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Home My WebLink AboutBuilding Permit #Exception - 575 OSGOOD STREET 5/1/2018 (11) BUILDING PERMITof "°RDT/r TOWN OF NORTH ANDOVER o _ APPLICATION FOR,.PLAN,'EXAM INATION =- 1YL Permit No#: D.ate.Receiued �R � .. ,, �SSACHl15E� Date Issued: IMPORTANT:Applicant must complete ali:-'tems;'on.thi' age Ar fPRO�PERTY®WN,ERS _ z F +Pgint? e AOD�YeartStc rid a yeS,:A o. _ x� -T k,RAR IMA _ iHis orr i]rstk,N - �IVIachlne Shy pIa;ge ayes, Brio TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg IT Others: ❑ Demolition ❑ Other — +Weill ❑� — s ❑ Septic p am: !, F -k- .— W 5. IR OR„ 1lUetlantl � tnctF _ '❑kWater/Sewers � �U11a ®i tel- , DESCRIPTION OF WORK TO BE PERFORMED:- . j I Identification- Please Type or Print Clearly ;"",. ., OWNER: Name: --Phone: Address: b �. ._. re- , ame.; h h T. " blC®nstrLctieAm__entlLlicense rEXp — , ARCH ITECT/ENGINEE _ R Phone: . _• Address: FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED-COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE Check No.: Receipt No •:_' NOTE: Persons contracting with unregistered.contractors.—dol—riot.have access to the guaranty fund ni attire,©f A�ent/:�,i�Iner' - - � r Building Department r The following 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 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) j ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of.Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TypF OF SEWEP•.AGE DISPOSAL i Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On '� Signature_ COMMENTS 6 1rlf P14-7u YL V tJtw W1W'C lt_ Altk-Cl-e.d — 5 tTe MJ 1 Ikke P5Jr 11-13-14 CONSERVATION Reviewed on Si nature N"-i'AV'411zA- 4Jr COMMENTS __aL wk / m � IEALTH Reviewed o Si na u �� U 1z COMMENTS r ( C� 'OW4k t-jf'JM Zoning Board of Appeals: variance, Petition No: Zoning Decision/receipt submitted yes t •S Planning Board Decision: Comments r Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street _ El DEP ^LT nE,reet Wim" ®umpster on S _ _ - R MENT LL�ocated a`t„fl 2�` IVIa F`"rye[Departmentats pgnat pe%dates --__ • C'011%IMEN� --- NOR7N 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 ser vice`droptie-4uires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No` MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) 0 Notified for pickup Call Email Date Time Contact Name- , Doc.Building Permit Revised 2014 r - Location No. 7 V '�� Date TOWN OF NORTH ANDOVER s n` Certificate of Occupancy $ Building/Frame Permit Fee $ . 0.0-" Foundation Permit Fee $ rA Other Permit Fee $ TOTAL $ Check# 33? 7d �. 285 ;/ 2 B61(ling Inspector i Joseph A. Cahalane Construction/Design Senior Construction Supervisor LEEDS AP I c- 617.908.1119 cell joec@chap-con.com yes° all Mr �F N x. E s i o L P, — - _ constroction management. P.617.630 8408,Consulting 84 Winchester St. ' f 617 630 8409 education• 'leap con.com 02461-1720 N 1 I'1 I � r I it 1� I if I I i " � NORTH own o.f t Llv,4. Andover iIn No. IL G h ," ver, Mass, J 01 �Q COC"Kt4t WICK S U BOARD OF HEALTH t Food/KitPERMIT T LD chen Septic Sy�;j THIS CERTIFIES THAT ..... � ;.. C �'?`f ..! . : ...:.��.:%�7�N:�........................................................... //`' BUILD NG INSPECTOR h / buildin on '' .� ..................................... Fou;datio has permission to erect ... ......... g ........ .... ....... �.��...5.f£'�c: : � ,. 7 fl.vh'..r r.^.�i -� ,ems- f. I to be occupied as ........-. :.x.:....�: ... :.....fr y..3�.. :-:.F ... ................ ................................... Chimne �� G� ®� at the person accepting this permit shall in every respect conform to the terms of the application Final f lis office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and �n of Buildiffgs'in the Town of North Andover. r � ,'yC JCfr ,/�:. JUMBIN INSPECTO � ugh N 1 of the Zoning or Building Regulations Voids this Permit. Fin ale m 0 E PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR o L UNLESS CONSTRUCTION STARTS Rough / o C-ec � 6- Q Service 5 C3 UJ .�� .� .�� ...�....BUILDING.INSPECTOR. J a, GAS INSPECTOR U o Occupancy Permit Required to Occupy Building Rough t lay in a Conspicuous Place on the Premises — Do Not Remove Final 1. -No Lathing or Dry Wall"To Be Done FIRE DEPARTMENT U Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. -� ^�-��a ��a / eG�� CSS �, �� -� 3 Location CJ No. t �(� Date w l2.(06`� f . - TOWN OF NORTH ANDOVER Certificate of Occupancy $1 t Building/Frame Permit Fee $ Foundation Permit Fee $ TT Other Permit Fee $ A� .TOTAL $ Check it � i, 2 :/' +7 Building Inspector O`NO o7M�N •�,S 1CNUSE449 CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 740-15 on 3/26/2015 Date: October 26, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED at 575 Osgood Street MAY BE OCCUPIED AS an addition per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement Community 575 Osgood Street North Andover, MA 01845 Buildi g Inspector Fee: $100.00 Receipt: 29575 Check : 35897 mss' Tp Location No. ,L/O`/6 Date . - TOWN OF NORTH ANDOVER • S�,'STGEb'7�-y� � Certificate of Occ pan $ � Building/Frame Permit Fee $ Foundation Permit Fee $ rk Other Permit Fee $ C t TOTAL $ o 3. Check-# Building Inspector 2� 33 . w N�pTM h b s SSACHUSE TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from September 11, 2015, Exp October 13, 2015 Building Permit Number 740-15 on 3/26/2015 Date: September 11, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 575 Osgood Street MAY BE OCCUPIED AS Addition per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement 575 Osgood Street North Andover, MA 01845 Buil'ling Insp ctor Fee: $50.00 Receipt: 29338 Check : 75172 `w NORTh own of 2 s E n over ., 0_ i r Pi h ver, Mass1`" COC MIC Kl WICK �q A°tATEC) 0,', �5 S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic Syf '/. THIS CERTIFIES THAT � � � �?y: .. :::: .:??�F�Y: ........................................................... // BUI D NG INSPECTOR .... n ! building on ..i..! ......�!��-�' '( tfoundatio has permission to erect .......................... ..., .................................. !R.ou h-' g to be occupied as .......... .".G: = .! c/C r..c::1.''.. "'� ..,��................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application 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. LIMBINl INSPECTO Rough/ VIOLATION of the Zoning or Building Regulations Voids this Permit. Final �,� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough ---0k. Service CC4,6 c......................................... ! (mow 1 �'� 3/ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. t ' 7-Z3-/IS'! f , / dw � �� 4,,r �, Final Construction Control Document F To be submitted at completion of construction by a off Registered Design Professional for work per the 8th edition of the J Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Edgewood Additions and Renovations Date: August 27,2015 Permit No. 740-15 Property Address: 575 Osgood Street,North Andover, MA 01845 Project: Check(x)one or both as applicable: X New construction X Existing Construction Project description: Renovations to Wellness Center and single story additions to Clubhouse I, Ruth Neeman MA Registration Number: 20028 Expiration date: 8/31/15 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, 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. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been 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 was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet" or electronic signature and seal: NM..� . 40, Mass �� PV Fq�rH©h thPs� Phone number: (978) 371-1945 Email: rneemanAlwda.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Final Construction Control Document at completion of construction b To be submittedp y a K x d Registered Design Professional M 'rey. for work per the 8t' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Edgewood Additions and Renovations Date: August 27,2015 Permit No. 740-15 Property Address: 575 Osgood Street,North Andover,MA 01845 Project: Check(x)one or both as applicable: X New construction X Existing Construction Project description: Renovations to Wellness Center and single story additions to Clubhouse I,Amir S.Mesgar MA Registration Number: 48814 Expiration date: 6/30/16, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural X Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1,or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,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. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the i progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or AtNOF>>�Ss9c electronic signature and seal: moo`' AMiR S. yG�, MESGAR a STRUCTURAL No.48814 o� FFG/STtiQ�O Q �c`ps/0 Phone number: (617)948-5622 Email:amesgar(&lafy.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Final Construction Control Document H To be submitted at completion of construction by a Registered Design Professional for work per the 8`h edition of the Massachusetts State Building Code, 780 CMR, Section 1.07 Edgewood Clubhouse Additions Project Title: and Renovations Date: 9/1/15 Permit No. Property Address: 575 Osgood St. Project: Check(x)one or both as applicable: ❑New construction [XExisting Construction Project description: Interior renovation of "wellness" wing and office/ameni— ties addition. Drawings H-0, H-1 , E-11, E2 . I Gary M. E l ovi t z MA Registration Number: 3 5 4 51 Expiration date: 6/30/16 , am a registered design professional, and I have prepared or directly supervised the preparation,of all design plans, computations and specifications concerning:- [ ] Architectural [ ] Structural [X] Mechanical [ ] Fire Protection Q(] Electrical [ ] Other: Describe for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site at intervals appropriate to the stage of construction.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,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. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been 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 was performed in a manner generally consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Sri Of Enter in the space to the right a"wet"or ,AR electronic signature and seal: O 545: Digi ally si,111 by Gary M.EIIIi,PE �� i DN_cn=Gary M.Elovilz,PE,c=US, „a o=Energy Economics,Inc., Ti mail=.:I—therWho,.mm Date 2015.09 0l am 90e 16:26 of this document Date:2015 09.01 18:26:x6-09'W Phone number: 617-527-3353 Email: gary@energyguys . com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 1 1 2013 Final Construction Control Document To be submitted at completion of construction by a i x d Registered Design Professional °t< for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Edgewood Clubhouse Additions Project Title: and Renovations Date: 8/26/15 Permit No. Property Address: 575 Osgood St. Project: Check(x)one or both as applicable: ❑New construction IxExisting Construction Project description: Interior renovation of "wellness" wing and office/ameni- ties addition. Drawi ncls FP-1 , FA-1 , P-0, P-1 . I Gary M. E l ov i t z MA Registration Number: 3 5 4 51 Expiration date: 6/30/16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural [ ] Mechanical [X] Fire Protection [ ] Electrical [X] Other: Describe Fire Alarm, Plumbing for the above named project. 1,or my designee,have performed the necessary professional services and was present at the construction site at intervals appropriate to the stage of construction. To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the j building permit and that I or my designee: 1. Have reviewed, 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. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been 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 was performed in a manner generally consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. �l�H QF Enter in the space to the right a"wet"or , electronic signature and seal: �+ y D'gitally slgnetl by Gary M.Elovitz,PE 1 ..'''...',','r'.,+',...'.._. DN:m=Gary M.Elovltz,PE,pUS, -Energy Emnomica,Inc-. mail=nary®energyn or of to Reason: a0 the 1Nhorof-04-tlommenl Date:2015 06.2616:54:11-04'00' Phone number: 617-527-3353 Email: gary@energyguys . com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Of Massochusem Inc. `The Cmsfl'uc ion TeakV PeoW August 27. 