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Miscellaneous - 20 LAVENDER CIRCLE 4/30/2018
10103 Date . ../.19../ . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that...111..?7.. , , ....... . . . .. . has permission to perform '1 ............... plumbing in the buildings of. -.?. 4. Ai ,�.vt. � .......... at.941-xl.,f ,,,,,,,,,,,,,,,,,,,,,INorth Ando v r, Mass. Fee i6/1.,.o.o..Lic.NoO—Tq./... a✓ 0�� ... ... Check # 44ZOO PLUMBING INSPECTOR 1) 0 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK CITYV _ MA DATE _ PERMIT # -ii _( },-- JOBSITE ADDRESS 2�A �r v �� l �-c �, OW ER'S AME h� I1,1 POWNER ADDRESSr _ _ TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL PRINT CLEARLY .�€ NEW: Ell RENOVATION:,( REPLACEMENT: ® PLANS SUBMITTED: YES © NO�I FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB ._ _! = -_-_€ __._._ I= ____._I .__.___ i € =.= = = ._€ _-_-__€ -€ CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM DEDICATED GREASE SYSTEM __ J _..-_--_ ( !---____.€ .-.-.—----.___€ I _...-_.__.._( __---. .____--1 _..___J ._ __..€ .-_-----I ----i ---► DEDICATED GRAY WATER SYSTEM __€ DEDICATED WATER RECYCLE SYSTEM DISHWASHER DRINKING FOUNTAIN f -_._...-._( J I ._...__._4 _ _ #.__.E FOOD DISPOSER __-I € I ( r I i ( i .__.__.I ._._.-_.I —I ....__.._.I FLOOR/AREA DRAIN INTERCEPTOR (INTERIOR) KITCHEN SINK _._—► __._-_! __...._ I _.. __� __-____.i __..___J ._____-€ .--____J .____€ __..___-€ .-____-€ ----_......f _.-.____-€ _--_( .-.__.__.� LAV TORY ROOF DRAIN _._.--___� ._.._.. I ,..__..._.€ SHOWER STALL ' J ( l I ..._._.� l !f - SERVICE / MOP SINK TOILET URINAL ...._..__J WASHING MACHINE CONNECTION _- _. € ___ 1 _.. I WATER HEATER ALL TYPES f € € _ . _._i i _ s_ _.^I -`f ...--_.___I WATER PIPING _.._I ._ _--i OTHER f _ ___..! _€ .___..J INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YESxf NO EJ IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY It OTHER TYPE OF INDEMNITY 0 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 requir HECK ONE 0 Y: OWNER _i AG SIGNATURE OF OWNER OR AGENT A en B hereby certify that all of the details and information I have submitted or entered regarding this applicatiNo are true and a u t to a 9,t o k wledge and that all plumbing work and installations performed under the permit issued for this application will be compliance inent r ision f the h4assachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER'S NAMO-!( -f 'moo . _ C._ ._,.__.._.._ . _. �LICENSE IG URE IVIP� JP PiCORPORATION 01 # - ___ _ ;PARTNERSHIP __.€ # ;LLC COMPANY NAM (W ADDRESS G' CITY Q;-/ STATE ZIP�� TELE FAX GZ € CEf r�---(FG'%/j EMAIL of -1 z N ❑ W CL Lii w The Commonwealth of Massachusetts - Department of IndustriolAccidints Office of Investigations 600 Washington Street Boston, MA. 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslEl please Print Le ibl Applicant Information ii Name (Business/Organization/Individual): Address: ✓ t U.- N A Phone #: � � � cis — �-� City/State/Zip:• — Are you an employer? Check ;tV appropriate box: 4. ❑ I am a general contractor and I 1PI am a employer withff employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 2. El I am a sole proprietor or partner- These sub -contractors have ship and'have no employees working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no employees. [No workers' insurance required.] t comp. insurance required.] Type of project (required): 6. ❑ New construction 7..❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11 E] Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tr, .,+..,,.+_ +i,at this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:. Expiration Date: Policy # or Self -ins. Lie. #: City/State/Zip: Job Site Address: Lb, �ps?,,,i �h—� ' U—`��= Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 ad ' ed that a copy of this statement may be forwarded to the Office of r,,.rP�+;cmt;razR-nf-t4+e_D1A for ins4ance coveraZ ve ifiieation. I do her certify under he pena jury that the information provided above is true �and correct. Date: Si ature: Phone #: 11 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License U. 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 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 loeal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152; §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that 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: The Commonwealth of Massachwetts Department of Industrial.A.ccidents Office ofInvestigations 600 Washington Street Boston, MA. 02111 Tei. # 617-727-4900 ext 406 or 1-877�,MASSAFB Revised 5-26-05 Fax # 617-727-7749 www.mass,gov/dia tT i a eLbS- 1 l CO L' �—j d O CL co N t.- W LLw w .� c V d ' aFW...cwi Q \ otn W'o . LLO o 2 A w � - Ln J N to CD to y Ww UJ NI co Q W W .>Mz 2 2 _w CLU V J H CD 9 1. Date ..... //.../`�-'........... TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifiesthat .... :.........�'.�.......... �...........I.................. ............................................................ has permission to perform............................. ......'� . f b ........................................................ wiring in the building of ..........:.... t.../,................................................................. df-� o..� ��2r�c�,. at..........:................................................................................... , orth Andover, Mas . Fee ....9 — ..... Lic. No. 2�' .. L.. � �( ELECTRICAL INSPECTo Check # 11790 Y.J �L\ Commonwealth of Massachusetts Official Use Only Department of Fire Services Permit No. I �� Occupancy and Fee Checked , BOARD OF FIRE PREVENTION REGULATIONS [Rev. uv] (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 5J7 CMR 12.00 (PLEASE PRINT IN)NK OR TYPE ALL INFORMATION) Date: City or Town of: NORTH ANDOVER To the Ins ecto of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) '20 Z—dlyC/f?Z Owner or Tenant t/-"crr 1171,2 6p�k/;,_ p ITelephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑�No ❑ (Check Appropriate Box) Purpose of Building St !���,,, L, Utility Authorization No. - Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires p No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- El rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets 2 cy No. of Oil Burners FIRE ALARMS No. of Zones No. of SwitchesNo. 2- of Gas Burners No. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number .................................................... Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal E] Other Connection No. of Dryers Heating Appliances K VV Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or E uivalent OTHER: k Attach additional detail if desired, or as regidred by the Inspector of Wires. Estimated Value of lectrical Work: 3 4 1YQ (When required by municipal policy.) Q/ I Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. 14\ 114SURANCE C VE GE: 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 covera e is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE OND ❑ OTHER ❑ (Specify:) 4✓V I certify, under the aims andpenalties ofperjury, that the information on this application is true and complete. FIRM NAME:. LIC. NO.: i9 Licensee: Signature LIC. NO. :.Zrx 22,c (If applicable, enter "exempt" in the license number line) Bus. Tel. No. • g � 8 a d� �i�fpy Address: 7 7G r 8,,yd Alt. Tel. No.: *Per M.G.L c. 147,-s. 57-6 , security work requires Department of Public Safety "S" License: Lic. No. 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, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ Signature Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the ` permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed i on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the , notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall.be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012. ❑ Rule 8 — Permit/Date Closed: *** Note: Reapply for new permit ❑ ❑ Permit Extension Act — Permit/Date Closed: Trench Inspection Pass M Failed Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: . Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPE ION: Pass 0 Failed 0 Re- Inspection Required ($.) ❑ Inspectors Comme 1 Inspectors Signature: Date: FINAL INS E ION: Pass 0 Failed ❑' Re- Inspection Required ($.) ❑ Inspectors Commen Inspectors Signature: Date: V DEB WEINHOLD ... TOWN OF MERRIMAC, MA........dweinhold@townofinerrimac.com ,. The Commonwealth of Massachusetts Department ofIndustrial Accidents 07 Office of Investigations Ut 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):e-,L6,5� Address: City/State/Zip: Phone Are you an employer? Check the appropriate box: 1. Eft'am a employer with y 4. ❑ I am a general contractor and I _A&— employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I 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. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.❑ 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 aie 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. I4 -;n an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. le—, In..Wrance Company N Policy # or Self -ins. Lic. #:I .T� y6 6 % 2 ) , Expiration Date: Job Site Address: LrfreVd� Com/'✓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 dv hereby cert WIN ofperjury that the information provided abovgis 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone #: 1 r 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that 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 permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. F 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 of Massachusetts Department of Industrial Accidents Office of Inivestigations 600 Washington Street Boston, MA. 02111 Tek. # 617-727-4900 at 406 or 1-877rMASSAkB Revised 5-26-05 Fax # 617-727-7749 ww.nlass.govfdia IV Date TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION This certifies that.. Hf . ................. has permission for gas iiastallation. ................. I I t in the buildings of .... ( ....................... at -2-0 Lckoo,d-,-I-rCIS �-� orthAndov,e: Mass. Fee 3t- ... Lic.No.zqC; C. . ... ... GASINSPECTOR Check# 2-(rq -Z) r •` MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY��IYI�11����� MA DATEI PERMIT # JOBSITE ADDRESS �OWNER'S NAME GOWNER _ _� ADDRESS e TE11 ���--------- FAX _ TYPE OR PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL) RESIDENTIAL�- CLEARLY NEW: J RENOVATION: E] REPLACEMENT: 0 PLANS SUBMITTED: YES F-11 NO[-I APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER _ L=j =1 =j BOOSTER =-E=1= CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE 25 v �� I---- I �- - I --- ! �-- - - - I - _ -.. I _ 1 FRYOLATOR_ FURNACE GENERATOR- - -(�_. _ I . 11. I -J GRILLE GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT _-.._ _ ...- ,.- . . . _— -, L -.,L- .. I__•.�_( - -1 ---I OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT! TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER _, OTHER I - -•r�.-.==.-J _ _ .I -�-..� T-.-__.- - ��t.--._..._ ....� -, . m �.-.��I r-- INSURANCE COVERAGE have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch.142 YES -NO Ej IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY (:jjk"� OTHER TYPE INDEMNITY EI 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: OWNER 0-1 AGENT �I SIGNATURE OF OWNER OR AGENT 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 with all Pertinent provision of the Massachusetts State Plumbing Code d Chapter 142 of the General Laws. PLUMBER-GASFITTER NAME' LICENSE # „-y SIGNATURE MP ED M G F D1 JP , JGF LPGI�_I CORPORATION Q;� PARTNERSHIP 0#��-���_� LLC []#__ COMPANY NAME: tn- DRESS Ff --�-J CITY _�.�,.._r__.... - )'STATE =ZIP - -- I FAX CELL EMAILL{' W 6- 3 - us f/ r (-/ z z 0 F U z O y� d W >- COD � W 0 a °z w CA Q w O LLI az > a z W w w C a a zCOD a a n J F CL CLa Cn w x w F- w H O z 0 H U W W U' C7 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): i/�/ %��h' �i �� ii,— /�� L Address:_) /SC e City/State/Zip: Phone #:�-- Are you an employer? Check the appropriate box: L ❑ I am a employer with 4. ElI am a general contractor and I e yees (full and/or part-time).* have hired the sub -contractors 2. am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.l Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ 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. tCon�tractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site inf .zr.;m n. Insurance Company Name: Policy # or Self -ins. Lic. #: lob Site Address: Expiration Date: City/State/Zip: attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). ailure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ine 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 )f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurancB-c-ev e-. vPr, ,moi-„ do hereby certify Wtifer t z1 pins and 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 # — SU— 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 #: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. / City or Town Officials Please be sure that 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 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 of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www.mass.gov/dia 12/03/2012 07:21 5087562655 FEDEX OFFICE 2597 Division of ProfeSSi.onal Licensure: License Search The Otnrlal Web&Ito ofthP OfAce of ConsumerAffalrs and Bi.lshleSS Regulation (OCABR) Division of Professional Licensure ,�Mss%a.G�ov Mass,Gov Homo. State Agencies A -Z Toplcs�� Homo ) Division of Professional Licensuro > Cheep A Professional License By the Dlvl9io-n of Pro essIonaj_LicensuLe, LICENSEE Name: PAUL MARKHAM SHREWSBURY, MA NEW SEARCH j Licensing Board: PJ.,.UMBERS Et GASFITTCRS License Type: JOURNEYMAN PLUMBER License Number: 21456 Status: 9y ttlENT Expiration Date: 5/1/2014 Issue Date: I 7/29/1988 Exam Date: iSchool: I This web s'it'e displays disciplinary ar_tlons dating, back to 1993. I This lirense has had no disciplinary actions taken during this time. The page, Above has been eoneratod by the Division of professional Licoosure wr.l) server on Monday, December 01. 