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Miscellaneous - 1160 GREAT POND ROAD 4/30/2018 (9)
Location '\ Uo 9-p,4)p "jy No. 11-7 -L6112, Check # ka 25665 Date Aa—ZC) ('L-- TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee Co $ mo, orb TOTAL $ Building Inspector • 32 e•.e.+� � . OOt r • r SS�cHusa CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 177-2012 on 9/1/2011 Date: August 30, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1160 Great Pond Road at Brooks School. MAY BE OCCUPIED AS a dormitory — Chase Hall IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Brooks School 1160 Great Pond Road North Andover, MA 01845 Bui ding Inspector Fee: $100.00 Receipt: 25665 Check: 1033 i� CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 177-2012 on 9/1/2011 Date: August 30, 2012 THIS CERTIFIES THAT THE BUILDING LOCATED ON 1160 Great Pond Road at Brooks School. MAY BE OCCUPIED AS as dormitory Chase HallChase Hall IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Brooks School 1160 Great Pond Road North Andover, MA 01845 Fee: $100.00 Receipt: 25665 Check: 1033 i ding Inspector �? t'Et1`ci" F6'6ryOL - APPLICATION FOR CERTIFICATE OF OCCUPANCYANSPECTION BUILDING PERMIT # % 7 7 9SSACHUS ADDRESS/LOCATION OF PROPERTY: f),.Pjc�_If Map _Parcelh Lot Number, SUBDIVISION: DATE REQUESTED FILED/READY FOR INSPECTION: CLOSING DATE ON PROPERTY: FIVE (5) DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN -OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A REINSPECTION FEE OF TWENTY DOLLARS ($20.00) WILL BE CHARGED IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. APPLICANT SIGNATURE Permit Issued to: o�Ls SC9 1Uc71 Address: &vim N Vis' or -3 F -e ROUTING TOWN ENGINEER, SITE PLAN — DRIVE -WAY REV1EWP1 CONSERVATION'`'` MIF0 ##"*' —2" i a . 9 /1,9#V v PLANNING #parr v DPW -WATER METER SEWER CONNECTION C� DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCY/INSPECTION REQUEST DPW IS File: Application for OC form revised Jan 2007/2011 V_ �i/ -30 / / �, SIGNATURE 601�9//z S CONSTRUCTION CONTROL FINAL AFFIDAVIT To: Gerald Brown Inspector of Buildings RE: Brooks School -Chase Hall Dormitory- North Andover MA 01845 Permit # 1 T7-2-012 I, as the design professional and Civil Engineer of record, hereby certify that I have performed all required inspections and reviewed all pertinent data relative to the Civil Engineering portions of the above referenced project. I further certify that all work performed under my supervision conforms to the requirements of the MSBC 780 CMR — 8" edition and all pertinent laws, ordinances and regulations, to the best of my knowledge. N - �&A",tX A , I John L. Scott, P.E. Professional Engineer - MA Reg. No. 29134 Rist-Frost-Shumway Engineering, P.C. 71 Water Street Laconia, NH 03246 603-524-4647 On this day of August, 2012, before me, the undersigned notary public, personally appeared -1-06h L•.- proved to me through satisfactory evidence of identification, to be the person who signed the preceding or attached document in my presence, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. Before me, RHONDA BLACKIE, Notary Public My Commission expires My Commission Expires March 24, 2015 ROB BRAMHALL ARCHITECTS CONSTRUCTION CONTROL FINAL AFFIDAVIT To: Gerald Brown Inspector of Buildings RE: Brooks School -Chase Hall Dormitory- North Andover MA 01845 Permit# I, as the design professional and Architect of record, hereby certify that I have performed all required inspections and reviewed all pertinent data relative to the above referenced project. I further certify that all work performed under my supervision conforms to the requirements of the MSBC 780 CMR — 8t' edition and all pertinent laws, ordinances and regulations, to the best of my knowledge. Robert A. Bramhall, AIA Registered Architect — MA Reg. No.8200 Rob Bramhall Architects 14 Park Street Andover, MA 01810 978-749-3663 On this 19' day of X2012, before me, the undersigned notary public, personally appeared Robert A. Bramhall, AIA., proved to me through satisfactory evidence of identification, to be the person who signed the preceding or attached document in my presence, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. :.MENW4 �kr .� � t Lwit My Commission expires Mo 4 11 �4 01 B 9 RICHA GOYAL 14 Park Street Notary P&c, Commonwealth of MassadvAb Andover, Massachusetts My Gemmisslen E)#m May 11, 2818 01810 Telephone: 978 749 3663 Facsimile: 978 749 9659 FINAL CONSTRUCTION AFFIDAVIT MECHANICAL To: Permit No. il-7 zoi2— Re: Brooks School - New Dormitory, 1160 Great Pond Road, North Andover, MA 01845 Ward: In accordance with Section 116.2.2 of the Massachusetts State Building Code, I, Erik Gath, Registration No. 48162, being a registered Mechanical Professional Engineer hereby certify that I am responsible for the construction phase services for the above referenced project mechanical systems. To the best of my knowledge, the building was constructed in accordance with the plans and specifications prepared and/or amended by this office subject to punch list items. Furthermore, the building appears to have been constructed in accordance with the provisions of 780 CMR. Commonwealth of Massachusetts County of Middlesex Erik Gath - 48162 PROFESSIONAL ENGINEER - MASS. REG. NO. BLW Engineers, Inc. COMPANY 311 Great Road, P.O. Box 1551, Littleton, MA ADDRESS 978.486.4301 PHONE On this 17th day of July , 2012, before me, the undersigned notary public, personally appeared Erik Gath , proved to me through satisfactory evidence of identification, which were Personal Knowledge , to be the person who signed the preceding or attached document in my presence, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. Befor me, October 24, 2014 My Commission expires DONNA P. HAGENS W NOTARY PUBLIC OMMONWEALTH OF MASSACHUSETTS y Commission Expires Oct. 24, 2014 FINAL CONSTRUCTION AFFIDAVIT ELECTRICAL To: Permit No: 177 laiZ Re: Brooks School - New Dormitory, 1160 Great Pond Road, North Andover, MA 01845 Ward: In accordance with Section 116.2.2 of the Massachusetts State Building Code, 1, John C. Pierga, Registration No. 48291, being a registered Electrical Professional Engineer hereby certify that I am responsible for the construction phase services for the above referenced project electrical systems. To the best of my knowledge, the building was constructed in accordance with the plans and specifications prepared and/or amended by this office subject to punch list items. Furthermore, the building appears to have been constructed in accordance with the provisions of 780 CMR. ZH OF MgSo c o JOHN C. yG PIERGA R ELECTRICAL - No. 48291 Commonwealth of Massachusetts County of Middlesex John C. Pierga - 48291 ENGINEER - MASS. REG. NO. BLW Engineers, Inc. COMPANY 311 Great Road, Post Office Box 1551, Littleton, MA 01460 ADDRESS 978.486.4301 PHONE On this 17th day of July 2012, before me, the undersigned notary public, personally appeared John C. Pierga , proved to me through satisfactory evidence of identification, which were Personal Knowledge , to be the person whose name is signed on the preceding or attached