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HomeMy WebLinkAboutBuilding Permit #698-2017 - 50 HIGH STREET 1/6/2017Permit No#: Date Issued. BUILDING PERMIT ✓ �%t�- TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date I IMPORTANT: Applicant must complete all items on this page LO A. ION so w V C'�� _ � �. y:C_ (PF2T�Y ®WNER PMn 1100 Yjea Str cur 1�k no IM.O `iP/� E -L: Z® -SNI G D�.I TRI T' Him for Di� 0E~�(Mach ne�Shop� I aqetno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition Iteration ❑ One family ❑ Two or more family No. of units: ❑ Industrial §Wommercial 44Repair, replacement ❑ Demolition ❑ Assessory Bldg ❑ Other ❑ Others: tf"� l'�"'y�" E_ Se' -- Wel3` �';�` `° 1 © Ullate TISK% erg I *-��"f'�"�`�'n,."�'r` d'"•�r�.`�'.�y„� ,"1,,"_ `�. IW Pl�oodplain� (® Wetlantls� �...r' f"�•,: �e-4. �.-.i'e�sf �%< �.'jc {.®]IWatershed' Dtst`r` ct�' �' DESC I TIUN OF WUKK I U tit rtKFUKivity: v\ v C f G' CL-- tit -n X;s C AC -0 3 V t13 i I i UP OWNER: Name*-Uo%4\Z Address: - Please Type or Print Clearly Ad(X-6 Vi V+ - N 4 oKZ- rtuA�G r `` L— Supr stirs Const nuc®n (Licensed' �7+3Exp1. ri ARCHITECT/ENGINEER L Phone: 2 1? 1 . t 4Sd a Address: Z 6 0 R6-rtA C- � /QISw.QJrc-y PSS Reg. No. FEE SCHEDULE. BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ . -1 1 a FEE: $ o `i' Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund t innatiirP`nf`Aa'en-jbwier�l STgnatu`re'Of c-RritraCtor'. Plans Submitted ❑ flans Waived.❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE -FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTALSIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed OnU Si nature n � , �� Z 1 COMMENTS CONSERVATION COMMENTS FOU Reviewed on Signature n 1 HEALTH Reviewed on Signature 1 i COMMENTS ' Z,9ning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ice• k,'anning Board Decision: Comments :Conservation Decision: Comments } Water & Sewer Connection/signature � Date � Driveway Permit DPW Town Engineer: Signature: � e=m�•D�'''` ',` . ,•, ••:-y����i,�� �ocatea.� � �4 ooa S�tree� �FIREDEP�ARTMENT - �} T NTT umpster{on;site��, noa�sg Lr cat d at124'MainSfre t t ..�+# a. r. ,+.:.� it uJ �,,'4 �q ''"U '���`. Yz y 1 ,, ( ' t � c 't �+ �� ° t • .` 4 •n .r:. `COMMEIVT�S, _� � �...' ����.�:�� � .�. � d.z,r 1.',•, „� � �,tt� � =4�,, _ �����, �. _�.� ,,..:�:.�.+� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) I ❑ Notified for pickup Call Email I Date Time Contact Name Doe.Building Pennit Revised 2014 Building Department The followings is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Klass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products DTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Li Building PermitApplication o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products ATE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Location v j � No. c1 — U i Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ CheckLA - " Building Inspector / < 0 0 v "11, —I O = CD 0 p 0 CA' Z 0 N. O vs „�,Fg.N C p� 0 0 CL m -« _cn �• �. CD O O --I N= cC '0 m 2 QC. 0 0 -� W C o (D O � Z "0o 0 L Cr- rn �- �o 'b Cl) CD 0 0 N � r (13 Co — 3 Zocre �' O C7 �D 0 0 0, = v, C �' a CD cr N � � CD O CD O -e Q Z 0 W c� O cc oan Ncl). fi S.c ?