2011 at 7:21:04 AM. 2007-2017 Commgnwe,,Iltil of Ma"schii�f_tt9 PAGE 01/01 Page 1 of 1 1 ONLINE SERVICES € Check License, { Locate a Lk eased 1 Prgr(gc1011al Online Address Change i j Contact the AgenL More... REFERENCES & RELATED .INFO Disclaimer Regarding Website License Searches Enforcement Process. i Glossary Glossary of License Status i Codes More Site Policies Contact Us http://license.reg.state.m,a-us/pub.lic/pubLicettseQ.asp?board_code=PL&tYpe-_claw=` T&I.i c... 12/3/2012 Date ...... :0k...... NORTH 0 TOWN OF NORTH ANDOVER 0 PERMIT FOR WIRING CHU This certifies thatZ� ............ has permission to perform ................................................. wiring in the building..................................... of.... ......... at.r-4 4�.../ld( -�" / -. Z� North Andover, Mass. Fee.. . ov . I i c. N o. 4 - 51 .... ............ ...... ..... .. ......................................................... ELECTRICAL INSPECTOR Check # IJ70 5378 "�'� UV1111!lVl/r�cca•N• v• •.•...vv... v.........--� Department of Fire Services Penn it No. 5_3. / --'�� - 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 (MF,('). 527 CMR 12.00 (PLEASE. PRJNT' IN INK OR TYPE, ALL INFORMATION) Date:_ 1 La In q City or Town of: IN - Aq Qyerz- TO the Inspector of fres: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) `Do La -eheicr- circle_ Owner or Tenant Telephone No. Owner's Address Is this permit in conjunction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Existing Service New Service Amps / Volts Amps / Volts Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work and LIGHT Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters INGROUND POOL: BONDING, PVC, GFI, FIL" 'ER, "UMP Completion of the followine table may be waived by the Inspector of Hires. No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Above n- Swimming Pool rnd. ❑ rnd. ❑ o. o Emergency tg ng Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. of Detection an Initiating Devices No. of Ranges _ No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat um Totals um er ons .'" o. o el - ontatned Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal ElOther Connection No. of Dryers _ o�'ater� Heaters KW Heating Appliances KW o. o o. o Signs Ballasts ecunty Systems: No. of Devices or Equivalent Data Wiring: No. of Devices or E uivalent No. Hydromassage Bathtubs No. of Motors Total HP a ecommunicationsWiring: No. of Devices or Equivalent OTHER: .dttuch additional detail if desired, or cis required I>v the Inspector i INSURANCE COVERAGE: Unless waived by the owner, no pen -nit 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 the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) �fiZ OO. (Expiration [Yate) L;stimated Value of L;lectrlcal ork: (When required by municipal policy.) Work to Start: Inspections 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: Village Electric. Inc LIC. NO.: 9163 Licensee: Anthony P DclPapa Signatur LIC. NO.: 21-861 (Ifapplicable. enter "exempt " in the license number line,) Bus: Tel. No.: 978-256-4845 Address: 4 Kidder Rd. Chelmsford, MA 0182.4 Alt. Tel. No.: 978-256-5804 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, I hereby,waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature. Telephone No. rPERMIT FEE: $FEE — = s E U O z CD cm C C o•— co— a y .g CD O m m CD = a O� F- a CD cc C LUui C S o d M C.3♦ Z O cc E w a c c 2 U C u. � a 0, � a; � XO w � w w N w H w w w ° z cn (n E U O z 8 O > 0 00COz 0 U CO 90, O O v v y CD cm C C o•— co— y .g CD O m m CD = o O� F- o CD cc C LUui C S o d M C.3♦ Z O cc E c 0. m CLCWS COD C. N H Z 8 O > 0 00COz 0 U CO 90, O O v v y CD cm C C o•— co— y .g CD O m m CD 0 CD = O� CD cc c L O C �aIA Co S c� cc d C C.3♦ Z O O 00O2.* c 0. V y O uj UI U) W W oc W U) Atlantic Design Resources, Ltd. 152 Portsmouth Avenue, Stratham, New Hampshire 03885 Phone / Fax 603/418-0764 email: asdr@conversent.net HYDRAULIC CALCULATION PRODUCT SPECIFICATIONS & INFORMATION For LOCATION 20 Lavender Circle Peachtree Farms North Andover, Massachusetts CONTRACTOR Northpoint Realty Development P.O. Box 907 North Andover, Massachusetts PROJECT 204049 THE ENCLOSED INFORMATION WAS USED IN PREPARING THE DRAWINGS FOR THE REFERENCED PROJECT, WHICH IS A PART OF THIS SUBMITTAL. THE PRODUCT INFORMATION PRESENTED WAS USED AS THE BASIS FOR DESIGN. ALTERNATE PRODUCTS OR MATERIALS OF EQUAL OR BETTER QUALITY OR OPERATIONAL CHARACTERISTICS, WHICH ARE LISTED FOR USE UNDER THE DESIGN CONDITIONS, MAY BE SUBSTITUTED AT THE INSTALLER'S DISCRETION WITH THE APPROVAL OF THE AUTHORITY HAVING JURISDICTION. 0 VI. HYDRAULIC C A L C U LAT IONS C O V E R S H E E T 20 Lavander Circle N..Andover, Ma NFPA-13 D'2 head sprinkler test W A T ER S U P P L Y STATIC PRESSURE (psi) 65 RESIDUAL PRESSURE (psi) 55 RESIDUAL FLOW (gpm) 1080 B O O S T E R P U M P S NUMBER OF BOOSTER PUMPS 0 S P R I N K L E R S MINIMUM FLOW PER SPRINKLER (gpm) 14 MINIMUM PRESSURE PER SPRINKLER (psi) 11.11 THIS SYSTEM OPERATES AT A FLOW OF 28.28 gpm AT A PRESSURE OF 43.64 psi AT THE BASE OF THE RISER (REF. PT. 2) PIPES USED FOR THIS SYSTEM -------------------------------------- 018 COPPER TYPE 'L' 009 BLAZEMASTER CPVC A Lavander Circle N. Andover, Ma NFPA-13 D 2 head sprinkler test PAGE 1 HYDRAULIC CALCULATIONS AT SPECIFIED FLOW THE FOLLOWING SPRINKLERS ARE OPERATING IN: [ ] TEST AREA 1 [ ) TEST AREA 2 [ ] TEST AREA 3 [ ) REMOTE AREA Elevation of sprinklers = Elevation above water test. REF. PT. K ELEV. FLOW ---- PRESSURE (psi) ---- ft gpm Total Velocity Normal 21 4.20 25.00 14.28 11.56 0.00 11.56 22 4.20 25.00 14.00 11.11 0.00 11.11 THE SPRINKLER SYSTEM FLOW IS 28.28 gpm THE OUTSIDE HOSE FLOW AT REFERENCE POINT N0. 1 IS 0.00 gpm [ ) THE INSIDE HOSE [ ] RACK SPKLR'S. [ ] YARD HYDT. FLOW IS 20.00 gpm THE FOLLOWING PRESSURES & FLOWS OCCUR ---> AT REF. PT. 1 <--- STATIC PRESSURE 65.00 psi RESIDUAL PRESSURE 55.00 psi AT 1080.00 gpm TOTAL SYSTEM FLOW 48.28 gpm AVAILABLE PRESSURE 64.97 psi AT 48.28 gpm OPERATING PRESSURE 51.40 psi AT 48.28 gpm PRESSURE REMAINING 13.57 psi THE ABOVE RESULTS INCLUDE 9.00 psi FRICTION LOSS AT REF. PT. # 3 FOR A [ ] BACKFLOW PREVENTER [ ] METER [ ] DETECTOR CHECK VALVE [ ] OTHER DEVICE 20 Lavan'der Circle N. Andover, Ma NFPA-13 D 2 head sprinkler test PAGE 2 FITTING Equivalent Length P er.NFPA 13 1994, 6-4.3 '-' Indicates Equivalent Length. 'T' Indicates Threaded Fitting 1=45 Elbow, 2=90 Elbow, 3='T'/Cross, 4=Butterfly Valve,"5=Gate Valve, 6=Swing Check Valve ---=------------------------------------- FROM TO FLOW PIPE FITS EQV. H -W PIPE DIA. FRIC. ELEV. PRESSURE (psi) (gpm) (ft) (ft). C TYPE (in) (psi) (psi) Pt Pt DIFF Pv Pv Pn Pn l 2 28.28 75.00 23 3.32 120 18 1.265 0.099 0.000 51.40 43.64 2 3 28.28 8.00 22354 4.98 120 18 1.265 0.099 1.733 43.64 40.62 1.29 3 4 28.28 36.00 2232 5.98 120 18 1.265 0.099 0.000 40.62 27.46 13.16 4 5 28.28 21.00 32 9.27 120 9 1.400 0.060 9.100 27.46 16.53 1.83 5 6 28.28 63.00 32 9.27 120 9 1.400 0.060 0.000 16.53 12.16 4.37 6 21 14.28 8.00 3 3.31 120 9 1.109 0.053 0.000 12.16 11.56 0.60 6 22 14.00 14.00 '33 6.62 120 9 1.109 0.051 .0.000 12.16 11.11 1.05 A MAX. VELOCITY OF 7.21 ft./sec. OCCURS BETWEEN REF. PT. 3 AND 4 Sprinkler-CALC Release 7.2 Win By Walsh Engineering Inc. North Kingstown R.I. U.S.A. P R E S S U R E 15l�00 140.00 130.00 120.00 110.00 100.00 90.00 80.00 X0.00 60.00 50.00 40.00 30.00 20.00 10.00 000 WATER SUPPLY/DEMAND GRAPH 20 Lavander Circle N. Andover, Ma NFPA-13 D 2 head sprinkler test t 4 li 1( IL0 500 - 1000 1500 2000 Supply: 55.00 psi @ 1080.00 gpm FLOW Demand: 51.40 psi @ 40.20 gpm onn ler-CALL 7.2,Win 'fL�CO Fire &Building Products Technical Services: Tel: (800) 381-9312/ Fax: (800) 791-5500 Series LFIi Residential Flush Pendent Sprinklers 4.2 K -factor General Description The Series LFII (TY2284) Residential Flush Pendent Sprinklers are decora- tive, fast response, fusible solder sprinklers designed for use in residen- . tial occupancies such as homes, apartments, dormitories, and hotels. When aesthetics is the major consid- eration, the Series LFII (TY2284) should be the first choice. The Series LFII are to be used in wet pipe residential sprinkler systems for one- and two-family .dwellings and manufactured homes per NFPA 13D;. wet pipe residential sprinkler systems for residential occupancies up to and including four .stories in height per NFPA 13R; or, wet pipe sprinkler sys- tems for the residential portions of any occupancy per NFPA 13. The Series LFII (TY2284) has a 4.2. (60,5) K -factor that provides the re- quired residential flow rates at reduced pressures, enabling smaller pipe sizes and water supply requirements. The flush design .of the Series LFII (TY2284) features a separable es- cutcheon providing 318 Inch (9,5 mm) vertical adjustment This adjustment reduces the accuracy to which the pipe drops to the sprinklers must be out to help assure a perfect fit installation. The Series LFII (TY2284) has been designed with heat sensitivity and water distribution characteristics proven to help in the control of residen- tial fires and to Improve the chance for occupants to escape or be evacuated. WARN/NGS The Series LFII (TY2284) Residential Flush Pendent Sprinklers described herein must be installed and main- tained in compliance with this docu- ment, as well as with the applicable standards of the National Fire Protec- tion Association, In addition to the standards of any other authorities hav- ing jurisdiction. Failure to do so may impair the integrity of these devices.. The owner is responsible for maintain- ing their Lire protection system and de- vices in proper operating condition. The installing contractor or sprinkler manufacturer should be contacted relative to any questions. . Sprinkler/Nodel identification Number SIN TY2284 Technical Data Approvals: UL and C -UL Listed. Maximum Working Pressure: 175 psi (12,1 bar) Discharge Coefficient: K = 4.2 GPM/psil/2 (60,5 LPM/barl/2) Temperature Rating: 162°F/72°C Vertical Adjustment: 318 Inch (9,5 mm) Finishes: Sprinkler and Escutcheon: White, Chrome, or Black Physical Characteristics: Body .............. Bronze Deflector .. ....... Copper Valve Cap ......... Brass Orifice Seal ......... Copper Heat Collectors : . . . . . . Copper. CENTRAL Customer ServicelSales: Tel: (215) 362-0700 / (800) 523-6512 Fax: (215) 362-5385 Operation The sprinkler assembly contains a small fusible solder element. When ex- posed to sufficient heat from a fire, the solder melts and enables the internal components of the sprinkler to fall away. At this point the sprinkler acti- vates with the deflector dropping into its operated position (Reference Fig- ure 1 C), permitting water to flow. Page 1 of 8 JANUARY, 2003 TFP420 Page 2 of 8 TFP420 (a) For coverage area dimensions less than or between those indicated, it is necessary to use the minimum required flow for the next highest coverage area for which hydraulic design criteria are staled. (b) Requirement is based on minimum flow in GPM (LPM) from each sprinkler. The associated residual pressures are calculated using the nominal K -factor. Refer to Hydraulic Design Criteria Section for details. TABLE A NFPA 13D AND NFPA • 13R HYDRAULIC DESIGN CRITERIA FOR THE SERIES LFII (TY2284) RESIDENTIAL FLUSH PENDENT SPRINKLER Design Criteria The Series LFII (TY2284).Residential Flush Pendent Sprinklers are UL Listed and C -UL Listed for installation In accordance with the following crite- r1a. NOTE When conditions exist that are outside the scope of the provided criteria, refer to the Residential Sprinkler Design Guide TFP490 for the manufacturer's recommendations that may be accept- able the local Authority Having Jurus- diction. System Type. Only wet pipe systems may be utilized. Hydraulic Design. The minimum re- quired sprinkler flow rate for systems designed to NFPA 13D or NFPA 13R are given in Table A as a function of temperature rating and the maximum allowable coverage areas. The sprin- kler flow rate is the minimum required discharge from each of the total number of "design sprinklers" as speci- fied in NFPA 13D or NFPA 13R. For systems designed to NFPA 13, the number of design sprinklers is to be the the four most hydraulically de - mantling sprinklers. The minimum re= quired•discharge from each of the four sprinklers is to be the greater of the following: The flow rates given in Table A for NFPA 13D and 13R as a function of temperature rating and the maxi- mum allowable coverage area. • A minimum discharge of 0.1 gpm/sq. ft over the "design area" comprised of the four most hydraulically de= manding sprinklers for the actual coverage•areas being protected by the four sprinklers. Obstruction To Water Distribution. Locations of sprinklers are to be in accordance with the obstruction rules of NFPA 13 for residential -sprinklers. Operational Sensitivity. The sprin- klers are to be installed in the flush position per Figure 1 with the provided escutcheon. Sprinkler Spacing. The minimum spacing between sprinklers is 8 feet (2,4 m). The maximum spacing be- tween sprinklers cannot exceed the length of the coverage area (Ref. Table A) being hydraulically calculated (e.g., maximum 12 feet for a 12 ft. x 12 ft. coverage area, or 20 feet for a 20 ft. x 20 ft. coverage area). Beam Ceiling Design Criteri a The Series LFII (TY2264) Residential Flush Pendent Sprinklers are UL and C -UL Listed for installation in residen- tial occupancies with horizontal ceil- ings (i.e., slopes up to a 2 inch rise over a 12 inch run) with beams when installed In accordance with the follow- ing criteria: General Information. The basic con- cept of this protection scheme is to locate the sprinklers on the underside of the beams, Ref. Figure 4, (not in the beam pockets); to identify the main beams that principally run in one direc- tion as "primary beams"; and, to iden- tify the beams that run principally per- pendicular to the main beams, as may be present (or in some cases may be necessary for proper sprinkler protec- tion), as "secondary beams". Primary and Secondary Beam Types. Solid surface, solid or hollow core, combustible or non-combustible. Primary and Secondary Beam Posi- tioning. Directly attached to the un- derside of a combustible or non-com- bustible smooth ceiling at any elevation. Primary Beam Cross -Section: Maxi- Minimum Flow (b) and . Minimum Flow (b) and Minimum Flow (b) and Residual Pressure Maximum Maximum Residual Pressure Residual Pressure For Sloped Ceiling Coverage Spacing For Horizontal Ceiling For Sloped Ceiling (Max. 8 Inch Rise for 12 Inch Run) Area (a) Ft. (Max. 2 Inch Mise (Max. 8 Inch Rise Three sprinkler design when there are more Ft. x FL (m) for 121nch:Run) for 12 Inch Run) than two sprinklers in *a.dompartment. (mxm) 162"Ff72"C 162"F/72"C 162"F/72"0 12 x 12 12 13 GPM (49,2 LPM) 17 GPM (64,3 LPM) 14 GPM (53,0 LPM) (3,7 x 3,7) (3,7) 9.6 psi (0,66 bar) 16.4 psi (1,13 bar) 11.1 psi (0,77 bar) 14 x 14 14 13 GPM (49,2 LPM) 17 GPM (64,3 LPM) 14 GPM (53,0 LPM) (4,3 x 4,3) (4,3) 9.6 psi (0,66 bar) 16.4 psi (1,13 bar) 11.1 psi (0,77 bar). 