document, and who swore or affirmed to me that the contents of the document are truthful and accurate to the best of his/her knowledge and belief. Befor me October 24, 2014 My Commission expires DONNA P. HAGENS NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS My Commission Expires Oct. 24, 2014 Location h u o PJ. Date 1 Z No. (/ —7' 201 Z Check # 117 i TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ ' Foundation Permit Fee $ (5erMit Feec I° 25528 Building'Inspector O�•N�•eTN 4 Cis ,SSMC HUSf4 TEMPORARY EXPIRES 30 DAYS FROM ISSUE DATE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 177-2012 on 9/l/2011 Date: July 20, 2012 THIS CERTIFIES THAT Brooks School THE BUILDING LOCATED ON 1160 Great Pond Road - Chase Hall MAY BE OCCUPIED AS a Dormitory IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Brooks School 1160 Great Pond Road North Andover, MA 01845 Building Inspector Fee: 50.00 Receipt: 7166 Zg Check: // V V 6,� ". / 1-:20 No. '2 % - Iz- Check 25410 Date �� z TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ . TOTAL'S a f O $�' BATH ng Inspector o� NO °TM q 0 i �Ss�cHuSeS TEMPORARY EXPIRES 30 DAYS FROM ISSUE DATE CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number - 177-2012 on 9/1/2011 Date: June 12, 2012 THIS CERTIFIES THAT Brooks School THE BUILDING LOCATED ON 1160 Great Pond Road MAY BE OCCUPIED AS Two Dwelling Units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Brooks School 1160 Great Pond Road North Andover, MA 01845 Building Inspector Fee: 50.00 Receipt: 25410 Check :19445 • -m4p ri www.slagelassociates.com February 15, 2012 Mr. Gerald Brown Building Department 1600 Osgood Street North Andover, MA 01845 RE: STRUCTURAL INSPECTION AFFIDAVIT New Brooks'Sclioo7'Dormitoryj 1160 Great Pond Road North Andover, MA Dear Mr. Brown, Siegel Associates, Inc. Consulting Structural Engineers 634 Commonwealth Avenue Newton Centre, MA 02459 617.244.1612 tel 617.244.1732 fax Siegel Associates has been retained by architectural firm Rob Bramhall Architects Inc. to perform as the structural engineer of record for the above referenced project. In this capacity, we reviewed proposed architectural plans, performed structural calculations, drafted structural permit drawings that were previously submitted to the building department, preformed periodic site inspections and provided verbal instruction to the contractor. Today we made a final inspection of the work completed to confirm compliance with our design. On the basis of this involvement, I certify that to the best of my knowledge, information and belief, the specified structural work performed at the new dormitory building complies with the submitted permit drawings, our written and verbal direction, with the structural provisions of the Seventh Edition of the Massachusetts State Building Code, and with accepted structural practice. Please feel free to call if you have any further questions. Sincerely, SIEGEL ASSOCIATES, INC. Steven P. Siegel, P.E., Principal 9+83 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that has permission to perform .................................... plumbing inJ e b ildd*ings� f. drool- .S �ho�L at . l�l�� �hcY. .. o h Andover, Mass. Fee../... Lic. No.�3?%.. !/.!Ch�� Gr� ............... PLUMBING INSPECTOR Check # 931 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Towns �� j;vGE �MA. Date: Permit# / Building Location: G Owners Name: 62!ngjj.:y Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New:�Alteration: ❑ Renovation: ❑ Replacement: ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES o: DEDICATED 2 Z SYSTEMS w w Z fa Y Q y U U Fes- La 0: C7 [] � Q � LnZ c� o � to Z Q Q W CG jQ Q � Z 1.5 d 2 p 0 w D w Z w Z U a W z Q 3 w U F z ° o F- U m m 0 Q 0 5 n x Q 2 w w o: �� \ � .6 Q O D 2 Y -SUB BSMT. x d it v� Ln Q a a H K O v� w Q N BASEMENT 11T FLOOR r 2ND FLOOR 3RD FLOOR 4' FLOOR 5T" FLOOR 0 FLOOR 7T" FLOOR ST" FLOOR Insta;llr o 4j/�CL./i�ri�:� ,. '- �� �� Ct Iv �•r !.lifts �i'i!.'1 ?.' Address: 4 3 KIy//� y� / '� C3/��( Cit Town: ©Corporation �G js State: _/�•' Business Tel: C"' /l'�'%` �jSJ j El Partnership .l�l Fax•. El Firm/Company -Name of Licensed Plumber: INSURANCE COVFIznr_r=• 1 have a current liabili insurant:e policy or its substantial equivalent which meets the requirements of MGL. Ch. 942 Yes-0No I] If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy. [ Other type of indemnify ❑ Bond ❑ - OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 942 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information 1 have submitted (or entered) regarding this application are true and accura+o to the best of my Knowledge and that all plumbing work and Instalrations performed under the permit issued for this application e will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. •� '- = 4 -�Q' AM W�)'• )' — ,A0® I;r Type of License: 14(g/' of /! `��� n El"Plumber Signatu fe Of L1cense"Iumder a E24ftster ❑Journeyman License Number: ge The Commonwealth ofMassachusefts Department oflndustrialAccidents Office of Investigations, 600 Washington Street z. Boston, MM 02111 www mass govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers mlicant In Please Print T,pulhl. Name Address: City/State/Zip:�,c Phone #:_ r."' Y =4;: ;r-- 7 j TJ Are you an employer? Check the appropriate box: L ❑ I am a employer with 1 4. ❑ I am a general contractor I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or and have hired the sub -contractors listed partner- ship and have no employees on the attached sheet. ? These sub -contractors have working for mein any capacity. [No workers' comp. insurance workers' comp, insurance. 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing .officers have exercised their all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] r employees. [No workers' comp, insurance re uir d . Type of project (required): 6. 21—Aew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ Other q e .] I Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information. lam an employer iliat is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name Policy # or Self -ins. Lic. # Expiration Date: l �i J•ob Site Address:l/ G City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP 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 certify under flte pains and penalties ofperjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. PIumbing Inspector Contact Person: ' Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more Of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constnzciion or repair work on such dweilia house g or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers', compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confiimation 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 regarding the law or if you are required to obtain a workrs' e Industrial Accidents. Should you have any questions reg compensation policy,; please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "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 bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Iffie Comzowweal` , of massacausetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston; MA 02111 Tol. # 61.7-•727•-4900 ext 406 ox 1-877-MA.SS.AFE Revised 5-26-05 Fax # 617,727-7749 www.mass.govldia `COMMONWEALTH OF MASSACHUSETTS Rib 4 S-ANU UA51-1 1 1 rm,') LICENSED AS A MASTERTLUMBER ISSUES THIS LICENSE TO ALFRED A SPOLIDORO 23 -CHAMPA RD BILLERICA, MA 01821-291,4 8326 05/01/12 753849' 1 of `COMMONWEALTH OF MASSACHUSETTS Rib 4 S-ANU UA51-1 1 1 rm,') LICENSED AS A MASTERTLUMBER ISSUES THIS LICENSE TO ALFRED A SPOLIDORO 23 -CHAMPA RD BILLERICA, MA 01821-291,4 8326 05/01/12 753849' 1 C 9 IS > 121 � >- S' > � 1Q�i o`: �q Q Q Q Q Q Q "Q G 'Q Q Q Q Q N c O�1 T N N a N N N N N T R a 0 c� OC R AI m M _9 9 Q, Q M M R 9 til 4 a A, 'a a C. a s m � D Ew m m- m m G- m NO. N m. N N m no c :a j N N N ry m ' ti ff ti d d ci o ti ti ti ti d .it9 c�• E c c c c c .c .c c c s c c__ E E E E E- E: E E EE E E E E 75 S 2 2 z 'v v s u S v v v w v .