2015 Mr. Bob Coppola Edgewood Retirement Community 575 Osgood Street North Andover, MA 01845 RE: UTS Project#18328 Edgewood Retirement Community i Clubhouse Expansion & Wellness Center North Andover, Massachusetts Dear Mr. Coppola: As requested, UTS has made a review of all soil,concrete, structural steel, and reinforcing steel reports for the above referenced project. It is our opinion, based upon this review that the work for the above project was found to be in compliance with project drawings and specifications. Should you have any questions,or if we may be of any further assistance, please do not hesitate to contact this office. Sincerely, UTS OF MASSACHUSETTS, INC. .w GEORGES AS Georges N. Nehme Professional Engineer#37 99 © GNN/cah '"'�UAL 5 Richardson Lane, Stoneham, Massachusetts 02180 • (781) 438-7755 Fax (781) 438-6216 Website: http://www.utsofmass.com • Email address: generaloffice@utsofmass.com �r Construction Completion Certification j To be submitted at completion of construction by Contractor to the Design Professional for work per the 8`h edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.3 Project Title: Edgewood Retirement Community Date: 08-21-2015 Permit No. 740-15 Property Address: 575 Osgood Street, North Andover, MA, 01845 Project description:4,200 SF renovation of an existing fitness center, restrooms, and spa area. Two building additions totaling 2,200 SF, areas consists of meeting rooms, offices, and arts&crafts rooms. 1 pl-W 60M.4'w-A MA License Number:Cf UV 07- Expiration date: -3/7/16 ,am the contractor responsible for construction of the above-named project per 780 CMR 107.6.3. 1 hereby certify that,to the best of the my knowledge and belief,construction has been done in substantial accord with the contract documents and 780 CMR with the following deviations and exceptions: (Additional sheets may be provided as needed.) Signe)im Company: Chapman Construction/ Design Phoner: 61 9 '6 Email: C)h A IF a C,1nc�,0— cxn _ tom FROM 780 CMR: 107.6.3 Construction Contractor Services. The actual construction of the work shall be the responsibility of the general contractor as identified on the approved building permit and shall involve the following: 1. Execution of all work in accordance with the approved construction documents. 2. Execution and control of all methods of construction in a safe and satisfactory manner in accordance with all applicable local,state,and federal statutes and regulations. 3. Upon completion of the construction,certification in writing to the registered design professional in responsible charge that,to the best of the contractor's knowledge and belief,construction has been done in substantial accord with section 107.6 and with all pertinent deviations specifically noted. The building official may require a copy of this certification. Of Massachusetts Inc. `The Construction Testing PeopW August 27. 2015 Mr. Bob Coppola Edgewood Retirement Community 575 Osgood Street North Andover, MA 01845 RE: UTS Project #18328 Edgewood Retirement Community Clubhouse Expansion & Wellness Center North Andover, Massachusetts Dear Mr. Coppola: As requested, UTS has made a review of all soil,concrete, structural steel, and reinforcing steel reports for the above referenced project. It is our opinion, based upon this review that the work for the above project was found to be in compliance with project drawings and specifications. Should you have any questions,or if we may be of any further assistance, please do not hesitate to contact this office. Sincerely, UTS OF MASSACHUSETTS, INC. +u GEES AAS �v Georges N. Nehme Professional Engineer#37 99 GNN/cah 5 Richardson Lane, Stoneham, Massachusetts 02180 • (781) 438-7755 Fax (781) 438-6216 Website: http://www.utsofmass.com • Email address: generaloffice@utsofmass.com � r FIRE SYSTEMS —INC.— CO TRACTOR'S PROJECT COMPLETION I hereby certify to the best f my knowledge and belief, that the installation has been completed as per the following: 1. All work has been executed insubstantial accordance with the approved construction documents. 2. Execution and control of all methods of construction has been in a safe and satisfactory manner in accordance with all applicable local, state and federal statutes and regulations. 3. Functional and integrit testing has been performed confirming system operation in accordance with specified tests and the required operational sequences. Project: Ed ewood Retirem nt Community Location: 575 Os ood Stre -North Andover MA 01845 Construction Documents: Drawiniz SP-1 Date on Plans and Specifications submitted for approval and issuance of the Building Permit: 5/8/15 Addendums/Revisions: None Signature: Date: 8/26/15 Company: Professional Fire Systems Address: 107 South Street Hopkinton,MA 1 p 748 License Number: SC21002 License Expiration Date: M/2016 Contractor's Malerial and Test Certificate for Aboveground Piping PROCEDURE Upon Completion of work,inspection and tests sh ill be made by the contractor's representative and witnessed by an owners representative.All defects shall be corrected and ystem left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both epresentatives.Copies shall be prepared for approving authorities,owners,and contractor.It is understood the owner's represen ive's signature in no way prejudices any claim against contractor for faulty material,poor workmanship,or failure to comply with approving 4 iuthority's requirements or local ordinances. Property name Edgewood Retirement Cc mmunity TDe�te 8/26/2015 Property address 575 Osgood Street Accepted by approving authoi dies(names) North Andover Fire Department Address North Andover, MA Plans Installation conforms to acce ted plans LX Yes No Equipment used is approved QX Yes ❑ No If no,explain deviations Has person in charge of fire a juipment been instructed as ® Yes ® No to location of control valves ai id care and maintenance of this new equipment? If no,explain Instructions Have copies of the following been left on the premises? 1. System component instructions EXIYes ❑ No 2. Care and m aintenai ice instructions � Yes No 3. NFPA 25 ❑ Yes No Location of Addition/Gym system Year of Orifice Temperature Make Model manufacture size Quantity. rating Victauluic V3802 2015 1/2" 56 155 Sprinklers Victauluic V2704 2015 1/2" 26 200 i Pipe and Type of pipe Black steel fittings Type of fittings Groovedrrl ireaded Alarm Maximum time to operate valve or Alarm device through test connection flow Type Make Model Minutes Seconds indicator Existing Potter VSR-F 35 Dry valve Q.O.D. Make Model Serial no. Make Model Serial no. NIA Time to trip Time water Alarm through test Water Air Trip point reached operated connection pressure pressure air pressure test outlet property Dry pipe Minutes Second psi psi psi Minutes Seconds Yes No operating Without test Q.O.D. With Q.O.D. If no,explain Operation Pneumatic MElectric Hydraulics Piping supervised Yes QNo I Detecting media supervised [ Yes ONo Does valve operate from the r rianual trip,remote,or both Dyes No Deluge and control stations? preaction Is there an accessible facility n each circuit If no,explain valves for testing? MYes MNo -Noe-s-e-a-c-Fe-ircuit operate Does each circuit operate Maximum time to Make Model supervision loss alarm? valve release? operate release Yes No Yes No Minutes Seconds Location Make at id Setting Static pressure Residual pressure Flow rate Pressure and Floor Modelflowin ( 9) reducing Inlet(psi) Outlet(psi) Inlet(psi) Outlet(psi) Flow(gpm) valve test Hydrostatic:Per NFPA 13 s ction 24.2.1.6 modifications that cannot be isolated,such as relocated drops,shall not require testing in excess of system working pi essure. Test description Pneumatic: Establish 40 psi(2.7 bar)air pressure and measure drop,which shall not exceed 1.5 psi(0.1 bar)in 24 hours.Test pressure tanks at normal wate level and air pressure and measure air pressure drop,which shall not exceed 1.5 psi(0.1 bar)in 24 hrs. All piping hydrostatically teste I at psi( bar)for hours If no,state reason Dry piping pneumatically test d [:]Yes allo not required per NFPA 1316.2.1.6 Equipment operates properly M Yes ONO Do you certify as the sprinkler contractor that additives and corrosive chemicals,sodium silicate or derivatives of sodium silicate,brine,or other corrosive chemicals wet a not used for testing systems or stopping_leaks? ]Yes MNo ramea ing of gage Ic catednear water Residual pressure with valve In test Tests test supply test tonne ion: 98 psi( bar) connection open wide: 92 psi( bar) Underground mains and lead n connections to system risers flushed before connection made to sprinkler piping Other Explain Verified by copy of the Contra-,toes Material and Test Yes ❑No Certificate for Underground PI 3ing. Flushed by installer of underg ound sprinkler piping ®Yes No If powder-driven fasteners are used in concrete, =Yes No If no,explain has representative sample to ting been satisfactoril completed? esIg Number use m r removed kets Welding piping Dyes x❑No If yes... Do you certify as the sprinkler contractor that welding procedures comply MYes MNo with the requirements of at le st AWS 82/17 Welding Do you certify that the weldin was performed by welders qualified in ®Yes MNo compliance with the requlrem nts of at least AWS B2/1? Do you certify that the weldin was carried out in compliance with a Dyes ❑No documented quality control pr cedure to ensure that all discs are retrieved,that openings in piping are smoot that slag and other welding residue are removed,and that the interna diameters of piping are not penetrated? Cutouts Do you certify that you have a control feature to ensure that MR Yes [:]No (discs) all cutouts.(dlscs)are retrieve re Hydraulic Nameplate provided If no,explain data Yes % nameplate Existing Sprinkler System Remarks Date left in service with all cor trol valves open August 26,2015 Name of sprinkler contractor Professional Fire Systems,Inc. Test witnessed by Signatures For property owner(signed) Title Date rinkler ) Title Date 1 M FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. 1. PROPERTY INFORMATION Name of property: EDGEWOOD RETIREMENT Address: 575 OSGOOD ST NO.ANDOVER,MA Description of property: RESIDENTIAUBUSINESS Occupancy type: RESIDENTIAUBUSINESS Name of property representative: EDGEWOOD Address: 575 OSGOOD ST NORTH ANDOVER,MA Phone: N/A Fax: N/A E-mail: N/A Authority having jurisdiction over this property: NORTH ANDOVER FIRE Phone: Fax: N/A E-mail: N/A 2. INSTALLATION,SERVICE,AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: D and D Electric Address: 10 Everburg Rd.Woburn,MA License or certification number: 11933A Phone: 781-932-0707 Fax: 781-932-6290 E-mail: gary@danddnet.com Service organization for this equipment: SIMPLEX GRINNELL Address: N/A License or certification number: N/A Phone: N/A Fax: N/A E-mail: N/A A contract for test and inspection in accordance with NFPA standards is in effect as of: N/A Contracted testing company: N/A Address: N/A Phone: N/A Fax: N/A E-mail: N/A Contract expires: N/A Contract number: N/A Frequency of routine inspections: N/A 3. DESCRIPTION OF SYSTEM OR SERVICE ®Fire alarm system(nonvoice) ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with the following components: ❑Fire alarm ❑EVACS ❑MNS ❑Two-way,in-building,emergency communication system ❑Other(specify): NFPA 72, Fig. 10.18.2.1.1 (p. 1 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 3. DESCRIPTION OF SYSTEM OR SERVICE(continued) NFPA 72 edition: 2010 Additional description of system(s): N/A 3.1 Control Unit Manufacturer: SIMPLEX Model number: 3.2 Mass Notification System ®This system does not incorporate an MNS 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone ❑Wide-area MNS ❑Distributed recipient MNS El Other(specify): N/A 3.2.2 System Features: ❑Combination fire alarm/MNS ❑MNS autonomous control unit ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface ❑In-building MNS to wide-area MNS interface ❑Other(specify): N/A 3.3 System Documentation ❑An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the numbered record drawings are stored on site. Location: N/A 3.4 System Software ❑This system does not have alterable site-specific software. Operating system(executive)software revision level: N/A Site-specific software revision