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HomeMy WebLinkAboutBuilding Permit #228-2011 - Suite 209 9/16/2010 BUILDING PERMIT `° NORTH TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION ., 70 Permit NO: Date Received p°gAreo ,9SSACHl15E� Date Issued: �� h j II M ORTANT: Applicant must complete all items on this page LOCATION '7 l )'l(�r'�1 ✓ - p �CLi7e © _ PROPERTY OWNER / 1 Print Print MAP 210 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes 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 Others: Demolition Other Septic Well floodplain Wetlands Watershed District Water/Sewer P-ESCRIPTION OF ORK TO BE PREF O ED: r v`C/►%.� nr denti, jcation P1 ase ype or Print Clearly) OWNER: Name: 4//1(' /' Phone: Address: 2 1O rI DZ2reX- = ZIX CONTRACTOR Name: Phone: Bal A?s6, Address: /5- Layell , - 0 S Supervisor's Construction License: p L^ Mc5 Exp. Date:. Home Improvement License: Exp. Dater ARCHITECT/ENGINEER ,�OS�pI2 LG,��c,�_ {� Phone: �X Address: EZM ST i/e/ A Reg. No. FEE SCHEDULE.BULDING P RMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0 00 FEE: $ -326 — Check z6Check No.: Receipt No.: NOTE: Per^ ons contracting with unregi eyed contractors do not have access to he guaranty fund ignature of Agent-/ a Signature of contracto Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools " Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS h Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments 4. Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Lo ed 384 Osgood Street FIRE DEPARTMENT -Temp DumpstK on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location No. ` 41 Date �/' 6 1O Np"T" TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ CNU5ES� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # s. 2 13 4 -� ilding Inspector ORTH To ofAndover No. 1 00 dover, Mass., ` �� /a 0 LAKE COCMICMEWICK A0RA-rE D P-le 5 SS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System /j /� / / BUILDING INSPECTOR THIS CERTIFIES THAT .&A..0/.. h.h...�. ........... ... .... ... ............. ....................................................................................... Foundation has permission to erect .................... buildings �! Gv .... ......... ........... .. 09 Rough to be occupied as ,<,.1. ... . '°'' G1 '. /!' 1. ... ...... .. .l..t`. ..� ........ .. . ..F..! I•I.�..... Chimney provided that the person accepting this permit shall in every respect conform to the term of the application on file in Final 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. ( PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations-Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION TARTS ELECTRICAL INSPECTOR Rough ............................. ............................. .............................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the- Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts ' r Department of Industrial Accidents Office of Investigations t ' 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/Organizattio�n,/Individuai):� ���j� Address: f�t(»PM � e &, #C_5*a City/State/Zip: kALdU �c 019 6a Phone#: . a2t_�12 Are you an employer?Check the appropriate box: Type of project(required): ICO I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or pact-time).' have hired the sub-contactors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.I 7. Remodeling ship and have no employees These sub-contractors have 8. (]Demolition working for me in any capacity. workers' comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.M. Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t .employees. [No workers' comp.insurance required.] 13.