¢.�a o c m N C —} C "O .p m m O O rte.. m mm L O m m O O: m T.. N .� ma �•�m mO Q'L'Sm O. -13 m m'p� m C m W O O). m m o L Z m L. C O m L O C O` m W j 7 O.9C �.-•C m m :3 Em -6N O o` N �: O y OOR ID m m n W.0 :3X +L-' m Cg C m m' -p r as �'b m N c c E. a c o m .L m.- m m Wi m, -0> a) >' m � o" 4) m"m o p O mO:-r� 3 O U'Gi . C . N � C pca N pm �i.p m i Nm , .cm .wO _ amad0� .rnvN�`maC �00 mL°o E6NmaO c� D- D w �m -Nd, d m oa.n Oonwmmm i . w to) m�-tcmN m12 Co. - o" c . aogy'•E ca m•.01.Om-.LL SO m°,a to-oN cO`°vo -p � cr"nLooEm U C izCL m Em Eo am afiO mC^ e 0 m 9mm m U m v M m . :Cy ' Oa 3: 4- m mw 70 m m pO . m. . ID NmaT 3 m �ma v E .O Ic'c m >omm om a om &Utoam12 vc m EE 03 Lu -0 m s2-rn O4 :a-m'ri Omommioam m°mm g... m c.m Toa v m °ao p caE: mo @) I, E or mc to EfO, amimm� Ecwm ocamampo a. -.o axmx iia xQ 3 �s c. "� mw. p_L�. o.a cmO IL T�_m . j �a mn-�moao IOD 20, a ,nrcmmr m�io per.. .Qm E� 9 C mo mcg m cocEa� m aci=mom aciE��ai0 mot11 Tm Q� >ra> a (D 0) SFac %m5 a t cc n �Sm m e s o W Te m� (D 0) S m m m m m'm "m Z� � E w m� E O� a = N, m .!� W O l0 C Ei CL -gyp a m O.. J, m N T O..a -m O p O O LL I r4 k §§ ;\ ) / z ca ca cc \ \\ CL to \2 - p3 cl \� \{ k 7/o E . E. f k # {(& _ ca } j a) o ) > ) « I p( 6E �k� )| @ƒƒ )\k �§ \® \ a & \\ 0 2 - �D2 2 y \� a.2j ,o k\ : kzkk § 4 < k)§ \\\ \\\\ \/ { C) C) a- o« -ao >L c _LL ) / z Date . ///,?`Jf� ........... TOWN OF NORTH ANDOVER p PERMIT FOR GAS INSTALLATION This certifies that. /� . SP.0 L ! Cep �p ............ . has permission for gas installation .0 /CiS/..�5 in the buildings of O!�2S. ,loo . ................... at .. �!l �.�Ca.. North ndover Mass. Fee.101t � Lic. No. R-�Z ... 1,�!� h ...... ,,�a.��..... . GASINSPECTOR Check #6., II ki G MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town,t f 116 e�e� MA. Date: h / Permit# Building Location://&C1-4 j2 � Owners Name: Type of Occupancy: Commercial ❑ Educational ❑ Industrial ❑ Institutional El Residential Zj— New: ©'Alteration: E]Renovation: EJ Replacement: E] Plans Submitted: Yes ❑ No ❑ FIXTURES Lu co W of Lu Lu co CW6 za co Q z W M w w W ~ W O co 6i z W H 0 O w O z z o w °� o N> CO Z to �0 a a Iw- o W X W 1— W a w Lu Lu w z 9 _ W o u� w = �- Z W w Z O JI— 1— O z J 0 LL co = z w W � Lu O Q R' W W m; O Z O tj 1- > Z F _ SUB BSMT. BASEMENT 1 FLOOR j 2 FLOOR 3 FLOOR 4 FLOOR 6 FLOOR 6 FLOOR 7 FLOOR 8 FLOOR G Installing Company Name,� Check One Only Certificate # : Jyj,�(�/���; -¢--J ,� Address ✓� c_ i� Corporation / � `/S— �, u' City/Town:_ / j(��c eeZj� State: El Partnership Business Tel:�'7�lrG>7 3,S`.�.J _ Fax: Name of Licensed Plumber/Gas Fitter: CFz-led? El Firm/Company INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes W{No ❑ If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability insurance policy Q/f Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owner's Agent Owner ❑ Agent ❑ By checking this box ❑; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance wi II P inent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. By Type of License: , 0-Ptii"mber / �L��( G( ��/�.,�<,1!�---.._ T 2/ �Z ❑Gas Fitter �S'cgnatur t Licensed Plumia�er/Gas Fitter jIVI s" TerCityrrown ❑Journeyman ense Number: _ c^ APPROVED -(OFFICEUSE ONLY ❑ LP Installer e The Commonwealth of Massachusetts Department oflndustrialMccidents Office of Investigations 600 Washington Street Boston, AM 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Inlic-n"f rnfni.m.144- Name (Business/Organization/Individual)A-51,7- v „�� 1 Lca�G t 11111. L('' 1D1 Address: 3 Gt'9�✓!�!a �2- City/State/Zip: r� /��e ��q C� /-f ( Phone Are you an employer? Check the appropriate box: 1. ❑ I am a employer with .Z�l • 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* 2.01 am a sole have hired the sub -contractors listed 6. ®-NM construction proprietor or partner- on the attached sheet.1 7. ❑ Remodeling ship and have no employees working for me in any capacity. These sub -contractors have workers' comp. insurance. 8. ❑ Demblition [No workers comp. insurance ' p 5. ❑ We are a corporation and its 9. ❑ Building addition required.] ;. ❑ I am a homeowner doing .officers have exercised their 10. El Electrical repairs or additions all work myself. [No workers' comp. right of exemption per MGL c. 152, § 1(4), and we have 11. ❑ Plumbing repairs or additions insurance required.] t no employees. [No workers' 12.❑ Roof repairs comp, insurance required ] 1311 Other *Any applicant that checks 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. #Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. -Tam an employer that is providing workers' compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name:_ A& (t c' (,r Aq Policy # or Self -ins. Lic. #: Expiration Job Site Address.] e City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration d te). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal penalties o a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I'do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct. A, l am Official use only. City or Town: Do not write in this area, to be completed by city or town offcial. Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Cle 6. Other rk 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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), addresses) andpho insurancene number(s) along with their certificate(s) of . 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 Depaitment 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 referencd number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current Policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)" A copy of the affidavit that has been 'officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related for any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth 01INTassachusetts Department ofIndustxial Accidents Office of Investigations 600 Washington Street Boston; MA 02111 Tel. # 617-727-4900 ext 405 or 1-877-mAssM13 Revised 5-26-05 Fax # 61.7-727,7749 www.raass.gov/dia -:COMMONWEALTH OF MASSACHUSETTS I BERS ANU LiAbrl I I r.Kzl L CENSED AS A MASTER PLUMBER ISSUES THIS LICENSE TO ALFRED A SPOLIDORO 23 CHAMPA RD BILLERICA MA 01821-2914 8326 05/01/12 753849 x am cori e .I 050 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING IV This certifies that ................................................. has permission to perform...............................PaRm ........................... wiring in the building of ....... je/ep.0 ... ...... .. ............. at ......I 0 ..... (��e .. .... .... 