date: N/A Revision completed by: N/A ❑A copy of the site-specific software is stored on site. Location: N/A 3.5 Off-Premises Signal Transmission ❑This system does not have off-premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: N/A Phone: N/A Supervisory: N/A Phone: N/A Trouble: N/A Phone: N/A Entity to which alarms are retransmitted: Phone: Method of retransmission: If Chapter 26,specify the means of transmission from the protected premises to the supervising station: N/A If Chapter 27,specify the type of auxiliary alarm system: ®Local energy ❑Shunt ❑Wired ❑Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) I I Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 1 4. CIRCUITS AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: N/A Survivability level: N/A Quantity: N/A (See NFPA 72,Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A 4.1.3 Device Power Pathways ®No separate power pathways from the signaling line pathway ❑Power pathways are separate but of the same pathway classification as the signaling line pathway ❑Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: N/A 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 0 Quantity: 1 (See NFPA 72,Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: NA/ Description: N/A 4.2.3 Device Power Pathways ®No separate power pathways from the initiating device pathway ❑Power pathways are separate but of the same pathway classification as the initiating device pathway ❑Power pathways are separate and different classification from the initiating device pathway 4.3 Non-Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 0 Quantity: 1 (See NFPA 72,Sections 12.3 and 12.4) 4.3.2 Pathways Utilizing Two or More Media Quantity: N/A Description: N/A 4.3.3 Appliance Power Pathways ®No separate power pathways from the notification appliance pathway ❑Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑Power pathways are separate and different classification from the notification appliance pathway NFPA 72; Fig. 10.18.2.1.1 (p. 3 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ®This system does not have manual fire alarm boxes. Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other(specify): N/A 5.1.2 Other Alarm Boxes ®This system does not have other alarm boxes. Description: N/A Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other(specify): N/A 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑This system does not have smoke detectors. Type and number of devices: Addressable: 3 Conventional: N/A Other(specify): N/A Type of coverage: ❑Complete area ®Partial area ❑Nonrequired partial area Other(specify): N/A Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Multicriteria ❑Aspirating ❑Beam Other(specify): N/A 5.2.2 Duct Smoke Detectors ❑This system does not have alarm-causing duct smoke detectors. Type and number of devices: Addressable: 1 Conventional: N/A Other(specify): N/A Type of coverage: N/A Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Aspirating ❑Beam 5.2.3 Radiant Energy(Flame)Detectors ®This system does not have radiant energy detectors. Type and number of devices: Addressable: N/A Conventional: N/A Other(specify): N/A Type of coverage: N/A 5.2.4 Gas Detectors ®This system does not have gas detectors. Type of detector(s): N/A Number of devices: Addressable: N/A Conventional: N/A Type of coverage: N/A 5.2.5 Heat Detectors ®This system does not have heat detectors. Type and number of devices: Addressable: N/A Conventional: N/A Type of coverage: ❑Complete area ❑Partial area ❑Nonrequired partial area ❑Linear ❑Spot Type of heat detector sensing technology: ❑Fixed temperature ❑Rate-of-rise ❑Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p. 4 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ❑This system does not have monitoring modules. Number of devices: 7 5.2.7 Waterflow Alarm Devices ®This system does not have waterflow alarm devices. Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A 5.2.8 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: N/A Alarm verification set for N/A seconds 5.2.9 Presignal ®This system does not incorporate pre-signal. Number of devices g res subject to i nal: N/A J P Describe presignal functions: N/A 5.2.10 Positive Alarm Sequence(PAS) ®This system does not incorporate PAS. Describe PAS: N/A 5.2.11 Other Initiating Devices ®This system does not have other initiating devices. Describe: N/A 6. SUPERVISORY SIGNAL-INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ®This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other(specify): N/A 6.2 Fire Pump Description and Supervisory Devices ®This system does not have a fire pump. Type fire pump: ❑Electric pump ❑Engine Type and number of devices: Addressable: N/A Conventional: N/A Coded: N/A Transmitter: N/A Other(specify): N/A 6.2.1 Fire Pump Functions Supervised ❑Power ❑Running ❑Phase reversal ❑Selector switch not in auto ❑Engine or control panel trouble ❑Low fuel Other(specify): N/A 6.3 Duct Smoke Detectors(DSDs) ®This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: N/A Conventional: N/A Other(specify): N/A Type of coverage: N/A Type of smoke detector sensing technology: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam 6.4 Other Supervisory Devices ®This system does not have other supervisory devices. Describe: N/A NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. MONITORED SYSTEMS 7.1 Engine-Driven Generator ®This system does not have a generator. 7.1.1 Generator Functions Supervised ❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto ❑Low fuel ❑Other(specify): N/A 7.2 Special Hazard Suppression Systems ®This system does not monitor special hazard systems. Description of special hazard system(s): N/A 7.3 Other Monitoring Systems ®This system does not monitor other systems. Description of special hazard system(s): N/A 8. ANNUNCIATORS ®This system does not have annunciators. 8.1 Location and Description of Annunciators Location 1: N/A Location 2: N/A Location 3: N/A 9. ALARM NOTIFICATION APPLIANCES 9.1 In-Building Fire Emergency Voice Alarm Communication System ®This system does not have an EVACS. Number of single voice alarm channels: N/A Number of multiple voice alarm channels: N/A Number of speakers: N/A Number of speaker circuits: N/A Location of amplification and sound-processing equipment: N/A Location of paging microphone stations: Location 1: N/A Location 2: N/A Location 3: N/A 9.2 Nonvoice Notification Appliances ❑This system does not have nonvoice notification appliances. Horns: 5 With visible: 5 Bells: N/A With visible: N/A Chimes: N/A With visible: N/A Visible only: 2 Other(describe): N/A 9.3 Notification Appliance Power Extender Panels ®This system does not have power extender panels. Quantity: N/A Locations: N/A NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright 02009 National Fire Protection Association.This forth maybe copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 10. MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: N/A Location 2: N/A Location 3: N/A 10.2 High-Power Speaker Arrays Number of HPSA speaker initiation zones: N/A Location 1: N/A Location 2: N/A Location 3: N/A 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: N/A MNS-only visible appliances: N/A Textual signs: N/A Other(describe): N/A Supervision class: N/A 10.3.1 Special Hazard Notification ®This system does not have special suppression predischarge notification. ®MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ®This system does not have a two-way telephone system. I Number of telephone jacks installed: N/A Number of warden stations installed: N/A Number of telephone handsets stored on site: N/A �I Type of telephone system installed: ❑Electrically powered ❑Sound powered 11.2 Two-Way Radio Communications Enhancement System ❑This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: N/A % General building areas: N./A % Amplification component locations: N/A Inbound signal strength: N/A dBm Outbound signal strength: N/A dBm Donor antenna isolation is: N/A dB above the signal booster gain Radio frequencies covered: N/A Radio system monitor panel location: N/A NFPA 72; Fig. 10.18.2.1.1 (p. 7 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems ®This system does not have an area of refuge(area of rescue assistance)emergency communications system. Number of stations: N/A Location of central control point: N/A Days and hours when central control point is attended: N/A Location of alternate control point: N/A Days and hours when alternate control point is attended: N/A 11.4 Elevator Emergency Communications Systems ®This system does not have an elevator emergency communications system. Number of elevators with stations: N/A Location of central control point: N/A Days and hours when central control point is attended: N/A Location of alternate control point: N/A Days and hours when alternate control point.is attended: N/A 11.5 Other Two-Way Communication Systems Describe: N/A 12. CONTROL FUNCTIONS This system activates the following control fuctions: Hold-open door releasin devices Smoke management HVAC shutdown F/S dampers ❑ p g ❑ g ® ❑ p ❑Door unlocking ❑Elevator recall ❑Fuel source shutdown ❑Extinguishing agent release ❑Elevator shunt trip ❑Mass notification system override of fire alarm notification appliances Other(specify): PRIORITY 2 NURSE CALL 12.1 Addressable Control Modules ®This system does not have control modules. Number of devices: N/A Other(specify): N/A 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of control panel: 120vac Control panel amps: SA Overcurrent protection: Type: CIRCUIT BREAKER Amps: 20A Location(of primary supply panel board): Main Electric Room Disconnecting means location: Main Electric Room 13.1.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER(continued) 13.1.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 13.1.4 Batteries Location: FACP Type: SLA Nominal voltage: 24 Amp/hour rating: 35AH Calculated capacity of batteries to drive the system: In standby mode(hours): 60 In alarm mode(minutes): 15 ®Batteries are marked with date of manufacture ❑Battery calculations are attached 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System ®This system does not have an EVACS or MNS system. 13.2.1 Primary Power Input voltage of EVACS or MNS panel: N/A EVACS or MNS panel amps: N/A Overcurrent protection: Type: N/A Amps: N/A Location(of primary supply panel board): N/A Disconnecting means location: N/A 13.2.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A 13.2.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 13.2.4 Batteries Location: N/A Type: N/A Nominal voltage: N/A Amp/hour rating: N/A Calculated capacity of batteries to drive the system: In standby mode(hours): N/A In alarm mode(minutes): N/A ❑Batteries are marked with date of manufacture ❑Battery calculations are attached NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER(continued) 13.3 Notification Appliance Power Extender Panels ®This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): N/A Power extender panel amps: N/A Overcurrent protection: Type: N/A Amps: N/A Location(of primary supply panel board): N/A Disconnecting means location: N/A 13.3.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: N/A Location of fuel storage: N/A Type of fuel: N/A 13.3.