_ Q 0 N = Cl) o0 CQ cD fi s =r C _ cD 0 (D f N ' Z c � a, Z CD 0 0 — O nom: CD CD CD -0 O n p m o C • N V)n co i C T 77 7 O T LI) fD ;a O T � >' O T �' S .Z7 O 'T O V1 fD T O X, (D ' °— Dia D—' 2 °—' � °—' 3 Oro . a tD 'Y Z r) (D S S 7 m =rO_ d r) \ 7: � r*. N •< r+ ' m m C O 7 C 3 3 Oo m^ W ° Z > v Z D Gl C ° D LA r O m 3 m O O 0 z = 7 0 e ``'E::i4YP8if�' Ivenix 50 High Street North Andover MA , www.ivenix.com Ivenix is a medical device company that provides infusion pumps to hospitals and clinics for the delivery of fluids and medications to patients. 50 High Street will be the primary office space for the company that will support Management, Sales, Marketing, Customer Service, Finance, General Administration, and Research & Development. The company does not manufacture any product on site. All products are manufactured and tested by external vendors. The various "laboratory" spaces designated for the 5th and Vt floor of High Street will be built to support product development of new products and quality control of existing products. There will be no biological or chemically hazardous materials used at the facility. The following is a description of each lab area and its intended use: 5th Floor Flow Lab — The main flow lab is used by engineering and quality teams to develop new products and verify the performance of existing products. The Ivenix infusion pump is designed to accurately deliver fluids to a patient in a typical hospital setting. The pump accuracy and performance is continuously tested 'using sterile water or standard saline. These fluids are measured using highly accurate scales. This space is also used to support product development activities and therefore may contain typical adhesives and household cleaners. EE Lab (Electrical Engineering) —The Ivenix infusion pump is a highly sophisticated electronic device that has a large color touch screen and wireless connectivity. The electrical engineering lab area supports the design,, evaluation, testing, and prototyping of small, mobile electronic devices. This space will be mostly occupied with electronic test equipment including small prototyping soldering stations. QA Lab — The QA lab on the 5th floor is dedicated for final product software testing. This room will be populated with standard desktop computers. Field Support Lab — A dedicated work space for customer service and field support engineers to diagnose issues found in the field. This room will be occupied by Ivenix products and software running on PCs simulating a user environment. Usability Lab - The Ivenix pump is a medical device that could be use by nurses and care givers in several high risk health care settings such as emergency rooms, operating rooms and intensive care units in a hospital. Human factor and user interaction design is critical to avoid common medical errors. This room and its adjacent observation room is set up to simulate a hospital environment so representative users can be observed interacting with the product. This is a simulation environment only. No hazardous materials other than typical cleaning products are used in this setting. . � �_- ter'.. V-7 , , I IV I 152 Floor: Machine shop — The machine shop is used by engineering for prototyping of new product concepts. It is not used in any way for production or finished product manufacturing. It will have basic manual shop tools used intermittently as needed. Typical cleaning products, solvents, lubricants, adhesives will be stored in appropriately controlled cabinets. Set Assembly - The Ivenix pump system utilizes a disposable, sterile component that is used only once for a given patient. This assembly is produced by an external contract manufacturer in very high volumes. This room is designed to support engineering and quality teams working on external manufacturing process development and quality control of existing processes. This is an R&D function only, no product is manufactured on site. Clean room —Any medical device requires validation of cleanliness and sterility. This space is a controlled area for sampling of finished product as well as verify cleanliness of any product that may be returned from the field for failure analysis. Only typical household and healthcare cleaners are used and no special handling is required. PROJECT NUMBER: 15-0718 OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL PROJECT TITLE: West Mill - 50 High St. Ivenix - 5th Floor PROJECT LOCATION: 50 High Street, N. Andover, MA NAME OF BUILDING: West Mill NATURE OF PROJECT: Tenant fit out. IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ' ARCHITECTURAL STRUCTURAL ' MECHANICAL ' FIRE PROTECTION ' ELECTRICAL ' OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar�PG\S IERcolq �a with6the progress and quality of the work and to determine, in general, if the work is being,' o DM performed in a manner consistent with the construction documents. e o Hyl ti� 4 09 m ) PURSUANT TO SECTION 116.2 .2 1 SHALL SUBMIT WEEKLY, A PROGRESS REPOR q o .111 736 10TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INS q F PON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE OF SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. M�$SP aid SIGNATURE SUBSCRIBED AND SWORM TO BEFORE ME THIS �J J DAY OF LBURKINSHAW T a +s+ y Public ' f of Massachusetts NOTARY UBLIC MY COMMISSION EXPIRE I .... Commission Expires March 7, 2019 H 4 Vol C. sem. G 1- JK Contracting LLC 4 High Street, Suite 108 North Andover, MA 01845 617-592-6775 (Kieran) 781-254-2862 (Judy) Bill To: RCG West Mill NA LLC Daviid Steinbergh 17 Ivaloo Street Somerville, MA 02143 Proposal Proposal Date: 12/20/2016 Proposal #: 203-76 Project: 50 High, 5th FI, Iv... Ship To 5th Floor Ivenix North Andover, MA 01845 ,- 1 ..... _. -. .- :,y Description Est. Hours/Oty. ;Dust Containment` Wall Framing Roofrig, Flashing` Thank you for your business. Approved: (Initials) Rate Total 8,908.00 8,908.00 1,000.00 1,000.00 45,000.00 45,000.00 40,000.00 40,000.00 40,000.00 40,000.00 `, 15,000.00 15,000.00 1-25,000.00 125,000 00' 20,000.00 20,000.00 50,000.00 50,000.00 60,000.00 60,000.00 15, 000.00 151,000:00, 100, 000.00 100, 000.00 105,000.00 ` 105,000.00 '. 