16 x 16 16 14 GPM (53,0 LPM) 17 GPM (64,3 LPM) 14 GPM (53,0 LPM) (4,9 x 4,9) (4,9) 11.1 psi (0,77 bar) 16.4 psi (1,13 bad 11.1 psi (0,77 bar) 18 x 18 18 18 GPM (68,1 LPM) 19 GPM (71,9 LPM) 18 GPM (68,1 LPM) (5,5 x 5,5) (5,5) 18.4 psi (1,27 bar) 20.5 psi (1,41 bar) 18.4 psi (1,27 bar) 20 x 20 20 22 GPM (83,3 LPM) 24 GPM (90,8 LPM) N/A (6,1 x 6,1) (6,1) 27.4 psi (1,89 bad 32.7 psi (2,25 bad (a) For coverage area dimensions less than or between those indicated, it is necessary to use the minimum required flow for the next highest coverage area for which hydraulic design criteria are staled. (b) Requirement is based on minimum flow in GPM (LPM) from each sprinkler. The associated residual pressures are calculated using the nominal K -factor. Refer to Hydraulic Design Criteria Section for details. TABLE A NFPA 13D AND NFPA • 13R HYDRAULIC DESIGN CRITERIA FOR THE SERIES LFII (TY2284) RESIDENTIAL FLUSH PENDENT SPRINKLER Design Criteria The Series LFII (TY2284).Residential Flush Pendent Sprinklers are UL Listed and C -UL Listed for installation In accordance with the following crite- r1a. NOTE When conditions exist that are outside the scope of the provided criteria, refer to the Residential Sprinkler Design Guide TFP490 for the manufacturer's recommendations that may be accept- able the local Authority Having Jurus- diction. System Type. Only wet pipe systems may be utilized. Hydraulic Design. The minimum re- quired sprinkler flow rate for systems designed to NFPA 13D or NFPA 13R are given in Table A as a function of temperature rating and the maximum allowable coverage areas. The sprin- kler flow rate is the minimum required discharge from each of the total number of "design sprinklers" as speci- fied in NFPA 13D or NFPA 13R. For systems designed to NFPA 13, the number of design sprinklers is to be the the four most hydraulically de - mantling sprinklers. The minimum re= quired•discharge from each of the four sprinklers is to be the greater of the following: The flow rates given in Table A for NFPA 13D and 13R as a function of temperature rating and the maxi- mum allowable coverage area. • A minimum discharge of 0.1 gpm/sq. ft over the "design area" comprised of the four most hydraulically de= manding sprinklers for the actual coverage•areas being protected by the four sprinklers. Obstruction To Water Distribution. Locations of sprinklers are to be in accordance with the obstruction rules of NFPA 13 for residential -sprinklers. Operational Sensitivity. The sprin- klers are to be installed in the flush position per Figure 1 with the provided escutcheon. Sprinkler Spacing. The minimum spacing between sprinklers is 8 feet (2,4 m). The maximum spacing be- tween sprinklers cannot exceed the length of the coverage area (Ref. Table A) being hydraulically calculated (e.g., maximum 12 feet for a 12 ft. x 12 ft. coverage area, or 20 feet for a 20 ft. x 20 ft. coverage area). Beam Ceiling Design Criteri a The Series LFII (TY2264) Residential Flush Pendent Sprinklers are UL and C -UL Listed for installation in residen- tial occupancies with horizontal ceil- ings (i.e., slopes up to a 2 inch rise over a 12 inch run) with beams when installed In accordance with the follow- ing criteria: General Information. The basic con- cept of this protection scheme is to locate the sprinklers on the underside of the beams, Ref. Figure 4, (not in the beam pockets); to identify the main beams that principally run in one direc- tion as "primary beams"; and, to iden- tify the beams that run principally per- pendicular to the main beams, as may be present (or in some cases may be necessary for proper sprinkler protec- tion), as "secondary beams". Primary and Secondary Beam Types. Solid surface, solid or hollow core, combustible or non-combustible. Primary and Secondary Beam Posi- tioning. Directly attached to the un- derside of a combustible or non-com- bustible smooth ceiling at any elevation. Primary Beam Cross -Section: Maxi- TFP40 r-�• 3/32" (2,4 mm) TYR FACE OF DO NOT SPRINKLER OVER -TIGHTEN r_ FITTING I I l_ 1 2913213/16" (23;014,8 mm) mum FEC�ILING LEVEL MOUNTING OLERANCE SURFACE LIMIT SPRINKLER WRENCHING PROTECTIVE CAP AREA A' 2"(50 mm) DIA. I I 29/3213/16' ( I 2-1/4' (23.0.t 4,8 mm) O (57,2 mm) HEAT I COLLECTOR i- - 2-15116"(75 mm) DIA. --{ B 12' NPT f- -� 7/16'(11,1 mm) NOMINAL MAKE -IN 9/16' (14,2 mm) j 15/16-(23,6 mm) C DEFLECTOR IN OPERATED POSITION FIGURE 7 SERIES LFII (TY2284) RESIDEN77AL FLUSH PENDENT SPRINKLER WRENCH RECESS ACCEPTS 3/8' SOCKET #4947 DRIVE SOCKET Page 3 of 8 . #4948 WRENCH & SOCKET COMBINATION WRENCH FIGURE 2 SPRINKLER SOCKET WRENCH & SOCKET COMBINATION FIGURE 3 PROTECTIVE CAP REMOVAL TOOL Page 4 of 8 A z E E E E coq r.:00 N QFWSH TY2284 POSITION B z E E E E mq N N � N e TY2284 MAXIMUM ONE-HALF BEAM WIDTH PLUS 2' (50,6 mm) . FIGURE 4 SPRINKLER POSITIONING UNDER PRIMARY BEAMS (Refer to the "Beam Cefling Design Criteriao section) mum depth of 14 inches and the maxi- mum width is unlimited. The cross-sec- tional shape of the primary beam may be rectangular to circular. . Secondary Beam Cross -Section. Maximum depth to be no greater than the primary beam and the maximum width is unlimited.The cross-sectional shape of the secondary beam may be rectangular to circular. Primary Beam Spacing. The primary beams (Fig. 5A) are to be 3 ft. - 4 in. to 6 ft. from the compartment wall to cen- ter of the nearest beam and from cen- ter to center between beams. Secondary Beam Spacing. The sec- ondary beams principally run perpen- dicular to the primary beams. Secondary beams of a depth equal to the primary beam must be placed so that the beam pockets created by the primary beams do not exceed 20 feet in length (Fig. 5B). NOTE When the beam pockets created by the primary beams exceed 20 feet in length, the. installation will require the use of secondary beams as described above. Otherwise, secondary beams need not be present. Secondary beams of a cross-sectional depth greater than. one-quarter 'tfie depth of the primary beams are to be a minimum of 3 ft. - 4 in. from the compartment wall to center of the nearest beam and from center to cen- ter between beams (Fig. 5C). Secondary beams of a cross-sectional depth no greater than one-quarter the depth of the primary beams may be placed at any compartment wall to center of the nearest beam distance and from any center to center distance between beams (Fig. 5C). Lintels. Lintels over doorways exiting the compartment must be present. The minimum height for the lintels is 8 inches or no less than the depth of the Primary Beams, whichever is greater. TFP420 Sprinkler Types. Series LFII (TY2284), 162F, Flush Pendent Resk dential Sprinklers. Sprinkler Coverage Area and Hy- draulic Design. The sprinkler cover- age areas and hydraulic design criteria as presented in the Table A for 'Hori- zontal Ceilings" are to be applied. Sprinkler Position. The bottom of heat collector to bottom of primary beams for the Series LFII (TY2284) Flush Pendent Sprinklers Is to be 23/32 to 1-3/32 inches (Fig. 4A). The vertical centerline of the Series LFII (TY2284) Flush Pendent Sprinklers is to be no greater than half the primary beam cross-sectional width plus 2 Inches from the centerline of the pri- mary beam (Fig 413). NOTES Core drilling of beams to allow the installation of sprinkler drops requires consulting with a structural engineer. Where core drilling is not permitted, the previously stated sprinkler position criteria for the Series LFII (7Y2234) Pendent Sprinklers allows for the sprinkler drop to be placed adjacent to the primary beam. Beam and Soffit Arrangements. A soffit is permitted to be placed around the perimeter of a compartment with the beam arrangement within the sof- filed area (Fig.6). The cross-section of the soffit may be any size as long as it does not create an obstruction to water distribution per the obstruction rules of NFPA 13 for residential sprinklers. When soffits are present, the pre- viously provided 3 ft: 4 in. to 6 It. "compartment wall to adjacent beam" distance for the primary and secon- dary beams is to be measured from the face of the soffit as opposed to the compartment wall. NOTE Although the distance to the beams is measured from the face of the soffit, the sprinkler coverage area is to be measured from the compartment wall. TFP420 ■ ALL FIGURES: DISTANCES ARE MEASURED TO COMPARTMENT WALL FACES AND TO CENTERLINES OF BEAMS PRIMARY BEAM COMM W FIGURE 6A PRIMARY BEAM SPANS UP TO 20'-0' (6,1 m) SECONDARY BEAM PRIME BEA FIGURE 6B PRIMARY BEAM SPANS GREATER THAN 20'-0' (6,1 m) Page 5 of 8 3'-4' to 6'-0' (1,0 to 1,8 m) 1 PRIMARY BEAMS HAV - A 14' (356 mm) MAXIMUM 'TH 0'-0- (6,1 m) MAXIMUM A= 3'4' to 6'-0' (1,0 to 1,8 m) FOR PRIMARY BEAMS HAV- ING AVING A 14' (356 mm) MAXIMUM DEPTH B= W -(r (6,1 m) MAXIMUM FORSECONDARYBEAMS THATARE TO BE EQUAL IN DEPTH TO PRIMARY BEAMS AND THAT MUST BE IN PLACE SO THAT PRIMARY BEAM POCKETS DO NOT EXCEED 20'4' (6,1 m) A= 3'-4' to 6'-W (1,0 to 1,8 m) FOR PRIMARY BEAMS HAV- ING AVING A 14'(3% mm) MAXIMUM DEPTH C = 3'-4' (1,0 m) MIMMUM FOR SECONDARY BEAMS HAVING DEPTHS GREATER THAN 25% OF PRIMARY BEAMS =Tc C = ANY DISTANCE FOR SEG ONDARY BEAMS HAVING DEPTHS UP TO 25% OF *REFERTO PRIMARY BEAMS FIGURE 5B COMPARTMENT - FOR SPANS WALLS EXCEEDING -, •.:,:. E.- 7:55 m) FIGURE 6C COMBINATIONS OF PRIMARYAND SECONDARY BEAMS FIGURES BEAM ARRANGEMENTS (Refer to the "Seam Ceiling Design Criteria" section).- TFP420 spection, testing, and maintenance of their fire protection system and de- vices in. compliance with this docu- ment, as well as' with the applicable standards of the National Fire Protec- tion Association (e.g., NFPA 25),' in addition to the standards of any other authorities having jurisdiction. The in- stalling contractor or sprinkler manu- facturer should be contacted relative to any questions. NOTE The owner must assure that the sprin- klers are not used for hanging of any objects and that the sprinklers are only cleaned by means of gently dusting with a feather duster, otherwise, non- operation In the event of fire orinad- vertent operation may result It is recommended that automatic sprinkler systems be Inspected, tested, and maintained by a qualified Inspection Service. Page 7of8 Limited Ordering Warranty Procedure Products manufactured by Tyco Fire Products are warranted solely to the original Buyer for ten (10) years against defects in material and work- manship when paid for and properly installed and maintained under normal use and service. This warranty will ex- pire ten (10) years from date of ship- ment by Tyco Fire Products. No war- ranty is given for products or components manufactured by compa- nies not affiliated by ownership with Tyco Fire Products or for products and components which have been subject to misuse, Improper installation, corro- sion, or which have not been installed, maintained, modified or repaired in ac- cordance with applicable Standards of the National Fire Protection Associa- tion, and/or the standards of any other Authorities Having Jurisdiction. Mate- rials found by Tyco Fire Products to be defective shall be either repaired or replaced, at Tyco Fire Products' sole option. Tyco Fire Products neither as- sumes, nor authorizes any person to assume for It, any other obligation in connection with the sale of products or parts of products. Tyco Fire Products shall not be responsible for sprinkler system design errors or inaccurate or incomplete Information supplied by Buyer or Buyer's representatives. IN NO EVENT SHALL TYCO FIRE PRODUCTS BE LIABLE, IN CON- TRACT, TORT, STRICT LIABILITY OR UNDER ANY OTHER LEGAL THE- ORY, FOR INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL DAMAGES, INCLUDING BUT NOT LIMITED TO LABOR CHARGES, RE- GARDLESS OF WHETHER TYCO FIRE PRODUCTS WAS INFORMED ABOUT THE POSSIBILITY OF SUCH DAMAGES, AND IN NO EVENT SHALL TYCO FIRE PRODUCTS' LI ABILITY EXCEED AN AMOUNT EQUAL TO THE SALES PRICE. THE FOREGOING WARRANTY IS MADE IN LIEU OF ANY AND Ar OTHER WARRANTIES EXPRESS OR IMPLIED, INCLUDING WARRANTIES OF MERCHANTABILITY AND FiT NESS FDR A PARTICULAR PUR- POSE. When placing an order, indicate the full product name. Contact your local dis- tributor for availability.. Sprinkler Assembly: Series LFII (TY2284), K=4.2, Residen- tial Flush Pendent Sprinkler without Escutcheon and having a (specify) finish, PIN (specify). Chrome .................. .51-123-0-162 White .................... 51-123-4-162 Bieck.................... 51-123-6-162 Escutcheon: Escutcheon for Series LFII (TY2284), K=4.2,, Residential Flush Pendent Sprinkler with (specify) finish, PiN (specify). Chrome .................. 56-123-9-001 White .................... 56-1234-001 Black .................... 