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: N/A Location of UPS system: N/A Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): N/A In alarm mode(minutes): N/A 13.3.4 Batteries Location: N/A Type: N/A Nominal voltage: N/A Amp/hour rating: N/A Calculated capacity of batteries to drive the system: In standby mode(hours): N/A In alarm mode(minutes): N/A ❑Batteries are marked with date of manufacture ❑Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults,and improper branching, but before conducting operational acceptance tests. This is a: ❑New system ®Modification to an existing system Permit number: The system has been installed in accordance with the following requirements:(Note any or all that apply.) ®NFPA 72, Edition: 20,10, ®NFPA 70,National Electrical Code,Article 760,Edition: 2014 ®Manufacturer's published instructions Other(specify): N/A System deviations from referenced NFPA standards: N/A Signed: f/2L�C'�BL'L' Printed name: MICHAEL DRISCOLL Date: 8/25/15 Organization: D&D Electrical Title: Fire Tech Phone: 781-932-0707 NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ❑New system All operational features and functions of this system were tested by,or in the presence of,the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements for the following: ®Modifications to an existing system All newly modified operational features and functions of the system were tested by,or in the presence of,the signer shown below, on the date shown below,and were found to be operating properly in accordance with the requirements of the following: ®NFPA 72,Edition: 2010 ®NFPA 70,National Electrical Code, Article 760,Edition: 2014 ®Manufacturer's published instructions Other(specify): N/A ®Individual device testing �documentation [Inspection and Testing Form(Figure 14.6.2.4)is attached] Signed: Printed name: MICHAEL DRISCOLL Date: 8/25/15 Organization: D&D Electrical Title: Fire Tech Phone: 781-932-0707 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system,as specified herein,has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: MICHAEL DRISCOLL Date: 8/25/15 Organization: D&D Electrical Contractors Title: Fire Tech Phone: 781-932-0707 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: N/A Printed name: N/A Date: N/A Organization: N/A Title: N/A Phone: N/A 16.3 Supervising Station: This system,as specified herein,will be monitored according to all NFPA standards cited herein. Signed: N/A Printed name: N/A Date: N/A Organization: N/A Title: N/A Phone: N/A NFPA 72 Fig. 10.18.2.1.1 . 11 of 12 9 (p ) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 16. CERTIFICATIONS AND APPROVALS (continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: NIA Printed name: NIA Date: N/A Organization: N/A Title: N/A Phone: N/A 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications,with its approved sequence of operations,and with all NFPA standards cited herein. Signed: N/A Printed name: N/A Date: N/A Organization: N/A Title: N/A Phone: N/A NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright @2009 National Fire Protection Association.This form maybe copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 1 Primary Air Balance Inc. P.O. Box 235, Francestown,NH 03043 Voicemail and Fax: (603) 386-6371 E-Mail: office@primaryairbalance.com Website: www.primaryairbalance.com AIR & WATER BALANCE REPORT ewood Retirement Community PROJECT: Edgewood Retirement Community 575 Osgood Street North Andover, MA ARCHITECT: Levi &Wong MECHANICAL ENGINEER: Energy Economics Inc. MECHANICAL CONTRACTOR: New England Air, Inc. DATE: 8/30/2015 Primary Air Balance, Inc. P.O. Box 235, Francestown, NH 03043 Voicemail and Fax: 1-603-386-6371 Email: office@primaryairbalance.com AIR MOVING EQUIPMENT TEST SHEET PROJECT: Edgewood Retirement Community DATE: 8/30/15 LOCATION: North Andover MA SHEET NO: 1 System Number HP-1A HP-2A HP-3A HP-4A Location GALLERY ARTS-CRAFTS MEETING ROOM 103 Manufacturer CLIMATE MASTER CLIMATE MASTER CLIMATE MASTER CLIMATE MASTER Model No. I TCH015A I TCH018A I TCH018A TCH018A Serial No. T12842737 T12842761 T12842760 T12842759 Conditions DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL Total CFM 480 510 580 538 580 612 570 563 Return CFM 430 437 525 476 505 543 510 474 OSA CFM MIN 50 73 55 62 75 69 60 89 Total/ESP NA 0.293 NA 0.470 NA 0.318 NA 0.303 Suction SP NA 0.097 NA 0.109 NA 0.116 NA 0.103 Discharge SP NA 0.196 NA 0.361 NA 0.202 NA 0.2 Fan RPM NA MED NA HIGH NA HIGH NA HIGH Fan Sheave NA DD NA DD NA DD NA DD Motor Sheave NA DD NA DD NA DD NA DD Belts NA DD NA DD NA DD NA DD Motor Mfg. NA US Motor NA US Motor NA US Motor NA US Motor Voltage/Phase 265-1 271-1 265-1 272-1 265-1 272-1 265-1 273-1 Motor RPM 10201850 MED 1020 HIGH 1020 HIGH 1020 HIGH Amperage 0.70 0.421 0.70 0.49 0.70 0.57 0.70 0.59 Horsepower NA 118 NA 1/8 NA 118 NA 118 Frame -- 48Y --- 48Y — 48Y 48Y 4 Primary Air Balance, Inc. P.O. Box 235, Francestown, NH 03043 Voicemail and Fax: 1-603-386-6371 Email: office@primaryairbalance.com AIR MOVING EQUIPMENT TEST SHEET PROJECT: Edgewood Retirement Community DATE: 8/30/15 LOCATION: North Andover MA SHEET NO: 2 System Number HP-5A HP-7 AHU-1 Location MEETING ROOM GIFT SHOP MECH ROOM Manufacturer CLIMATE MASTER McQuay CARRIER Model No. I TCH015A WCRH1009M 1 40RUAA12A2A6 Serial No. T12842736 285694400 3215U16029 Conditions DESIGN ACTUAL DESIGN ACTUAL DESIGN ACTUAL DESIGN I ACTUAL Total CFM 480 514 200 221 2700 2727 Return CFM 410 447 100% 100% 85% 85% OSA CFM MIN 70 67 NA NA 15% 15% Total/ESP NA 0.209 NA 0.216 NA 1.44/1.09 Suction SP NA 0.092 NA 0.053 NA 0.63/0.28 Discharge SP NA 0.117 NA 0.163 NA 0.81 Fan RPM NA MED NA HIGH NA 868 Fan Sheave NA DD NA DD V AK84 Motor Sheave NA DD NA DD 5/8" VP50 Belts NA DD NA DD A39 Motor Mfg. NA US Motor NA McQuay --- Marathon Voltage/Phase 265-1 269-1 265-1 271-1 460-3 460-3 Motor RPM 1020/850 MED 1550 HIGH 1725 1712 Amperage 0.70 0.41 0.65 0.43 2.80 1.95 Horsepower NA 1/8 NA 1/8 --- NA Frame --- 48Y -- NA --- 56Y AHU-Final CFM recorded at 60Hz with Actual Static at 0.40 AHU-to operation at 0.35"Duct Static Pressure Primary Air Balance, Inc. Heat Pumps P.O. Box 235, Francestown, NH 03043 Voicemail and Fax(603) 386-6371 TEST SHEET FOR OUTLET AND INLET PROJECT: Edgewood Retirement Community DATE: 8/30/2015 LOCATION: North Andover, MA SHEET NO: 3 a OUTLET ROOM CODE SIZE EFFECTIVE DESIGN DESIGN ACTUAL ACTUAL CWMENT NUMBER NUMBER AREA CFM FPM/VE L FPMNEL CFM HP-1A GALLERY 1 110 1A 8"o 0.35 200 209 2 110 1A 10"0 0.55 280 301 480 510 A 110 FG-1 12"o 0.79 430 339 OSA 110 DUCT 6"o 0.20 50 250 365 73 F 480 412 1 2 HP-2A ARTS&CRAFTS 3 109 1A 8"o 0.35 250 187 4 109 1 10"o 0.55 330 351 A 580 538 B 109 FG-1 12"o, 0.79 525 334 A OSA 109 DUCT 6"o 0.20 55 275 310 62 F 580 396 4 I 3 "Construction Obstruction Primary Air Balance, Inc. Heat Pumps P.O. Box 235, Francestown, NH 03043 Voicemail and Fax(603) 386-6371 TEST SHEET FOR OUTLET AND INLET PROJECT: Edgewood Retirement Community DATE: 8/30/2015 LOCATION: North Andover, MA SHEET NO: 4 OUTLETROOM CODE SIZE EFFECTIVE DESIGN DESIGN ACTUAL ACTUAL COMMENT NUMBER NUMBER AREA CFM FPMNEL FPMNEL CFM HP-3A MEETING ROOM 5 106 1 1 10"o 0.55 290 313 C 6 106 1 10"0 0.55 290 299 C 580 612 C 106 FG-1 12"o 0.79 505 420 A OSA 106 DUCT 6"0 0.20 75 375 347 69 A 580 489 5 6 HP-4A ROOM 103 7 105 1 8"o 0.35 1 190 195 A 8 104 1 8"o 0.35 190 183 C 9 103 1 8"o 0.35 190 185 C 570 563 D 105 FG-2 8"o 0.35 NA 112 C E 104 FG-2 8"o 0.35 NA 109 A F 103 FG-2 8"o 0.35 NA 108 C OSA 103 DUCT 6"o 0.20 601 3001 447 89 F 601 1 418 D E F 7 8 9 Primary Air Balance, Inc. Heat Pumps P.O. Box 235, Francestown, NH 03043 Voicemail and Fax(603) 386-6371 TEST SHEET FOR OUTLET AND INLET PROJECT: Edgewood Retirement Community DATE: 8/30/2015 LOCATION: North Andover, MA SHEET NO: 5 OUTLETROOM CODE SIZE EFFECTIVE DESIGN DESIGN ACTUAL ACTUAL COMMENT NUMBER NUMBER AREA CFM FPMIVEL FPM/VEL CFM HP-5A MEETING ROOM 10 102 1 1 8"o 0.35 240 253 C 11 102 1 8"o 0.35 240 1 261 C 480 514 G 102 FG-1 12"o 0.79 410 344 A OSA 102 DUCT 6"o 1 0.20 70 350 333 67 A 480 411 10 000 11 HP-7 12 111 2 8"o 0.35 200 221 Primary Air Balance, Inc. P.O.Box 235,Francestown,NH 03043 Voicemail and Fax (603)386-6371 Email:office@primaryairbalance.co FLOW MEASURING STATION PROJECT: Edgewood Retirement Community DATE: 8/30/15 LOCATION: North Andover, MA SHEET NO: 6 STATION LOCATION SIZE I MODEL I DESIGN DESIGN FINAL FINAL NUMBER GPM PD PD GPM 1 HP-1A 110 0.50 UM050 3.50 NA 42" 3.50 HP-2A 109 0.50 UM050 4.50 NA 39" 4.00 HP-3A 106 0.50 UM050 4.50 NA 53" 4.00 HP-4A 103 0.50 UM050 4.50 NA 46" 4.00 HP-5A 102 0.50 UM050 3.50 NA 51 3.50 HP-7 111 0.75 YR075 NA NA 24" 1.50 HP-1-5 =Autobalancing Valves(Nexus) Final Pd measure in inches FDI -Flow Design Inc. Primary Air Balance, Inc. AHU-1 P.O. Box 235, Francestown, NH 03043 Voicemail and Fax(603)386-6371 TEST SHEET FOR OUTLET AND INLET PROJECT: Edgewood Retirement Community DATE: 8/30/2015 LOCATION: North Andover, MA SHEET NO: 7 "OUTLET ROOM CODE SIZE EFFECTIVE DESIGN DESIGN ACTUAL ACTUAL COMMENT NUMBER NUMBER AREA CFM FPM/VEL FPM/VEL CFM 1 114 CD-1 To 0.35 300 275 2 113 CD-2 6"o 0.20 100 1 128 3 118 CD-1 12"o 0.79 450 605 F 4 118 CD-1 12"o 0.79 450 298 A 5 120 CD-1 12"o 0.79 400 410 C 6 120 CD-1 12"o 0.79 1 400 404 A 7 121 CD-1 12"o 0.79 400 386 A 8 121 CD-1 12"o, 0.79 200 221 A 2700[__ 2727 1 3 4 2 5 6 7 8 No access to volume damper-Sheetrock Profided Prima1XAirBaIancA4Inc,. P'f'aryAirBalance,Inc.provides qualified technicians to test and balance: Air Distribution Systems,Heating&Cooling Systems and Hydropic.Systems Primary Air Balance,Tues breadth of experience includes solving problems encounteredn' a wide range of structures such as o Multistoried Buildings o Laboratories o Schools o Hospitals o Factories o Offices QUALMCATTONS Primary Air Balance,Inc.,is an independent testing and balancing organization,and is able to direct its resources to help solve the many problems faced by owners and sponsors of commercial,military and industrial facilities. This expertise a espemlly valuable during the construction phase, but can also effectively be used to solve problems,which have developed in Mcistting facilities. a services which Primary Air Balance,Inc provides are primarily in the testing aid balancing of airflow,liquid flow and associated systems contro S. State-of-the-art-instruramtation is used to provide documentation that the system is perfocani ng according to its design specification.If the syste n is not performing to specification,details are provided to identify the corrective steps needed to assure a smooth woAOag system. The qua'ificd testing and balancing procedure used by Primary Air Balance,Inc.is a professional approach,which assures an optimal operating system,and ri sults are presented in an unbiased report. PPOCI9DURES Primary Air Balance,Inc employs the testing and balancing procedures established by AABC,ASHRAE and applicable government standards. CAPABHXfM 1. Balancing and Luing of air and water 6. Ternp"Iture ustin& 12. Equipment perfommtioe testing. systems- 7. Humidity and dew point testing. 13. Pressurization testing. 2. Analysis of mechanical systems. 8. Process system testing,adjusting 14. Operating Mstrtudions. 3. Design analysis of beating,cooling and analysis. 15. Maintenance manuals. and ventilation loads. '9. Refrigeration 16. As-Built Drawings. 4. Field performance testing of system testing. 17. Systems Economics. RV'C equipment. 10. Electronic and pneumatic control S. Ductwork system design and system adjusting and calibration analysis. 11. Fitter leak test PROJECTS Adanticare Hospital,Lynn,MA Fleet Bank,Cbelmsford,MA Borth Shore Medical Center,Salem,MA Andover Donor's Park,Andover,MA Georgetown Schools,Georgetown,NU Nynex,Manchester,NH Aries Medical,Chelmsford,MA Greendale Mall,Worcester,MA Orehard Cove Retirei+ent,Canton,MA AT&T,World Trade Center GTE,Tauton. Lynn and Waltham,MA Peabody High School,Peabody,MA Bard USCI,Billerica,MA Hanscomb Air Force Base,Bedford,NL Plymouth State College,Plymouth,NH Bentley College,Waltham,MA Henry Heywood Hospital,Gardner,Mi. Prince Foods,Lowell,MA Beth Israel Hospital,Boston,MA Holy Cross College,Worcester MA Pushy Supreme Stores throughout NE Billerica House of Correction,MA iasextmn,Burlington,MA Quigley Hospital,Chelsea,MA BioGen,Cambridge,MA Lawrence Geneat HosprtaL MAsbmy Biotech 11 Worcester,MA Lexington Igo School,Lexington,MA SaNashua,Nashua,NH Bordon Chemical,Andover,MA Lincoln Labs,Bedford,MA Showcase Cinema,Revere,MA Brookline High School,Brookline,MA Lowell General Hospital,Lowell,MA Souhegan M&h School,Amherst NH Cabot Corp.,Billerica,MA Lynn English Hij&Schott,Lyng MA Textron Iabs,Lowell,MA Cambrex,Hopkinton,MA Matheson Gas,Gloucestq MA Thomas C-Mn Elementary School, Csmbnidgeside GaIless,Cambridge,MA MBIA,Quincy.MA pesky,MA Chades River tabs.Wdmin MA MCI,Contort],MA U.N.H NH Circuit City,Portsmouth and Nashua NH. Milford Middle School,Milford,NH U.S.Post O�Billerica MA, Darn DaFarber,Boston,MA MIT,Lexington and Cambridge,MA Hudson NH Emerald Square Man. Attleboro,MA Moro Labs,Tewksbury,MA WaWeerks,Brookh y MA Federal Reserve Bank,Bostork MA, New England Power,Wurcestm MA Wang rowers. Lowcll,MA Filene's Basement,Nashua,NH I NH Police Training Facility,Contort). Wentworth Douglass Hospital,Dover, Danvers,MA NH NH i I SUMMARY SHEET Explanation of comment column on outlet-inlet sheet A— Inlet-Outlet Damper: No adjustrrent required B— Inlet-Outlet Damper: Adjusted C —Voume Damper: Adjusted D — Splitter Damper: Adjusted E— Inlet-Outlet: Not Installed F— Inlet-Outlet Damper. Not Installed G — Inlet-Outlet: Noisy H — Inlet-Outlet: Deleted O —Volume Damper: Not Installed Key to Abbreviations: UC — Under Construction CD— Ceilir g Diffuser NA— Not Available WD—Wall Diffuser NI — Not Indicated LD— Linea Diffuser DD— Direct Drive FS — Future Space TH —Test Hood EG — Exhaust Grill ER— Exhaust Register Aid McGill tl"i1lJLl�11�J1:l1:! 