10,000.0010,000.00 421000.00 ` 42,000.00 66,200.00 66,200.00 6,620.00 6,620.00 SIGNATURE Total $750,728.00 JKCON-1 OP ID: CD ACORO` CERTIFICATE OF LIABILITY INSURANCE `--� D 07/261201TE YY) 07/26/2016 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 DeSanctis Insurance Agcy, Inc. 100 Unicorn Park DriveAIC, Woburn, MA 01801 CONTACT NAME:___________________ PHONE I FAX No, Ex* I (A/C, Nol: EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # N. Andover, MA 01845 INSURER A: Star Insurance Company 012245 t 02/10/2016 INSURED JK Contracting, LLC. INSURER B: Selective Insurance Company 19259 4 High Street Suite 108 North Andover, MA 01845 INSURER C: -- ��gg /�/� ,��A 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� LTR TYPE OF INSURANCE ADDL SUBRi I O WVD — POLICY NUMBER POLICY EFF .I MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY IM CLAS -MADE l XI OCCUR N. Andover, MA 01845 S2205113 i t 02/10/2016 02/10/2017 EACH OCCURRENCE $ 1,000,00 DAMAGE TO RE PREMISES (Ea occurrence $ 100,00 MED EXP (Any one person) $ 10100 ��gg /�/� ,��A _ PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 3,000,00 i i GEN'L AGGREGATE LIMIT APPLIES PER: I X POLICY PRO f I— JCLOC PRODUCTS - COMP/OP AGG $ 3,000,00 OTHER: I I C $ AUTOMOBILE LIABILITY ANY AUTO 4 ( i COMBINED SINGLE LIMIT $ Ea accident B' ODILY•INJURY (Per person) $ ALL OWNED I SCHEDULED AUTOS AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS i i I I BODILY INJURY (Per accident) $ r PROPERTY DAMAGE $ Per accident) $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVEN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) / A IWC0853742 MA 02/17/2016 I 02/17/2017 X PER OTH- STATUTtE ER -] _ E.L. EACH ACCIDENT $ 100,00 — E.L. DISEASE - EA EMPLOYEE $ 100,00 If yes, describe under DESCRIPTIUN OF,OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) "ADDITIONAL INSURED LIMITS ARE NO GREATER THAN THOSE REQUIRED BY WRITTEN CONTRACT" Illustration of Coverage; Town of North Andover is add'I ins'd as respects to the GL policy. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NORTHA- 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. 43 High Street N. Andover, MA 01845 AUTHORIZ PRESENTATIVE ��gg /�/� ,��A ACORD 25 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents - .I Congress Street, Suite 100 Boston, MA. 02114-2017 www mass.gov/dia s�. Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plulnbers. TO BE FILED WITH THE PERMITTING AUTHORITY- Applicant UTHORITY.A licant Information Please Print Legiblj Name'(Business/Organization/Individnal): NTA& C-7 I N -- LZ--' C_ :Su lrs god, 4-)4(6-X City/State/Zip: IV. A 1'1(0 t_ J N_ , K,i9(_X Phone #: G j-k__J-J z -6 "} .s Are you an employer? Check tlie�appropriate box: 1 „Lj'fam a employer with -f.: employees (full and/or part time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.FJ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4. ❑ 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 employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6. Q We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have nq employees. [No workers' comp. insurance required.] Type of project (required): 7. [] New construction 8.'lemodelirig 9. ❑ Demolition 10 (] Building addition 11.