56-123-6-001 Accessories: Socket for Series LFII (TY2284) Resi- dential Flush Pendent Sprinkler, PIN 56-000-4-947. Wrench & Socket for Series LFII (TY2284) Residential Flush Pendent Sprinkler, PIN 56-000-4-948. Protective Cap Removal Tool'for Se- ries LFII (TY2284) Residential Flush Pendent Sprinkler, PIN 56-000-4-30D. Page 6 of 8 SECONDARY BEAM TFP420 COMPARTMENT WADS FIGURE 6 BEAM AND SOFFIT ARRANGEMENTS (Refer to the "Beam Ceiling Design Criteria" section) installation The Series LFII (TY2284) must be in� stalled in accordance with the follow- ing instructions: NOTES The Protective Cap Is to remain on the sprinkler during Installation until the ceiling installation is complete. The Protective Cap must be removed to place the sprinkler in service. A leak tight 1/2 inch NPTsprinkler joint should be obtained with a torque of 7 to 14 ftlbs. (9,5 to 19,0 Nm). A maxi- mum of 21 ft.lbs. (28,5 Nm) of torque is to be used to install sprinklers. Higher levels of torque may distort the sprinkler inlet with consequent leak- age or impairment of the sprinkler. Do not attempt to compensate for in- sufficient adjustment in an Escutcheon Plate by under- or over -tightening the Sprinkler. Readjust the position of the sprinkler fitting to suit. Each sprinkler must be inspected be- fore installation. Do not use any sprin- kler that exhibits any deformations or cracks, including cracks on the protec- tive cap. Step 1. The Sprinkler must be installed only in the pendent position and with the Sprinkler waterway centerline per- pendicular to the mounting surface.. Step 2. Install the sprinkler fitting so that the distance from the face of the fitting to the mounting surface will be nominally 29132 inches (23,0 mm) as shown in Figure 1A. Step 3. With pipe thread sealant ap- plied to the pipe threads, hand tighten the Sprinkler into the sprinkler fitting. Step 4. Wrench tighten the Sprinkler using only the Sprinkler Socket or Wrench & Socket Combination (Ref. Figure 2): The wrench recess of the Socket Is to be applied to the sprinkler wrenching area (Ref. Figure 1A). Step 5. Use the °ceiling level tolerance limit° indicator on the Protective Cap to check for proper installation height. Relocate the sprinkler fitting as neces- sary. If desired the Protective Cap may also be used to locate the center of the clearance hole by gently pushing the ceiling material against the center point of the Cap. Step 6. After the ceiling has been com- pleted with the 2 inch (50 mm) diame- ter clearance hole, use the Protective Cap Removal Tool (Ref. Figure 3) to remove the Protective Cap and then push on the Escutcheon until its flange just comes in contact with the ceiling. Do not continue to push the Escutch- eon such that it lifts a ceiling panel out of its normal position. If the Escutch- eon cannot be engaged with the Sprin- kler, or the the Escutcheon cannot be engaged sufficiently to contact the ceiling, relocate the sprinkler fitting as necessary. Care and Maintenance The Series LFII (TY2284) must be. maintained and serviced in accord- ance with the following instructions: NOTES Absence of an Escutcheon Plate may delay the time to sprinkler operation in a fire situation. Before closing a fire protection system main control valve for maintenance work on the fire protection system which it controls, permission to shut down the affected fire protection sys- tem must be obtained from the proper authorities and all personnel who may be affected by this action must be no- tified. Sprinklers which are found to be leak- ing or exhibiting visible signs of corro- sion must be replaced. Automatic sprinklers must never be painted, plated, coated, or otherwise altered after leaving the factory. Modi- fied or over heated sprinklers must be replaced. Care must be exercised to avoid dam- age - before, during, and after instal- latlon. Sprinklers damaged by drop- ping, striking, wrench twist/slippage, or the like, must be replaced. The owner is responsible for the in- ` USE DISTANCES SHOWN PRIMARY ' IN FiGURES 5A, 5B & 5C, BEAM EXCEPT MEASUREMENTS ARE TAKEN FROM FACES OF SOFFITS INSTEAD OF FROM COMPARTMENT WALLSURFACES FACE OF SOFFIT COMPARTMENT WADS FIGURE 6 BEAM AND SOFFIT ARRANGEMENTS (Refer to the "Beam Ceiling Design Criteria" section) installation The Series LFII (TY2284) must be in� stalled in accordance with the follow- ing instructions: NOTES The Protective Cap Is to remain on the sprinkler during Installation until the ceiling installation is complete. The Protective Cap must be removed to place the sprinkler in service. A leak tight 1/2 inch NPTsprinkler joint should be obtained with a torque of 7 to 14 ftlbs. (9,5 to 19,0 Nm). A maxi- mum of 21 ft.lbs. (28,5 Nm) of torque is to be used to install sprinklers. Higher levels of torque may distort the sprinkler inlet with consequent leak- age or impairment of the sprinkler. Do not attempt to compensate for in- sufficient adjustment in an Escutcheon Plate by under- or over -tightening the Sprinkler. Readjust the position of the sprinkler fitting to suit. Each sprinkler must be inspected be- fore installation. Do not use any sprin- kler that exhibits any deformations or cracks, including cracks on the protec- tive cap. Step 1. The Sprinkler must be installed only in the pendent position and with the Sprinkler waterway centerline per- pendicular to the mounting surface.. Step 2. Install the sprinkler fitting so that the distance from the face of the fitting to the mounting surface will be nominally 29132 inches (23,0 mm) as shown in Figure 1A. Step 3. With pipe thread sealant ap- plied to the pipe threads, hand tighten the Sprinkler into the sprinkler fitting. Step 4. Wrench tighten the Sprinkler using only the Sprinkler Socket or Wrench & Socket Combination (Ref. Figure 2): The wrench recess of the Socket Is to be applied to the sprinkler wrenching area (Ref. Figure 1A). Step 5. Use the °ceiling level tolerance limit° indicator on the Protective Cap to check for proper installation height. Relocate the sprinkler fitting as neces- sary. If desired the Protective Cap may also be used to locate the center of the clearance hole by gently pushing the ceiling material against the center point of the Cap. Step 6. After the ceiling has been com- pleted with the 2 inch (50 mm) diame- ter clearance hole, use the Protective Cap Removal Tool (Ref. Figure 3) to remove the Protective Cap and then push on the Escutcheon until its flange just comes in contact with the ceiling. Do not continue to push the Escutch- eon such that it lifts a ceiling panel out of its normal position. If the Escutch- eon cannot be engaged with the Sprin- kler, or the the Escutcheon cannot be engaged sufficiently to contact the ceiling, relocate the sprinkler fitting as necessary. Care and Maintenance The Series LFII (TY2284) must be. maintained and serviced in accord- ance with the following instructions: NOTES Absence of an Escutcheon Plate may delay the time to sprinkler operation in a fire situation. Before closing a fire protection system main control valve for maintenance work on the fire protection system which it controls, permission to shut down the affected fire protection sys- tem must be obtained from the proper authorities and all personnel who may be affected by this action must be no- tified. Sprinklers which are found to be leak- ing or exhibiting visible signs of corro- sion must be replaced. Automatic sprinklers must never be painted, plated, coated, or otherwise altered after leaving the factory. Modi- fied or over heated sprinklers must be replaced. Care must be exercised to avoid dam- age - before, during, and after instal- latlon. Sprinklers damaged by drop- ping, striking, wrench twist/slippage, or the like, must be replaced. The owner is responsible for the in- Series 909 «Engineered for high Sizes 3/a" - 2" capacify relief To prevent back -siphonage and.backpressure of con- taminated water into the safe drinking water supply, when installed at each high hazard cross -connection. Use Series 909 for backflow protection in cross -connec- tion control and containment at the service entrance. The 909 high capacity relief incorporates the "air-in/water-out" principle and substantially improves the relief valves dis- charge performance. The emergency condition of com- bined back -siphonage and backpressure with both checks fouled can defeat the effectiveness of a standard RPZ backflow preventer. Standardly furnished with NPT body connections and quarter -turn, full port, resilient seated, bronze ball valve shut -offs No. 909QT. Sizes 3/a" and 1" have Tee handle shut -offs. Available Models Prefix C - with strainer clean and check, 3A" and 1" only Suffix QT - with quarter -turn, full port, resilient seated ball valve shut -offs S - with bronze strainer HW - with stainless steel check modules for hot water and harsh water conditions PC - with internal Polymer Coating LF - without shut-off valves Prefix U - with integral body unions (:Ya"and 1" only) FAE - with flanged adapter ends (11/4",1'h", 2" only) Features Quarter -turn ball valve shut offs • Replaceable bronze seats Designed pressure drop Modular design • Simple and economical service No special tools required for e. High capacity relief protection servicing against combined back -siphonage/ backpressure backflow Standards (see page 3) Pressure -Temperature Series 909 suitable for supply pressure up to 175 psi and water temperatures up to 140°F continuous and 180°F in- termittent.•Suffix HW stainless steel check modules suit- able for supply pressure up to 175 psi and water tempera- ture up to 210°F for harsh water conditions. Connections 3/a" -1" 9090T has NPT female threaded body connections, 1'/4" - 2" 909QTM1 has NPT male threaded body connections. Dimensions-WeightS (approximate) Size Dimension (I thea) Wgt.(lbs.) inches A 8 C I D I E F G H w/o strainer e/ 21 Y► 1714+ 7Yie 4 1 4:16, 11 K 6:14, 31/ 15V. 14 1 22�/ 17Y4 Nis 4 4°/i 13 7 37/ 17Y: 15 1 Y 25% 20% 10% 5 We 14 714 5Ye 42Y4 40 •1 Ya 27%o 2174 10% 5 13% 15 7rh 5'/ 44 40 2 3DYi 23 10% 5 6% 16 1 7W, 1 51/i 41�Ye 40 Reduced Pressure Zor F� IL jj Patent 14,241.752 4 909QT-S S rr' Note: The installation of a drain line recommended. When installing a drain line, and air gap in necessary (see page 5). BACKFLOW PREVENTION FOR HIGH HAZARD CROSS -CONNECTION and CONTAINMENT INSTALLATIONS WITH CONTINUOUS PRESSURE Capacity As compiled from documented Foundation for Cross-Connectlen Control and Hydraulic Research at the University of Southern California lab tests. *Typical maximum mechanicallydlialion system flow rate (7.5 feet per second) 16 X12 U) 20 015 L 5 0 20 (315 a10 5 0. 20 0715 a.10 .r. �����ti��tl•��illi� �t�l��l �rl•ti�ni•�t��t� ► uuuml •s• �_���_if• fi�_fl•�1��_ ta��tr•li�� 1il�fif•fi1��� ����� �fl•�fl•fl•fl• t�11•����l�it�l��� i c auawi r g For more information, send for ES -909S 0 25 50 75 100 125 150 175 200 GPM 5 75 10 15 FPS L PPOTTER VSR-SF VANE TYPE WATER FLOW Y o FOR SMALL PIPE ALARM SWITCH WITH RETARD Potter Electric Signal Company Potter Electric Signal & Mfg,, LTD. 2081 Craig Road - St. Louis, MO 63146-4161 55 Glen Cameron Road (314) 878-4321 - (800) 325-3936 Thornhill, Ontario, Canada L3T 1 P2. www.pottersignal.com (905) 882-1833 Stock No. 1113000 U.S. PAT. NO. 3921989, CANADIAN PAT. NO. 1009680 OTHER PATENTS PENDING. The Model VSR-SF is a vane type waterflow switch for use on wet sprinkler systems that use 1", 1 1/4", 11/2" or 2" pipe size. The unit may also be used as a sectional waterflow detector on large systems. The unit contains two single pole double throw snap action switches and an adjustable, instantly recycling pneumatic retard. The switches are actuated when a flow of 10 gallons per minute or more occurs downstream of the device. The flow condition must exist for a period of time necessary to over- come the selected retard period. INSTALLATION: These devices may be mounted in horizon- tal or vertical pipe. On horizontal pipe they should be installed on the top side of the pipe where they will be accessible. The units should not be installed within 6" of a valve, drain or fitting which changes the direction of the waterflow. The unit has a 1" NPT bushing for threading into a non -corrosive TEE. See Fig. 2 for proper TEE size, type and installation. Screw the device into the TEE fitting as shown in Fig. 2. Care must be taken to properly orient the device for the direction of UL, ULC, CSFM LISTED and NYMEA ACCEPTED Service Pressure: Up to 250 PSI Minimum Flow Rate for Alarm: 10 GPM Maximum Surge: 18 FPS Enclosure: Die-cast, red enamel finish Cover held in place with tamper resistant screws Contact Ratings: Two sets of SPDT (Form C) 15.0 Amps at 125/250 VAC 2.0 Amps at 30 VDC Conduit Entrances: Two knockouts provided for 1/2" conduit. Usage: Listed plastic, copper and schedule 40 iron pipe. Fits pipe sizes -1", 1 1/4", 1 1/2" and 2" Note: 10 paddles are furnished with each unit, one for each pipe size of threaded and sweat TEE, one for 1" CPVC and one for 1 1/2" polybutylene. (CTS -Copper tubing size) Environmental Specifications: -Suitable for indoor or outdoor use with factory installed gasket and die-cast housing. • NEMA4/IP55 rated enclosure -use with appropriate conduit fitting. -Temperature range: 40" F to 120° F (4.5" C to 49" C) Caution: This device is not intended for applications in explosive environments. Service Use: - Automatic Sprinkler. NFPA-13 One or two family dwelling NFPA-13D Residential occupancy up to four stories NFPA-13R National Fire Alarm Code NFPA-72 Optional: Cover Tamper Switch Kit, order Stock No. 0090018 waterflow. The vane must not rub the inside of the TEE or bind in any way. The stem should move freely when operated by hand. The device can also be used in copper or plastic pipe installa- tions with the proper adapters -so that the specified TEE fitting may be installed on the pipe run. INSPECTION AND TESTING: Check the operation of the unit by opening the inspector's test valve at the end of the sprinkler fine or the drain and test connection, if an inspector'k test valve is not provided. If there are no provisions for testing the operation of the flow . detection device on the system, application of the VSR-SF is not recommended or advisable The frequency of the inspection and testing and its associated protective monitoring system should be in accordance with the applicable NFPA Codes and Standards and/or authority having jurisdiction (manufacturer recommends quarterly or more frequently). PRINTED IN USA MKT. #8800003 - REV M PAGE 1 OF 2 MFG. #5400802 - 2197 ER (E90 ./I FIG. 1 SWITCH TERMINAL CONNECTIONS CLAMPING PLATE TERMINAL 01s, Ile DWG. /923-3 CAUTION: An uninsulated section of a single conductor should not be looped around the terminal and serve as two separate connections. The wire must be severed, thereby providing supervi- sion of the connection in the event that the wire becomes dislodged from under the terminal. FIG. 2 RETARD ADJUSTMENT: TO CHANGE TIME TURN KNOB (EITHER DIRECTION) FOR DESIRED TIME DELAY. USE THE MINIMUM AMOUNT OF RETARD NECESSARY TO PREVENT FALSE ALARMS, A "B" SETTING IS USUALLY ADEQUATE FOR THIS. FACTORY IS SET TO "B". TO INSTALL, DRILLA HOLEAS INDICATED: PIPE SIZE HOLE SIZE 2' to 2 11T 11/4'4-1/8'-1116' (50mm to 65mm) (33mm f2mm) 3' to 8' 2'x118• (80mm to 200mm) (50mm:2mm) DWG. 1761-30 DIRECTION WATERFLOW VSR-F VANE TYPE WATERFLOW SWITCH WITH RETARD DO NOT LEAVE COVER OFF FOR EXTENDED PERIOD OF TIME TIGHTEN NUTS ALTERNATELY TO AN EVENTUAL 5OFT.