7f 7 0 ...... North Andover, Mass. Ve Z 4 e� - ..... ... . . . .... . ............ .. L Fee'?.ic. NoJ t�? 'ELECTRICALINSPECTOR Check W' Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked Rev. 11/99 Leave Blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: L© I z- I A .I City or Town of: Arvkkn "DURA 0M - To the Inspector cf Wires By this application the undersigned gives notice of his or her intention to per orm the electrical work described below. re Location (Street & Number) Owner or Tenant Telephone No. Owner's Address S'1rou 8_ Is this permit in conjunction wikh a building permit? Yes ❑ Purpose of Building Q Existing Service Amps / Volts bverhead ❑ New Service _(OjLQ Amps 12p/ ?jp�CVolts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Work h )t IK V%p L-) nm" No ❑ (Check Appropriate Box) Utility Authorization No. Undgrd. ❑ No. of Meters Undgrd. 0 No. of Meters Cmmnletion nfthe fnllnwino tnhlo mnv ho wnivod by rho Ine—t—ofW;— No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans Transformer °' ° 6 Total KVA No of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures E(Q � Swimming Pool Above ❑ In- Grnd. Grnd. ❑ o. o Emergency Lighting No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No of Switches No. of Gas Burners o. of Detection an InitiatinLy Devices AW No. of Ranges 3 No. of Air Cond. Total Tons No of Alerting Devices LZ No of Waste Disposers Heat Pump Number Tons KW No. ot Selt-Coniamed Z�Device No. of Dishwashers 3 Space/Area Heating KW Local umcipa Connection ❑ Other No. of Dryers Heating Appliances KW security yst .ms No. o No. of WaterKW LleAgggs. No. of Signs o. o Ballasts Data Wiring o. o Devices or LaUivalmt No. Hydromassage BathtubsNo. No. of Motors Total HP Telecommunications Wiring 2 of Devices or Eauivalent CO Wher Attach additional detail if desired, or as required by the Inspector of Wires Insurance Coverage: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent . The undersigned certifies that such coverage is in force, and has exhibited proof of same to permit issuing office. CHECK ONE: INSURANCE M BOND ElOTHER ❑ (Specify:) Insurance (Expiration Date) Estimated Value of Electrical Work: ' (When required by municipal policy.) Work to Start Inspecti ns to be requested in accordance with MEC Rule 10, and upon completion. I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: Nardone Electrical Corp. LIC. NO.: Licensee: Nardone Electrical Corp. Signature LIC. NO.: A11691 (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 781-391-27272f Address: 100 Winchester Street, Medford, MA 02155 Alt. Tel. No.: 781-727-9175 OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the liability insurance coverage normally required by law. By my signature below, ereby waive t is ement. I am the (check one owner❑ owner agent Owner/ Agent PERMIT FEE: Signature �?relephon No. o 7 el �8 z� g 7 �l i 7e-eF7L er 2--v> ��":5ve a / 2- P-J�7 3--R- 12- PlIv V " PL,� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, Mass. 02111 u,p www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (susiness/Organization/IndiN ideal) : i%k A-fz b(;4Z-- Address: 1 VD U } j (1c i oft Phone#: !3 q ( 730-1 f : a I Are,you an employer? Check the appropriate box: 1. I am an employer with .3C3 4. 2., I am a general contractor and I employees (full and/or part time).* have hired the sub -contractors 2.7 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees 'These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. $ required] 5. We are a corporation and its 3. '-1 1 am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption perm MGL insurance required] t c. 152, § 1(4), and we have no employees. [no workers' comp. insurance required.] Type of project (required): 6. C New construction 7. i Remodeling 8. = DemoIition 9. Building addition 10. E Electrical repairs or additions 11. = Plumbing repairs or additions 12. E Roof repairs 13. C Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. ti3omeoivners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContactors that check this box must attach an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. if the sab-46rit_-actors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below i$ the policy and job site informal ion lnsuranee Company Name: iyt CA- We - � . ` 1 f a e" ,G _ -- Policy If or Self -ins. Lie_ #: �i E/�j C two (:6i C. ij � k d i Expiration Datc: t � 1-- Job Site ALddress:116f. 6-,-e T ;Piga Ag_City,'State!ZipAA Ai dpy w /Y/' (0)f R 4 S 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 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for..coverage verification. I do herby cer* under the pains andpenaldes ofperjury that the information provided above is true and correct Si natuY. ! C4'�,UUk Date: i 1 u t i i Print Phone #. I OfficiW1 use only Do not write in this area to he completed by city or town official City or Town: Permitllicense Issuing Authority (circle one): l.Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Otheir Contact person: Phone #: A,& NAUSET CONSTRUCTION CORP. 10 KEARNEY ROAD, SUITE 307. NEEDHAM, MA 02494 TEL: 781.453.2220. FAX: 781.453.2250. WEB: WWW.NAUSETCONSTRucnON.COM January 14, 2012 Mr. Gerald Brown, Inspector of Buildings Town of North Andover Building Department 1600 Osgood Street North Andover, MA 01845 Re: Brooks School — New Dormitory Dear Mr. Brown, This. letter is requesting your authorization to allow Nauset Construction to commence with rough electrical and low voltage wiring at the Brooks School - New Dormitory currently under construction. At this juncture, the building envelope is "weather tight". All exterior windows, doors and flashings have been installed, the exterior wood siding is near complete and we have installed a W.R. Grace self -adhering, 30 -mil, polyethylene membrane on the roof (we anticipate the metal roofing to commence on or about mid-February). Through recent periods of heavy precipitation, no water has permeated into the building from the exterior building envelope. As of this week, we are essentially on -track to commence with rough electrical wiring. Understanding that the metal roof panels will not be installed during this phase of work, and to avoid delays to the progress of work, Nauset agrees to take full responsibility to replace any electrical wiring that should become wet and/or damaged prior to or during the installation of the metal roofing. Our Field Superintendent, Kevin Randall, will closely monitor the condition of the building to insure that the interior remains dry and "water -free". If this course of action is deemed acceptable, please contact Kevin at 617.592.9579. We certainly value your feedback and appreciate your continued cooperation throughout the construction process. Our intent from the onset is to provide the Brooks School community a quality, safe and well -constructed residential facility. Sincerely, Nauset Co struction Corp. lz Anthony N. Papantonis President cc: K.Randall C.Jacob ROB BRAMHALL ARCHITECTS March 21, 2012 Gera. ..Frown Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 Dear Gerald: On the last inspectional walk thru by your office at the new Brooks Dormitory; there was an inquiry regarding the spray foam insulation being used in the project. The attic spaces in the dorm and residences are only to be accessed for the service of mechanical equipment. The spaces are not to be used for storage and access will be controlled by Brooks school. 