❑Other Any applicant that checks bo>t#t must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they ate 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 acme of the subcontractors and their workers'comp.policy information. I ant an employer that is providing workers'compensation Insurance for nV entployees. Below is the policy and job site information. Insurance Company Name: �M➢ Q� S �Q� ,��5 c� Policy#or Self-ins.Lie.##: 'We f.ea(Q ta:3 IQ, Expiration Date: `3)10 Job Site Address: qSj act& Citylstate/Zip: N61CV0w&_ (Yl p 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 fine up to$1,500.00 and/or one-year imprisonment,as well as.civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification. I do hereby ce 0 under pains and penaltlees ofperyury that the information provided above is true and correct Si ature: Date: ��06 Phone#: Offlelal 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#: 07/15/2010 M 15;53 FAX 978 683 0028 FRAVEL INSURANCE AGENCY I�OO�lOUI i4CORD CERTIFICATE OF LIABiLiTY.INSURANCE °A�%i�%1�o PRonucEa THIS CF3i1 MALE IS ISSM ASA MATiEROFMRMATI N w Ger y r•!w.w 1 a�.�veli i,aae'siai-e3TaT;:r'e c�geacy ��ve..r hryv VVPN•CFti 3VU Kllitil.`IiUYtilYl!'tCtttl Y�I{:A I't 231 Sutton street HOI-M.THIS CSZTIFICATEDOM NOT AMM WaD D OR suite 18 ALTER THE COVERAGE AFFORDED Uf 1HEPOU CIS BLOW. t North Andover, MA 01845 WSUI S AFFORDING COVEMGE MAIC# INSURE i INSUREIA:One B2acon Insurance IIS Property SpsvxCeB tNAEER B:Graaito State xsac Ca INSURER C- '515 Lowell St.-SUIte 3 NSURERo: Peabody, MA 01960 Qty RERE { COVEI?AGES THE POLICIES OF INSURANCE LISTED BELOW HAvE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ^"v Finay Rcmaw Tumm oR 4VDn oomom or neGCNTm0=T cR 01"tyN�r W t=CumtITH RESPECT TO WHICH THIS CERTIFICATE 6MY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRI88D HERRN IS SUBJECTTip ALL THE TERM.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIhWS SHOWN MAY HAVE BEEN REDUCED SY PAID CLAIMS. tNSRXWOFINISIMANCE y POUCYNUU911R FOLI�E6 FOLCYOWIRMDN LeNTNs GENERALLUIBRDY EACH0CCURRmCE S 1,000,000 A R CDI69RCIALGII0E MUMUrY FB 2018418 20/27/091 10/27/10 DAmAGETO s 1,0000000 _j CVM MADE t X!OCCUR {{ MEDEXR "s 5.000 {PERSONALaADVINJURY S 11000.000 GFaIERALRGGREGATE s- 2,000,000 GEMLAGGRErG!►TEUMIrAFagSPER: mw—tL S-COMR0PAGO s 2 000 000 POLICY 1 MPT !DC AUTDNf}HII,EtlABL1TY { C 'COMBINED&mG.EUMri a {wrau;T; � ,EFs3r��tI AILOMES AUTO$ NJURY 3CNEDULEDAUTOS ( em) S t HIRE)AUTOS ' SODLYINJIRY NDN-OWM3)AUY03 (PcmmdoM 3 G_AIWELLIBILRY ! AUTOONLY-EAACCIDENT S ANYA`TO OTHFRTHAN EAACC S _ AUTOONLIF AGO S 1 EXCEMIMBRELLAtu8M.ITY ! /EACH OCCURRe C--wum S 1 1 { 1 A(2A Q3ATC i f I O®ULTIBLE 3 S RETENTION 3 i WOMMSCOMIP84SMONMD XVVCSTATU- LO EMTH 8 RaYERS'umu" SPC 8266712 11/3/09 11/3/10 M>U31. ER APIYPRORtIETOWP/RTN'WET:UTNE I ELEACHAC, 80 �S 100,000 OFFIGGOPRIE ORIEXCLUD ii 11 M dtlstailslsldlr 1tLEjD$5ASE-EAEh1PLOj$ 1UV.UUU OTHM 3TH6ALPROVf$ayseebw t !"01spsE-PoucyUmrr { 500,000 I I D33Cfl1PT10NDFOFE7tATi0NStLOGATIONSiVEIICLEF/DS,LUSION9ADDID BYENDORSFJNT/Si'ECIAL PROVISIONS NAOP, LLC is listed as additional insured. pmt er.-Arr tw nee - - - i.crci irs�.iii c sndr_i+aa GAIVG'ELLN- 6N SHOULD A'iYOFTNE ABOVE DESCRIBEPDLICIESBECANCELLED BEMRETNE E7pEtARON DATETI' i.TNEI�JM&INSURERWILLENDFAVORToMAL 30 DAR4WRITTI:N NADP, LLC. NDTICETOTHECERTIFICATEHOLDER NAMEDTOTNELEFT..BUTFALURET00030SMALL 451 Andover sTreet ILVOSENOOsuGzATSONORuABRIrYOFANyMNDUPON EINSURER.ITSAGENTS OR North Andover, MA 01845 REPRTSENTAnVES. I AU OR=REPRE$EN{ATIVB AGO W25(200IMS) ACORO CORPORATtoA[1968 I Massachusetts- Department of Public Safet) Board of Buildin!- Re!-ulations and Standards Construction Supervisor License License: CS 104350 LISA GOMES 40 HIGHLAND ST 3 PEABODY, MA 01960 �—�- Expiration: 9/1/2013 ( numi.