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Building Permit #349-2017 - 586 MASSACHUSETTS AVENUE 9/30/2016
�ja,�5 Nvt scRNw�'b /� L NORTH A., BUILDING PERMIT TOWN OF NORTH ANDOVER 0 ; A APPLICATION FOR PLAN EXAMINATION Permit No#: — ,1 Date Received °�Q.TED�Pa cy gSSAC HU`''B( Date Issued:4*MPORTANT: Applicant must complete all items on this page LOCATION, - � - Pnnt PROPERTY OWNER ���Sk CC��yt3�t'�i 'k 6f' 1DD Year Structure yes no MAP _ . _ PARCEL. _ZONING DISTRICT:�H�storrc District yes no; Machine Shop Village _„yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition El Two or more family ❑ Industrial V'AIteration No. of units: ❑ Commercial 0 Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other T_ _ 0 Septic. ❑WeII” 0 Floodplain ❑Wetl'ands ❑ Watershed District r 0 Wates/Sewerr- DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly i OWNER: Name: t:5k Y\urC Phone:Oil Z(02S 1502 Address: biq to m0.5" :- ` '-fi�,� Phone q�t to 5 5� tr, Contractor Name: c�o (nc�rnst5 - Email $c`c�2a.\cl L Address<. -_0y4 Z - �_ Supervisor's C.onstructron;L'icense .:Exp`.°>. Date:_ Y - Home Improvement.License: - - _ - - ARCHITECT/ENGINEER Con -kin S En - Phone: CIi1�"_�05�-26 ( (0 Address: 2o® :5QkCy'ecScn Q-' JLO M%ngWn MO Reg. No. 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.: 015- Receipt No.: 3tA�D NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund / inature of contractor -- ! _ "'�"..• Signature of Agent/Owner _ - `g Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. i Roofing, Siding, Interior Rehabilitation Permits Li Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o. Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign-off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application u Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses i� Li Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) L, Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineeredineered products NOTE: Allumpster 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 thea appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording PP must be submitted with the building application Doc:Building Permit Revised 2014 i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ [WellEl YPE OF SEWERAGE DISPOSAL blic Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ To Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: 4 FIREtDEPART�E�I - - - _ _ -_ Located 384 Osgood Street �� M iT TempT®urn c �rLocated�afF 1lllam' eta to° yes� � n , 124 psi o rStrel �- -� F,i:re D:epa_rtrnent sgna#ure/d_ate COMMENTS.R _ - I Dimension Number of Stories:_Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21 --F and G min.$100-$l 100 $ 1000 $ fine I NOTES and DATA — (For department use) ❑ Notified for pickup Call Email -.Date. Time Contact Name Doc.Building Permit Revised 2014 i f r Location No. '� —2.01 Date ;�Cl �o ry • - TOWN OF NORTH ANDOVER A "n4 Certificate of Occupancy $ Building/Frame Permit Fee $a9Q0-- -- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# � 3 6c;' U Building Inspector NORTFf Town of s 6Andover O •1. ~7 No. t A- ?_Aq : h ver, Mass, A- 40k* COCNICHEWICK 7,9 q�R'�TEO PPa,`'�y S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System fib THIS CERTIFIES THAT . ..... r BUILDING INSPECTOR has permission to erect ..................... buildings on ..5 ......... ,,,,, �. Foundation • Rough to be occupied as p ....RA.604....� .& .....�..� .... .... ...... ... ... ..