-LBS OF TORQUE MOUNT ON PIPE SO ARROW ON SADDLE POINTS IN DIRECTION OF WATERFLOW ROLL PADDLE IN OPPOSITE DIRECTION OF WATERFLOW APPROX. RETARD SETTINGS (IN SECS.) 0 0 A 10-25 8 20-40 C' 35-55 D 150_7T90 FII;. 3 TYPICAL ELECTRICAL CONNECTIONS LOCAL BELL TRANSFORMER STYLE a (CLASS B) END -OF -UNE RESISTOR CKT. OR BATTERY POWERED (SEE NOTE) OPEN ON ALARM ACLOSE LARM ON OPEN ON CLOSE ON EOL ALARM ALARM RESISTOR SIGNALING DEVICE NOTE: FOR SUPERVISED CIRCUITS SEE 'SWITCH TERMINAL CONNECTIONS' DRAWING AND CAUTION NOTE (FIC. 1). SUPERVISED LOOP (SEE NOTE) TYPICAL SWITCH ACTION OPEN ON CLOSE ON TO ADD'L FROM ALARM ALARM DEVICES OPEN ON \�l'o"CLOSE ON CONTROL OR RETURN ALARM ALARM PANE- TO CDNTROL DWG. X761-15 NOTES: 1. The Model VSR-F has two switches, one can be used to operate a central station, proprietary or remote signaling unit, while the other contact is used to operate a local audible or visual annunciator. 2. A condition of LPC Approval of this product is that the electrical entry must be sealed to exclude moisture. TESTING, The frequency of inspection and testing for the model VSR-F and its associated protective monitoring system should be in accordance with applicable NFPA Codes and Standards and/or the authority having jurisdiction (manufacturer recommends quarterly or more frequently). If provided, the inspector's test valve, that is usually located at the end of the most remote branch line, should always be used for test purposes. If there are no provisions for testing the operation of the flow detection device on the system, application of the VSR-F is not recommended or advisable. A minimum flow of 10 gpm is required to activate this device. IMPORTANT NOTICE: Please advise the person responsible for testing of the fire protection system that this system must be tested in accordance with the testing instructions. PRINTED IN USA MKT. #8800001- REV L PAGE 2 OF 2 MFG. #5400761-11/95 moi.%® Y '�` �` MULTITONE ELECTRONIC SIGNALS Potter Electric Signal Company Potter Electric Signal & Mfg., LTD. 2081 Craig Road • P.O. Box 28480: 55 Glen Cameron Road St. Louis, M0.63146-41-61 -Thornhill, Ontario, Canada UT 1P2 (314) 878-4321 - (800) 325-3936 (905) 882-1833 Wheelock's MT and MT Strobe Series Multitone Electronic Signals offer a choice of eight (8) nationally and internationally'recognized alerting sounds: Horn, Bell, March Time*Horn, Code -3 Tone; Code -3 Horn, Slow Whoop, Siren or Hi/Lo Tone. Wheelock's Code -3 horn and tone patterns are engineered to comply with NFPA/ANSI Temporal Pattern specifications without requiring additional coding means. With MT and MT Strobe Signals, one alarm appliance meets most of your signaling needs. Wheelock's MT and MT Strobe Signals are UL Listed, FM, CSFM and NYMEA Approved. Features --One alarm appliance with (6) eight selective signals to provide superior sound penetration for - various ambient and wall conditions with two field selectable sound output levels. Code -3 Horn and Tone meet N.FPA/ANSI/ISO temporal pattern for standard emergency evacu- . ation signaling. • Audible and strobe can operate from a single signaling circuit. -.Designed to meet or exceed NFPAIANSi Standards and ADA Accessibility Guidelines. Low current draw with low temperature compensa- tion to reduce, power consumption and wiring costs. Low cost installation via standard electrical boxes. Attractive flush or surface mounting options available. Model MT -24 -LSM (strobe/horn shown) PRINTED IN USA MKT. #8850002-. REV A PAGE 1 OF 2' 11195 dBA and Current: Ratings Model MT 12/24 MT-24-LSM (Horn) (Strobe/Nom) Stock No. 1610914 Stock No. 1610915 Tone Amps Typical Amps Typical at 24VDC dBA at 10' at 24VDC d8A at 10' HI STD HI STD HI STD HI STD Horne 0.040 0.023 99 93 0.405 0.388 99 93 Bell 0.014 0.012 92 87 0.379. 0.377 .92 87 March Time Horn 0.040 0.023 99 93 0.405 0.368 99 93 Code -3 Horn 0.040 0.023 99 93 0.405 0.388 99 -93 Code -3 Tone 0.028 0.017 95 90 0.393. 0.382 95 90 Siow Whoop 0.048 0.026 99 94- 0.413 0.391. 99 94 Siren 0.036 0.023 98 93 0.401 0.368 98 93 HVLo 0.020 0.014 93 88 0.385 0.379 93 88 PRINTED IN USA MKT. #8850002-. 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System Requirements and limitations: All fire protection sprinkler systems winterized with FireFighter or FireFighter PG should conform to local, state and NFPA requirements. The use of antifreeze within these systems should also conform to NFPA requirements. r r` '�� Use of antifreeze solutions should also be in �:;.• • : conformance with any state or local health codes. Please contact your local health authorities if you XV',i.0' ' 1, ,w have any questions concerning the codes in your area. Maintenance: Because the chemicals which compose FireFighter Av • and FireFighter PG can break down over time, systems should be tested to determine the level of freeze protection at the beginning of each freezing season. , To test the freeze protection level of FireFighter, use a small hydrometer to determine the specific gravity of the solution. To maintain a —15°F flow protection, the '��= s`�R •���•`:specific gravityof FireFi hter.should be 1.141 at 77°F w, To test the freeze protection level of FireFighter PG, use a small hydrometer to determine the specific gravity of the solution. To maintain a —15°F flow protection, the specific gravity of FireFighter PG should be 1.030 at 77°F f�tiu When the test indicates that the solution has N- weakened, empty the system and replace with fresh r�7 ' FireFighter or FireFighter PG, according to the installation instructions. .o aa: INSTALLATION INSTRUCTIONS If the filling cup is above the highest sprinkler, use the following installation procedure: 1. Close the water supply valves and drain the system. 2. Add FireFighter or FireFighter PG to the system through a filling cup. 3. Use the end sprinklers to vent air from the piping. 4. Back out all of the sprinklers slightly, until antifreeze appears. This assures that the piping is completely filled and all air has been purged from the system. If the filling cup is NOT above the highest b o sprinkler, use one of the following installation° procedures: 1. Administer FireFighter or FireFighter PG at the CLL highest sprinkler branch line using a filling cup. The , drop pipe should be filled through the filling cup as shown in the diagram below. 2. Tighten the sprinkler heads and open the valve l marked #1 until the drop pipe and the section of pipe above valve.#1 are empty. 3. Close valve # 1. Close the filling connection valve. Slowly open the supply valve wide. rprti.; . Or: pp i Use a small pump to add FireFighter or FireFighter PG to the system at the valve marked # 2 in the diagram ; below. Ftl�r C HEATED AREA UNHEATED AREA Filling Cup Sprinkler Head Water Supply 7/77 Non -Freezing '•'s ' -- Solution ` 12 ins. ` '!•� Approved �� "•e Indicating 'W •- Valve Wall Drop 5 h. min. # ■ ---�-- e`; Check Valve (1/32" hole in Clapper)) Lorain Valve Please turn to back panel for additional information.? PRODUCT DESCRIPTION FireFighter and FireFighter PG are non-toxic antifreezes designed specifically for fire protection systems. These products are used in place of water and other water -like fluids in sprinkler systems where freezing may either cause damage or interfere with the functioning of systems or equipment, and/or toxicity to humans or animals is a concern. _ FireFighter is compatible with all approved types of pipe, including BlazeMaster'", CPUC sprinkler pipe and fittings. FireFighter PG is compatible with all approved types of sprinkler pipe systems, with the exception of CPVC. Sizes: FireFighter and FireFighter PG are available in: One gallon plastic bottles [6 per case) _ Five gallon pails 30 gallon drums 55 gallon drums 5000 gallon tank trucks Color: p� FireFighter is orange _ FireFighter PG is red S`•: z Applications: ;+ v Wet fire protection sprinkler systems •• 1(1.1 Ingredients: 1 FireFighter: 4 —Active Ingredient: Glycerine Other Ingredients: Water ' n' Viscosity Reduction Agent Dye d'FireFighter PG: :.:•:;.�::; _ Active Ingredient: Propylene Glycol Other Ingredients: Water Viscosity Reduction Agent v ' Dye f� a S ` -FireFighter Freeze Protection Fluid- is a trademark of The Noble Compal y. BlazeMester- is a registered trademark of B.F. Goodrich —Non-toxicis used to describe extremely low chronic and acute toxicity. No maximum safe intake for humans has been established. The product is • considered GRAS (Generally Regarded As Safe) by The Food and Drug �"e.°� Administration Chemical and Physical Properties: FireFighter: Density at 77°F is 1.137 grams/ml _Viscosity at 77°F is 7.05 centipoise _ pH of FireFighter is 7 _. Boiling Point at Atmospheric Pressure (760 mm) is 212°F FireFighter PG: _ Density at 77°F is 1.026 grams/ml _ Viscosity at 77°F is 6.15 centipoise pH of FireFighter PG is 8.0.9.6 _ Boiling Point at Atmospheric Pressure 060 mm) is 222°F Freeze Protection Properties: FireFighter and FireFighter PG:(, _Minimum Fluid Flow Temperature is —15°F _ Minimum'Burst" (Hard Freeze) Temperature is —50°F . J Flammability: f t''^i o FireFighter and FireFighter PG are not flammable since they have no measurable flash point (Pensky- ' Martens Closed Cup): however, both products can flash or bum if the water content is evaporated off. FireFighter: —Flash Point is 350"F"* '!r _Fire Point is 400°F;f", " FireFighter PG: _Flash Point is 2140F*" _Fire Point is 220°F** a ToKicological, Environmental and Health Information: FireFighter and FireFighter PG are virtually harmless to animals or plants: however, the disposal of these materials should be in conformance with national, state, and local health codes.. FOR References: GRAS: FireFighter and FireFighter PG are considered': "Generally Regarded as Safe" by the Federal Food and f Drug Administration.;°, • f rc t "Cleveland Open Cup �? L W, RECOMMENDED CONCENTRATIONS FireFighter and FireFighter PG are intended to be used undiluted only. AVAILABILITY FireFighter and FireFighter PG are available throughout the U.S. through wholesale distributors. Please contact The Noble Company for your local representative and wholesaler. TECHNICAL SUPPORT Specifications, installation design, installation techniques, and unique applications will be reviewed upon request. Address inquiries ATTN: FireFighter Technical Support. - • . Field service is available through factory representatives and Noble Company staff. Contact The Noble Company for local representatives. The Noble Company 614 Monroe Street Grand Haven, Michigan 49417 Phone: 161618427844 1 Sc]o-674, _�62 S FAX: [6161842-1547 1 z. .F Q, ••�,'+J�i.• iia. �,,UC+�• .. ;•:,:•t'i' oA ��a° 77��'li."=Ice' ;.•:. Ii�{•, ,rb � ° °:Y'i'p ; Q.P ..J,. •.i.� •. .'. J•'i :;!�• " +' • 000 .� • •�' . •' 'f/ arc' :_J:�+ `,%rjt�,ti +til .;�51� e;�•��� ' j, Printed In USA alp . 01989 The Noble Co. Form AFFPIG 289..: `:fMuitlSCt ' +i alert-us.bjuu «Engineerea jul l;;y,. Sizes W- 211 capacify relief To prevent back -siphonage and backpressure of con- taminated water into the safe drinking watersupply, when installed at each high hazard cross -connection. Use Series 909 for backflow protection in cross -connec- tion control and containment at the service entrance. The 909 high capacity relief incorporates the "air-in/water-out" principle and substantially improves the relief valves dis- charge performance. The emergency condition of com- bined back -siphonage and backpressure with both checks fouled can defeat the effectiveness of a standard RPZ backflow preventer. Standardly furnished with NPT body connections and quarter -turn, full port, resilient seated, bronze ball valve shut -offs No. 909QT. Sizes W and 1" have Tee handle shut -offs. Available Wrodels Prefix C -with strainer clean and check, 3A" and 1" only Suffix QT-- with quarter -turn, full port, resilient seated ball valve shut -offs S - with bronze strainer HW - with stainless steel check modules for hot water and harsh water conditions PC - with internal Polymer Coating LF - without shut-off valves Prefix U - with integral body unions (3/4" and 1" only? FAE - with flanged adapter ends (1114",11h", 2' only) Features a Quarter -turn ball valve shut offs Replaceable bronze seats o Designed pressure drop *.,;Modular design Simple and economical service a No special tools required for . High capacity relief protection servicing against combined back -siphonage/ backpressure backflow Standards (see page 3) Pressure -Temperature Series 909 suitable for supply pressure up to 175 psi and water temperatures up to 140°F continuous and 180°F in- termittent..Suffix HW stainless steel check modules suit- able for supply pressure up to 175 psi and water tempera- ture up to 210°F for harsh water conditions. Connections* 3/4" -1" 909QT has NPT female threaded body connections. 11/4" - 2"'909QTM1 has NPT male threaded body connections. d- imensions-WeightS (approximate) Size Dimension (i Chas) I • W .