�i aicr Tr": 104350 Proposal 9411 U.S. Property Services Page 1 200 Andover Street, Suite 312 Date 8/22/2010 Peabody, MA 01960 I. General Information Proposed by* U.S. Property Services Telephone: 978 836-1206 200 Andover Stree #312 Peabody, MA 01960 Submitted To: +F rst General Realty Corporation work Performed At 451 Andover Street 93 Union Street Suite 315 1 Suite 209B Newton Centre MA 02459 IL work Description: We hereby propose to furnish the materials and perform the necessary labor for the completion of the work described herein: Demo walls as per architectural plans $3,500.00 Patch walls from 11 HVAC walls units $2,200.00 Patch the exterior walls and apply one coat of white primer $3,95000 Build a demising wall to separate the two new spaces $6,020.00 Remove and install 13 double hung windows;6 over 6 grids $5,005.00 Ceiling tale system:Option One: Patch ceiling tile grid $2,875.00 Option Two: Replace entire ceiling tile grid system including tiles in the large office $8,550.00 The ceiling tiles will match the existing Any upgrades will be an additional cost III. Exclusions Electrical Allowance$8,500 Plumbing Allowance$1,200 HVAC Allowance$12,000 IV. Terms All material is guaranteed to be as specified, and the above work to be performed in accordance with the drawings and specifications submitted for above work, and completed in a substantial workmanlike manner for the sum of Twenty Seven Thousand Ninety-Five Dollars and 00400 cents (527.095.00); this will vary depending on which options are chosen. Payments to be made as follows: IS Deposit, 1f3 Progress Payment and Final payment upon completion *Any alteration or deviation from the above specifications involving extra costs will be executed only upon written order, and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays beyond our control. * *Note—This proposal may be withdrawn by us if not accepted within 30 days Respectfully submitted on behalf of Frank Gomes,US Property Services By signing below you accept—al[' andconditions of this contract: ------- --DATE����� 167 ---------- U.S. ---------- Property Services * Telephone: (978)836-1206 * uspropertyservices@hotmail.com 1 Architects LaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA Architects, Engineers& Land Planners 'Thomas F.Galvin,AIA Julianna E.Hoch,RA ARCHITECTURAL DESIGN AFFIDAVIT Permit No. To the Building Commissioner: Re:Office Renovation Precinct: N/A I certify to the best of my knowledge and belief,the plans and computations accompanying the attached application concerning the locus at 451 Andover Street,Andover MA, Suite 209 are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. 4153 ARCHITECT MASS. REG. NO. Joseph D.LaGrasse&Associates,Inc. COMPANY One Elm Square,Andover,MA 01810 ADDRESS 978-470-3675 PHONE August 17,2010 DATE Then personally appeared the above-named made oath that the above statement by him is true Before me, C;g3. My Commiss' n expires One Elm Square T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 www.lagrassearchitects.com Architects LaGrasse & Associates, Inc. Joseph D.LaGrasse,AIA _ ThomasJD . — F.Galvin,AIA ` Architects, Engineers &Land Planners I Julianna E.Hoch,RA CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: 2270 PROJECT TITLE: North Andover Office Park Unit 209 PROJECT LOCATION: 451 Andover Street,Andover,MA 2nd Floor NAME OF BUILDING: Building 1 SCOPE OF PROJECT: Construction of Office Suite In accordance with Section 116.0 of the Massachusetts State Building Code, 1, Joseph D.LaGrasse,AIA MA. Reg.