�......... Chimney provided that the person accepting this erml shall in eve res pct cbnfo�m to the terms of the application p g P rY p Final on file in this office, and to the provisions of the Codes and By-Laws re ting tp the Ins ecti n, Alteration� and Construction of Buildings in the Town of North Andover. vr�.r� PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR,_. UNLESS CONS TION Rough Service ........ .... .............. .. Final BUILDING INSPECT 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. ZX The Commonwealth of Massachusefts �=:� � Department of Fire Services w r Office of the State Fire Marshal c=*�E P.0.Box 1025 State Road Stow,MA 01775 APPLICATION FOR PERMIT Date: N An kCVQ V- Permit No (City or Town) (If Applicable) Dag Safe Number In accordance with the provisions of M.G.L. Chapter as provided in Section application is hereUy made Start Date by �•r�� - (Full name of person,Firm or Corporation) State clearly Address �� �;� '17 U t-eAwrg 11c.4 IV14y VY'-(Z purpose for (Street or P.O.Box City or Town) which permit For permission to Q k''n c is requested Comments: at (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Name of competent operator )�QY1 Cert.No. (If Applicable) Date Issued-rejected By (Sig.Ar.of Applicant) Date of expiration Fee$ Paid Due -- -------------------------------------------------------------------cut---------------------------------------- ------------------- -_--------- The Commonwealth of Massachusetts Department of Fire Services Office of the State Fire Marsha! P.0.Box 1025 State Road,Stow,MA 01775 PERMIT Date: Permit NO Dig Safe Nn tuber (City of Town) (If Applicable) In accordance with the provisions of M_G.L. Chapter as provided in section Start Date This Permit is granted to: Full name of person,Firm or Corporation Permission to Comments: Restrictions: at (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid$ This Permit will expire (Signature of offical granting permit} Offical granting permit (Title) TWIG PERMIT MI IAT RI= r' KIRPIr l ir51 IAI V Pr)CTl-n I IPr)K1 TWP PPPMIgFq The Commonwealth of Massachusetts Department of•jndustrialACcidents ��• r X Congress Sheet,Suite 100 _ Boston,MA 02114-2017 www mass. v/diago Y ^Vqr ders/Contractors/Electr:iciansfPluwbers. °'^�.• ��' davit:Sural � ux ante AfFi . yParkers Compensationlns TO BE TILED WITH THE PM MG AUTHORTIY. •Please Print Legibly A �licant Information Name(Business/OxgaAization/Individual).��t Address: City/State/Zip: �_—._---� :: .:. .. : ; R : . _ Type of project(required): Areyou empIoyer. eck.tlieapproprlatebox: ees full and/or part-time,)-' 7. ❑New'construction toy 1. I am a employer with—em p 2.❑I am a sole proprietor or partnership and have no employees Working for me in s. E]Remo del!Ag any capacity.[No workers'comp.insurance required] 9. Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑Building addition 4.F]I am a homeowner and will be hiring contractors to conduct all work on my properly. I will l l.❑Electricalrepairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12 o PljmbiTag repairs or additions proprietors with no employees. 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 110 Ro6f repairs These sub-contractors have employees and have workers'comp.inswance.t 14.� other I1 6.❑We are a corporation and its,officers have exercised their right of exemption per MGL c. 152,§1(4),and we Have no employees.