200 dAoousticaltaboedKvic y� �y q B�oadwryAve.,Wc�rtville,Ohio 43081-1617 wdbsite:www.megOiuQDow cam Labaanyphone(614)882-3337 Certificate of Calibration n .»Mrq•�frtrr�•»r•»»r»•»rr•O»rr••s.r»»r•r••IHN»»a••ap»H•••»••»�»»•• rssr»•v.r•nr»ngrrrra»»r»rrrsrrrr.»»r»»»r»r»• Instrumentation and test procedures implemented during the calibration of the orificebe referenced herein ate traceable to the National Institute of Standards and Technology(NIST). Physical d . sustained by and/or ge modifications made to these orifice tubes minifies beth the calibration curve and este provided with the product It is recommended that the orifte urbe be recalibrated 2 to 3 years m the calibration date shown on this certificate,but no later than 5 years. No chart will be reissued for i tube ager 10 years from the date of the last calibration The uncertainty in indicated flow rate is estimated to be+/-2%of indicated reading W 95%confidence. Information regarding kit capacities may be found at www.mcgWairnow.com. You A ust register fust before you can gain access to this information. Contact the nearest McGill AirRow LLC sales o tie or sales for any questions relating to any Leak-Detectives product. Date of Calibration: 1-Mar-2005 Calibrated Orifice Tube Number. 4970-5 Calibration Direction: Forward Plow Tube Diameter. 5.04 inches Orifice Diameter: 3.25 inches Calibrated Against Reference Tube: MTS-95 Calibrated by: J.Gietzak Engineering&Laboratory Manager OF dyi GIEF17JW CC i E-64497 McGill AGM—Coryontion is-0=teaks of Uniud MoCn71 wpmagii—Founft in 1951 Cal-Tek Co. In 3. 20 Republic Road N. Billerica, MA 01862 Tel: 800-447-4020 Certificate of Calibration Fax: 978-667-8901 UNIT UNDER TEST:SHORTRIDGE HDM-300 DESCRIPTION: HYDRODATA MULTIMETER TEST RESULT: PASS SERIAL NUMBER: W99107 CAL DATE: July 10,2015 ID#: PAB100 CAL DUE DATE: July 31,2016 ASSET#: 100 TEMPERATURE: 70.00"F PROCEDURE: 33K6-4-427-1 05/30/13 HUMIDITY: 40% CALIBRATED BY: CT66 CAL INTERVAL: 12 M P.O.NUMBER: N/A RECEIVED CONDITION: IN TOLERANCE SITE LOCATION: LAB RETURNED CONDITION:IN TOLERANCE CUSTOMER: PRIMARY AIR BALANCE CERTIFICATE NO. 1377 POOR FARM ROAD PAB100:1436540050 FRANCISTOWN,NH 03043 Cal-Tek Co.Inc.ccrtifies that the above listed instrument has been calibrated,and verified to met the defined calibration specifications. It has been calibrated using measurement standards traceable to the National Institute of Standards&id Technology(NIST),or another National Metrology Institute.The basis of compliance stated is a comparison of the measurei nent parameters to the specified or required calibration process. The expanded uncertainties,using a coverage factor of K--2 to approximate the 95%confidence leve of the measurement standards used, do not exceed 25%(TUR—4: of the instruments specifications unless otherwise noted. This report may not be reproduced,except in full,without written permission from Cal-Tek Co.h 1C.Calibration certificates without signatures are not valid. REMARKS: Standards Used Asset# Description CTI364 HEISE H31468 PRESSURE STD. Cal Date .Due Date CT7673 SEEGERS GN293 PRESSURE GAGE 0-1000/PSI 5/27/2015 5/27/2016 CTI901 PRACTICAL DESIGN GRP THUM TEMP-HUMIDY 11/3/2014 11/3/2015 USB MONITOR 9/30/2014 9/30/2015 Test Results Test Description True Value Test Result Ltiwer lin it Upper limit Units _ - TUR QA Manager: Rick Finch Signature: ', ` CERTIFICATE NO. PAB100:1436540050 Inspected KO ✓ Date Printed:July 10,2015 Page 1 of 2 Cal-Tek Co. Inc. 20 Republic Road N. Billerica, MA 01862 Tel: 800-447-4020 Fax: 978-667-8901 Certificate of Cali ration UNIT UNDER TESMSHORTRIDGE ADM-860C DESCRIPTION: AIRDATA METER TEST RESULT: PASS SERIAL NUMBER: M13416 CAL DATE: July 20,2015 ID#: PAB109 CAL DUE DATE: July 31,2016 ASSET#: N/A TEMPERATURE: 70.00'F PROCEDURE: CP5-ADM-860C HUMIDITY: 40% CALIBRATED BY: CT66 CAL INTERVAL: 12 M P.O. NUMBER: N/A RECEIVED CONDITION: INTOLERANCE SITE LOCATION: LAB RETURNED CONDITION:IN TOLERANCE CUSTOMER: PRIMARY AIR BALANCE CERTIFICATE NO. 1377 POOR FARM ROAD PAB 109:1437389197 FRANCISTOWN,NH 03043 Cal-Tek CO.Irie.certifies that the above listed instrument has been calibrated and verified to m et the defined calibration specifications It has been calibrated using measurement standards traceable to the National Institute of Standards andrechnology(NIST),or another National Metrology Institute The basis of compliance stated is a comparison of the meas ement parameters to the specified or required calibration process. The expanded uncertaintie4 using a coverage factor of K--2 to approximate the 95%confidence IcN el of the measurement standards used do not exceed 25%(TUR-4:1)of the instruments specifications unless otherwise noted This report may not be reproduces(except in full,without written permission from Cal-Tek CO. nc.Calibration certificates without signatures are not valid REMARKS: ` Standards Used Asset# Description Cal Date Due Date CT1784 SHORTRIDGE ADM-860 AIRDATA MULTWETER 5/27/2015 5/27/2016 CTI901 PRACTICAL DESIGN GRP THUM TEMP-HUMIDY US B MONITOR 9/30/2014 9/30/2015 Test Results Test Description True Value Test Result Lower 1 mit Upper limit Units TUR OA-Manager: Rick Finch Signature: r <—�-V"� G ` CERTIFICATE NO. PAB109:1437389197 x'67 Date Printed:July 20,2015 Page 1 of 2 Cal-Tek Co. til . 20 Republic Road N. Billerica, MA 01862 Tel: 800-447-4020 Certificate of Calibration Fax: 978-667-8901 UNIT UNDER TESMALNOR 9870 DESCRIPTION: THERMO-ANEMOMETER TEST RESULT: PASS SERIAL NUMBER: 02127058 CAL DATE: July 20,2015 ID#: PAB101 CAL DUE DATE: July 31,2016 ASSET#: N/A TEMPERATURE: 70.00°F PROCEDURE: CP5-9870 HUMIDITY: 40% CALIBRATED BY: CT66 CAL INTERVAL: 12 M P.O. NUMBER: N/A RECEIVED CONDITION: IN TOLERANCE SITE LOCATION: IAB RETURNED CONDITION:IN TOLERANCE CUSTOMER: PRIMARY AIR BALANCE CERTIFICATE NO. 1377 POOR FARM ROAD PAB101:1437389089 FRANCISTOWN,NH 03043 Cal-Tek Co.Inc.certifies that the above listed instrument has been calibrated and verified to met the defined calibration specifications It has been calibrated using measurement standards traceable to the National Institute of Standards ffechnology(NIST),or another National Metrology Institute The basis of compliance stated is a comparison of the measurement parameters to the specified or required calibration process The expanded uncertainties,using a coverage factor of K=2 to approximate the 95%confidenceleveof the measurement standards used do not exceed 25%(TUR>=4:1)of the instruments specifications unless otherwise noted This report may not be reproduced except in full,without written permission from Cal-Tek Co.h ic.Calibration certificates without signatures are not valid REMARKS: Standards Used Asset# Description CTISHORTRIDGE ADM-860 AIRDATA MULTIMETER 5/27/2015 5/27/2016 Cal Date Due Date CTI901 901 PRACTICAL DESIGN GRP THUM TEMP-HUMIDY USB MONITOR 9/30/2014 9/30/2015 Test Results Test Description True Value Test Result Lower Ii i it Upper limit Units 'per QA Manager: Rick Finch Signature: : CERTIFICATE NO. PAB101:1437389089 Inspe CTC4'� 44 J Date Printed:July 20,2015 Page 1 of 2 Cal-Tek Co. Inc 20 Republic Road N. Billerica, MA 01862 Tel: 800-447-4020 Certificate of Calibration Fax: 978-667-8901 UNIT UNDER TEST:EXTECH AN200 DESCRIPTION: ANEMOMETER TEST RESULT: PASS SERIAL NUMBER: 08081983 CAL DATE: July 10,2015 ID#: PAB106 CAL DUE DATE: July 31,2016 ASSET#: 106 TEMPERATURE:70.00°F PROCEDURE: TB9-6680-295-40 01/24/11 HUMIDITY: 40% CALIBRATED BY: CT66 CAL INTERVAL: 12 M P.O. NUMBER: N/A RECEIVED CONDITION: LIMITED CAL SITE LOCATION: LAB RETURNED CONDITION:LIMITED CAL CUSTOMER: PRIMARY AIR BALANCE CERTIFICATE NO. 1377 POOR FARM ROAD PAB106:1436545041 FRANCISTOWN,NH 03043 Cal-Tek Co.Inc.certifies that the above listed instrument has been calibrated,and verified to meet t e defined calibration specifications. It has been calibrated using measurement standards traceable to the National Institute of Standards and echnology(NIST),or another National Metrology Institute.The basis of compliance stated is a comparison of the measuremel it parameters to the specified or required calibration process. The expanded uncertainties,using a coverage factor of K=2 to approximate the 95%confidence level of the measurement standards used, do not exceed 25%(TUR>=4:1)of the instruments specifications unless otherwise noted. This report may not be reproduced,except in full,without written permission from Cal-Tek Co.Inc.Calibration certificates without signatures are not valid. REMARKS: Limited Calibration Air temperature probe intermittent-break in probe cable Standards Used Asset# Description CT1784 SHORTRIDGE ADM-860 AIRDATA MULTIMETER Cal Date Due Date CTI901 PRACTICAL DESIGN GRP THUM5/27/2015 5/27/2016 TEMP-HUMIDY USB MONITOR 9/30/2014 9/30/2015 Test Results Test Description True Value Test Result Lower limit Upper limit Units _ TUR QA Manager: Rick Finch Signature: CERTIFICATE NO. PAB106:1436545041 Date Printed:July 10,2015 Page 1 of 2 .:w a �'_ 47, r —W 2> M' eZ fz..et ' y# L t xt I �'R �� i CONTROL # J22763E >}MPORTAVT i if y r license is lost,damaged or destroyed;is ina urate;dir E' needs to be corrected,visit ew web site at Mass. i for instructions to ensure the proper mailing of your Re �wal Application and any other correspondence. This license is subject to Massachusetts General Lai and regulations.Your license is a privilege,and cannot b lent or assigned to any person or entity under penalty of la ' Keep this ILMSS dh yeur person dr posted as required by law 6nd/or regulations. =, _ � P I f I trau��e . folio r;R � T�i+`A' ��I" 'Y *?i •rr _ � onTOIA "AW ' 4t { i . ni x , of NON7H 1H s �1 O+nn.'r"19 ,`tS•C HU`+E4 TEMPORARY CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Valid for 30 Days from September 11, 2015, Exp October 13, 2015 Building Permit Number 740-15 on 3/26/2015 Date: September 11, 2015 THIS CERTIFIES THAT THE BUILDING LOCATED ON 575 Osgood Street MAY BE OCCUPIED AS Addition per plans IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Edgewood Retirement 575 Osgood Street North Andover, MA 01845 Buil ing Insp ctor Fee: $50.00 Receipt: 29338 Check : 75172 pORTH own of E 'Andover 0 No. I C% ver, Mass,0 11K COCNIC.t.ICK ��• �d A�RATEO PP�,�'�5 S U BOARD OF HEALTH Food/Kitchen ...PERMIT T LD Septic System THIS CERTIFIES THAT6 BUILDING INSPECTOR ..... ........... ............................................................................................... has permission to erect .... building on Foundation Rough to be occupied as .......a�!e! � fr6 � A . 2aChimney C/ provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. � � Alh c Iew R-,4 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS. Rough .... .....ry�"�C Service c.s. ...................................... -_� Final BUILDING INSPECTOR `^ GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost �' �i,w$JOOO.