# 4153 being a registered professional engineer/architect hereby certify that I have prepared or directly supervised the preparation of all design plans,computations as specifications concerning: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other For the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 116.2.2: 1. Review of shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix Pursuant to Section 116.4,1 shall submit periodically,a progress report together with pertinent comments to the Building Inspector. Upon completion of the work,I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Joseph D.LaGrasse,AIAP�7ze__/ 4!f l�O Si ture of Archit t/Engineer Date One Elm Square T 978.470.3675 1420 Celebration Blvd. Andover,MA 01810 F 978.470.3670 Celebration,FL 34747 AA26001333 www.lagrassearchitects.com J Building Department 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 4/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/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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 I ❑ Engineering Affidavits for Engineered products NOTE: 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 2008 i FUNDAMENTALS OF FIRE ALARM SYSTEMS 72-33 FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. PROTECTED PROPERTY INFORMATION Name of property: FIRST GENERAL REALTY Address: 451 ANDOVER STREET-UNIT 209 Description of property: Occupancy type: COMMERCIAL OFFICE SPACE Name of property representative: FIRST GENERAL REALTY CORP Address: 93 UNION STREET NEWTON,MASS Phone: 617-332-6400 Fax: E-mail: Authority having jurisdiction over this property: NORTH ANDOVER FIRE DEPARTMENT Phone: Fax: E-mail: 2. FIRE ALARM SYSTEM INSTALLATION,SERVICE,AND TESTING INFORMATION Installation contractor for this equipment: AFA PROTECTIVE SYSTEMS,INC. Address: 200 HIGH STREET BOSTON,MASS Phone: 617-772-5900 Fax: 617-772-5923 E-mail: Service Organization for this equipment: AFA PROTECTIVE SYSTEMS,INC. Address: 200 HIGH STREET BOSTON,MASS Phone: 617-772-5900 Fax: 617-772-5923 E-mail: Location of as-built drawings: Location of historical test reports: OFFICE Location of system operation and maintenance manuals: A contract for test&inspection in accordance with NFPA standards is in effect as of: Contracted testing company: AFA PROTECTIVE SYSTEMS,INC. Address: 200 HIGH STREET BOSTON,MASS Phone: 617-772-5900 Fax: 617-772-5923 E-mail: Contract expires: Contract number: Frequency of routine inspections: QTR 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE NFPA 72 Chapter Reference of System Type: CHAPTER 8 Name of organization receiving alarm signals with phone numbers(if applicable): Alarm: AFA Phone: 1-888-232-1873 Supervisory: AFA Phone: 1-888-232-1873 Trouble: AFA Phone: 1-888-232-1873 Entity to which alarms are retransmitted: DACT Phone: Method of retransmission of alarms to that organization of location: PHONE LINES (NFPA 72, 1 of 5) FIGURE 4.5.2.1 Record of Completion 2007 Edition 72-34 NATIONAL FIRE ALARM CODE 3. TYPE OF FIRE ALARM SYSTEM OR SERVICE(continued) If Chapter 8,note the means of transmission from the protected premises to the central station: X Digital Alarm Communicator ❑ McCulloh ❑ Multiplex ❑ 2-way radio ❑ l-way radio ❑ N/A If Chapter 9,note the type of connection: ❑ Local energy ❑ Shunt ❑ N/A 3.1 System Software Operating system(executive)software revision level: Site-specific software revision date: Revision completed by: 4. SIGNALING LINE CIRCUITS Characteristics of signaling line circuits connected to this system (see NFPA 72, Table 6.6.1): Quantity: 2 Style: 7 Class: A 5. ALARM-INITIATING DEVICES AND CIRCUITS Characteristics of initiating device circuits connected to this system (see NFPA 72, Table 6.5): Quantity: Style: Class: 5.1 Manual Initiating Devices 5.1..1 Manual Pull Station Number of manual pull stations: Type of devices: ❑ Addressable ❑Conventional ❑ Coded ❑Transmitter ❑ N/A 5.2 Automatic Initiating Devices 5.2.1 Area Smoke Detectors Number of Smoke Detectors 5 Type of Coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: X Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.2 Duct Smoke Detectors Number of Duct Smokes: Type of Coverage: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A Type of smoke detector sensing technology: ❑ Ionization ❑ Photoelectric 5.2.3 Heat