❑ Electrical repairs or additions 12. Plumbing repairs or additions 13. [] Roof repairs 14.0 Other clic information. *Any applicant that checks box#1 must also nit out the section oeiow snowing u— wvinoizi wiuNounu ival p y t Homeowners who stibriiit'tkiis affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must -attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. lithe sub -contractors fiave employees, 'they must provide their workers' comp. policy number. ' I am an employer tliat is providing workers' compensation insurance for my employees.' Below is the policy and job site information. Insurance Company Name: S I es, C!1— l L/5' L 0 '� y r Cd M �1 1"t V -- Policy # or Self -ins, Lic. #: �S L Expiration Date- Z,/ —fes Job Site Address: �~ q 1 G K �Cr City/State/Zip: N • 1'yWO d V-- � Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DLA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Phone #: 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other, Contact Person: Phone 4'J 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 -contractors) 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 &-affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-NUSSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -066334 rho Ccnstru. ;i`ioil Supervisor KIERAN T WHELAN 31 RICHMOND STREIA.—! WEYMOUTH MA 02t#I Z + �-J-7 Expiration: Commissioner 09/26/2017 Op2 d1 Cor' . G u,v-^A Ael --t�j fie , ill �.► — -T-J � -VID v w a LL Z Q Z W H X CO v w 9 t/ rn R N L fU a m Z z c a` 0 c a� o� CL O a c 0 0 a` d EL CNH 0 N N N 0 rn 0 U O N a� 0 am �O L O a y m Eo Q =a �+ W �s N iG � Oi N O L � L a A @J i u `x o Ifl O m O o N f/' d a� d� n o, f` eY 0 H C .r, O O Ln C 4 O 10 O rY Q O Q U = O � . O � U p ro Q � C IM a� o� CL O a c 0 0 a` d EL CNH 0 N N N 0 rn 0 U O N a� 0 HYDRAULIC CALCULATIONS for Job Information Project Name: IVENIX -TENANT FIT -UP Contract No.: 290-043 City: NORTH ANDOVER, MASSACHUSETTS 01845 Project Location: 50 HIGH STREET - 5TH FLOOR Date: 1/18/2017 Contractor Information Name of Contractor: A&A FIRE PROTECTION Address: 5 RADDIN TERRACE City: SAUGUS, MA 01906 Phone Number: (781) 520-1718 E-mail: Name of Designer: JFP SOLUTIONS, INC. Authority Having Jurisdiction: NORTH ANDOVER FD Design Remote Area Name 1 Remote Area Location 5TH FLOOR RENOVATED SPACE Occupancy Classification LIGHT HAZARD Density (gpm/ft2) 0.249 Area of Application (ft2) 1125 Coverage per Sprinkler (ft2) 85 Number of Calculated Sprinklers 23 In -Rack Demand (gpm) 0 Special Heads Hose Streams (gpm) 100 Total Water Required (incl. Hose Streams) (gpm) 747.3 Required Pressure at Source (psi) 85.2 Type of System Wet Volume - Entire System (gal) 381.1 gal Water Supply Information Date 2017 Location SYSTEM RISER Source' W1 Notes THIS CALCULATION INCLUDES THE HMD 1 125 SF OF RENOVATED OFFICE AREA File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 Copyright © 2002-2012 Tyco Fire Protection Products Page 2 tt= tt= 00 z� cn '=6 O a` r t5 d O a` loL T F- N N O O N m CL 0 U O N its Job: IVENIX -TENANT FIT -UP Calculation Info Calculation Mode Hydraulic Model Fluid Name Fluid Weight, (Ib/ft3) Fluid Dynamic Viscosity, (Ib-s/ftz) Hydraulic Analysis for: 1 Demand Hazen -Williams Water @ 60F (15.6C) N/A for Hazen -Williams calculation. N/A for Hazen -Williams calculation. Water Supply Parameters Supply 1 : W1 Flow (gpm) Pressure (psi) 0 125 750 105 Hoses Inside. Hose Flow / Standpipe Demand (gpm) Outside Hose Flow (gpm) Additional Outside Hose Flow (gpm) 100 Other (custom defined) Hose Flow (gpm) ----------------------------------------------------------------------------------- Total Hose Flow (gpm) 100 Sprinklers Ovehead Sprinkler Flow (gpm) 647.3 InRack' Sprinkler Flow (gpm) 0 Other (custom defined) Sprinkler Flow (gpm) 0 ----------------------------------------------------------------------------------- Total Sprinkler Flow (gpm) 647.3 Other Required Margin of Safety (psi) 0 W1 - Pressure (psi) 85.2 W1 -Flow (gpm) 647.3 Demand w/o System Pump(s) N/A File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 Copyright 0 2002-2012 Tyco Fire Protection Products Page 4 CL LL H Z Q Z W H X_ Z W O o O 1- r O O O OO O O O O L—fO O o O V f7 N O 0) 00 1,- O u7 Q co N r isd `ainssaad YF 0 L � 0 7 O Z o coa c O O t5 O N O O + a` c ii 0 .0 8 N O a` o N N N qLL O CN Q Qu + L + m O O U Y O Job: IVENIX - TENANT FIT -UP Hydraulic Analysis for: 1 Graph Labels Label Description Pressure (Psi) Values Flow (gpm) Pressure (psi) S1 Supply point #1 -Static 0 125 S2 Supply point #2 - Residual 750 105 D1 Elevation Pressure 0 27.9 D2 Isystern Demand 647.3 85.2 D3 System Demand + Add.Out.Hose 747.3 85.2 Curve Intersections & Safety Margins Curve Name Intersection Safety Margin Pressure (Psi) Flow (gpm) Pressure (Psi) @ Flow (gpm) Supply 104.6 758 19.9 747.3 Open Heads File: D:\+WORK+\+JOBS+\+ABPA Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 ' Copyright © 2002-2012 Tyco Fire Protection Products Page 6 Required Calculated Head Ref. Head Type Coverage K -Factor Density Flow Pressure Density Flow Pressure (ft2) (gpm/pSP/2) (gpm/ft2) (gpm) (psi) (gpm/ft2) (gpm) (psi) S1 Overhead 85 8 0.1 8.5 7 0.284 24.2 9.1 Sprinkler S10 Overhead 85 8 0.1 8.5 7 0.333 28.3 12.5 Sprinkler S11 Overhead 85 8 0.1 8.5 7 0.361 30.7 14.7 Sprinkler S12 Overhead 85 8 0.1 8.5 7 0.324 27.6 11.9 Sprinkler S13 Overhead 85 8 0.1 8.5 7 0.33 28 12.3 Sprinkler S14 Overhead 85 8 0.1 8.5 7 0.366 31.2 15.2 Sprinkler S15 'Overhead 85 8 0.1 8.5 7 0.274 23.3 8.5 Sprinkler S16 Overhead 85 8 0.1 8.5 7 0.249 21.2 7 Sprinkler S17 Overhead Sprinkler 85 8 0.1 8.5 7 0.323 27.5 11.8 S18 Overhead 85 8 0.1 8.5 7 0.354 30.1 14.2 Sprinkler S19 Overhead 85 8 0.1 8.5 7 0.316 26.8 11.2 Sprinkler S2 Overhead Sprinkler 85 8 0.1 8.5 7 0.317 26.9 11.3 S20 Overhead 858 0.1 8.5 7 0.397 33.8 17.8 Sprinkler File: D:\+WORK+\+JOBS+\+ABPA Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 ' Copyright © 2002-2012 Tyco Fire Protection Products Page 6 S21 Overhead Sprinkler 85 8 0.1 8.5 7 0.358 30.4 14.4 822 Overhead Sprinkler 85 8 0.1 8.5 7 0.387 32.9 16.9 S23 Overhead Sprinkler 85 8 0.1 8.5 7 0.429 36.5 20.8 S3 Overhead Sprinkler 85 8 0.1 8.5 7 0.343 29.2 13.3 S4 Overhead Sprinkler 85 8 0.1 8.5 7 0.308 26.2 10.7 S5 Overhead Sprinkler 85 8 0.1 8.5 7 0.311 26.4 10.9 S6 Overhead Sprinkler 85 8 0.1 8.5 7 0.346 29.4 13.5 S7 Overhead Sprinkler 85 8 0.1 8.5 7 0.319 27.1 11.5 S8 Overhead Sprinkler 85 8 0.1 8.5 7 0.287 24.4 9.3 S9 Overhead Sprinkler 85 8 0.1 8.5 7 0.299 25.4 10.1 File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 ' Copyright © 2002-2012 Tyco Fire Protection Products Page 7 Job: IVENIX -TENANT FIT -UP PIPE INFORMATION Hydraulic Calculations Node 1 Elev 1 K -Factor 1 Flow added (q) Nominal ID Fittings L C Factor total (Pt) Node 2 Elev 2 K -Factor 2 Total flow (Q) Actual ID quantity x (name) = length F Pf per ft elev (Pe) NOTES T frict (Pf) S15 (ft) (gpm/psil/2) (gpm) (in) (ft) (ft) (psi) (psi) Path No: 1 S16 65.42 8 21.2 1 10.29 120 7 S15 65.42 8 21.2 1.049 0 0.144 0 10.29 1.5 S15 65.42 8 23.3 1 4.85 120 8.5 S19 65.42 8 44.5 1.049 0 0.5694 0 4.85 2.8 S19 65.42 8 26.8 12x(us.90)=4 4.04 120 11.2 016 65 71.3 1.049 4 1.3649 0.2 8.04 11 016 65 59.2 1.51x(us.Tee-Br)=8 0.42 120 22.4 015 65 130.51 1.61 8 0.5189 0 8.42 4.4 015 65 325.7 2.5 5 120 26.8 021 65 456.2 2.469 0 0.6572 0 5 3.3 021 65 121.8 3 5 120 30.1 007 65 578 3.068 0 0.3536 0 5 1.8 007 65 69.4 3 15 120 31.8 054 65 647.3 3.068 0 0.4362 0 15 6.5 054 65 0 3.5 lx(us.Tee-Br)=17 18.45 120 38.4 090 65 647.3 3.548 17 0.2149 0 35.45 7.6 090 65 0 5 3x(us.90)=36 103.36 120 46 209 8 647.3 5.047 36 0.0386 24.7 139.36 1 5.4 209 8 0 61x(coupling)=1 148.37 120 76.1 211-0 8 647.3 6.065 1 0.0158 0 149.37 2.4 211-0 8 0 6 3.04 0 78.4 AmesC200V 211-I 8 647.3 0 0 1.0091 0 3.04 3.1 211-I 8 0 6 2x(us.90)=28 13.74 120 81.5 W1 1 647.3 6.065 28 0.0158 3 41.73 0.7 W1 85.2 File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 Copyright 0 2002-2012 Tyco Fire Protection Products Page 8 Job: IVENIX -TENANT FIT -UP PIPE INFORMATION Path Noi 2 Hydraulic Calculations S1 65.42 8 24.2 1 12 120 9.1 S2 65.42 8 24.2 1.049 0 0.1839 0 12 2.2 S2 65.42 8 26.9 1 2x(us.90)=4 7.18 120 11.3 003 65 51.1 1.049 4 0.7362 0.2 11.18 8.2 003 65 55.4 1.5lx(us.90)=4 lx(us.Tee-Br)=8 5.42 120 19.7 005 65 106.5 1.61 4 0.3562 0 9.42 3.4 005 65 107.3 2 5 120 23.1 010 65 213.8 2.067 0 0.3837 0 5 1.9 010 65 111.9 2.5 5 120 25 015 65 325.7 2.469 0 0.3522 0 51 1 1.8 015 26.8 Path No: 3 S8 65.42 8 24.4 1 12 120 9.3 S7 65.42 8 24.4 1.049 0 0.1868 0 12 2.2 S7 65.42 8 27.1 1 2x(us.90)=4 7.18 120 11.5 006 65 51.5 1.049 4 0.7474 0.2 11.181 8.4 006 65 55.8 1.5lx(us.Tee-Br)=8 lx(us.Tee-Br)=8 0.42 120 20 005 1 65 107.3 1.61 8 0.3616 0 8.42 3 005 23.1 Path No: 4 S9 65.42 8 25.4 1 12 120 10.1 S10 65.42 8 25.4 1.049 0 0.202 0 12 2.4 S10 65.42 8 28.3 1 2x(us.90)=4 7.18 120 12.5 011 65 53.7 1.049 4 0.8077 0.2 11.181 1 9 011 65 58.2 1.5 lx(us.Tee-Br)=8 0.42 120 21.7 010 65 111.9 1.61 8 0.3907 0 8.42 3.3 010 25 Path No: 5 S4 65.42 8 26.2 1 12 120 10.7 S3 65.42 8 26.2 1.049 0 0.214 0 12 2.6 S3 65.42 8 29.2 1 lx(us.90)=2 4.24 120 13.3 897 65.42 55.4 1.049 2 0.8556 0 6.241 1 5.3 897 1 65.42 0 1.51x(us.Tee-Br)=8 0.59 120 18.6 003 65 55.4 1.61 8 0.1062 0.2 8.59 0.9 003 19.7 File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/1812017 Copyright 6 2002-2012 Tyco Fire Protection Products Page 9 Job: IVENIX - TENANT FIT -UP PIPE INFORMATION Hydraulic Calculations Node 1 Elev 1 K -Factor 1 Flow added (q) Nominal ID Fittings L C Factor total (Pt) Node 2 Elev 2 K -Factor 2 Total flow (Q) Actual ID quantity x (name) = length F Pf per ft elev (Pe) NOTES T frict (Pf) S6 (ft) (gpm/psi/2) (gpm) (in) (ft) (ft) (psi) (psi) Path No: 6 S5 65.42 8 26.4 1 12 120 10.9 S6 65.42 8 26.4 1.049 0 0.2173 