[No workers'comp.insurance required.] *Any applicant that check§box#1,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 tContractors that check this box must attached'an additional sheet showing the name of the sub-contractors and state whether or not(hose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. X am an employer that is providing workers'compensation insurance for my employees. Below is the policy andJob site information. Insurance Company Name: v . of `G� CA� Expiration Date_ Policy#or Self-ins.Lie.#: W cs 3 Job Site Address: 1 �U.S� ikVQ , (, c3v`�2�/n City/State/Zip: C Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). al violation Failure to secure coverage as required as oivil penaltieser MGL c. ?inthe form of a25A is a aSSTOP WORK ORDER and as fine p to $250.00 a and/or one-year imprisonment, day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA.for insurance coverage verification. X do hereby certify under tlaepaiLadpenalties of eJurythat the information providedaove s taue and correctSi ature: � Ph official use only. Do not write in this area,to he completed by city or town official. Permit/License# City or Town: Issuing Authority(circle one): 1.Board of Healtb. 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivbf6r trustde of n individual,partnership,association or other legal,entity,employing emplbyees..However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or ,renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage r'egui-red." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial•Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. - City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Tob Site Address"the applicant should write•"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 v Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASS.AFE Fax#617-727-7749 Revised 02-23-15 wwwm.ass.gov/dia Initial Construction Control Document To be submitted with the building permit application by a F d Registered Design Professional for work per the 8t"edition of the ve Massachusetts State Building Code, 780 CMR,.Section 107 Project Title: First Calvary Baptist Church Date: April 26,2016 Property Address: 586 Massachusetts Avenue,North Andover,MA Project: Check(x)one or both as applicable: New Construction X Existing Construction Project description: . Fire Protection Tenant Fit-Up. I,Richard D Cummings Jr,MA Registration Number: 49023 Expiration date: 6/16 , 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 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'. A-4 tHOFMq Enter in the space to the right a"wet"or U p taI,1MMIN GS,JR. �c electronic signature and seal: o RVIN S MIN m0 � v ECTIO p► o.49 Phone number: 978 658 2616 Email: cummingseng@comcast.net � PIQQ�aa� 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 HYDRAULIC CALCULATIONS for Job Information Project Name:Rennovations Contract No. : City: North Andover, MA Project Location: Calvary Baptist Church Date:4/20/2016 Contractor Information Name of Contractor: Cummings Engineering Address: 200 Jefferson Road Suite 201 City: Wilmington, MA Phone Number: E-mail: Name of Designer: Richard Cummings jr. FPE Authority Having Jurisdiction: North Andover Fire Department Design Remote Area Name Dry Attic System Remote Area Location Occupancy Classification Commercial_Light Density(gpm/ft2) 0.114 Area of Application(ft2) 1560 Coverage per Sprinkler(ft2) 130 Number of Calculated Sprinklers 12 In-Rack Demand(gpm)(gp ) 0 Special Heads Hose Streams(gpm) 100 Total Water Required(incl.Hose Streams)(gpm) 297.8 Required Pressure at Source(psi) 41.1 C P � E Type of System Dry Volume-Entire System (gal) 831.4 gal Q Water Supply Information Date 04/20/2016 Location Mass Ave, North Andover Source Bride and Grimes Flow Test Notes