Detectors Number of Heat Detectors: Type of Coverage: ❑ Complete area ❑ Partial area ❑ Nonrequired partial area ❑ N/A Type of devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A 5.2.4 Sprinkler Waterflow Detectors Number of Waterflow Switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: Alarm verification on this system is: ❑ Enabled ❑ Disabled ❑ Set for seconds NFPA 72(p.2 of 5) FIGURE 4.5.2.1 Continued 2007 Edition FUNDAMENTALS OF FIRE ALARM SYSTEMS 6. SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUITS 6.1 Sprinkler System Number of valve supervisory switches: Type of devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A 6.2 Fire Pump Type of fire pump: ❑ Electric ❑ Diesel Type of fire pump supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A Fire pump Functions Supervised ❑ Fire pump power ❑ Fire pump running ❑ Fire pump phase reversal ❑ Selector switch not in auto ❑ Engine or control panel trouble ❑ Low fuel Other: 6.3 Engine-Driven Generator Type of generator supervisory devices: ❑ Addressable ❑ Conventional ❑ Coded❑ Transmitter ❑ N/A ❑ Engine or control panel trouble ❑ Generator running ❑ Selector switch not in auto ❑ Low fuel Other: 7. ANNUNCIATORS 7.1 Annunciator 1 ❑ Local X Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: MAIN LOBBY ENTRANCE 7.2 Annunciator 2 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: 7.3 Annunciator 3 ❑ Local ❑ Remote Type: ❑ Addressable ❑ Directory ❑ Graphic ❑ N/A Location: B. ALARM NOTIFICATION DEVICES AND CIRCUITS 8.1 Emergency Voice Alarm Service Number of single voice alarm chanmels: Number of multiple voice alarm channels: Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑ Electrically powered ❑ Sound powered ❑ N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system(see NFPA 72, Table 6.5): Quantity: 2 Style: Z Class: A NFPA 72(p. 3 of 5) FIGURE 4.5.2.1 Continued 2007 Edition 72-34 NATIONAL FIRE ALARM CODE 8. ALARM NOTIFICATION DEVICES AND CIRCUITS(continued) 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: With Visual device: Horns: With Visual device: 3 Chimes: With Visual device: Bells: With Visual device: Visual devices without audible devices: Other(describe): 9. EMERGENCY CONTROL FUNCTIONS ACTIVATED ❑ Hold-open door releasing devices ❑ Smoke management or smoke control ❑ Door unlocking ❑ Elevator recall ❑ Other 0. SYSTEM POWER SUPPLY 10.1 Primary Power Nominal Voltage 110 VAC Amps 20 AMP Overcurrent protection: Type BREAKER Amps 20 AMP Location(of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: FACP Type: BATTERY Nominal voltage: Current rating: Number of standby batteries: 2 Amp hour rating: 7 Location of emergency generator: Location of fuel storage: Calculated capacity of secondary power to drive the system In standby mode: 24 In alarm mode: 15 11.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. The system has been installed in accordance with the following NFPA standards: (Note any or all that apply.) X NFPA 72 X NFPA 70,National Electrical Code,Article 760 X Manufactur pu fished i st u ons❑ Other(please specify): System devi; s from a standards: Signed: Printed name: JOE GOLINI Date: 4/13/2011 Organization- AFA AOTECTIVE SYSTEMS Title: SALES SUPERVISOR Phone: 617-772-5900 12.RECORD OF SYSTEM OPERATION 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 of: X NFPA 72 X NFPA 70,National Electrical Code,Article 760 X Manufacturer's published instructions❑ Other(please specify): X Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3)is attached Signed: � ed name: KEN FOULDS Date: 4/13/2011 e � ) Organization: AFA PR. T VE SYSTEM P�.lA1C itle: TECHNICIAN Phone: .NFPA 72(p. 4 of 5) FIGURE 4.5.2.1 Continued 20077777 FUNDAMENTALS OF FIRE ALARM SYSTEMS 13.CERTIFICATIONS AND APPROVALS 13.1 System Installation Contractor This system as spe ' herein s een