(lbs.) inches A 8 C I 0 E F I G H w/o strainer V4 211/4 171/4 75/ 6 4 43/4 11Y, 6'Y4 3r/e j2Y4 14 1 221/4 17:i6 75/16 4 43/4 13 7 3% 15 15/4 25% 205/e 103A 5 61/6 14 7'h 51/4 40 1% 27:/16 213/4 103/a 5 65A 15 7�h 51/4 40 2 3D3/i 23% 1D3h 5 fish 16 73/4 51/4 40 g For more information, send for ES -909S III d1ft IF tiduced I�pRy pressure F:1 ` Patent 14,241,752 909OT-S Note: The installation of a drain line recommended. When installing a drain line, and air gap in necessary (see page 5). BACKFLOW PREVENTION FOR HIGH HAZARD CROSS -CONNECTION and CONTAINMENT INSTALLATIONS WITH CONTINUOUS PRESSURE Capacity As compiled from documented Foundation for Cross -Connection Control and Hydraulic Research at the UnWrslty of Southern California lab tests. 'Typical maximum mechanicalrirripation system flow rate (7.5 feet per second) 20 0 15 a10 5 0 20 015 U) l '/2 10 20 30 40 50 60 70 80 90 100 GPM 2" 909M1 5 75 10 15 FPS 25 50 75 100 125 150 175 200 GPM 1 5 7.5 10 15 FPS STRENGTH OFCOPPER TUBING SAFE WORKING INTERNAL PRESSURES S (Allowable stress in pounds per square Inch), 6000 psi '.'S 59DO psi S 31160 psi S MO psi L UME OF COPPER TUBING Cubic Inches Per Cubic Feet Per 'Foot of Tubing 100 Feet of Tubing 41. 1 Gallons Per 100 Net of Tubing 51: L TYPE. K K TYPE L M K TYPE M m am Size -.f 150.017. 2500F. 3504'. 4000F. 11500F. 2500F. 4000F. 1500F. 2500F. 3500F.: 4000F. In in"chek;:-.,i."'O.D. (PSI) (PSQ (PSI) (PSI) (PSI) (PSQ .3500F. (PSI) (PSI) (PSI) (PSI) (PSI) (PSI) .151 . .162 .176* 1.132 1.210 1319 4DD8 4.176 2 1/& 3130 3030 1980 1300 5232 5.808 6.204 .303 .336 .359 3/16 1950 1890 1230 810 99DO MASS '88 .1 . .540 .573 .6D7 4.042 4.286 174 1530 1480 970 640 1160 1120 73D 4 80 1160 1120 730 480 5/1 & 12DD 1160 760 5D0 1.24 1.27 8.94 9.25 9.51 36.12 37.03 3/i 1200 1160 760 500 900 870 570 380 750 730 470 310 1A 1170 1130 740 490 8D0 770 500 330 560 540 350 230 rj 'Sh 920 890 580 390 740 720 470 310 500 480 320 210 3/ 4 76D 730 480 320 650 630 410 270 450 430 290 IM it, 83D 850 560 370 590 570 370 250 40 390 250 170 321.6 630 660 -430 290 510 490 320 210 340 330 220 140 55D 530 350 M 460 440 29D 19D 340 330 220 140 52D 500 330 220 430 420 270 IN 340 330 220 140 IA. 450 430 290 190 370 360 23D 150 300 29.0 190 120 5/1 420 400 270 180 35D 340 220 140 280 270 190 120 Alt! 410 400 260 170 330. 320 210 140 260 250 160 110 330 370 240 160 320 310 200 130 260 250 160 110 370 360 230 ISD 300 290 1916 IM 260 250 160 110 'A 30 -350 230 150 280 270 180 120 240 230 150 IDD 0 360 230 `150 260 M 10 110 230 220 140 IDD W -.1 81A 390 3180 250 160 2110 270 180 IN 240 230 150 IDD 3PD 330 250 160 291) 280 180 1 ZD 240 230 150 IDD 390 390 250 160 270 260 170 110 240 230 150 IDD . S (Allowable stress in pounds per square Inch), 6000 psi '.'S 59DO psi S 31160 psi S MO psi L UME OF COPPER TUBING Cubic Inches Per Cubic Feet Per 'Foot of Tubing 100 Feet of Tubing 41. 1 Gallons Per 100 Net of Tubing 51: L m K L M K L m .936 .0542 405 3/ 1.524 1.740 1)8 1.908 .0882 .101 .110 .660 326 7-6116 2.796 3.048 148M .151 . .162 .176* 1.132 1.210 1319 4DD8 4.176 2 .242 1.735 1.808 5232 5.808 6.204 .303 .336 .359 2.265 2.514 2.686 336 99DO MASS '88 .1 . .540 .573 .6D7 4.042 4.286 4.540 111/4 14.64 15.12 15.72 .135 .88 .91 634 6.55 6.81 1 20 A4 2136 21.96 1.19 1.24 1.27 8.94 9.25 9.51 36.12 37.03 38.04 2,07 2.15 220 15.64 16.05 16-A7 21/2 55.92 .5724 58.68 1 324 3.31 3AD 2421 24.78 25A0 3 79.63 81.72 8376 4.61 4.7.3 4.85 3A.5D 35.38 * 3626 1108.09 11052 117.80 625 6A0 653 4675 47.84 48.113 4 140.4 144D 146A 8.1 :83 85 603 623 63.4 2172 224A 226.8 12.6 13.0 13.1 94.0 97.1 98.2 .310.3 321.6 326A 18.0 1-9.6 18.9 134.5 1392 141.3 24. rrA Table A-2-3.4 Copper Tube dimensions Type K Yp Type L Type 1,11Nominal Outside Inside Wall Inside Wall Inside Wali Tube Size Diameter Diameter Thickness Diameter Thickness Diameter . In. (mm) Thickness in. (mm) In. in. (mm) in. (mm) in. (mm) in. (mm) in. (mm) 3/4 0.875 (22.2) .0.745 (18.9) 0.065 (1.7) 0.785 (19.9) 0.045 O.050 (1.1) (1.3) 0.811 1.055. (20.6). (26.8) 0.032 0.035 (0.8) (0.9) 1 1'14 1.125 1.375 (20.6) (34.9) 0.995 1.245 (25.3) (31.6) 0.065 0.065 (1.7) (1.7) 1.025 1.265 (26.0) (32.1) 0.055 (1.4) 1.291 (32.8) 0.042 (1.1) 1'12 1.625 (41.3) 1.481 .(37.6) 0.072 (1.8) 1.505 (38.2) 0.060 0.070 (1.5) (1.8) 1.527 2.009 (38.8) (51.0) 0.049 0.058 (1.2) (1.5) 2 211: 2.125 2.625 (54.0) (66.7) 1.959 2.435 (49.8) (61.8) 0.083 0.095 (2.1) (2.4) 1.985 2.465 (50.4) (62.6) 0.080 (2.0) 2.495 (63.4) 0.065 (1.7) 3 3.125 (79.4) 2.907 (73.8) 0.109 (2.8) 2.945 (74.8) 0.090 (2.3) 2.981 3.459 (75.7) (87.9) 0.072 0.083 (1.8) (2.1) 3'/2 3.625 (92.1) 3.385 3.857 (86.0) 0.120 0.134 (3.0) (3.4) 3.425 3.905 (87.0) (99.2) 0.100 0.110 (2.5) (2.8) 3.935 (99.9) 0.095 (2.4) 4 5 4.125 5.125 (104.8) (130.2) 4.805 (98.0) (122.0) 0.160 (4.1) 4.675 (123.8) 0.125 (3.2) 4.907 (124.6) 0.109 (2.8) 6 6.125 (155.6) 5.741 (145.8) 0.192 . (4.9) 5.845 (1.48.5) 0.140 (3.6) 5.881 7.785 (149.4) (197.7) 0.122 0.170 . (3.1) (4.3) a 8.125 (206.4) 7.5B3 9.449 (192.6) 0.271 0.338 (6.9) (8.6) 7.725 9.625 (196.2) (244.5) 0.200 0.250 (5.1) (6.4) 9.701 (246.4) 0.212 (5.4) . 10 10.13 (257.3) (240.0) a INCORPORATED CORONA, CA • (714) 737.5598 FIG. 22 HANGED FOR C. P. V. C. PLASTIC PIPE SINGLE FASTENED STRAP TYPE Size Range - 3/4" thru 2" C.P.V.C. pipe. Material - Carbon Steel with galvanized finish G-90 govt. spec. Function - Figure 22 is intended to perform as a hanger to support only C.P.V.C. piping used in automatic fire sprinkler systems. The product acts as a hanger when tab is upward and the fastener screw is in the horizontal position. Figure 22 can be installed on the top of a beam, but in this situation acts as a guide to the piping which is supported by the beam itself. Figure 22 is not intended to support C.P.V.C. pipe from under a flat horizontal surface, such as a ceiling. For this type of installation use the Tolco Figure 23, Double Fastener Strap Hanger for C.P.V.C.. Piping. Figure 22, when inverted, with the hanger tab downward, does not act as a hanger, but can function as a restrainer to prevent the upward movement of the sprinkler head during activation. Approvals - Underwriters' Laboratories listed to support fire sprinkler piping. Meets and exceeds the requirements of N.F.P.A. 13, 13R, and 13D. Features - Figure 22 incorporates features which protect the pipe and ease installation. The flared edge design* protects C.P.V.C. pipe .from any rough. surface. Figure 22 is easily attached to the building structure using the special hex head self threading screw" furnished with the product. It is recommended that rechargeable electric drills fitted with a hex socket attachment be used as installation tools. No impact tools (such as a hammer) or impact fasteners (such .as drive screws or nails) are allowed. Damage has been known to result from installations using impact type tools. No pre drilling of a pilot hole in wood is required. Order By - Figure number and C.P.V.C. pipe size. - Patent Pending ° - Minimum fastener size acceptable, #12 x 1-1/4" hardened hex head self threading screw. 32A A MAX. HANGER FASTENER APPROX. C.P.V.C. SPACING HEX HEAD WEIGHT PIPE SIZE A B C (FT.) SIZE LENGTH PER 100 3/4 2-7/16 1- 5/16 1.3/16 5-1/2 5/16 1- 1/4 9 �... wv_u.•nF}:iB 1S. -"0, r.�vr..o,•rua .5n;.a+. •sr. gin. arC°"��i... :;Ik".';•:tJ:ar. :;1'.} .:,.f::..'�n•;; a -ix w.p•.rv�;•rpr,�w:.1-1/4 ,x:;. rnw^r.;•!...-....''r•..r.'c:i,-...�tr�....Y._,,.a:, y .ew �. •�`'�« xY4' a}�.�„�., sy'*• "'("''•�•� Yt i �- r� h e i i} A�.,�{• .,aiir `j `fes f int` I t µ �.c,<'�w.-,.,�ra• a „�' .'.•� �:6�t�_a...��� �% ,: u ,;3,/�.�'„ `' •��( %., •''-��lfi, v �r1a.�..,.�.i4t�..f�'!�•;.����.My9�, Irk e�a�ST`* reri.5:' ,.;�se:i. .?,�r.,n. tr..���(.�'. �'i' F � ���'�ti�. ..•%:-�"di-'i?4 t.I dr.-a....�r.'�,.1 .�ik `1:.:�n .E"MnLt-!H�..b � ....., 1-1/4 3-1/16 1-5/8 1 .3/16 6-1/2 5/16 1-1/4 11 rr� .?r�'•%.� �:• +:�"r�"p_=°GT11f.�ry"}'•"i'- x. u . ,� ii`i'I•V''ilM�,'l�t..•y-.•uRw•.:TTII'isi•V`•�.;wY%;•"i7�!('?':fi!:Y,`iY::. K��}i�'.4hiyl+.fq.tlt�:;;f^rrcn1�ay.•„','.',•-ymJ!!�R!,.v.p.,�:�',:1.. •: 4%;n .�^ F� y"� � Ir^' 1 4 0"�%• r� knix y 2��j }�C ' �`- '^ �d� ar+\' ,. v > �"! � f �•}d�+i� x!� +Y _S K� tide /� '. i�r�4��il;:if •�7aC:-�,� t•+!.'.i.'+•.r,�� ��Lj.-;�+� } ��� (-j�`s .7 �f`+„ i�J.p rH}�L:•ry-fi'iu- 2F i ii,:t ��O•V: ic} m 7.� �f(�'ryi' �'iL �L {. -,itfl: os...—:,.•. ^':i;aiL"i5� :.�.4.,Naueix�':..�. �+.kw•-�nt�;i;;a�s�i:aua.r,..-a. x`.I,s.,.�J;:..,. r..'�c:i.r�;we<�.JP:,.$l _t..u..,..t• i,.l. .,,..•...,.. 2 3-3/4 2 -1/8 1-3/16 8 5/16 1-1/4 15 ru-vlsn M)I TVL0 INCORPORATED 32B CORONA, CA - (714) 737.5599 FIG. 23 HANGER FOR C.P. V. C. PLASTIC PIPE DOUBLE FASTENER STRAP TYPE I Imo- B -1►'I� B—I-I -: A —1► Size Range - 3/4" thru 2" C.P.V.C. pipe. Material - Carbon Steel with galvanized finish G-90 govt. Spec. Function - The Fig, 23 and Fig. 24 are intended to perform as a hanger / restrainer to support only C.P.V.C. piping used in automatic fire sprinkler systems. . Fig. 23 and Fig. 24 can be installed on the top or on the bottom of a beam. The Fig. 23 can also be installed on the side of a beam. The Fig. 23 and Fig. 24 can also function as a restrainer to prevent the upward movement of the sprinkler head during activation. , Approvals - Underwriters' Laboratories listed to support fire sprinkler piping. Meets and exceeds the requirements of N.F.P.A. 13,13R, and 13D.' FIG. 24 HANGER FOR C.P.V.C. PLASTIC PIPE DOUBLE FASTENER STRAP TYPE -SIDE MOUNT I��r-ISI C E-= A -=10 Features - The Fig. 23 and Fig. 24 incorporate features which protect the pipe and ease installation.. The flared edge design* protects the C.P.V.C. pipe from any rough surface. The Fig. 23 and Fig. 24 are easily attached to the building structure using the two hex head self threading screws— furnished with the product. It is recommended that rechargeable electric drills fitted with a hex socket attachment be used as installation tools. No impact tools (such as a hammer) or impact fasteners (such as drive screws or nails) are allowed. Damage has been known to result from installations using impact -type tools. No pre drilling of a pilot hole in wood is required. Order By - Figure number and C.P.V.C. pipe size. ° Patents Pending Minimum fastener size acceptable, #12 x 1-1/4" hardened hex head self threading screw, PIPE SIZE A FIG. 23 FIG. 24 S FIG. 23 FIG. 24 Ic FIG. 23 FIG. 24 MAX. HANGER SPACING (FT.) . FASTENER . HEX HEAD SIZE LENGTH APPROX.C.P.V.C. WEIGHT PER 100 3/4 3.18 2-5/16 1- 9/16 1-5/132 1-3/16 1-3/16 5-1/2 5/16 1-1/4 j 9 •.n.� +R��'- 'R `� Iry}• �. p... �'�fi..p•: +N'e3Vg`+np 1«J.l,.1. J�:�Ga��Sr4y..rK. ,,iu.*i�'9,.. t 'J�r' rMiq„n^i6n7en,Y.';a.l vm ��.••.c ;f qpG . 1 1-1/4 4 - 3/16 3 ei1°'�vp'^. 2 3/32 1-1/2 1.3/16 1- 3/16 6 -1/2 ?+j 5/16 :i.'�.o r 1-1/4 11 ��-:,Sfif. .je 1'•YA,•a,�r''/7 . •+il ai wt Y.lrc.. Wdt ..�i4+ Irl lay�AOly�� i?::y.lw/n.S .��'.� ('"'•t+�.. � r} jy�))/yj�,.. a7Nt•t .ii� .r:C ySL'dJ�)i uD:.. ...t!'t`: : r., ]Q + '� .� ii+: /17 •,�nF:-fi.. 'fn -�W /j '� y�J 16 ,y;til `� �+�, r �ri t':?'Fpj�''�!t.tn,t 7 /g,lh-'A .:,+t�.'Yalai v�9'!w»i�Y�Rn.Li��1i � , r "..ipx,it:l.'°47P,i'�'aiw7'b"3j�9:."sig" f,��'S�f-1p1• ���p,1��,m, ISFtn VIK 9 re,�^P j�" i �Z iln ':.Mu �' 3.�r 2 4.78 3-11/16 2-7/16 1- 27/3 1-3/16 1.3/16 8 5/16 1-1/4 15 REVW) 8/91 �3 Central Sprinkler BlazeMaster o INSTALLATION INSTRUCTIONS & TECHNICAL MANUAL U.S., Canadian and U.K. Edition No. 19.1.0 Rey 4 596 Table of Contents Introduction......................................... 1 Conversion Factors ................................. I Listings and Approvals .......................... . . 1 Where and hour to use a Central BlazeMaster S,,slem:.... I Central BlazeMaster Specifications ..................... 3 Pipe ............ .....3 Central Biazehiaster Fitrings ......................... 3 Solvent/Cement .................................... 3 Dimensions for Central BlazeMaster CPVC Pips. .......... 3 Fitting Socket Dimensions 3 Product Ratings and Capabilities ........................ 4 Pressure Rating & Pressure listing .................... 4 FrictionLoss.......................................4 Deburring....................................... Thermal Expansion ................................. 4 Physical and Thermal Properties of Central 12 BlazeMaster CPVC................................ 6 Permissible Deflections of Central Blazelvlaster CPVC ..... 6 Support and Hanger Recommendations .................. 7 Pipe Bracing with Standard Band Hanger .............. 7 Hanger/Support Spacing ...........................7 Assembly........................................ Vertical Restraint .................................... 7 Underground Installation Specifications ................ 9 Pipe..............................................9 Fittings........................................... 9 Primer/Solvent Cement ............................ * 9 System Design .......... 9. Installation Procedures ........................ 9' Inspection ...... ................ .. 9 Trenching......................................... 9 Snaking of Pipe .................................... 9 Back -Filling .................... ................ 10 Maintenance....' . .............................. 10 System Riser Installation Requirements..........'....... 10 . System Riser Installation Recommendation .............. 10 Handling & Storage ................................. 11 Handling........................................ 11 Storage ............. ......................... 11 Handling of Central BlazeMaster Cements and Primers Solvent/Cementing Instructions ...................... 11 Joining Central BlazeMaster Pipe Systems .............. 11 Cutting.......................................... 11 Deburring....................................... 11 Fitting Preparation ................................ 12 Safety and Health Precautions ....................... 12 Estimating Primer and Cement Requirements .......... 12 Primer Application . ..................... ......... 12 Solvent Cement Application ........................ 12 Assembly........................................ I2 Set and Cure Times ............................... I ;I Pressure Testing the System ......................... 14 Transition to Other Materials ......................... 14 Flanged Connections .............................. 14 Grooved Coupling Adapters ........................ 15 Penetrating Fire Rated Walls & Partitions .............. 15 Other Design Criteria ............................... 15 Freeze Protection ................................. 