File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 1 Job: Rennovations Node Labels: Node Reference Pipe Labels: Off Diagram for Design Area : Dry Attic System MO h6 h11 h2 h7 h3 h9 h5 h1 n17 n9 1$121 h12 n1 14113 19 h8 n5 4111 h4 n2O n3 n12 N File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 2 Job: Rennovations Hydraulic Analysis for : Dry Attic System Calculation Info Calculation Mode Demand Hydraulic Model Hazen-Williams Fluid Name Water @ 60F (15.6C) Fluid Weight, (Ib/ft3) N/A for Hazen-Williams calculation. Fluid Dynamic Viscosity, (lb•s/ft2) N/A for Hazen-Williams calculation. Water Supply Parameters Supply 1 : src1 Flow(gpm) Pressure(psi) 0 75 1190 60 Supply Analysis Static Pressure Residual Flow Available Total Demand Required Pressure Node at Source Pressure Pressure (psi) (psi) (gpm) (psi) (gpm) (psi) srci 75 60 1190 74.5 297.8 41.1 Hoses Inside Hose Flow/Standpipe Demand(gpm) Outside Hose Flow(gpm) Additional Outside Hose Flow(gpm) 100 Other(custom defined) Hose Flow(gpm) ........................................................................................................................................................................ Total Hose Flow(gpm) 100 Sprinklers Ovehead Sprinkler Flow(gpm) 197.8 InRack Sprinkler Flow(gpm) 0 Other(custom defined)Sprinkler Flow(gpm) 0 ........................................................................................................................................................................ Total Sprinkler Flow(gpm) 197.8 Other Required Margin of Safety(psi) 0 Base of Riser -Pressure(psi) 41.1 Base of Riser -Flow(gpm) 197.8 Demand w/o System Pump(s) N/A File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 3 Job:Rennovations Hydraulic Analysis for : Dry Attic System Is Supply $ System Demand I* Add.Out,Hose 70 _— S2 60 57.P35 y 50 i D2 D3 _.. w 40 d a 30 20 – D1 10 0-- 0 400 500 600 700 800 900 1000 1100 1200 1300 Flow,gpm File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 4 Job: Rennovations Hydraulic Analysis for : Dry Attic System Graph Labels Values Label Description Flow (gpm) Pressure (psi) S1 Supply point#1 -Static 0 75 S2 Supply point#2-Residual 1190 60 D1 Elevation Pressure 0 10.8 D2 System Demand 197.8 41.1 D3 System Demand+Add.Out.Hose 297.8 41.1 Curve Intersections & Safety Margins Curve Name Intersection Safety Margin Pressure (psi) Flow (gpm) Pressure (psi) @ Flow (gpm) Supply 73.9 293.9 32.7 297.8 Open Heads Head Ref. Head Type Coverage K-Factor Required Calculated Density Flow Pressure Density Flow Pressure (ft2) (gpm/psi1/2) (gpm/ftz) (gpm) (psi) (gpm/ftz) (gpm) (psi) hl Overhead 130 5.6 0.114 19.5 7 0.139 18.1 10.5 Sprinkler h2 Overhead 130 5.6 0.114 19.5 7 0.119 15.5 7.7 Sprinkler h3 Overhead 130 5.6 0.114 19.5 7 0.119 15.4 7.6 Sprinkler h4 Overhead 130 5.6 0.114 19.5 7 0.139 18 10.4 Sprinkler h5 Overhead 130 5.6 0.114 19.5 7 0.136 17.6 9.9 Sprinkler h6 Overhead 130 5.6 0.114 19.5 7 0.115 14.9 7.1 Sprinkler h7 Overhead 130 5.6 0.114 19.5 7 0.114 14.8 7 Sprinkler h8 Overhead 130 5.6 0.114 19.5 7 0.135 17.5 9.8 Sprinkler h9 Overhead 130 5.6 0.114 19.5 7 0.137 17.8 10.1 Sprinkler h10 Overhead 130 5.6 0.114 19.5 7 0.117 15.2 7.3 Sprinkler h11 Overhead 130 5.6 0.114 19.5 7 0.116 15.1 7.2 Sprinkler h12 Overhead 130 Sprinkler 5.6 0.114 19.5 7 0.136 17.7 SO File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 5 Job:Rennovations Hydraulic Calculations/Fluid Delivery Time Analysis Node Data Node# Type K-Fact. Discharge Coverage Tot. Pres. Req. Pres. Elev Hgroup Open/Closed Overdischarge Density Elev. Pres. Req. Discharge