installed and tested according to all NFPA standards cited herein. Signed: Printed name: JOE GOLINI Date: 4/13/2011 Organization: &PTECTIVE SYSTEMS,INC.Title: SALES SUPERVISOR Phone: 617=772-5900 13.2 System Service Contactor This system as specified herei ha een installed and tested according to all NEPA standards cited herein. Signed: Printed name: JOE GOLINI Date: 4/13/2011 Organization: A P OTECTIVE SYSTEMS,INC.Title: SALES SUPERVISOR Phone: 617-772-5900 13.3 Central Station This system as d herein ill bt monitored according to all NFPA standards cited herein. Signed: Printed name: JOE GOLINI Date: 4/13/2011 Organizatio • F.A P TECTIVE SYSTEMS,INC.Title: SALES SUPERVISOR Phone: 617-772-5900 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NEPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction 1 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,its approved sequence of operations,and with all NFPA standards cited herein. Signed: �� � �/L, Q� Printed name: Date: 5/3/2011 Organization: NORTH ANDOVER FIRE DEPT Title: Phone: Notes: NFPA 72(p. 5 of 5) Revised 5/5/09 FIGURE 4.5.2.1 Continued 2007 Edition AFA Protective Systems, Inc. zoo High Street, Boston -MA 02110 Inspection Report ..................................................................................................................................... ............................................................... ............................ ........................................ ................................................................ .................................................................... SIfBSCRIBER:NAME::::::::::::::::::::::::::::::::::::::::::::::: SERVICING:BRANCH:;:;:::::::::;:;::::Ui4TE:: :: First general reality corp. Boston May 2,2011 ..... ... ........................ ................................................................... .................................. ............................................ ............................................... ........................................ ..................................................................................................................................... SEftY10E ADDRESS :::::::: CI7Y: .:.:,ST,ATE 8 SIF:CODE::::::: CENTRALATATION lJt1A116fR 451 andover st N.Andover MA 1-888-232-1873 ..................................................................................................................................... ............................................................................................ ........................................ .....................................................................................................I............................. .................................................... ........................................ ........................................ RJSAECTi�R#1 :: :::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::TICKET:NUMBER::;:::::::: Ken Foulds 100477592 ............................................................................................ .......................I................ ................................................................ .. ............................ ....................................... ..SFE.....CT..................................................................................... ........................................ {NOR#2: BU.ILDINC�CON FACT: 7irire In: flitie:O►it::: Total:Ti►ne::: ............................................ ............................................... ........................................ ......................................................................... ........................................................... Contract:Number::::::::::::::: ::::::::Bdi Numbe►:::::::::::::'lo Lt58d:�est::: ::::::::::::::Periel:CbcAtion::::::::::::: 267478 n/a I st floor closet ................................................................ .................................................................... Cont(dl:lVl0del andW9IIdfactW6(. NUmtSer:OfZOhes:: Tessa e: amts: Software:R@ViSioh:::::::::::. fci 7100 1 add 0.2 ................................... ................. ...................................... ........................................ ................................................................................................................. ................... Fowe�Sorirce::::::::::::::CKT;:$rkr�:locatio : �::::Lodked:and:Marked: :::�D!eiticated�CKT.:: 12volt 7 amp 120 v main electric room yes yes ................................... ................. ...................................... ........................................ CBiiiiectibn L'oeal CerStral St8ti0n :.FRC.:: :ln§p&Aion Fre uenc' 9�o Test:::::: n/a n/a 30-5149 Iq 100 new space .......... .............................................................. ........ ...I...... .................... ................... trade:: ReviGe: Dade. Devioe ............ .. .... MP Manual Pull Station DA Dry Air Pressure LP Low Pressure All SNAC panel SSD System Smoke Detector FPP Fire Pump Power BHL Bell Horn Light test results must DSD Duct Smoke Detector FPR Fire Pump Running CSC Central Station Communicator include panel LSD Local Smoke Detector SP Sump Pump MB Municipal Box Connection location and HD Heat Detector RT Room Temperature LA Local Alarm battery age WWF Wet Water Flow FP Fire Phone ER Elevator Recall PAWF Pre-Action Water Flow ANN Annunciator FACP Fire Alarm Control Panel FD Flame Detector HL Horn Light STBY Stand By Power OSB Out Side Beacon SL Speaker Light SNAC SNAC Booster Panel PW Protective Wire HS Horn Strobe BAT Battery RR Rate of Rise Heat Detector SO Strobe Only DH Door Holder TO Tamper Device BD Beam Detector X Other ............................................................................................................................. ..................................................................................................................................... Failuies:arid S stein QeviBtion3:from NF..PA:Standards::List:Details::< >: .`......»:.....>. 100 percent test of new devices,2nd floor suite 209 Customer Signature 5/2/2011 Sales 877-232-1873 Service 888-232-1873 Fax 617-772-5923 72-110 NATIONAL FIRE ALARM CODE INSPECTION AND TESTING FORM Date: April 13,2011 Time: Service Organization Property Name(User) Name: AFA PROTECTIVE SYSTEMS Name: FIRST GENERAL REALITY CORP Address: 200 HIGH ST Address: 451 ANDOVER ST,NORTH ANDOVER MA BOSTON MA Owner Contact: Representative: Telephone: License No.: Telephone: 617 772 5900 Monitoring Entity Approving Agency Contact: AFA PROTECTIVE SYSTEMS Contact: Telephone: 1-888-232-1873 Telephone: Monitoring Acct No. 30-5149 Type Transmission Service McCulloh Weekly Multiplex Monthly X Digital X Quarterly Reverse Priority Semi-annually RF Annually Other(Specify) Other(Specify) Panel Manufacturer: FIRE CONTROL INSTRUMENTS Model No.: 7100 Circuit Styles: 4 No.of Circuits: 2 Software Rev: Last Date System Had Any Service Performed: April 13,2011 Last Date System Software or Configuration was Revised: ALARM-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Devices Quantity Of Installed Circuit Style Devices Tested MANUAL STATIONS ION DETECTORS 5 4 5 PHOTO DETECTORS DUCT DETECTORS HEAT DETECTORS WATERFLOW SWITCHES SUPERVISORY SWITCHES OTHER:(SPECIFY) Alarm verification feature is disabled X enabled 2007 National Fire Protection Asscociation NFPA 72(p.1 of 4) Revised 5/5/09 FIGURE 10.6.2.3 Inspection and Testing Form. 2007 Edition INSPECTION,TESTING,AND MAINTENANCE 72-111 ALARM NOTIFICATION APPLIANCE AND CIRCUIT INFORMATION Quantity of Quantity of Appliances