15 Central BlazeMaster Systems and Penetration of Metal Studs ...................... I .............. 15 Solvent Cement and Primer Spills .................... 15 Joining Central BlazeMaster CPVC in Cold Weather ..... 16 Joining Central BlazeMaster CPVC in Hot Weather ...... 16 Appendix ................................. ......16 Helpful Tips......... ....................:....16 Material Safety Data for Solvent Cements and Primers ... 16 Training/Demonstration ............................ 16 Material Safety Data Sheets .......................... 17 This Installation and Technical Manual contains the c iteria to install a Central BlazeMaster CPVC piping system in accordance with the UL Listing, C -UL Listing and/or FM Approval. Additionally, the manual contains recommendations for easier installation, general piping prac- tices and other suggestions that may not be required to satisfy the ULListing, C -UL Listing and/or FM Approval. To difereniiate between a requirement and a suggestion, use the following defimiions: . SHALL - The use of the word "shall" indicates a mandatory requirement of the Listings/Approval. SHOULD - The use of the word "should" indicates a suggestion that is not required to meet the Listings�Approval. 04. Warranty Central BlazeMaster CPVC products are warranted against defects in material and workmanship solely to original purchasers from Central. This warranty will continue for a period of ter years from the shipping date. Materials found to be defective by Central shall be repaired or replaced at Central's option. Central will nct be responsible for labor charges or consequential expenses or damages incurred as a result of use of its products. This warranty is eypressiy made in lieu of any and aL other warranties, es,nressed or implied, including the war- ranties of merchantability and fitness. Al! sales by Central shall be subject to the term= and conditions stated herein. The placement of orders with Central shall constitute acceo- . tance of these terms and conditions. If buyers' purchase orde.. or confirmations are at a variance with the terms and conditions herein, they shall not be binding upon Central and Central's terms and conditions shall take precedence. These terms and conditions of sale shall be construed under and in accordance with the laws of the Commonwealth of Pennsylvania. Buyer consents and agrees to the jurisdiction and venue of the Court of Common Pleas of Montgomery County, Pennsylvania and the U.S. District Court for the Eastern District of Pennsylvania v-ith respect to any proceedings arising out or in connection with any purchase and sale contract entered into betwe?n Central and buyer. Buyer further agrees that mailing to either party by certified registered mail shall constitute lawful and valid service of process. Look for the UL, C -UL, FM and NSF-pw S.E. marls on the product. B1azeMaster4' is a registered trademark of the BFGoodrich Company. All Central Sprinkler Blazeb4aster CPVC Products are manufactured in the USA. Introduction Central Sprinkler Company in conjunction with BFGoodrich has created a line of BlazeMaster CPVC (Post Chlorinated Polyvinyl Chloride) sprinkler pipe and fittings. Central BlazeMaster pipe systems are designed specifically for fire sprinkler s;,stems and provide the following advantages over traditional sprinkler piping systems: • Increased hydraulic capabilities (C -Factor =150) •. No precutting and expensive fabrication required • NSF-pw S.E. approved for potable water • Can be easily connected to other sprinlrlet piping systems • Fle7ability in the piping for greater ease of installation • Resistant to rust,, scale and foreign contaminant build up • Inexpensive tools required for installation • Greater resistance to seismic activity than copper or steel systems • Easily repaired or modified on site • Easily transported and handled at installation • Resists sweating and condensation Conversion Factors • Appropriate conversion factors for values shown in this guide are as follows: linch = 25.4 mm 1 foot = 0.3048 meters . I psi = 6.895 kPa 1 psi = 0.0699 bar 1 psi = 6894.757 Pa 1000 Pa =1 kPa Listings and Approvals Central Sprinkler BlazeMaster CPVC piping systems have been evaluated and are UL Listed in accordance with U.S. requirements and C -UL Listed in accordance with Canadian requirements by Underwriters Laboratories Inc. and are Factory Mutual (FM) Approved for use in: • Light Hazard occupancies as defined in the Standard for "Installation of Sprinkler Systems", NFPA 13. • Residential occupancies as defined in the Standard for "Installation of Sprinkler Systems in Residential Occupancies up to and Including ,.� Four Stories in Height", NFPA 13R Residential occupancies as defined in the Standard for' Installation of Sprinkler Systems in One and Two Family Dwellings and Manufactured Homes", NFPA 13D, • Underground fire service systems as described in the " Standard for Installation of Private Fire Service Mains and Their Appurtenances", NFPA 24. Central Sprinlder BlazeMaster piping systems have also been evaluated and are UL Listed in accordance with U.S. requirements by Underwriters Laboratories, Inc. for use in return air plenums as described in the "Standard for Installation of Air Conditioning and Ventilating Systems", NFPA 90A. Central Sprinkler BlazeMaster CPVC pipe and fittings are not C -UL Listed for use in return air plenums. Central Sprinkler BlazeMaster CPVC sprinkler pipe and fittings are Listed by ME&A in Residential buildings as defined by NFPA 13D and 13R. Me ME&A listing number is 434.88-M. Central Sprinkler BlazeMaster CPVC sprinkler pipe and fittings are tested by NSF for chemical extraction to standard 61 and carry the NSF-pw S.E.. Listing. Central Sprin}ler Blazelvlaster CPVC sprinkler pipe and fittings are Approved by the City of Los Angeles and Metro -Dade County for use in Light . Hazard and Residential occupancies as defined above. Special Note: Central Sprinkler BlazeMaster CPVC pipe and fittings are UL and C -UL Listed and FM Approved for use with Central and/or other BlazeMaster CPVC fittings Listed and/or Approved in accordance with the appropriate U.S. and/or Canadian requirements. Please con- sult the current UL Fire Protection Equipment Directory, C -UL Products Certified for Canada Directory, FiJk Approval Guide and/or contact Central Sprinlder's Corporate Headquarters at 800-523-6512 for further information on Listings and Approvals. Where and how to use a Central BlazeMaster System 1. Central BlazeMaster pipe and fillings shall be employed in "wet" systems only. (A wet pipe 1 stem contains v.,ater and is connected to a water supply so that the water will discharge immediately when the sprinkler is epened.) Central BlazeMaster shall not be used in a system using compressed air or other gases. 2. National Fire Protection Association Standards 13,13R, 13D or 24 shall be followed and when applicable, the National Building Code of Canada shall be referenced for design and installation requirements in conjunction with these instructions. 3. For a concealed installation: R In accordance with the UL Listing, protection shall be provided for B1azeb4aster CPVC pipe and fittings. The minimum proteoft-n shall consist of either one layer of f" thick: gypsum wall board, {" plywood soffits, or a suspended membrane ceiling with lay -in panels or tiles having a weight of 0.35 pounds per sq. ft. when installed with metallic grids. For residential occupancies defined in NFPA 13D and 13R, the minimum protection may consist of one layer of %" plywood. In these cases, any standard sprinkler head rated at 170°F or less may he used. ..... ����. "A& &I ULU %.,'V I, WbU119, T ' iec;iorx 81)U11 De provxaea for muzeiviaster _M, pip ani inungs. ine minimum 1:ra Lection{shc ltinsift .;(eLther�lat'h and pla one layer of 9mm thick: gypsum wallboard, one layer of 13mm plywood, or a suspend- ed mey brave ceiling wxtu ltiy-in panels o. dles classified with respect to surface burning characteristics having a mass of not less than 1.7 kgiml when installed with metallic grids. The effectiveness of this protection can be impaired if penetrated by large open- ings such as ventilation grills, exhaust fans connected to metal ducts serving washrooms excepred. Where such penetration is pre- sent, individual openings exceeding 0.03m=, bu-, :lot exceeding 0.71 _'n2 fn area must be located such that the distance from the edoe of the opening to the nearest sprinkler does not exceed 300mm. BlazeMaster pipe and fittings shall not be used where such open ings exceed 0.71m2 in area. In these cases, any standard sprinkler head rated at 77°C or less may be used. C. For a concealed installation per FM Approvals, the piping shall be protected and completely separated by a permanently installed non-combustible barrier from ar, area protecied by the system. A permanently installed barrier is one that cannot be removed without substantial cosmetic damaoe. Drop in ceiling tiles, as used in suspended ceihngs are specifically considered not to be permanently installed for the purposes of Us definition. Non-combustible is defined as having a minimum finish lire rating of 15 minutes when tested per ASTM E 119. 4. For an exposed installation: A. In accordance with the UL Listing, Blazel&sier CPVC pipe and fittings shall be instal1led below a smooth flat horizontal ceiling construction. For pendent sprinkler installations, Listed Quick Response pendent sprinklers installed within 8" from the ceiling or Listed Residential sprinklers located in accordance ti rith their Lifting shall be used and the maximum distance between spriniders shall not exceed 15'. For horizontal sidewall installations, lasted Quick Response horizontal sidewall sprinklers having deflectors within 6" from the ceil- ing and within 4" from the sideivall or Listen Residential horizontal sidewall sprinklers located in accordance with their Listing shall be used and the maximum distance bete -ean sprinklers shall not exceed 14'. B. In accordance with the C -UL Listing, BlazeMaster CPVC pipe and fittings shall be ins►alled below a smooth, flat, horizontal, fired ceilings in conjunction with lasted Quick Response or Residential sprinklers with a maximum rating of 77°C. 5. Central BlazeMaster pipe and fittings shall be installed in areas where the ambient temperature does not exceed 150'F (65°C). 6. Central BlazeMaster pipe and fittings are not approved for installation in combustible concealed spaces requiring sprinklers, as refer- enced in NFPA 13. However, NFPA 13R and 13D permit the omission of sprinklers from combustible concealed spaces and Central Sprinkler Blazelvlaster pipe and fittings can be installed in these areas when sprinllering residential occupancies according to these standards. 7. In installations vrhere sprinkler pipe runs through an attic space that requires sprinklers per NFPA, CPVC piping shall be protected in order to meet the requirements of its UL and C -UL Listings. The Authority Having Jurisdiction shall be consulted prior to any installation of CPVC in attic spaces requiring sprinklers. Protection methods and requirements may vary by jurisdiction and are subject to interpre- tation. r . 8. Central BlazeMaster pipe and fittings, when installed in accordance with its UL listing in air plenums, shall be a minimum horizon- tal distance of 24" from an opening in the ceiling such as ventilation grills. The C -UL Listing and FM Approval restrict the use of Central Sprinkler BlazeMaster pipe and fittings in return air plenums as referenced in NFPA 90A. 9. Before penetrating fire rated walls and partitions, consult building codes and Authorities Having Jurisdiction in your area. Central Sprinkler BlazeMaster systems should be designed and installed so that the piping is not exposed to excessive temperatures from specific heat producing sources, such as light fixtures, ballasts and steam lines. Pipe shall not be positioned directly over open venti- lation grills. Note: There is no exact minimum distance Central BlazeMaster CPVC pipe and fittings should be installed from heat sources. Minimum distances are a function of the specific heat producing source, the maximum ambient temperature, heat shielding, if any, and proximity of CPVC piping to the above. Please consult Central's Technical Services department for answers regarding specific heat sources and recommended Central Sprinkler BlazeMaster CPVC spacing. 10. During remodeling or ceiling repair appropriate precautions must be implemented to properly shield the piping from the protected occupancy. 11. Central BlazeMaster pipe and fittings shag not be installed in outdoor applications. 