2603.4 and 2603.4.1.6 of the IBC describe the requirements of both thermal barriers and protection from ignition. 2603.4.1.6 allows an ignition barrier to be used in place of a thermal barrier to cover foam/plastic in attics or crawl spaces where entry is made only for service of utilities. 2603.4 still requires a thermal barrier between the interior space and the attic which is in place as a gyp board 2°a floor ceiling. 2603.4 Thermal barrier. Except as provided for in Sections 2603.4.1 and 2603.9, foam plastic shall be separated from the interior of a building by an approved thermal barrier of 1/2 -inch (12.7 mm) gypsum wallboard or equivalent thermal barrier material that will limit the average temperature rise of the unexposed surface to not more than 250°F (120°C) after 15 minutes of fire exposure, complying with the standard time -temperature curve of ASTM E 119 or UL 263. The thermal barrier shall be installed in such a manner that it will remain in place for 15 minutes based on FM 4880, UL 1040, NFPA 286 or UL 1715. Combustible concealed spaces shall comply with Section 717. 2603.4.1.6 Attics and crawl spaces. Within an attic or crawl space where entry is made only for service of utilities, foam plastic insulation shall be protected against ignition by 11/2 -inch -thick (38 mm) mineral fiber insulation; 1/4 -inch -thick (6.4 mm) wood structural panel, particleboard or hardboard; 3/8 -inch (9.5 mm) gypsum wallboard, corrosion -resistant steel having a base metal thickness of 0.016 inch (0.4 mm) or other approved material installed in such a manner that the foam plastic insulation is not exposed. The protective covering shall be consistent with the requirements for the type of construction. The International Code Council Evaluation Service (ICCES) has reported regarding the use of the foam insulation, MDC -200, which is being used on our project. ESR -3199 for MD-C-200TM section 4.4 covers the application of the insulation in attics and crawl spaces. Section 4.4.2.1 covers its use in without the need for an ignition barrier coating. If you have any questions please call. Sincerely, ROB BRAMHALL ARCHITECTS, INC. Robert A. Bramhall, AIA Principal 14 1'ark Street Andover, Massachusetts 01810 Telephone: 978 749 3663 Facsimile: 978 749 9659 IMES Evaluation Report ESR -3199 Reissued April 1, 2012 This report is subject to renewal in one year. www.icc-es.ora ( (800) 423-6587 1 (562) 699-0543 A Subsidiary of the International Code Council® DIVISION: 07 00 00—THERMAL AND MOISTURE PROTECTION Section: 07 21 00—Thermal Insulation REPORT HOLDER: ICYNENE, INC. 6747 CAMPOBELLO ROAD MISSISSAUGA, ONTARIO L5N 21_7 CANADA (905)363-4040 www.icynene.com ievans(Micvnene.com EVALUATION SUBJECT: ICYNENE MD-C-20OTM 1.0 EVALUATION SCOPE Compliance with the following codes: ■ 2009 International Building Code® (IBC) ■ 2009 International Residential Code® (IRC) ■ 2009 International Energy Conservation Code® (I ECC) ■ Other Codes (see Section 8.0) Properties evaluated: ■ Surface -burning characteristics ■ Physical properties ■ Thermal resistance (R -values) ■ Attic and crawl space installation ■ Air permeability ■ Vapor permeability ■ Fire resistance ■ Exterior walls of Types I–IV construction 2.0 USES Icynene MD -C-200 spray foam is used as a nonstructural thermal insulating material in Types I, 11, III, IV and V construction under the IBC and dwellings under the IRC. The insulation is for use in wall cavities, floor assemblies, ceiling assemblies, or attics and crawl spaces when installed in accordance with Section 4.4. Under the IRC, the insulation may be used as air - impermeable insulation when installed in accordance with Section 3.4, and as a vapor retarder when installed in accordance with Section 3.5. Icynene MD -C-200 spray foam may be used in fire -resistance -rated construction when installed in accordance with Section 4.5, and in Types I through IV construction when installed in accordance with Section 4.6. 3.0 DESCRIPTION 3.1 MD -C-200 Insulation: Icynene MD -C-200 foam plastic insulation is a two - component, closed -cell, spray -applied foam plastic with a nominal density of 2.0 pcf (32 kg/m3). The polyurethane foam is produced by combining Icynene Platinum Seal isocyanate (the A component) and Icynene MD -C-200 resin (the B component). The products have a shelf life of six months when stored in factory -sealed containers at temperatures between 60°F and 85°F (16°C and 29°C). The MD -C-200 is supplied in four grades designated as S, W, AS and AW. 3.2 Surface Burning Characteristics: The Icynene MD -C-200 insulation, at a maximum thickness of 4 inches (102 mm) and a nominal density of 2.0 pounds per cubic foot (32.0 kg/m3), has a flame - spread index of 25 or less and a smoke -developed index of 450 or less when tested in accordance with ASTM E 84. Thicknesses of up to 111/4 inches (286 mm) for wall and ceiling cavities are recognized based on room corner fire testing in accordance with NFPA 286, when covered with a minimum 1/2 -inch -thick (12.7 mm) gypsum board or an equivalent thermal barrier complying with the applicable code. 3.3 Thermal Resistance: Icynene MD -C-200 insulation has a thermal resistance, R -value, at a mean temperature of 75°F (24°C) as shown in Table 1. 3.4 Air Permeability: Icynene MD -C-200 insulation, at a minimum 1 -inch (25.4 mm) thickness, is considered air -impermeable insulation in accordance with IRC Section R806.4, based on testing in accordance with ASTM E 283. 3.5 Vapor Permeability: Icynene MD -C-200 insulation has a vapor permeance of less than 1 perm (5.7x10-11 kg/Pa-s-m2) at a minimum thickness of 1.5 inches (38.1 mm) and may be used where a Class II vapor retarder is required by the applicable code. 3.6 Intumescent Coatings: 3.6.1 DC 315: DC 315 intumescent coating, manufactured by International Fireproof Technology, Inc., is a water-based coating supplied in 5 -gallon (19L) pails and 55 gallon (208L) drums. The coating material has a shelf life of 24 months when stored in factory - sealed containers at temperatures between 41'F (5°C) and 95°F (35°). ICC -ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed, nor are they to be construed as an endorsement of the subject of the report or a recommendation for its use. There is no warranty by ICC Evaluation Service, LLC, express or implied, as to any finding or other matter in this report, or as to any product covered by the report. Copyright © 2012 Page 1 of 4 ESR -3199 I Most Widely Accepted and Trusted Page 2 of 4 3.6.2 No Burn Plus: No Burn Plus, manufactured by No Burn, Inc., is an intumescent coating supplied in 1 -gallon (4 Q and 5 -gallon (19 Q pails and 55 -gallon (208 Q drums. The coating material has a shelf life of 36 months when stored in factory -sealed containers at temperatures between 40°F (4.4°C) and 90°F (32.2°C). 