m z Psi Psi ft 9Pm/Psis/z gPm gpM/ftz psi gpm nl Node 12.9 15 NODE -5.6 hl Overhead Sprinkler 5.6 18.1 130 10.5 7 19 HEAD Open -1.4 0.139 -7.4 19.5 n2 Node 14.3 15 NODE -5.6 h2 Overhead Sprinkler 5.6 15.5 130 7.7 7 27 HEAD Open -4 0.119 -10.8 19.5 n3 Node 14.1 15 NODE -5.6 h3 Overhead Sprinkler 5.6 15.4 130 7.6 7 27 HEAD Open -4.1 0.119 -10.8 19.5 n4 Node 12.8 15 NODE -5.6 h4 Overhead Sprinkler 5.6 18 130 10.4 7 19 HEAD Oen -1.5 0.139 -7.4 1 P 95 n5 Node 15.5 15 NODE -5.6 n6 Node 18.3 12 NODE -4.3 n7 Node 15.3 15 NODE -5.6 n8 Node 18.1 12 NODE -4.3 n9 Node 12.2 15 NODE -5.6 h5 Overhead Sprinkler 5.6 17.6 130 9.9 7 19 1 HEAD Open -1.9 0.136 -7.4 19.5 n10 Node 13.6 15 NODE -5.6 h6 Overhead Sprinkler 5.6 14.9 130 7.1 7 27 HEAD Open -4.6 0.115 -10.8 19.5 nll Node 13.5 15 NODE -5.6 V Overhead Sprinkler 5.6 14.8 130 7 7 27 HEAD Open -4.7 0.114 -10.8 19.5 n12 Node 12.1 15 NODE -5.6 h8 Overhead Sprinkler 5.6 17.5 130 9.8 7 19 HEAD Open -2 0.135 -7.4 19.5 n13 Node 14.7 15 NODE -5.6 n14 Node 18.4 12 NODE -4.3 n15 Node 14.6 15 NODE -5.6 n16 Node 18.2 12 NODE -4.3 n17 Node 12.5 15 NODE 1-5.6 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 6 16b: Rennovations Hydraulic Calculations/Fluid Delivery Time Analysis Node Data Node# Type K-Fact. Discharge Coverage Tot. Pres. Req. Pres. Elev Hgroup Open/Closed Overdischarge Density Elev. Pres. Req. Discharge gpm/psi'/2 gpm ft2 psi psi ft gpm gpm/ft2 psi gpm h9 Overhead Sprinkler 5.6 17.8 130 10.1 7 19 HEAD Open -1.7 0.137 -7.4 19.5 n18 Node 13.8 15 NODE -5.6 h10 Overhead Sprinkler 5.6 15.2 130 7.3 7 27 HEAD Open -4.3 0.117 -10.8 19.5 n19 Node 13.7 15 NODE -5.6 h11 Overhead Sprinkler 5.6 15.1 130 7.2 7 27 HEAD Open -4.4 0.116 -10.8 19.5 n20 Node 12.4 15 NODE -5.6 h12 Overhead Sprinkler 5.6 17.7 130 10 7 19 HEAD Open -1.8 0.136 -7.4 19.5 n21 Node 15 15 NODE -5.6 n22 Node 18.7 12 NODE -4.3 n23 Node 14.9 15 NODE -5.6 n24 Node 18.6 12 NODE -4.3 n25 Node 24.4 12 NODE -4.3 n26 Node 24.2 12 NODE -4.3 n27 Node 25.6 12 NODE -4.3 n28 Node 28.4 12 NODE -4.3 n29 Node 27.3 15 NODE -5.6 n30 Node 28.1 15 NODE -5.6 n31 Node 30.4 10 NODE -3.5 n32 Node 35.3 10 NODE -3.5 n33 Node 39 2 NODE 0 n34 Node 39.3 2 NODE 0 n35 Node 39.5 2 NODE 0 n36 Node 39.7 2 NODE 0 n37 Node 39.9 2 NODE 0 n38 Node 43.6 -6 NODE 3.5 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 7 Job: Rennovations Hydraulic Calculations/Fluid Delivery Time Analysis Node Data Node# Type K-Fact. Discharge Coverage Tot. Pres. Req. Pres. Elev Hgroup Open/Closed Overdischarge Density Elev. Pres. Req. Discharge m z psi psi ft 9Pm/psi'/z gPm gPm/ftz psi gpm n39 Node 44 -6 NODE 3.5 n40 Node 44.5 -6 NODE 3.5 n41 Node 44.6 -6 NODE 3.5 srcl Supply -197.8 41.1 2 SUPPLY 0 n42 Node 29.9 11 NODE 1-3.9 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 8 Job: Rennovations Hydraulic Calculations PIPE INFORMATION Node 1 Elev 1 K-Factor 1 Flow added (q) Nominal ID Fittings L C Factor total (Pt) Node 2 Elev 2 K-Factor 2 Total flow (Q) Actual ID quantity x (name) = length F Pf per ft elev (Pe) NOTES T frict(Pf) (ft) (gpm/psiV2) (gpm) (in) (ft) (ft) (psi) (psi) Path No: 1 h7 27 5.6 14.8 1 lx(us.Tee-Br)=5 12 120 7 n 11 15 14.8 1.049 5 0.0744 5.2 17 1.3 nll 15 17.5 1 lx(us.90)=2 1.5 120 13.5 n 15 15 32.3 1.049 2 0.3159 0 3.5 1.1 n15 15 0 1 lx(us.Tee-Br)=6.22 3 120 14.6 n16 12 32.3 1.097 6.22 0.2541 1.3 9.22 2.3 n16 12 33.5 2 10 120 18.2 n24 12 65.8 2.157 0 0.0352 0 10 0.4 n24 12 32.8 2lx(us.90)=6.15 70 120 18.6 n26 12 98.6 2.157 6.15 0.0744 0 76.15 5.7 n26 12 0 2lx(us.Tee-Br)=12.31 . 