©0 m $ - $ 18,000.00 Plumbing Fee $ 2,250.00 Gas Fee 100 comm. $J 100.0,01 Electrical Fee $ 2,250.00 Total fees collected $ 22,600.00 575 Osgood Street Demo And Renovation 4000 SF,2500 Addition 740-15 on 3/25/15 1 Town of North Andover Office of the Planning Department Community Development and Services Division �91 '�•'O'�t�g 1600 Osgood Street SACHUSQ North Andover, Massachusetts 01845 NOTICE OF DECISION-SITE PLAN REVIEW WAIVER Date of Decision: December 16,2014 j Application of: Edgewood Retirement Center 575 Osgood Street North Andover,MA 01845 i ( Property Owner: Edgewood Retirement Center 575 Osgood Street North Andover,MA 0.1845 Premises Affected: 575 Osgood Street HISTORY AND BACKGROUND On November 24, 2014,representatives of the Edgewood Retirement Center filed a request for a waiver of Site Plan Review requirements with respect to three minor additions that cumulatively amount to just over the threshold triggering Site Plan Review; the additions totaled i approximately 2,400 square feet,and the Site Plan Review threshold is 2,000 square feet. q i The applicant has submitted the following information: I • There will be no change in the use of the space as a result of the additions; • No internal residential spaces will be affected or impacted by the additions; } • No new additional employees,parking,bathroom facilities, or other occupancy-based i facilities will be needed as a result of the additions; • The front-facing facade will keep with the character and style of the existing facade. i FINDINGS OF FACT The proposed use has been determined to be minor and can be completed without further review by the Planning Board, according to the following: i.) The proposed change falls into the category as defined in Section 8.3.2.c, which states that the change will not substantially alter any existing operating, functional, or physical characteristics of the site. r. Edgewood Site Plan Review Waiver December 16,2014 i The proposed building additions are therefore deemed insubstantial and in the Planning Board hereby waives the Site Plan Review requirements. Town of North Andover Planning Department i i By: Matthew Egge, Town Planner By: . Jean nright,Int •im Town Planner (on behalf of Matthew Egge) I I1 { 1 ; f ; {00031658;vl}2 i aA >Ap �6/ 4 � `►��`` / I �S r., I 1 ';S_Ik AM Ali Ax a�A 8/ i► ► f' f� n.i R lig }g�� N r v Si SiiE 1 1. j/`� IF � °},2 b. Sew• 1 `• ► ccc 1► ,J lilyF;fiT B/ R,.a3 a / IPA 8... 3, i� lily SSE; 'a' � �/ Psi � •��q° / ll�/0� � // \' "Sy as i •�° F ilii; �3 a / d ( / Z E Tiff o t'j p1• i;;::y 'S 8? 1�I�1 SiStoa �8'34 k �\I �9E fEfE / it: ESB; 1;° SSSSiy i:si a i�s:;.�i 5. i fns ' S 5::.♦ 1 Ir- ]�S 5S �� aiJ'II�hj�g�+jll'I'i•• 4 1 E'1 �-S�I rla i {. }iF • �I,R U Si li'�aF SSS; is 1 tt R 1 4Rim 1 °� �;_ � 6!•�n 4i 1�[dizlii 1 i \4'ia -II , �I Illy !t� .5a . �y I•� � f ti 5..::• ..t r E • �( I I i i 1i p ,,••• � • pfY tl5R5 ii�cif Yy —eR,s''�� ' � YYS a S� ..yq�r 1 °-'smart • �,,nop"sa a•N'• yl4• SITE PIAN APPROVED BY THE REGISTRY USE ONLY g'd TOWN OF NORTH ANDOVER PLANNING BOARD g 8 I `��• EDGEWOODRETSREMENTCOMMUNITY SI 0 DATE NORTH ANDOVER.MA PREPARED FOR EDGEWOOD RETIREMENT COMMUNSTY 2 Q g 6•�•••�. STS MAS SIRFEE nntartn.wQrLmrsms DRea Nr L 0 W IMPERVIOUS COVERAGE SUMMARY rc PROPOSED ADDITION•A• s� ® . 12 (96SF) LPAVEMWAREAPROPOSEDo SIM S.F. Ik PATIO �'. PAVEMENT AREA TO BE REMOVED• ON S.F. ,esu 3 g�^ NET PAVEMENT AREAREDUCTION• *750 S.F. m pp RLY.168.50' e 6 PROPOSED BUILDING ADDITION 2 1 O 1NV M e'16125' ' FOOTPRINT AREA 2,407S.F. j=Z NV BD7TDM158.60' EY. SW 07 / :w IN .15' NET INCREASE IN • 2.147SF. INV W A 8'PVC-156.02' Q IHV lY B 8'PVC=1!9.16' ¢ OMP�VIDV`S'�VER INV INC 8'PVC-15073 ' V OUT D 8'PVC-149.40;` 20 10 0 20 40 60 d SG1L`1�]C k 1NI.H B / �\I8M=168.'6 owDmmmwl // v \N INV.A 6'HDP-162.66 INV.B 6'1162.42 INV.C 6'HDP-162.2- INA 24'S'EEL161.42 / MV.0 6'HDP-162.2.4 V OUT B 24RW 161.36' / PROPOSED e [�o,n.1 ADDITION'C' \�G SEWER CLEANOUT (1,4098.F) PoM-168.16' DMw e MV 16134' - Cdv vv M yy MVM z C �` 7 IN S pp p :NV M S U 8 ADDITION'S• � � REMOVED O2 � K /,1 A8A.16'!.58' \ " / d'\�(A. 156.6 "0 /� \ \ MV CUT 3 �+ �\ W PAVEMENT a ^.P-156.00 / f o PROPOSED REMMDVED 5AREA 5169 / , mMarchionda C ll aAwodatl&LP. /1 fl:M-167.18' �� \I LP \ 1:'5 N A 24RCP 159.16 \•. / 1 i\6 12'RCP!79.52 \ d�CB Po ER 1 C 18'RCP 159.08 �� MWD W TER lfiO]4'/ aq Y D 1V RCP 159.31 e", v !/ SMH RYd t6°.S9' tlG� OUT E 24'SR'EL 158.99 •� 1LL91A9MAI 1.1M LOCl1110X ar OaS1om nrcc 1—m Ato ona ueaual0lAo D161R]Au McONsl1 Nor rAalANim ro ec mlevsr a caPlca Arm Ala alae eA®ur9.CO10RAc10A'srwatae a00Pla Alm VIC 6CIT M�ROa11A11011 Of 1RL ACW&LOu110NL 18oV A/810 alR1LT. IN ' WINpACIgL 114�MpLS lEI1ba1TR M, AK µp Aa 7D To 0 2D IO 60 PERMITTING PLANS >9l9YAR 91ALL!¢NOM1tm 1AtOR ro ANT pCAVAtpNC xAtC I'-39' NOT FOR CONSfRUC71ON 9�2a1 .. .... ..... ....'. ..... ....... .. .............. --------- .... ................. ... ...... _.._.. .. ... _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Chapman Construction/Design Company Address: 84 Winchester Street City/State/Zip: Newton /MA/02461 Phone #: 617-630-8408 Are you an employer?Check the appropriate box: Type of project(required): 1.;g I am a employer with '211 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. E] Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ 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#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Massachusetts Employers Insurance Policy#or Self-ins.Lic.#: MCC20020003942015A Expiration Date: 01/01/2016 Job Site Address: 5 75 Q s g asd City/State/Zip: a. A ` 4,4 018,4_j- -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-y imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a d y against t violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of t DIA for' urance coverage verification. I do — un er pains - that the information provided above is true and correct. Si nature: �,_ Date: 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#: I D& HINCKLEY 28 State Street Boston, MA 02109-1775 ALLEN p:617-345-9000 f:617-345-9020 ; hinckleyallen.com i March 19,2015 Paul A.Hedstrom 617 378-4154 phedstrom liinckleyallen.com Mr. Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 Re: Edgewood Retirement Comnrunlity, Inc.—575 Osgood Street("Property" Dear Mr. Brown: As you know, our firm represents Edgewood Retirement Community, Inc. ("Edgewood"). Thank you for providing me with a copy of the January 6, 1987 Special Permit granted to Edgewood by the Zoning Board of Appeals(the"1987 Special Permit"). The 1987 Special Permit lapsed prior to the development of the existing facility, as substantial use or construction had not commenced within the two(2)year period following the issuance of the 1987 Special Per.nit,as required pursuant to Section 10.31(3) of the By-Laws. Following the expiration of the 1987 Special Permit,Edgewood subsequently commenced construction of the facility pursuant to the Site Plan Review Special Permit referenced in a Notice of Decision of the North Andover Planning Board (the"Planning Board") dated October 5, 1989,and constructed additional improvements to the facility pursuant to the Site Plan Review Special Permit referenced in a Notice of Decision of the Planning Board dated January 15, 2008. As such,the conditions and provisions of the 1987 Special Permit, including, but not limited to,the provision prohibiting"future expansion of the facility beyond the submitted proposal", are not applicable. if you have any questions, please do not hesitate to contact me, Very truly yours, Paul A.Hedstrom PAH ►ALBANY ► BOSTON ► CONCORD ► HARTFORD ► NEW YORK ► PROVIDENCE HINCKLEY,ALLEN&SNYDER LLP,ATTORNEYS AT LAW 53153892 v1 098000/9820000 Z7,& HINCKLEY 28 State Street L L 9 Boston, MA 02109-1775 j p:617-345-9000 f:617-345-9020 hinckleyallen.Com I I March 18,2015 Paul A.Hedstrom 617 373-4151 phedstrom@hinckleyallen.com Mr. Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood.Street I Building 20, Suite 2035 j North Andover, MA 01845 j i i Re: Edgewood Retirement Community,Inc.—575 Osgood Street("Property") j Dear Mr. Brown: i Our firm represents Edgewood Retirement Community, Inc. ("Edgewood") and at i your request, we submit to you the following analysis of the relevant approval required in i connection with Edgewood's request for a building permit for proposed minor renovation of the existing structure on the Property, which would add roughly 2,400 square feet of gross floor area to the existing structure located at 575 Osgood Street. By way of background, pursuant to a Notice of Decision of the North Andover Planning Board (the "Planning Board") dated October 5, 1989 (the "1989 Decision"), the Planning Board approved the Site.Plan.Review Special Permit for the construction of a 1 Continuing Care Retirement Center. On January 15, 2008,pursuant to a Notice of Decision of the Planning Board dated January 15, 2008 (the "2008 Decision" and together with the 1989 Decision, collectively referred to herein as, the"Decisions"),the Planning Board approved a Site Plan Review Special Permit authorizing, among other things,.Edgewood to convert the"Mille Barn" structure into two (2) residential twits and add them, together with twenty-two (22) attached and single family cottage style units,to the already existing 219 units, bringing the total number of units onsite to 243. The Decisions require that all construction previously approved must conform to the previously approved plans and specifications and that any changes must receive prior written approval of the Town Planner. I Additionally,pursuant to Section 8.3(2)(a)(ii) of the Town of North Andover Zoning By-Laws (the "By-Laws"), because the construction of the proposed addition would result in ` I I ►ALBANY ► BOSTON ► CONCORD ► HARTFORD ► NEW YORK ► PROVIDENCE j HINCKLEY,ALLEN&SNYDER LIP,ATTORNEYS AT LAW 53150813 v1 098000/9820000 i Mr. Gerald Brown Iizspector of Buildings March 18,20I5 Page 2 the addition of more than 2,000 square feet of gross floor area to an existing structure; Site Plan review by the Planning Board is required,unless the Planning Board makes a determination that submission of a site plan review application is not required,which such determination the Planning Board may make without a public hearing pursuant to Section 8.3(2)(c) of the By-Laws. By letter to the Planning Board in November of 2014, Edgewood, through its architect, requested a waiver of Site Plan Review pursuant to Section 8.3(2)(c)(ii) of the.By-Laws, which was subsequently granted by the Planning Board on December 16, 2014. As Edgewood has complied with the terms of the Decisions and received a waiver of Site Plan Review,the proposed renovation of the Property does not require any additional Town Board approvals. . If you have any questions,please do not hesitate to contact me. Very truly yours, Paul A. Hedstrom PAH Enclosure ►ALBANY / 0- BOSTON p ► CONCORD ► HARTFORD ► NEW YORK ► PROVIDENCE 5315ANVT UJBUMYA8�6RER LLP,ATTORNEYS AT LAW i Department of Code Enforcement Debris Disposal Affidavit In accordance with the provisions of GL,c. 40,sec. 564, a condition of permit# is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defingd by GL,c. l 11, sec. 150A. The debris will,or has been disposed of at: 68 Hopkinton Rd, Westborough, MA 01581 Location of Facility 575 Osgood Street, North Andover, MA 01845 Location of action/jobsite (Street Address) Si ature of applicant/contractor Date t of pub dards s_Depa� ons.and Stan. ruseftegu%a 'x Massacix6%n9 v ervisox � . 8�ard Cin cxue{inCs.SUVI0551632 Ltice �.� Lw_ r3. OK A �` 3SSp1�S R pi ira`��on 011p512 GIDO { Client#: 1059278 CHAPMCON1 DATE(MM/DD/YYYY) ACORD.M CERTIFICATE OF LIABILITY INSURANCE. 1/02/2015 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 Maria Nixon NAME: USI Insurance Services LLCPHONE g55 874-0123 FAX 781-376-5035 A/C No Ext: AIC No 12 Gill Street Suite 5500 ADDRESS: Maria.Nixon@usi.biz Woburn,MA 01801 INSURER(S)AFFORDING COVERAGE NAIC# 855 874-0123 INsuRERA:Travelers Indemnity Company 25658 INSURED INSURER 8:Travelers Property Cas.Co.of 25674 Chapman Construction/Design Company INSURER C:Massachusettts Employers Insura 12886 Chapman Construction Design Holding LLC INSURER D:Charter Oak Fire Insurance Comp 25615 84 Winchester Street INSURER E: Newton Highlands,MA 02461 INSURERF: 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY 9D890943943COF15 1/01/2015 01101/2016 EACH OCCURRENCE $1,000,000 i X COMMERCIAL GENERAL LIABILITY PREMDAMAIE ESTO Ea occurrRENTEDence $300000 CLAIMS-MADEEx—]OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PROCT LOC $ JE D AUTOMOBILE LIABILITY BA3E9844341ND15 1/01/2015 0110112016 COMBINEDINGLELIMIT a ccidentS $1,000,000 Ea X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B X UMBRELLA LIAB X OCCUR CUP3E984446TIL15 1/01/2015 01101120116 EACH OCCURRENCE $20 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $20OOO OOO DED X RETENTION$10,000 1O 000 $ C WORKERS COMPENSATIONMCC20020003942015A 0110112015 01/01/2016 X WCSTATU- I 1OTH- AND EMPLOYERS'LIABILITY TORY LIMIT IER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 0 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE SAMPLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S14075398/M14074667 PRNZP This page has been left blank intentionally: i w I Marchlonda & Associates, L.P. I� �• j Engineering and Planning Consultants November 24,2014 i Mr.Matthew Egge j Town Planner North Andover Planning Board 1600 Osgood Street ! North Andover,MA 01845 RE: Edgewood Retirement Community (( Dear Matthew: As a follow up to the informal interdepartmental review meeting held in October,I am submitting a site plan sheets 1 and 2 dated November 13,2014 showing the proposed additions to the existing Club House building at the Edgewood Retirement Community. The proposed additions consist of the following: • A 1409 sf addition to the east side of the main building entrance i • A 962 sf addition to the west side of the main building entrance i • A 42 sf addition to the Wellness Center located at the northwest corner of the Club House building. The total square footage of the proposed additions is 2,41.3 sf which exceeds the threshold for site plan review of 2,000 sf.pursuant to section 8.3.2.a.i of the North Andover Zoning Bylaw. On behalf of The Edgewood Retirement Community we are requesting a waiver to site plan j review as provided for by section 8.3.2.c for the following reasons. 