4.0 DESIGN AND INSTALLATION 4.1 General: The manufacturer's published installation instructions and this report must be strictly adhered to and a copy of these instructions and this evaluation report must be available on the jobsite at all times during installation. 4.2 Application: Icynene MD -C-200 must be applied using spray equipment specified by Icynene, Inc. The insulation must not be used in areas having a maximum service temperature greater than 180°F (82°C), must not be used in electrical outlet or junction boxes or in contact with rain or water, and must be protected from the weather during and after application. Where Icynene MD -C-200 is used as an air -impermeable barrier, such as in unventilated attic spaces regulated by IRC Section R806, the insulation must be installed at a minimum thickness of 1 inch (25.4 mm). The insulation is applied to the intended thickness, with each pass being a maximum of 2 inches (51 mm). Where multiple passes are required, the cure time between passes is negligible. Icynene MD -C-200 must be installed only by factory - certified applicators. 4.3 Thermal Barrier: 4.3.1 Application with a Prescriptive Thermal Barrier: Icynene MD -C-200 spray foam insulation must be separated from the interior of the building by an approved thermal barrier of 1/2 -inch -thick (12.7 mm) gypsum board or an equivalent 15 -minute thermal barrier complying with, and installed in accordance with, IBC Section 2603.4 or IRC Section R316.4, as applicable. When installation is within an attic or crawl space as described in Section 4.4, a thermal barrier is not required between the foam plastic and the attic or crawl space, but is required between the insulation and the interior of the building. Thicknesses of up to 111/4 inches (286 mm) for wall and ceiling cavities are recognized based on room corner fire testing in accordance with NFPA 286, when covered with minimum 1/2 -inch -thick (12.7 mm) gypsum board or an equivalent thermal barrier complying with the applicable code. 4.3.2 Application without a Prescriptive Thermal Barrier: The prescriptive 15 -minute thermal barrier or ignition barrier may be omitted when installation is in accordance with this section. The insulation and coating may be spray -applied to the interior facing of walls, the underside or roof sheathing or roof rafters, and in crawl spaces, and may be left exposed as an interior finish without a 15 -minute thermal barrier or ignition barrier. The thickness of the insulation applied to the underside of the roof sheathing must not exceed 10 inches (254 mm). The thickness of the insulation applied to vertical wall surfaces must not exceed 6 inches (152 mm). The insulation must be covered on all surfaces with DC 315 coating at a minimum wet film thickness of 22 mils. The coating must be applied over the Icynene MD -C-200 insulation in accordance with the coating manufacturer's instructions and this report. Surfaces to be coated must be dry, clean, and free of dirt, loose debris and other substances that could interfere with adhesion of the coating. The coating is applied in one coat with low-pressure airless spray equipment. 4.4 Attics and Crawl Spaces: 4.4.1 Application with a Prescriptive Ignition Barrier: When Icynene MD -C-200 insulation is installed within attics or crawl spaces where entry is made only for service of utilities, an ignition barrier must be installed in accordance with IBC Section 2603.4.1.6 or IRC Sections R316.5.3 and R316.5.4, as applicable. The ignition barrier must be consistent with the requirements for the type of construction required by the applicable code, and must be installed in a manner so the foam plastic insulation is not exposed. Icynene MD -C-200 insulation may be installed in unvented attics in accordance with IRC Section R806.4. 4.4.2 Application without a Prescriptive Ignition Barrier: Where Icynene MD -C-200 spray foam is installed in an attic or crawl space without a prescriptive ignition barrier, in accordance with Sections 4.4.2.1 and 4.4.2.2, the following conditions apply: 1. Entry to the attic or crawl space is only for the service of utilities and no storage is permitted. 2. There are no interconnected attic, crawl space or basement areas. 3. Air in the attic or crawl space is not circulated to other parts of the building. 4. Combustion air is provided in accordance with the IMC (International Mechanical Code) Section 701. 5. Attic ventilation is provided when required by IBC Section 1203.2 or IRC Section R806, except when air -impermeable insulation is permitted in unvented attics in accordance with Section R806.4 of IRC. 6. Under -floor (crawl space) ventilation is provided when required by IBC Section 1203.3 or IRC Section R408.1, as applicable. 4.4.2.1 Attics and Crawl Spaces: In attics and crawl spaces, Icynene MD -C-200 insulation may be spray - applied to the underside of the roof sheathing and/or rafters, and to the vertical walls and the underside of floors as described in this section. The thickness of the foam plastic applied to the underside of the roof sheathing must not exceed 111/4 inches (285.7 mm). The thickness of the spray foam insulation applied to vertical wall surfaces must not exceed 111/4 inches (285.7 mm). The insulation does not require an ignition barrier or a coating. Optional: It is permitted to cover all surfaces of the foam plastic with the coating, as described below and in Section 3.6. The coating must be applied over the Icynene MD -C-200 insulation in accordance with the coating manufacturer's instructions and this report. Surfaces to be coated must be dry, clean, and free of dirt, loose debris and other substances that could interfere with adhesion of the coating. The coating is applied in one coat with low-pressure airless spray equipment, and must be applied to a minimum wet film thickness of 16 mils. Icynene MD -C-200 insulation may be installed in unvented attics or crawl spaces as described in this section in accordance with IRC Section R806.4. 4.4.2.2 Use on Attic Floors: Icynene MD -C-200 insulation may be installed exposed at a maximum thickness of 11'/4 inches (286 mm) between and over the joist in attic floors. The insulation must be separated FSR -3199 I Most Widely Accepted and Trusted Page 3 of 4 from the interior of the building by an approved thermal barrier. The ignition barrier in accordance with the IBC Section 2603.4 and IRC Section R316.5.3 may be omitted. 