6.5 120 24.2 n27 12 98.6 2.157 12.31 0.0744 0 18.81 1.4 n27 12 99.2 2.5 1x(us.90)=8.24 19 120 25.6 n28 12 197.8 2.635 8.24 0.1018 0 27.24 2.8 n28 12 0 4lx(us.90)=13.17 3 120 28.4 n29 15 197.8 4.26 13.17 0.0098 -1.3 16.17 0.2 n29 15 0 4 lx(us.90)=13.17 70 120 27.3 n30 15 197.8 4.26 13.17 0.0098 0 83.17 0.8 n30 15 0 4lx(coupling)=1.32 4 120 28.1 n42 it 197.8 4.26 1.32 0.0098 1.7 5.32 0.1 n42 it 0 4 1 0 29.9 DPV-1 w/Accel n31 10 197.8 0 0 0.1454 0.4 *** 1 0.1 n31 10 0 4 1 0 30.4 Febco805YD n32 10 197.8 0 0 4.8973 0 *** 1 4.9 n32 10 0 4 lx(us.90)=13.17 8 120 35.3 n33 2 197.8 4.26 13.17 0.0098 3.5 21.17 0.2 n33 2 0 4lx(us.90)=13.17 12 120 39 n34 2 197.8 4.26 13.17 0.0098 0 25.17 0.2 n34 2 0 4lx(us.90)=13.17 16 120 39.3 n35 2 197.8 4.26 13.17 0.0098 0 29.171 0.3 n35 2 0 41x(us.90)=13.17 2 120 39.5 n36 2 197.8 4.26 13.17 0.0098 0 15.17 0.1 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 9 Job:Rennovations Hydraulic Calculations PIPE INFORMATION Node 1 Elev 1 K-Factor 1 Flow added (q) Nominal ID Fittings L C Factor total (Pt) Node 2 Elev 2 K-Factor 2 Total flow (Q) Actual ID quantity x (name) = length F Pf per ft elev (Pe) NOTES T frict(Pf) (ft) (gpm/psi1/2) (gpm) (in) (ft) (ft) (psi) (psi) Path No: 1 n36 2 0 4lx(us.90)=13.17 6 120 39.7 n37 2 197.8 4.26 13.17 0.0098 0 19.17 0.2 n37 2 0 4lx(us.90)=13.17 8 120 39.9 n38 -6 197.8 4.26 13.17 0.0098 3.5 21.17 0.2 n38 -6 0 4lx(us.90)=18.33 50 140 43.6 n39 -6 197.8 4.3 18.33 0.007 0 68.33 0.5 n39 -6 0 4lx(us.90)=18.33 50 140 44 n40 -6 197.8 4.3 18.33 0.007 0 68.33 0.5 n40 -6 0 8lx(us.90)=31.7 200 140 44.5 n41 -6 197.8 8.55 31.7 0.0002 0 231.7 0.1 n41 -6 0 6 8 140 44.6 srci 2 197.8 6.4 0 0.001 -3.5 8 0 srci 41.1 Path No: 2 h6 27 5.6 14.9 1 lx(us.Tee-Br)=5 12 120 7.1 n10 15 14.9 1.049 5 0.0753 5.2 17 1.3 n10 15 17.6 1 1x(us.90)=2 1.5 120 13.6 n13 15 32.5 1.049 2 0.3192 0 3.5 1.1 n13 15 0 1 lx(us.Tee-Br)=6.22 3 120 14.7 n14 12 32.5 1.097 6.22 0.2567 1.3 9.22 2.4 n14 12 33.7 2 10 120 18.4 n22 12 66.2 2.157 0 0.0355 0 10 0.4 n22 12 33 2lx(us.90)=6.15 70 120 18.7 n25 12 99.2 2.157 6.15 0.0751 0 76.15 5.7 n25 12 0 2lx(us.Tee-Br)=12.31 3.5 120 24.4 n27 12 99.2 2.157 12.31 0.0751 0 15.811 1.2 n27 25.6 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 10 Job:Rennovations Hydraulic Calculations PIPE INFORMATION Path No: 3 hll 27 5.6 15.1 1 1x(us.Tee-Br)=5 12 120 7.2 n19 15 15.1 1.049 5 0.0766 5.2 17 1.3 n19 15 17.7 1 1x(us.90)=2 1.5 120 13.7 n23 15 32.8 1.049 2 0.3239 0 3.5 1.1 n23 15 0 1 1x(us.Tee-Br)=6.22 3 120 14.9 n24 12 32.8 1.097 6.22 0.2605 1.3 9.22 2.4 n24 18.6 Path No: 4 h10 27 5.6 15.2 1 lx(us.Tee-Br)=5 12 120 7.3 n18 15 15.2 1.049 5 0.0776 5.2 17 1.3 n18 15 17.8 1 lx(us.90)=2 1.5 120 13.8 n21 15 33 1.049 2 0.3273 0 3.51 1 1.1 n21 15 0 1 1x(us.Tee-Br)=6.22 3 120 15 n22 12 33 1.097 6.22 0.2632 1.3 9.22 2.4 n22 18.7 Path No: 5 h3 27 5.6 15.4 1 lx(us.Tee-Br)=5 12 120 7.6 n3 15 15.4 1.049 5 0.0801 5.2 17 1.4 n3 15 18 1 lx(us.90)=2 1.5 120 14.1 n7 15 33.5 1.049 2 0.3364 0 3.5 1.2 n7 15 0 1 lx(us.90)=2.49 3 120 15.3 n8 12 33.5 1.097 2.49 0.2706 1.3 5.49 1.5 n8 12 0 2 10 120 18.1 n16 12 33.5 2.157 0 0.0101 0 10 0.1 n16 18.2 Path No: 6 h2 27 5.6 15.5 1 lx(us.Tee-Br)=5 12 120 7.7 n2 15 15.5 1.049 5 0.0811 5.2 17 1.4 n2 15 18.1 1 lx(us.90)=2 1.5 120 14.3 n5 15 33.7 1.049 2 0.34 0 3.5 1.2 n5 15 0 1 lx(us.90)=2.49 3 120 15.5 n6 12 33.7 1.097 2.49 0.2734 1.3 5.49 1.5 n6 12 0 2 10 120 18.3 n14 12 33.7 2.157 0 0.0102 0 10 0.1 n14 18.4 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright 0 2002-2012 Tyco Fire Protection Products Page 11 Job:Rennovations Hydraulic Calculations PIPE INFORMATION