1. The purpose of the proposed additions is to provide additional space for the operation of the existing programs taking place at the Edgewood Retirement Community. No increase i in staffing or resident levels at the facility is required or proposed. As such there is no increase the intensity of uses on the site including no need for additional parking. 2. On sheet 2 of the enclosed plans we have included an impervious coverage summary. Although there will be a net increase of 2,147 sf of imperious area there will not be any impact on the existing drainage system or site hydrology. All the proposed additions are within the same 22.1 acre watershed and as such impact only '/4 of 1%of the water shed area. This minute percentage of increase in impervious area is so small that it will have absolutely no impact on the site generated runoff. I i 62 Montvale Avenue Tel: (781)438-6121 Stoneham, MA 02180 Fax: (781)438-9654 website: http://www.marchionda.com Email: mail@marchionda.com j I I Marchlonda & Associates, L.P. Engineering and Planning Consultants Please do not hesitate to call if there are any questions or if any additional information is necessary. er harch' rida&Associates,L.P. Pa WAarchionda,PE President Cc: Edgewood Retirement Center Trident Advantage Group. i EDGEW@i4?) 00, March 25, 2015 Gerald Brown Inspector of Buildings Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 RE: Edgewood Retirement Community 575 Osgood Street To Mr. Brown: As authorized agent for Edgewood Retirement Community, we authorize Chapman Construction to act' on the owner's behalf in all matters relating to the building permit and construction for Edgewood Additions& Renovations project at the above referenced location. Please contact me at 978-725-4117 should you have any questions. Sincerely, Robert Coppola Director Facilities Edgewood Retirement Community 575 Osgood Street North Andover, Ma. 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: Edgewood Additions and Renovations Date:March 18,2015 Property Address: 575 Osgood Street,North Andover,MA 01845 P Y Project: Check(x) one or both as applicable:X New construction X Existing Construction Project description: Renovations to Wellness Center and single story additions to Clubhouse I Ruth Neeman MA Registration Number: 20028 Expiration date: 8/31/15 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: X 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'. Enter in the space to the right a"wet" or electronic signature and seal: � . C 'C H 28 [ C 4� �P 4 . 5 (TM Q��pP Phone number: (978) 371-1945 Email: rneeman(alwda.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x' 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 Certification d To be submitted with the building permit application by a m Registered Design Professional �< for work per the 8th edition of the 4� O V� ' e Massachusetts State Building Code 780 CMR Section 107.6 Project Title: Edgewood Retirement Community-Additions &Renovations Date: March 18,2015 Property Address: 575 Osgood Street,North Andover,MA 01854 Project: Check one or both as applicable: X New construction X Existing Construction Project description: Concrete,Steel&Wood Framing for Building Additions&Renovation I Amir S.Mesgar Mass.Registration Number 48814 Expiration 06/30/2016, being a registered design professional, hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Entire Project [ ] Architectural [X] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other for the above named project and that 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. 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 Report/Approval Document" indicating that the work has been performed in accordance with the approved plans and this code. I hereby attest under the pains and penalties of perjury that all of the information contained in this document is true and accurate to the best of my knowledge and belief. �p1QFt Actual "wet"or Electronic signature and seal of registered design professional: /t �`y"' V �a AlyR4R S. G /mai i EUESGAR (/_7 STRUCTURAL r; v J No.48814 NFI. Phone number: 617-948-5600 Email: amesgar�@lafp.com Building Official Use Only Building Official Name: Permit No.: Date: Version 9-25-2012 Initial Construction Control Document To be submitted with the building permit application Registered Design Professional for work per the a edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Clubhouse Additions/Renovations Date: 3/20/15 Permit No. Property Address: Edgewood Retirement Community - 575 Osgood St. Project: Check(x)one or both as applicable: New construction Existing Construction Project description: Renovations to Fitness wing, Additions to Clubhouse per drawings dated 3/1/15, with Rev. 1 (3/19/15) on drawings H-0, H-1, and FA-1 . I Gary M. E 1 oy i t z MA Registration Number: 3 5 4 51 Expiration date: 6/3 0/16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural [X] Mechanical [)Q Fire Protection [X] Electrical [X] Other: Describe Fire Alarm 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), subject to contractual arrangements with my client, shall perform the necessary professional services and be present on the construction site at intervals appropriate to the stage of construction: 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 regardingjhe 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, ial a`Final Construction Control Document'. H Fiy� RM Enter in the space to the right a"wet"or o / O ym electronic signature and seal: No. 451 p�9�G�STER��tQ NAL ENG�� Phone-number: 617-527-3353 Email:.-gary@energyguys .com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 4 , FIRE PROTECTION SYSTEMS NARRATIVE REPORT 780 CMR — 901 .2.1 EDGEWOOD RETIREMENT COMMUNITY CLUBHOUSE First Floor Renovations and Additions 575 Osgood St., North Andover, MA Prepared For: P`t"° qss North Andover Fire Departmen E „ M q�yN AC -4 0.35451 March 19, 2015 �STFR�° �Q (1.a) BASIS (METHODOLOGY) OF DESIGN Section 1- Project description The project is interior-renovations to the Fitness wing, and two small additions to the first floor of the Edgewood Retirement Community Clubhouse building in North Andover. Fire protection Work for the project includes minor modifications to existing sprinkler and fire alarm systems and emergency lighting as needed for changes to interior partitions and space use in the renovated Fitness area, and extension of existing sprinkler and fire alarm systems and emergency lighting as needed to the two new construction areas. Section 1 - Building Description: The existing building is two stories above-ground with a partial story,partly below grade. Building Use Group: A-3. Building height: Approx. 36 ft. from lowest adjacent.grade to highest roof Number of floors above grade: 2 Height of highest floor: 12 ft. above lowest adjacent grade level. Number of floors below grade: 1 Edgewood FP Narrative - Page 2 of 6 Building square footages (approximate): Existing (unchanged) Renovation New 1 st fl: 18,428 4,292 2,404 2nd fl: 14,090 0 0 Total: 35,518 4,292 2;404 Type of construction: Type 5B construction. Stairwell and shaft enclosures have one- -hour rating (connecting up to three stories). Hazardous materials usage and storage: None High storage of commodities: -None Site access arrangement for emergency response vehicles: Vehicle access to front and one side of the building. Not changed b project.) ( 9 Y the p ro'l ) Section 2 -Applicable Laws, Regulations and Standards a) 780 CMR eighth edition - Chapter 9 b) NFPA Standards 13 (2013), 14{2013) and 72 (201-0) c) 527 CMR "Fire Prevention Regulations" d) ADA Accessibility Guidelines Section 3 — Design Responsibility for Fire Sprinkler System & Fire Alarm System Professional Engineer: Gary M. Elovitz j MA PE# 35451, HVAC Energy Economics, -Inc. 184 Gibbs Street Newton, MA 02459 tel. 617-527-3353 The professional engineer (PE) provides a partial design and specifies the design criteria to be used by the installing contractor. The-installing contractor will finalize the system layout, provide calculations to confirm the design criteria, install and test the system, and certify system installation for code compliance at completion. Section 4— Fire Protection Systems to be Installed -FIRE SPRINKLER SYSTEM NFPA 13 wet-pipe sprinkler system as required per 780 CMR Table 903.2 Renovation Areas: The existing sprinkler system will be modified to provide full coverage of the space. Edgewood FP Narrative - Page 3 of 6 New construction areas: Full sprinkler coverage will be provided, fed from an existing 6".sprinkler.main,adjacent to the.new-construction area. Light hazard: max. 225 sq. ft. per sprinkler. Sprinkler spacing: Max. 15°x1.5', except that in.small.rooms (up.to 8.0.00 sq. ft.) sprinklers may be up to 9 ft. from the wall. Complete automatic sprinkler protection will be provided throughout the building, -including above the ceilings-(in areas of-combustible construction). STANDPIPES Standpipes are not required per MA Building Code section 905, and will not be provided. FIRE PROTECTION WATER SUPPLY & DISTRIBUTION I Water supply with backflow prevention, fire department connections, alarm bell, flow switches, inspector's test and drain are existing to remain. Sprinkler zoning is existing to remain. FIRE ALARM SYSTEMS The building has an existing fire alarm system. The project will include relocation of existing devices and addition of new devices as required. A. Initiation: 1. Sprinkler flow and tamper (supervisory) switches - existing. 2. System smoke detectors in elevator lobbies for elevator recall - existing. 3. System smoke detectors in common hallways: not required by Code, provided as voluntary additional protection per NFPA 72, 17.5.3.3 4. Manual pull stations will be provided at each exterior egress door. 5. Duct smoke detectors on air-handling systems larger than 2,000 CFM shall shut down the air-handling fan and initiate a supervisory signal. B. Notification: Horn/strobes and strobes will be provided for occupant notification as required, including visible alarms in public and common areas. C. A beacon will be provided that will light upon initiation of any fire alarm - existing. D. Alarm retransmission by Master Box- existing. EMERGENCY POWER Edgewood FP Narrative - Page 4 of 6 The building has existing emergency generators and transfer switches. Exit signs and -emergency-lighting will be wired toexisting.emergency.