/2016 06/27/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ _.__-_ AUTOS rx AUTOS X HIREDAUTOS AUTOS NON-OWNED (Perac idem) fiAAGEW $ AUTOS Per accident) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE TH7Z11261323036 06/2712016 06127/2017 AGGREGATE $ 10,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS`LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTiVE YIN WCC50050135352016A 06/27/2016 06/27/2017 E,L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? ® N/A 000 (Mandatory in NH) MA E,L.DISEASE-EA EMPLOYEE $ 1,000,000 Ifyes,describe under ............................._,_......___.........._..__...._._,__._.__ DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 C Pollution CPP201858610 06/2712016 06127/2017 Aggregate 3,000,000 Liability OCCurrene 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN REQUIRED BY WRITTEN CONTRACT" RE:Annex Upgrades at 815 Chestnut St.,North Andover,MA.Watts Water Technologies, Inc, is Additional Insured With respects to the GL. CERTIFICATE HOLDER CANCELLATION WATTS-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Watts Water Technologies,Inc. ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 815 Chestnut Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD WISEC-1 OP ID: LO DATE(MM/DD/YYYY) CERTIFICATE F LIABILITY INSURANCE 08/03/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT DeSanctis Insurance Agcy,Inc. PHONE _ rAx 100 Unicorn Park Driveare,rio,Ext);781-935 8480 No). 781 933.5645 Woburn,MA 01801 InaIL ADDRESS: INSURE R(SyAFFORDING COVERAGE. INSURER A:Liberty Mutual Insurance Cas. 23043 INSURED Wise Construction Corp. INSURER B:Associated Employers 11104 21 East . INSURER C:Nautilus Insurance Cam an 173 1.70 Winchester, MA 01890-1127 -. _ -_.._ P�� _ . INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. !NSR POLICY EFF POLIO EXP _.._. ..._-. __. _,_,.___ . .._............. LTR TYPE OF INSURANCE D POLICY NUMBER MMlDDIYYW MMIDDlYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMA E E CLAIMS-MADE X occuR TB2Z11261323026 06/2712016 06!27!2017 PREMISES(Ea occurrence)___ _$..__._..._...._......_.__._300,00 X Per Project Agg MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY I A JE� 0 LOC PRODUCTS-COMP/OP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident A X ANY AUTO AS2Z11261323016 06/2712016 06127/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS X X NON-OWNED PROPERTY DAMAGE_..w ._$_w HIRED AUTOS Peraccident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,00 A EXCESS LIAR CLAIMS-MADE TH7Z11261323036 06/27/2016 06/2712017 AGGREGATE $ 10,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATIONX STATUTE ER AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE Y 1 N WCC50050135352016A 06/27/2016 06/27/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? NIA A — ------- (Mandatory in NH) MA E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under ,.,. .._.__.._w.__ ._. DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $ 11000,00 C Pollution CPP201858610 06127/2016 06/2702017 Aggregate 3,000,04 Liability Occurrent 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN REQUIRED BY WRITTEN CONTRACT" Evidence of Coverage. RE:Watts Water Technologies Annex Upgrades,815 Chestnut St., North Andover, MA. CERTIFICATE HOLDER CANCELLATION NORTA-1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St.,Suite 2043 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved.. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD "Ns 1'he Commonwealth of'Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street .Boston, MA 02111 wwminass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (liusitless/Organization/Individual): Wise Construction Address: 21 East Street City/State/Zip: Winchester, MA 01890 Phone #: 781-721-1100 Are you an employer? Check the appropriate box: Type of project(required): 1.El I am a employer with 4. ® I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.E1 I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have S. [J Demolition working for me in any capacity. employees and have workers' [No workers' comp, insurance comp. insurance. # 9. [] Building addition required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.® I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.® Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box Al must also fill out the section below showing their workers'compensation policy information. t Homeowners who subunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer Haat is providing workers'compensation insurance for ney employees. Below is the policy and job site information. Insurance Company Name: DeSantis Policy#or Self-ins. Lic. M WCC500501 5352016AMA Expiration Date: 6/29/17 Job Site Address: 815 Chestnut Street City/state/Zip: North Andover, MA 0184.5 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 WORD 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 DTA for insurance coverage verification. I do hereby c�erti gad l:epains andpenalties of`peijury that the information provided above is true and correct Si m�• ature: ° Date: 05/20/16 Phone#:781-721-1100 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town Cleric 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 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 permit 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"ail 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 fixture 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 (i.e. a dog license or permit to burn 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. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia i I Maa achn.n n tt.s _.k ���aftn�nien of PII - Ac, Safety Bo nnja�afnl���n°,naxa�annnIg n JWafinnlls and St an��nd'��apd,, i n ucena a�: CS-107883 NICHOLAS CUZZUPE 3 LLOYD ROAIy,�: Tewksbury MA 01876 I�';nn;q�aun aNra.'nen... aa,y nnu �m :nng.>innau° 09/1912017' j l