0 12 2.6 S6 65.42 8 29.4 11x(us.90)=2 lx(us.90)=2 4.24 120 13.5 009 65.42 55.8 1.049 2 0.8685 0 6.24 1 5.4 009 65.42 0 1.5lx(us.Tee-Br)=8 lx(us.Tee-Br)=8 0.59 120 18.9 006 65 55.8 1.61 8 0.1078 0.2 8.59 0.9 006 20 Path No: 7 S17 65.42 8 27.5 1 10.29 120 11.8 S18 65.42 8 27.5 1.049 0 0.2332 0 10.29 2.4 S18 65.42 8 30.1 12x(us.90)=4 lx(us.90)=2 8.89 120 14.2 022 65 57.6 1.049 4 0.9192 0.2 12.89 11.9 022 65 64.2 1.5 lx(us.Tee-Br)=8 0.42 120 26.2 021 65 121.8 1.61 8 0.4567 0 8.42 3.8 021 30.1 Path -No: 8 S12 65.42 8 27.6 1 12 120 11.9 S11 65.42 8 27.6 1.049 0 0.2348 0 12 2.8 S11 65.42 8 30.7 11x(us.90)=2 lx(us.90)=2 4.24 120 14.7 014 65.42 58.2 1.049 2 0.9381 0 6.24 5.9 014 65.42 0 1.5lx(us.Tee-Br)=8 0.59 120 20.5 011 65 58.2 1.61 8 0.1165 0.2 8.59 1 011 21.7 Path No: 9 S13 65.42 8 28 1 12 120 12.3 S14 65.42 8 28 1.049 0 0.242 0 12 2.9 S14 65.42 8 31.2 1 lx(us.90)=2 4.24 120 15.2 020 65.42 59.2 1.049 2 0.9664 0 6.24 6 020 65.42 0 1.5lx(us.Tee-Br)=8 0.59 120 21.2 016 65 59.2 1.61 8 0.12 0.2 8.59 1 016 22.4 7:J File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 Copyright© 2002-2012 Tyco Fire Protection Products Page 10 • Job: IVENIX -TENANT FIT -UP Path No: 10 PIPE INFORMATION Hydraulic Calculations S21 65.42 8 30.4 1 12 120 14.4 S20 65.42 8 30.4 1.049 0 0.2817 0 12 3.4 S20 65.42 8 33.8 l lx(us.90)=2 4.24 120 17.8 026 65.42 64.2 1.049 2 1.1237 0 6.241 1 7 026 65.42 0 1.5lx(us.Tee-Br)=8 2x(us.Tee-Br)=16 0.59 120 24.8 022 65 64.2 1.61 8 0.1395 0.2 8.59 1.2 022 26.2 Path No: 11 S22 65.42 8 32.9 1 12 120 16.9 S23 65.42 8 32.9 1.049 0 0.3258 0 12 3.9 S23 65.42 8 36.5 11x(us.90)=2 4.24 120 20.8 884 65.42 69.4 1.049 2 1.2981 0 6.241 1 8.1 884 65.42 0 1.5 2x(us.Tee-Br)=16 1.01 120 28.9 007 65 69.4 1.61 16 0.1612 0.2 17.01 2.7 k07731.8 * Pressures are balanced to a high degree of accuracy. Values may vary by 0.1 psi due to display rounding. * Maximum Velocity of 30.57 ft/s occurs in the following pipe(s): (021-015) File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Date 1/18/2017 Copyright O 2002-2012 Tyco Fire Protection Products Page 11 Job: IVENIX - TENANT FIT -UP 140- 130 120- 110 100... 90 20110100- 90 ,y °L 80 y 70- U) 6 60- 50- 40 3,0 20 10 0 10 9 8 7 CL 6 7 W 5 a` 4 3 2 1 Device Graphs Pressure vs. Flow Function Design Area: 1; Supply Ref.: W1; Supply Name:W1 0 0 O O O O O O O C O O O Flow, gpm Pressure Loss Function Design Area: 1; BFP Ref.: 919 (AmesC200V, Size = 6) 1 I _.._.__._._ 1 _......._._.. 3 ._.._.._._,._._ ..__ _ ._.__.......... _ _ .__.......... _._.......... _....._ ._..._..... _.............. 4 S j 3 _ ................... __ E 3.1 psi @ 647.3 gpm � 1 3 0 0 O O O O O O O C O O O Flow, gpm Pressure Loss Function Design Area: 1; BFP Ref.: 919 (AmesC200V, Size = 6) Date 1/18/2017 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Flow, gpm File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Copyright 0 2002-2012 Tyco Fire Protection Products 0 0 0 0 0 0 Page 12 I i j 3 3.1 psi @ 647.3 gpm 1 I Date 1/18/2017 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Flow, gpm File: D:\+WORK+\+JOBS+\+A&A Fire Protection +\290-043 - North Andover\IVENIX.dwg Copyright 0 2002-2012 Tyco Fire Protection Products 0 0 0 0 0 0 Page 12