Appliances Installed Circuit Style Tested BELLS 3 4 3 HORNS CHIMES STROBES SPEAKERS OTHER(SPECIFY): NO.OF ALARM NOTIFICATION APPLIANCE CIRCUITS: ARE CIRCUITS MONITORED FOR INTEGRITY? X YES NO SUPERVISORY SIGNAL-INITIATING DEVICES AND CIRCUIT INFORMATION Quantity of Devices Quantity of Installed Circuit Style Devices Tested BUILDING TEMP. SITE WATER TEMP. SITE WATER LEVEL FIRE PUMP POWER FIRE PUMP RUNNING FIRE PUMP AUTO POSITION FIRE PUMP OR CONTROLLER TRBL. GENERATOR IN AUTO POSITION GENERATOR OR CONTROLLER TRBL. SWITCH TRANSFER GENERATOR ENGINE RUNNING OTHER(SPECIFY): SIGNALING LINE CIRCUITS Quantity and style of signaling line circuits connected to system(see NFPA 72, Table 6.6.1): Quantity 2 Style(s) 4 SYSTEM POWER SUPPLIES a. Primary(Main): Nominal Voltage 120 Amps 20 Overcurrent Protection: Type BREAKER Amps 20 Location(of Primary Supply Panelboard): Disconnecting Means Location: b.Secondary(Standby) Storage Battery: Amp-Hr Rating 7 Calculated capacity in Amp-Hrs to operate system for hours Engine-drive generator dedicated to the fire alarm system: Location of fuel storage: TYPE BATTERY Dry Cell Lead-Acid Nickel-Cadmium Other(Specify): X Sealed Lead-Acid c. Emergency or standby system used as a backup to primary supply,instead of using a secondary power supply: Emergency system described in NFPA 70,Article 700 Legally required standby described in NFPA 70,Article 701 Optional standby system described in NFPA 70,Article 702,which also meets the performance of Article 700 or 701. 2007 National Fire Protection Asscociation NFPA 72(p.2 of 4) Revised 515109 FIGURE 10.6.2.3 Continued 2007 Editio 72-110 NATIONAL FIRE ALARM CODE PRIOR TO ANY TESTING NOTIFICATIONS ARE MADE Yes No Who Time MONITORING ENTITY _ BUILDING OCCUPANTS X _ BUILDING MANAGEMENT X _ OTHER(SPECIFY) X _ AHJ(NOTIFIED)OF ANY IMPAIRMENTS SYSTEM TESTS AND INSPECTIONS TYPE: Visual Functional Comments CONTROL PANEL X INTERFACE EQUIPMENT. X _ LAMPS/LEDS X _ FUSES X _ PRIMARY POWER SUPPLY X _ TROUBLE SIGNALS X DISCONNECT SWITCH X _ GROUND FAULT MONITORING X SECONDARY POWER TYPE: Visual Functional Comments BATTERY CONDITION X LOAD VOLTAGE _ DISCHARGE VOLTAGE _ CHARGER TEST SPECIFIC GRAVITY TRANSIENT SUPPRESSORS REMOTE ANNUNCIATORS X NOTIFICATION APPLIANCES AUDIBLE X VISUAL X SPEAKERS _ VOICE CLARITY INITIATING AND SUPERVISORY DEVICE TESTS AND INSPECTIONS Visual Functional Factory Measured Loc.&SIN Device Type Check Test Setting Setting Pass Fail Comments: Tech Signatur Customer Signature 2007 National Fire Protection Asscociation NFPA 72(p.3 of 4) Revised 5/5/09 FIGURE 10.6.2.3 Continued 2007 Editio INSPECTION,TESTING,AND MAINTENANCE 72-111 EMERGENCY COMMUNICATIONS EQUIPMENT Visual Functional Comments PHONE SET _ PHONE JACKS _ OFF-HOOK INDICATOR _ AMPLIFIER(S) _ TONE GENERATORS _ CALL IN SIGNAL _ SYSTEM PERFORMANCE Device Simulated COMBINATION SYSTEMS Visual Operation Operation Fire Extinguisher Monitoring Device/System _ Carbon Monoxide Detector/System _ (Specify) INTERFACE EQUIPMENT (Specify) _ (Specify) _ (Specify) SPECIAL HAZARD SYSTEMS (Specify) _ (Specify) _ (Specify) SPECIAL PROCEDURES COMMENTS SUPERVISING STATION MONITORING Yes No Time Comments ALARM SIGNAL X _ ALARM RESTORATION X _ TROUBLE SIGNAL X _ TROUBLE SIGNAL RESTORATON X _ SUPERVISORY SIGNAL X _ SUPERVISORY RESTORATION X NOTIFICATIONA THAT TESTING IS COMPLETE Yes No Who Time BUILDING MANAGEMENT X MONITORING AGENCY X _ BUILDING OCCUPANTS X _ OTHER(SPECIFY) THE FOLLOWING DID NOT OPERATE PROPERLY SYSTEM RESTORED TO NORMAL OPERATION Date: 4/13/2011 Time: THIS TESTING WAS PERFORMED IN ACCORDANCE WITH NFPA STANDARDS Name of Inspector: KEN FOULDS Date: 4/13/2011 Time: Signature: Name of Owner or Representati e: Date: Time: Signature: 2007 National Fire Protection Asscociation NFPA 72(p.4 of 4) Revised 5/5/09 FIGURE 10.6.2.3 Continued 2007 Editio