4.5 One-hour Non -load-bearing Fire -resistance - rated Wall Assembly: 4.5.1 Exterior Face: Nominally 6 -inch -deep (152 mm), No. 18 gage galvanized steel studs, spaced 16 inches (406 mm) on center, are fastened to No. 18 gage tgalvanized steel floor and ceiling tracks. One layer of /2 -inch -thick (12.7 mm) Georgia Pacific DensGlass® Gold Exterior Sheathing is installed parallel to steel studs with vertical joints offset a minimum of 16 inches (406 mm) from the vertical joints of the interior Type X gypsum board, and the horizontal joints offset a minimum of 24 inches (610 mm) from the horizontal joints of the gypsum board. The sheathing is attached using 11/4 -inch long (31.7 mm), self -drilling drywall screws spaced 8 inches (203 mm) on center around the perimeter and in the field. Hohmann & Barnard DW -10 brick ties, 6 inches (152 mm) long by 11/2 inches (38 mm) wide, are spaced 16 inches (406.4 mm) on center vertically on each steel stud, and secured using two 15/8 -inch -long (41.3) self -drilling screws, through 4 -inch (102 mm) red clay brick [31/2 inches (88.9 mm) by 21/4 inches (57.1 mm) by 73/4 inch (197 mm)], laid in a running bond pattern with Type S mortar, leaving a nominally 1 -inch (25.4 mm) air gap between the brick and the exterior sheathing. The stud cavity is filled with Icynene MD -C-200 insulation to a maximum nominal thickness of 6 inches (152 mm). 4.5.2 Interior Face: Type X gypsum board, 5/8 inch (15.9 mm) thick and complying with ASTM C 1396 is applied to the interior side with the long edge parallel to steel studs, and is secured using 11/4 -inch -long (31.7 mm), self -drilling drywall screws spaced 8 inches (203 mm) on center around the perimeter and 12 inches (305 mm) on center in the field. The gypsum board joints must be treated with vinyl or casein, dry or premixed joint compound applied in two coats to cover all exposed screw heads and gypsum board butt joints. A minimum 2 -inch -wide (51 mm) paper, plastic, or fiberglass tape is embedded in the first layer of compound over butt joints of the gypsum board. 4.6 Exterior Walls in Type I, II, III and IV Construction: 4.6.1 General: When used on exterior walls of Types I, Il, III or IV construction, the assembly must comply with IBC Section 2603.5 and this section, and the Icynene MD -C-200 insulation must be installed at a maximum thickness of 6 inches (152 mm). The potential heat of Icynene MD -C-200 insulation is 1918 B/ft2 per inch of thickness, when tested in accordance with NFPA 259. 4.6.2 Exterior Face: Nominally 6 -inch -deep (152 mm), No. 18 gage, galvanized steel studs, spaced 16 inches (406 mm) on center, are fastened to No. 18 gage galvanized steel floor and ceiling track using No. 8, /8 -inch -long (22.2 mm), self -tapping, pan head framing screws. Georgia Pacific DensGlass Gold Exterior Sheathing, 1/2 inch (12.7 mm) thick, is installed over the exterior side of steel studs with the long end perpendicular to the steel studs, using No. 6, Type S, 1'/4 -inch (31.7 mm), self -tapping bugle head screws spaced 8 inches (203.2 mm) on center around the perimeter and in the field. The stud cavity is filled with Icynene MD -C-200 insulation to a maximum nominal thickness of 6 inches (152 mm). 4.6.3 Interior Face: Type X gypsum board, 5/8 inches (15.9 mm) thick and complying with ASTM C 1396, is installed, with the long dimension perpendicular to steel studs, with No. 6, Type S, -11/4 -inch -long (31.7 mm), self - tapping bugle head screws spaced 8 inches (203 mm) on center around the perimeter and 12 inches (305 mm) in the field. The gypsum board joints must be treated with vinyl or casein, dry or premixed joint compound applied in two coats to cover all exposed screw heads and gypsum board butt joints. A minimum 2 -inch -wide (51 mm) paper, plastic, or fiberglass tape is embedded in the first layer of compound over butt joints of the gypsum board. 4.6.4 Exterior Wall Covering: Details of the exterior wall covering must be provided to the code official by the report holder, designer or specifier, with an engineering analysis demonstrating that (1) the exterior wall covering conforms to ASTM E 136 and (2) the addition of the wall covering to the assembly described in this section does not negatively affect conformance of the assembly with the requirements of IBC Section 2603.5. . 5.0 CONDITIONS OF USE The Icynene MD -C-200 spray foam insulation described in this report complies with, or is a suitable alternative to what is specified in those codes listed in Section 1.0 of this report, subject to the following conditions: 5.1 The product must be installed in accordance with the manufacturer's published installation instructions, this evaluation report and the applicable code. The instructions within this report govern if there are any conflicts between the manufacturer's published installation instructions and this report. 5.2 The insulation must be separated from the interior of the building by an approved 15 -minute thermal barrier in accordance with IBC Section 2603.4, except when installation is as described in Section 4.3.2 or in attics and crawl spaces as described in Section 4.4.2. 5.3 The insulation must not exceed the thickness and density noted in Sections 3.2, 4.3, 4.4, 4.5 and 4.6 of this report. 5.4 The insulation must be protected from the weather during and after application. 5.5 The insulation must be applied by installers certified by Icynene, Inc. 5.6 Use of the insulation in areas where the probability of termite infestation is "very heavy" must be in accordance with IRC Section R318.4 or IBC Section 2603.8, as applicable. 5.7 Jobsite certification and labeling of the insulation must comply with IRC Sections N1101.4 and N1101.4.1 and IECC Sections 303.1.1 and 303.1.2, as applicable. 5.8 The A and B components of the insulation are produced under a quality control program with inspections by Intertek Testing Services NA, Ltd. (AA -690). 6.0 EVIDENCE SUBMITTED 6.1 Data in accordance with the ICC -ES Acceptance Criteria for Spray -applied Foam Plastic Insulation, (AC377), dated October 2010, including reports of tests in accordance with Appendix X of AC377. 6.2 Report of air permeance tests in accordance with ASTM E 283. ESR -3199 I Most Widely Accepted and Trusted Page 4 of 4. 6.3 Report of vapor permeance tests in accordance with ASTM E 96. 6.4 Report of fire -resistance tests in accordance with ASTM E 119. 6.5 Report of fire tests in accordance with NFPA 285, and related engineering analysis. 6.6 Reports of room corner fire tests in accordance with NFPA 286. 6.7 Report of potential heat tests in accordance with NFPA 259. 7.0 IDENTIFICATION Containers of Icynene MD -C-200 components are identified with a label bearing the Icynene Inc. name and address; the product trade name (Icynene MD -C-200, Grade S, W, AS or AW); the lot number; the flame spread and smoke developed indices; mixing instructions; density; the shelf life and the expiration date; the evaluation report number (ESR -3199); and the name of the inspection agency (Intertek Testing Services NA Ltd.) Intumescent coatings are identified with the manufacturer's name and address, the product trade name and use instructions. 