Node 1 Elev 1 K-Factor 1 Flow added (q) Nominal ID Fittings L C Factor total (Pt) Node 2 Elev 2 K-Factor 2 Total flow (Q) Actual ID quantity x (name) = length F Pf per ft elev (Pe) NOTES T frict (Pf) (ft) (gpm/psis/2) (gpm) (in) (ft) (ft) (psi) (psi) Path No: 7 h8 19 5.6 17.5 1 lx(us.90)=2 4 120 9.8 n12 15 17.5 1.049 2 0.1016 1.7 6 0.6 n12 15 0 1 13 120 12.1 n 11 15 17.5 1.049 0 0.1016 0 131 1 1.3 n1l 13.5 Path No: 8 h5 19 5.6 17.6 1 lx(us.90)=2 4 120 9.9 n9 15 17.6 1.049 2 0.1025 1.7 6 0.6 n9 15 0 1 13 120 12.2 n10 15 17.6 1.049 0 0.1025 0 13 1.3 �nl 0 13.6 Path No: 9 h12 19 5.6 17.7 1 1x(us.90)=2 4 120 10 n20 15 17.7 1.049 2 0.1037 1.7 6 0.6 n20 15 0 1 13 120 12.4 n19 15 17.7 1.049 0 0.1037 0 131 1.3 n19 13.7 Path No: 10 h9 19 5.6 17.8 1 lx(us.90)=2 4 120 10.1 n17 15 17.8 1.049 2 0.1047 1.7 6 0.6 n17 15 0 1 13 120 12.5 n18 15 17.8 1.049 0 0.1047 0 131 1 1.4 n 18 13.8 Path No: 11 h4 19 5.6 18 1 lx(us.90)=2 4 120 10.4 n4 15 18 1.049 2 0.1071 1.7 6 0.6 n4 15 0 1 13 120 12.8 n3 15 18 1.049 0 0.1071 0 131 1 1.4 n3 14.1 File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 12 Job:Rennovations Hydraulic Calculations PIPE INFORMATION Path No: 12 hl 19 5.6 18.1 1 lx(us.90)=2 4 120 10.5 n1 15 18.1 1.049 2 0.1081 1.7 6 0.6 nl 15 0 1 13 120 12.9 n2 15 18.1 1.049 0 0.1081 0 13 1.4 n2 14.3 * Pressures are balanced to a high degree of accuracy. Values may vary by 0.1 psi due to display rounding. * Maximum Velocity of 12.49 ft/s occurs in the following pipe(s): (n5-n2) *** Device pressure loss (gain in the case of pumps) is calculated from the device's curve. If the device curve is printed with this report, it will appear below. The length of the device as shown in the table above comes from the CAD drawing. The friction loss per unit of length is calculated based upon the length and the curve-based loss/gain value. Internal ID and C Factor values are irrelevant as the device is not represented as an addition to any pipe, but is an individual item whose loss/gain is based solely on the curve data. File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 13 Job:Rennovations Device Graphs Pressure vs. Flow Function Design Area: Dry Attic System; Supply Ref.: srcl; Supply Name:Bride and Grimes Flow Test 85 80- 75- 70-: 07570 — — – 65 60 M 55 - CL 50 7 y 45 tll IL 40 35 30- 25 20 15 10 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 o o o 0 0 o rn N M 7 vp l� pp pi O Flow,gpm ^ Pressure Loss Function Design Area: Dry Attic System; BFP Ref.: BFI (Febco805YD, Size = 4); Inlet Node: n31; Outlet Node: n32 6.26 5.26 4.9 psi @ 197.8 gpm I � ';A- CL d 4.26 7 FA N P CL 3.26- 2.26- 1.26- 0.26- Flow, .262.261.260.26Flow,gpm File:C:\Users\ericc-000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 14 Jab:Rennovations Device Graphs Pressure Loss Function Design Area: Dry Attic System; DPV Ref.: DPI (DPV-1 w/Accel, Size = 4); Inlet Node: n42; Outlet Node: n31 I 4.5 a 3.s ti 3 N tl) f12.5- 1.5 0.5 M 7 V v� v� h 0p o0 O N Flow,gpm ~ File:C:\Users\ericc_000\Desktop\Sprinkcalc Files\Calvary Baptist Church North Andover.tyc3 Date 4/25/2016 Copyright©2002-2012 Tyco Fire Protection Products Page 15 ,4CCORCERTIFICATE OF LIABILITY INSURANCE F08/11/2016M DATE M/DDIYYYY) 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 Susan Merriam Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978 3227296 FAX (g78)454-1865 Lowell,MA 01851 (AIC,No AIC No (800)2251865 ADDRESS: smerriam@fredcchurch.cem INSURERS AFFORDING COVERAGE NAIC# INSURER A: Commerce Insurance Company 34754 INSURED INSURER B: Admiral Insurance Company 