(life safety) power.pariels. Section 5 - Features used in Design Methodology a) Occupant notification and evacuation: The premises fire alarm system will provide audio and visual notification of an alarm condition throughout the building. -b) E-mer-gency-response: Fire alarms will be transmitted to the-Fire Department-(via Master Box). c) Construction activities: The General Contractor is responsible for safety during all construction activities. d) Testing, monitoring and maintenance: The Owner will have a service contract with a fire alarm vendor for periodic testing and maintenance of the premises fire alarm -system. The fire alarm vendor will also monitor the system remotely for trouble and supervisory functions. Section 6 - Special Consideration None required (1.b) SEQUENCE OF OPERATION FIRE SPRINKLER SYSTEM Wet Pipe Sprinkler: Heat produced from a fire melts the fusible link or breaks the glass -bulb on one or more sprinkler heads, causing the sprinklerfs)to open. Water from the water filled pipe is discharged immediately from the sprinkler head(s)to control the fire. The fire department may pump the fire department connection to supplement the -system. Sprinkler system water flow alarms activate-upon system flow and-indicate to the FACP an alarm condition. The sprinkler(s) continue to flow water until manually shut off. FIRE ALARM SYSTEM In accordance with the Massachusetts State Building Code, the operation of a manual -station or activation of any automatic alarm--initiating device (water flow) shall cause the following to occur: Transmit the alarm to the Municipal Fire Station via the Master Box. Sound audio and visual notification devices in the approved building evacuation sequence. Light the exterior alarm beacon. Flash an alarm LED and sound an audible signal at the FACP and the remote annunciator. R i Edgewood FP Narrative - Page 5 of 6 Upon Acknowledgment, the alarm LED shall light steadily and the audible shall silence, .Subsequent.alarms-shall re-initiate this.sequen-ce. Alarm, trouble, and supervisory signals will also be transmitted to a Remote Supervising Station.. EMERGENCY GENERATOR In the event of loss of normal electrical power the emergency generator will start and the transfer switch will switch power on emergency panels to the generator. The -generator has sufficient fuel capacity to power the lights for at 1'12 hours. (Il x) TESTING CRITERIA GENERAL TESTING CRITERIA The general contractor has overall responsibility for setting up and coordinating all acceptance-testing with authorities having jurisdiction. All testing shall be in accordance with NFPA requirements, the Massachusetts State Building Code, 8th Edition, the National Electrical Code, and the contract specifications. FIRE SPRINKLER SYSTEM The sprinkler contractor is responsible for setting up and coordinating all sprinkler -system acceptance testing. All.testing shall be in accordance with NFPA 13, the Massachusetts State Building Code, and contract specifications. FIRE ALARM SYSTEM The completed system shall be subject to the final test and acceptance, UL certification and periodic inspection and testing, and the Massachusetts State Building Code, NFPA 72, Chapter 10as.follows: The test shall be conducted by the installing contractor and certified testing -company. Each and-every new device-shall-be functionally-tested. Upon function test of each device, the corresponding event sequences shall be verified. Subsequent events shall include-system annunciation and Remote Station reporting. Fault conditions shall be simulated and verified as to their proper reporting and system response. These-shall include-loss of AC-power,-battery-standby operation, and wiring faults of the modified circuits. A complete report demonstrating the activation and subsequent acknowledgement of -each activation shall be generated. An annual test and inspection contract will be in evidence at the time of final testing. The final system acceptance-test-shall be conducted-by the-holder of the test Edgewood FP Narrative - Page 6 of 6 contract, and witnessed by the local authority having jurisdiction. Upon successful test.and.acceptance, the testing company shall issue a final report and certificate_of compliance. certificate Testing and inspection shall be conducted by the testing company of record as -described and in accordance with NFPA 72, chapter 10. Section 2— Equipment and Tools FIRE SPRINKLER SYSTEMS The sprinkler contractor shall be responsible for providing all required equipment and -tools, including but not limited to: hydrostatic testing equipment, pressure gauges, hoses, nozzles, manufacturers instructions, radios, etc. FIRE ALARM SYSTEM The Electrical Contractor shall provide all tools necessary to complete the successful testing of the Fire Alarm systems. Section 3 —Approval Requirements The General Contractor will obtain written approval of all acceptance testing from the North Andover Fire Department. Report all-system failures to the General Contractor, North Andover Fire Department, and design engineer. Provide the North Andover Fire Department with copies of NFPA 13 and 72 testing certificates, instruction manuals and as-built drawings. The building owner will submit to the North Andover Fire Department the names and telephone numbers of emergency contacts. I ' a Y COMcheck Software Version 3.9.4 Interior Lighting and Power Compliance Certificate 2012 I ECC Section 1: Project Information Project Type:Addition Project Title : Edgewood Retirement Community-Clubhouse Construction Site: Owner/Agent: Designer/Contractor: 575 Osgood St. Gary M Elovitz, PE No.Andover,MA 01845 Energy Economics, Inc. 184 Gibbs St. Newton,MA 02459 617-527-3353 gary@energyguys.com Section 2: Interior Lighting and Power Calculation A B C D Floor Area Allowed Allowed Watts Wafts/ft2 Addition(Office) 2246 0.9 2021 Renovation(Exercise center) 2981 1 2981 Renovation(Retail) 297 1.4 416 Total Allowed Watts= 5418 Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Addition(Office 2246 sq.ft.) R-1:R-1(A):Recessed:Other: 1 19 40.4 767.6 R-2:R-2:Recessed:Other: 1 27 17.5 472.5 LR-1:LR-1:Recessed linear:Other: 1 10 41.4 414 LR-3:LR-3:Recessed linear:Other: 1 3 41.4 124.2 LR-5:LR-5:Recessed linear:Other: 1 4 27.7 110.8 U:U:Utility 2'x2':Other: 1 1 40 40 UC:UC:Under-cabinet:Other: 1 6 10 60 Renovation(Exercise center 2981 sq.ft.) P-1:P-1:Pendent:Other: 1 1 36 36 R-1:R-1(A):Recessed:Other: 1 37 40.4 1494.8 R-2:R-2:Recessed:Other: 1 23 17.5 402.5 R-7:R-7:Recessed-wet:Other: 1 4 16 64 LR-2:LR-2:Recessed linear:Other: 1 10 18.7 187 U:U:Utility 2'x2':Other: 1 1 40 40 W-1:W-1:Vanity:48"T8 32W:Electronic: 2 _ _ 2 64 128 ;Renovation(Retail 297 sq.ft.) P-2:P-2:Pendent:Other: 1 4 7.5 30 R-2:R-2:Recessed:Other: 1 12 17.5 210 LR-6:LR-6:Recessed linear:Other: 1 10 18.7 187 Total Proposed Watts= 4768 Project Title: Edgewood Retirement Community-Clubhouse Report date:03/17/15 Data filename: D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 1 of 2 Section 4: Compliance Statement Compliance Statement: The proposed lighting design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed lighting system has been designed to meet the 2012 IECC requirements in COMcheck Version 3.9.4 and to comply with th andatorXie in the Requirements Checklist. Gary M. Elovitz, PE 3/17/15 Name-Title gnature Date Digitally signed by Gary M.Elovttz,PE IINSection 5: Post Construction Compliance Statement :;: {_ eem cn=GaryM Elovilz,PE,c=US, ' y =Energy Economics,Inc., +?.. @mail=garyQenergyft,ofom Reason:amthe author 8this document Date'2018.03.17 17:48:1 S-0400' Record Drawings and Operating and Maintenance Manuals: 1. Construction documents with record drawings and operating and maintenance manuals provided to the owner. Lighting Designer or Contractor Name Signature Date Project Notes: No exterior lighting i i I Project Title: Edgewood Retirement Community-Clubhouse Report date:03/17/15 Data filename: D:Wctive\Current\LWDA\Edgewood\Edgewood.cck Page 2 of 2 y COMcheck Software Version 3.9.4 Inspection Checklist Energy Code: 2012 IECC Requirements: 83.0% 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. I i I 1 JHigh Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Edgewood Retirement Community-Clubhouse Report date: 03/17/1 Data D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 1 of 5 2012 IECC Plan Review Complies? Comments/Assumptions C103.2 ;Plans, specifications, and/or 1❑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 sand electrical systems and equipment :❑Not Applicable . , sand document where exceptions to ;the standard are claimed. Information ;provided should include interior I !lighting power calculations,wattage of ;bulbs and ballasts,transformers and !control devices. C406 ;Plans, specifications, and/or I❑Complies ;Requirement will be met. [PR9]1 ;calculations provide all information :❑Does Not iwith which compliance can be ;determined for the additional energy Observable: .efficiency package options. ;❑Not Applicable ; Additional Comments/Assumptions: i it 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Edgewood Retirement Community- Clubhouse Report date: 03/17/1 Data D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 2 of 5 012 IECC Rough-in Electrical Inspection Complies? Comments/Assumptions C405.2.2. Automatic controls to shut off all ;❑Complies ;Exception: Lighting controlled by occupancy sensors. 1 building lighting installed in all T❑Does Not [EL22]2 buildings. UNot Observable ❑Not Applicable C405.2.1. I Independent lighting controls installed ;❑Complies ;Exception: Areas such as security or emergency areas that 1 per approved lighting plans and all :❑Does Not :need continuous lighting. [EL23]2 manual controls readily accessible and i❑Not Observable visible to occupants. ;❑Not Applicable C405.2.1. ;Lighting controls installed to uniformly;❑Complies ;Exception: Areas that are controlled by an occupancy sensor. 2 :reduce the lighting load by at least :❑Does Not [EL15]1 150%. ❑Not Observable ❑Not Applicable C405.2.2. Daylight zones provided with ;❑Complies ;Exception: Requirement does not apply. 3 individual controls that control the I❑Does Not [EL16]2 lights independent of general area ❑Not Observable 9 g• li htm :❑Not Applicable C405.2.3 ISleeping units have at least one ❑Complies ;Exception: Requirement does not apply. [EL17]3 master switch at the main entry door ❑Does Not III 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 [EL18]1 ;❑Not Observable: ❑Not Applicable C405.2.2. ;Primary sidelighted areas are I❑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 :[-]Not Observable: controls. ❑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 C405.3 Fluorescent luminaires with odd ;❑Complies ;Exception: Requirement does not apply. [EL19]3 numbered lamp configurations that UDoes Not are with 10 feet center to center(if recess mounted)or are within 1 foot ;❑Not 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. [EL6]1 liface. UDoes Not , ;❑Not Observable: +❑Not Applicable C405.2.3 !Additional interior lighting power ;❑Complies ;Requirement will be met. [EL8]1 !allowed for special functions per the :❑Does Not approved lighting plans and is ;automatically controlled and :❑Not Observable: !separated from general lighting. ;❑Not Applicable Additional Comments/Assumptions: 1 IHigh Impact(Tier 1) 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Edgewood Retirement Community- Clubhouse Report date: 03/17/1 Data D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 3 of 5 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Edgewood Retirement Community- Clubhouse Report date: 03/17/1 Data D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 4 of 5 20121ECC Final Inspection Complies? Comments/Assumptions C408.2.5. Furnished as-built drawings for ;❑Complies ; 1 electric power systems within 30 days T❑Does Not [FI16]3 of system acceptance. ❑Not Observable; ❑Not Applicable C303.3,C41 Furnished O&M instructions for ;❑Complies 08.2.5.2 systems and equipment to the ;❑Does Not [F117]3 building owner or designated ;❑Not Observable representative. ❑Not Applicable C405.5.2 :Interior installed lamp and fixture ;❑Complies ;See the Interior Lighting fixture schedule for values. [FI18]1 :lighting power is consistent with what !❑Does Not is shown on the approved lighting ❑Not Observable ;plans, demonstrating proposed watts :are less than or equal to allowed ;❑Not Applicable watts. C408.3 ;Lighting systems have been tested to ;❑Complies [F133]1 :ensure proper calibration, adjustment, :❑Does Not ;programming, and operation. ❑Not Observable ❑Not Applicable C406 ;Efficient HVAC performance, efficient :❑Complies ;Requirement will be met. [F134]1 :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) 3 Low impact(Tier 3 ) Project Edgewood Retirement Community - Clubhouse Report 03/17/15 Data D:\Active\Current\LWDA\Edgewood\Edgewood.cck Page 5 of 5