8.0 OTHER CODES In addition to the codes referenced in Section 1.0, the products recognized in this report have also been evaluated for compliance with the following codes: ■ 2006 International Building Code® (2006 IBC) ■ 2006 International Residential Code® (2006 IRC) ■ 2006 International Energy Conservation Code (2006 IECC) The products comply with the above-mentioned codes as described in Sections 2.0 through 7.0 of this report, except as noted below: ■ Application with a Prescriptive Thermal Barrier: See Section 4.3.2, except the approved thermal barrier must be installed in accordance with 2006 IRC Section R314.4. ■ Application with a Prescriptive Ignition Barrier: See Section 4.4.1, except attics must be vented in accordance with 2006 IBC Section 1203.2; and crawl space ventilation must be in accordance with 2006 IBC Section 1203.3 or 2006 IRC Section R408, as applicable. Additionally, an ignition barrier must be installed in accordance with 2006 IRC Section R314.5.3 or R314.5.4. ■ Application without a Prescriptive Ignition Barrier: See Section 4.4.2, except attics must be vented in accordance with 2006 IBC Section 1203.2; and crawl space ventilation must be in accordance with 2006 IBC Section 1203.3 or 2006 IRC Section R408, as applicable. Combustion air must be provided in accordance with Sections 701 and 703 of the 2006 International Mechanical Code®. ■ Protection against Termites: Replace Section 5.7 with the following: Use of the insulation in areas where the probability of termite infestation is "very heavy' must be in accordance with 2006 IRC Section R320.5 or 2006 IBC Section 2603.8. ■ Jobsite Certification and Labeling: See Section 5.8, except jobsite certification and labeling must comply with 2006 IECC Sections 102. 1.1 and 102.11, as applicable. TABLE 1 -THERMAL RESISTANCE (R -VALUES) THICKNESS (inch) R -VALUE (°F.ft-.h/Btu) 1.0 6.5 3.5 21 4.0 24 5.5 33 6.0 36 7.5 45 8.5 51 9.5 57 10.0 60 11.25 68 For SI: 1 inch= 25.4 mm; 1 °F.ft2.h/Btu = 0.176110°K.m2.h/W. 'R -values are calculated based on tested K -values at 1- and 4 -inch thicknesses. ROB BRAMHALL ARCHITECTS March 26, 2012 Gerald Brown Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Brooks Dorm — Spray foam insulation Dear Gerald: At the beginning of this project there was an interoffice meeting that we attended at the Towns request. It was explained that the egress requirements of the dormitory were met via the main stair and secondary stair egress without requiring egress thru the residences positioned at either end of the main dormitory. It was requested that we provide additional egress thru the residence at the East end of the dormitory on the second floor. This would require the door to have a lockset that is tied to the fire alarm system I the building. These residences are private and secured from the dormitory. Security is a concern for the school. As this is a supplemental egress for the dormitory, Brooks would prefer to use "Fail safe" egress door hardware in lieu of "15 second delay" egress door hardware. The door will contain a contact tied to the fire alarm which will release the magnetic lock in the case of a Fire Alarm permitting immediate egress. If you have any questions please call. Sincerely, ROB BRAMHALL ARCHITECTS, INC. Robert A. Bramhall, AIA Principal 14 Park Street Andover, Afassachusetts 01810 Telephone: 978 749 3663 Facsimile: 978 749 9659 Page 1 bvsetts sting P eaatei f "'OSSOC Uct►an T e lot cQnst� _ 7g1.438-6216 lFaxl 7755 N°►cel p5 / p9 I2p12 m, MA 021g0 7g1.43$ R..Ort Date N th Andover ne�Stoneha a ortN°• 4 p0 ;tory' o-L 5 Richardson L, . Transmittail Rep° rt Rjo Number B400ks gclz° p a Road Result project 11a t 0 ea struotion 1 goil C00Nesting bution C° pistriContractor le oo- 158 Sarr1 Subn►itted ' Date 1 Submitted B lark Sam 1e Our Representative: Jason e ® e nt Subbase StpCkP ve il ether °f Sam 1 pace S°urce @location: On.Site Existing bbaSe ®,row from: t gu O{{.SiteB Pavemen Arohite°tl ❑ use' the Pr°P° a submitted AS' Shall be approved by Mate Fin: 141 p1, 0 11Granuiar Mgp p TYPe' 141 p3.1 ❑ Structura Borrow- 141.03 • Nj 'D ❑ Ordin, Borrow; 14gp se Course: 14Hp 14I.-11.0 11 0 ❑ G r aessed Gravel F r B 1.09 ' for Base Course. 142 p1 ❑ Sand B°,row ' veme t BOro w MHp ❑ ed pa 14gp 142 .()1.0 r Base Course. ❑ C(uaim Stone. Stone fo shed Grade Crushed Dense onBorro`C. N,drOmeter sir ® comm ❑ ve An,IY d1: sh Sie ❑ ,,,,nage F Analys►s ®Wa ❑ Ree nested .� estin ®Gradation its ❑permeability Atte erg ❑ctor r avel ® Modified pro With Sand ❑ Other Silt Results the Material Classi1ca{1o°�C°nfOrmance eWed for aPpYOval by pro ect S eclf 1 Sample be -Levi Doe cOnform'forrn: Basis: this soi ❑ NOT con *conform... t of bl d use ❑ Does ll dpes no e tabu r Y o f-R r a specific i to ❑ Ma ging gTAege tnd the V ded to our office t Sample not submw thout specificati.1111111"ons'Sting Archite tions pro d to our °ffice but ded use an ❑ N° Specific, rovided °f inters of °omPaCtyO� to tions P dicatlon d for the purpose ❑ Specific, L,bmitfed without in Sample RKS Material subn`itte ofmass' for ,`ore infoy�'a ❑ com � GENERAL REMA oteChn1Cal Depa-Ltment a email us at reports@'its REVIEWED BY Ge via email • pleas able in pDF form Car reports are avayl _ A Mo� r• of age he C has fs s Richardso OnS�rU��oA n 'ane' est - Stoneham, 41A -9 781-438. g1 ��9 PeoPI Soil Testing Resul -438.755 (Voice) tS - Transmittal e 781,43g.6216 Dlstribut �FaX) ion Copy Report Repo pate Page 2 eportNo. 5/0g12012 Job Number 4 PrOject 14700 oo. Brooks Sc ho01 Rn °ry, North Andover o Contractor utt ptool N seConstOnd a cctract1. ructiOIvausetCon R Rob Bra uction John Sa AETr RY Aldrich rhitects e 1n " ,age is ls Randall 1 iegAociatY,PC, TonJab eto BNorthAdmer own rd Mill r xall John Scott Steve Siegel Gerald Brown i UTS of Massachusetts, Inc. Page 3 5 Richardson Lane, Stoneham, MA 02180 781-438-7755 (Voice) 781-438-6216 (Fax) Report Date 05/09/2012 Report No. 4 Job Number 14700 Project Brooks School Dormitory, North Andover Attachment 1160 Great Pond Road Particle Size Distribution Report 3 in. 100.0 2 in. 96.8 1 in. 92.2 I 88.3 mill I -iniiiii1mil1 #4 78.0 #]0 74.0 #20 67.5 #40 61.0 #100 46.4 , III IN 1111111111 in 11 limill-illillm--Illllin W Z UL limillililimillillop milililliniiiiiiinZ W U llimililillimillillinilill Lillillilinilillilin W o_ llloillilli millililloillililiniiiiiiiiniiiiiiiin llimililill oil llimillillisillill oil 1-10 llimililillimilillillollill lnillillilmilillilini GRAIN SIZE - mm % COBBLES % GRAVEL % SAND % SILT %C 0.0 22.0 42.4 35.6 SIEVE PASS? Material Description PERCENT SPEC." SIZE FINER PERCENT (X=NO) F -M SAND, AND SILT, SOME GRAVEL Atterbera Limits 3/8 in. 82.8 PL= LL= P1= Coefficients D85= 13.4 D60= 0.392 D50= 0.192 #50 56.3 D30= D15= D10= Cu= Cc= #200 35.6 Classification USCS= SM AASHTO= Remarks (no specification provided) Sample No.: 158 Source of Sample: PAVEMENT SUBBASE STOCKPILE Date: 5/09/2012 Location: Elev./Depth: UTS OF MASSACHUSETTS, INC. Client: NAUSETCONSTRUCTIONCORP. 5 Richardson Lane Project: BROOKS SCHOOL, NORTH ANDOVER, MA Stoneham, MA 02180 Project No: 14700 Fi ure 158 3 in. 100.0 2 in. 96.8 1 in. 92.2 3/4 in. 88.3 #4 78.0 #]0 74.0 #20 67.5 #40 61.0 #100 46.4 page A vo\ce1�81�3a,52161p p5 � 09I 2p12 No�tb Andov er C, S"1551 V)ate D mitozY chusett9 p2AsoIsA Rep ort N0. 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