24856 Bride-Grimes,Inc. INSURER C: Wesco Insurance Company 25011 P.O.Box 776 Lawrence,MA 01842 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:58889 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE D LVVVD BR POLICY NUMBER MM/DD POLICY EFF MM/DDPOLICYYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGET RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 50,000 CLAIMS-MADE 1XI OCCUR MED EXP(Any one person) $ 5,000 B CA00001162210 8/9/2016 8/9/2017 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 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED OZY002 3/10/2016 3/10/2017 AUTOSBODILY INJURY(Per accident) $ X HIRED AUTOS X AUTOS ED PROPERTY DAMAGE Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2.000,000 B EXCESS LIAR CLAIMS-MADE GX00000005801 8/9/2016 8/9/2017 AGGREGATE $ 2,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION XWC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNEWEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA WWC3193982 427/2016 4/27/2017 (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 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE y7 Client# Mst# bU689 Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Commonwealth of Massachusetts Department of Public Safety License: SC-002405 . Sprinkler Contractor KENNETH J KOLIFRATH 11 PALMER DRIVE '• KENSINGTON NH 03833 Expiration: 1211412017 Commissioner AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street North Andover, MA 01845 Insured: First Calvary Baptist Church Address: 586 Massachusetts Avenue North Andover Policy: CPP 0160 54 04 49 Loss Date: June 1, 2015 Loss Type: Roof leak ACS File: 32090 Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Tim McLaughlin Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 6/4/15 7 KIMBALL LANE,BUILDING C,LYNNFIELD,MASSACHUSETTS 01940 TELEPHONE (781) 245-9516/FAX(781) 245-1077 E-MAIL—daims.aes@verizon.net AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 INSURED: First Calvary Baptist Church ADDRESS: 586 Massachusetts Avenue North Andover POLICY: CPP0160540449 LOSS DATE: 02/22/2015 LOSS TYPE; Ice Dam ACS FILE: 31264 PD Claim has been made involvingloss damage or destruction of the above-captioned 9 p property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Tim McLaughlin Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to a an Y 9 pay Y portion of this claim to you. Date 02/26/2015 7 KIMBALL LANE,BUILDING C,LYNNFIELD,MASSACHUSETTS 01940 TELEPHONE (781)245-9516/FAX(781)245-1077 E-MAIL—claims.acs@verizon.net AMERICAN CLAIMS SERVICE MULTI-LINE ADJUSTERS BUILDING INSPECTOR/COMMISSIONER, BOARD OF HEALTH AND/OR BOARD OF SELECTMAN Building Inspector Town of North Andover 1600 Osgood Street Building 20, Suite 2035 North Andover, MA 01845 INSURED: First Calvary Baptist ADDRESS: 586 Masachusetts Avenue North Andover POLICY: CPP0160540449 LOSS DATE: 02/17/2015 LOSS TYPE; Sprinkler Burst ACS FILE: 31154 PD Claim has been made involving loss, damage or destruction of the above-captioned property, which may either exceed $1,000.00 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim file number. Tim McLaughlin Claims Representative On this date, I caused copies of this notice to be sent to the persons named above at the addresses indicated above by first class mail. Unless we hear from you within the next 10 days, we will not be obligated to pay any portion of this claim to you. Date 02/18/2015 7 KIMBALL LANE,BUILDING C,LYNNFIELD,MASSACHUSETTS 01940 TELEPHONE (781)245-9516/FAX(781)245-1077 E-MAIL—daims.acs@verizon.net