12. The use of Blazelvlaster CPVC in ceiling spaces above non-sprinklered areas has not been investigated by UL or FM. L Pipe Central Sprinkler B1azeMasler CPVC sprinkler pipe conforms to the requirements of ASTM F442 and carries the markings of Underwriters • ' Laboratories Inc. (UL & C -UL), Factory Mutual (FM), IEU, and the National Sanitation Foundation (143F S.E.) for use in potable water systems. Fittings . Central BlazeMaster sprinkler fittings conform to the requirements of ASTA4 F43B (Schedule 40 dimensions from "' to l ") and ASTM F439 (Schedule 80 dimensions for 2" to 3"). Female threaded adapters for sprinller head connections contain brass inserts. Fittings carry the marl; ings of Undemrriters Laboratories Inc. (UL & C -UL), Factory Mutual (FM), ME&A, and National 5aimaticr. Foundation T?SF-p,; S.E.) for use in potable water systems. Solvent/Cement BlazeMaster CPVC socket connections can be joined using one of two solvent/cementing processes. Connections shall be joined with Central Sprinkler BlazeMaster One -Step CSC -300, CSC-400,or CSC -500 Solvent Cements or Two Step CSC -100 Primer and CSC -200 Solvent Cement. CSC -100, CSC -200, CSC -300, and CSC400 or CSC -500 Solvent/Cements meet ASTM F493 and NSF requirements. Please review solvent cement- ing instructions within this manual prior to installation. Other primer or cements shall not be used with Central Blazel-haster products and the use of such non -approved welding agents will void the Manufaciurer's warranty and product Listings/Approvals. Dimensions for Central BlazeMaster CPUC Pipe Table A • Central BlazeMaster Pipe Dimensions in Inches (Millimeters) (SDR 13.5 ASTM F 442) Nominal Size (see note) Average 00 Average ID Pounds per Feet '/' (19.1) 1.050 (26.7) .874 (22.2) .168 1' (25.4) 1.315 (33.4) 1.101 (28.0) _ .262 11i (31.8) 1.660 (42.2) 1.394 (35.6) •.418 114' (38.1) 1.900 (48.3) 1.598 (40.6) .548 _ 2' (50.8) 2.375 (60.3) 2.003 (50.9) • .859 _ 2X (63.5) 2.875 (73.0) 2.423 • (61.7) 1.257 3' (76.2) 3.500 (88.9) 2.952 (75.1) 1.867 3" 3.516 3.492 1.875 _2.316 2192 _ _ 0.300 0.375 ASTM CPUC Fitting Socket -Dimensions Table B • ASTM Dimensions for CPVC fittings in Inches: Nominal Size A Socket Entrance Diameter Average Diameter 8 Socket Bottom Diameter Average Diameter C Socket Length Minimum 0 Inside Diameter Minimum E F Minimum Wall Thickness _ 1.058 1.046 0.719 1 0.820 0.113 0.141 _'4 1' 1.325 1.310 0.675 1.044 0.133 0.166 1.670 1.655 0.938 1.375 0.140 0.17.5 _1A, lf' 1.912 1.894 1.094 1.604 0.145 0.181 2' 2.387 2.369 1.500 1.933_ 027_5_ 214' _ 2.889 2.868 1.750 _0.218 0.276 0.345 3" 3.516 3.492 1.875 _2.316 2192 _ _ 0.300 0.375 Note: Central BlazeMaster pipe is produced in SDR 13.5 dimensions in accordance with AM- M442, SDR (Standard Dimension Ratio) is the ratio of the out- side pipe diameter to the wall thickness of the pipe. t Product Ratings and Capabilities Pressure Rating & Pressure Listing Central Sprinkler BlazeMaster pipe and fittings are UL and C -UL Listed and FM Approved for.a rated pressure of 175 psi (1210 kPa) for sprinkler service up to 150°F (65°C). Friction Loss Central BlazeMaster CPUC pipe has a Hazen -Williams C -Value of 150. Pipe friction loss calculations shall be made according to i1FRk Standards. ne following table s_,ov:s the alfo'nance of friction loss forfitt.ncs, expressed in equivalent feet of pipe. Table D � Loop Length (30°F to IDO'F) AT= 70°F Allowance for Friction Loss In Fittings Table C • Thermal Expansion Sam. Pipe Size (Equivalent Feet at Pipe) 10 Temp Change Filling Size (In.) %" 1" 1Y" im. 2" 2Y" 3" Tee Branch 3 5 6 8 10 12 15 Elbow 90' 4 5 6 7 9 12 13 Elbow 45' 1 1 2 2 2 3 4 Coupling 1 1 1 1 1 2 2 'The above slated friction lose values are for Central Blozelifasler fillings only. Wher, using other Listed BlazeMaster CPVC 90' e1cws with Central Sprinkler BlazeMaster products, please consult the filling man ufacture:'s installation and design manuals. . Thermal Expansion BlazeMaster plastics, like all piping materials, expand and contract with changes in temperature. The coefficient of linear expansions is: 0.0000340 inchlinch /"F. A 25'F change in temperature will cause an. expansion of Y inch for a 50 foot straight length. For most operating and installation conditions, expansion and contraction can be accommodated at changes in direc- con of the pipe run. For additional information on Thermal Expansion please see Table C below. Where AL = .12el (AT) e = 3.4 x 10" in/in/°F (Coefficient of Linear Expansion) L = Lenath of Run in Feet , AT= Temperature Change in `F An example of Thermal Expansion is shown below: Example: Now much will a 40 foot run of •'<"of Blazeh4aster CPVC pipe increase in length (or expand) if the expected ambient temperature ranges from 35T to 8571 Changes in length due to fittings are insignificant relative to the pipe, AL =12el (AT) AL = 12 (.000034) x 40 x 50 AL = .82 in. or 1Y,6" Central BlazeMaster CPVC exhibits a relatively high coefficient of thermal expansion (see Table Q. When designing Central BlazeMaster sprinlder systems, expansion of long runs must be considered if temperature variations will be encountered (ie; summer to winter extremes). : Methods of compensating for thermal expansion are; expansion loops, offsets and change of direction of the pipe run. (See Figure G for exam- ples of control methods.) The expansion loops and offset tables are shown below. If the change in temperature and the mcnamum* working temperature are lower than those used to derive the tables, the numbers will be conser- vative in nature. For example, for a temperature change from 60'F to 125'F use Table F because the maximum tem- perature is greater than those shown in Tables U and E. For conditions which are not covered in the Loop Length Tables, use the formulas and examples found in Table H. Note: Table based on Stress and Modulus of Elasticity at 1007. Refer to Table B on page 4. AT = 70T S =1560 psi E = 3.85 x 10' psi Table D � Loop Length (30°F to IDO'F) AT= 70°F Table C • Thermal Expansion Sam. Pipe Size Ate' O.D. 10 Temp Change 5 10 15 20 25 30 Length of Run (IL) 35 40 45 50 70 90, 129 160 .iT°F 11 15 18 21 Thermal Expansion, AL (In.) 30 32 33 37 39 20 ,04 .OB ,12 .16 20 .24 .29 .33 37 .41' .57 .73 ,98 1.31 30 .05 .12 .18 24 31 .37 .43 .49 ,55 .61 .86 1.10 1.47 1.96 40 .08 .16 24 .33 .41 .49 .57 .65 .73 .82 1.14 1A7 1.96 2.61 50 ,1D .20 ,31 ,A1 51 .61 .71 .82 .92 1.02 1.43 1.84 2.45 3.26 60 .12 24 37 ,49 .61 .73 .86 .98 1.10 1.22 1.71 2.20 2.94 3.92 70 .14 .29 .43 ,57 .71 .86 1.00 1.14 129 1.43 2.00 2.57 3.43 4.57 80 .16 .33 All .65 .82 .98 1.14 1.31 1.47 1.63 2,28 2.94 3.92 5.22 90 .18 .37 55 .73 .92 1.10 129 1.47 1.65 1.84 2.57 .3.30 4.41 5.88 t OD 2D .41 .61 _ .82 1.02 1.22 1.43 1.63 1.84 2.04 2.86 3.67 4.90 6.53 AL =12el (AT) AL = 12 (.000034) x 40 x 50 AL = .82 in. or 1Y,6" Central BlazeMaster CPVC exhibits a relatively high coefficient of thermal expansion (see Table Q. When designing Central BlazeMaster sprinlder systems, expansion of long runs must be considered if temperature variations will be encountered (ie; summer to winter extremes). : Methods of compensating for thermal expansion are; expansion loops, offsets and change of direction of the pipe run. (See Figure G for exam- ples of control methods.) The expansion loops and offset tables are shown below. If the change in temperature and the mcnamum* working temperature are lower than those used to derive the tables, the numbers will be conser- vative in nature. For example, for a temperature change from 60'F to 125'F use Table F because the maximum tem- perature is greater than those shown in Tables U and E. For conditions which are not covered in the Loop Length Tables, use the formulas and examples found in Table H. Note: Table based on Stress and Modulus of Elasticity at 1007. Refer to Table B on page 4. AT = 70T S =1560 psi E = 3.85 x 10' psi 4 r�. Table D � Loop Length (30°F to IDO'F) AT= 70°F Sam. Pipe Size Ate' O.D. 10 20_ 30 40 Lenplh al Run (it.) 50 60 70 80 90 100 120 140 160 Length of Loop (In.) Y 1.050 11 15 18 21 24 26 28 30 32 33 37 39 42 -V 1.315 12 17 2D 24 26 29 31 33 35 37 41 44 47 1T 1.660 13 19 23 26 30 32 35 37 40 42 46 50 53 1K' 1.900 14 20 25 28 32 35 38 40 43 45 49 53 57 2' 2.375 16 22 27 32 35 39 42 45 48 50 55 59 63_ 2Y' 2.875 18 25 30 35 39 43 46 49 52 55 60 65 3' 3.50D 19 27 33 38 43 47 51 54 58 61 61 72 _70 77 4 r�. Table F e Loop Length (70'F to 150'F)AT = t10'F Pipe Size Nom. A°0' 0.0. Table E e Loop Length (GOT to 120TI AT= 60°F 20 30 40 Nom. Pipe Size Avg O.0. 10 20 30 40 Length of Run (ft.) 50 60 70 Length of Loop (fn.) 80 90 100 120 140 160_ 3" 1.050 10 15 18 21 23 25 27 29 31 33 36 39 41� 1' 1.315 11 18 20 23 26 28 31 33 35 37 40 43 46 1Y' 1.660 13 18 22 26 29 32 34 37 39 41 45 49 52 11S 1.900 14 20 24 28 31 34 37 39 42 44 48 .52 56 2' 2.375 15 22 27 31 35 38 41 44 47 49 54 58 62 2%* 2.875 17 24 30 . 34 38 42 45 49 51 54 59 64 69- 3' 3.500 19 27 33 38 42. 46 50 54 57 60 66 71 76 Table F e Loop Length (70'F to 150'F)AT = t10'F Pipe Size Nom. A°0' 0.0. 10 20 30 40 Length of Run (u.) 56 60 70 Length of Loop (in.) 80 90 100 120 140 160 V 1.050 14 19 23 27 30 33 36 38 40 43 47 50 54 ; 1.315 15 21 26 30 34 37 40 43 45 48 52 56 60 1W 1.660 17 24 29 34 • 38 41 45 48 51 53 59 63 68 1W 1.900 18 26 31 36 40 44 48 51 54 57 63 68 72 2' 2.375 20 29 35 41 45 50 53 57 61 64 70 76 81 2W 2.875 22 31 39 45 50 55 59 63 67 70 77 83 89 3' 3.500 25 35 43 49 55 60 65 69 74 78 85 92 98 Loop Onset change of Direction ,w N �lnikll� Long Pun of Pipe . - Wenger w aufd . aeeuew Figure G • Expansion Loop and Offset Configurations Table H • Modulus of Elasticity & Stress vs Temperature Temperature T 73' 80' 90' 100' 110' 120' 140' 150' Modulus of Elasticity 4.23 4.14. 3.99 3.85 3.70 3.55 3.23 3.08 "E" x 101 (psi) Working Stress 2,000 1,875 1,715 1,560 1,415 1,275 1,000 875 "S" (psi) Note: Table based on Stress and Modulus of Elasticity at 120T Refer to Table H. AT = 60'F S = 1275 psi E= 3.55 x 10' psi Note: Table based on Stress and Modulus of Elasticity a 150T Refer to Table H. AT = 80'F S = 875 psi E = 3.08 x 10` psi Hangers should only be placed in the loop, offset or change of direction as indicated. Piping supports should restrict lateral movement and shall direct arif movement into the expansion loop. .The Expansion Loop Formula has, the following com• ponents as shown below: F= Length of Expansion Loop in Inches E = Modulus of Elasticity at 1007 (Table H below) D = Average O.D. of Pipe AL = Change in Length of Pipe Due to Change in Temperature S = Working Stress at 1007 (Table H below) The Modulus of Elasticity & Stress vs Temperature table 1 will need to be used to find "E" in the Expansion Loop Formula. An example is presented to demonstrate the cc culation of expansion given a defined thermal change and to calculate the length of the expansion loop or off se in inches. Example . How much expansion can be expected in a 240 foot run of 2" Central &a`eMasier CPUC pipe installed in 40T given a maximum temperaiure change to 100'F? Additionally, how long should the expansion loop be to compensate for this expansion? . First, find the temperature change expressed as AT. AT=100'F— 40'F AT = 60T Now use Table C to calculate the change in length expressed as AL Since the run is 240 feet and the table is inclusive to only 160 feet, two cal- culations will need to be made. Length of run =160 feet with AT = 60'F From Table C, AL = 3.92 in 2 Support and Hanger Recommendations* KdY.F,7lSwia � � erd :-_Y;.".":.i•�i�eiy.L •.�_-.:�.:.c.: •... �� � ... 600 5 ;4=t,'ni}ar,�•,....,�.�aj.��p:-.iii.' ..i:.: ...5n=3.� ,TM:� Model No. 22 (shown) Model No. 23 (shown) Some.hangers designed for metal pipe are suitable for CPUC pipe. The hanger shall not have rough or sharp edges which can come in contact with the pipe. Do not use under sized hangers. Hangers with sufficient sizing shall be selected based on pipe size (ie; 1.-C hangers for IC pipe). Pipe hangers must comply with the appropriate Standard, NFPA 13, 13D, or 13R, whichever applies. Some local codes may not allow plastic to metal contact. In this case, plastic sleeves or vir electrical tape should be used to isolate the materials. Strapping pipe overly tight to a stn lural member can cause damage to the pipe when pressurized. Please ensure the pipe is held snug by the hanger, but is not pinched or crushed in any way. PLUMBERS TAPE OR I HOOKS ARE NOT RECOMMENDED WITHOUT SHIELDING FOR ROUGH EDGES IN NFPA 13D APPLICATIONS. Pipe Bracing with Standard Band Hanger" - . Tolco, Inc. and Alcon make three hanger/restraining devices that are available for use w: Central B1azeMasler. The Tolco Model No. 22, shown left, or Afcon Model 513 can function as a hanger and as c restraining device. As a restraining device, invert the hanger so that the fastener is down ward. Installation in this manner will prevent upward movement of the sprinkler head dI: ing activation. The Tolco Model No. 23, as shown left, or Afcon Model 510 can function as a hanger and a restraining strap. Both products incorporate features which protect the pipe and ease installation. The hex head self -threading screw (furnished with the product) is easily installed using a recharg able electric drill and a %-" socket attachment. No predrilling of a pilot hole is required. Both Tolco Models 22 and 23 and Afcon Models 513 and 510 were designed and tested for CPVC plastic pipe only and are UL Listed for this appli cation. The Tolco Models 22 and 23, and Afcon Models 513 and 510 satisfy both support and vertical restraint criteria. For more information abou Tolco or Afcon products, consult the Central Sprinkler Company. Table L " Support Spacing "L" (ft.) CPVC SDR 13.5 Tem F Nominal Pipe Size P " %" 1" 1Y" 1 1%" 1 2" 73' 5% 6 6l4 7 8 9 10 Vertical Restraint Table M • Support Spacing Distance with an In Line Sprinkler Head Drop Tee Nominal Pipe Size Less than 100 psi (690 kPa) Greater than 100 psi (690 kPa) Y inch 4' 3' 1 inch 5' 4' I Y,, inch 6' S' 1 � inch 7' 7' >1 i inch 7' 7' 'Local codes have final authority on Much types of hangers can be used. Hanger/Support Spacing Because Central B1azeMaster pipe is more rigid than other types of plastic systems, the support spacing shown in Table L shall be adhered to when installing the system. For exposed installations, Listed support devices shall be used which mount the B1azeMaster piping directly to the ceiling or side wall. When a sprinkler head activates, a significant reactive force is exerted on ih pipe, especially at system pressures greater than 100 psi. The reactive force will cause the pipe to lift vertically if it is not properly secured, especially if tl sprinkler drop is from a small diameter pipe. When a sprinkler drop is from ar.",1" or 1 X" pipe, the closest hanger should brace the pipe against vertical lift -up. A number of techniques can be used i brace the pipe such as a standard band hanger positioning the threaded su port rod to A inch above the pipe or using a split ring or a wrap-around han er for restraint. Note: Threaded rod should not conte in contact with CPVC when installed. 1 advisable to use lift restraint devices such as the Tolco Model number which prevents the threaded rod from coming in contact with the CPV pipe as shown to the left. Branch lines shall be braced at a distance from a tee or elbow to prevent lift of sprinklers as shown in Tables N and F. 0 . a 6 Vdhen piping is suspended from a deck, hangers are raquired to suspend the pipe as well as for vertical lift -_ straint. One support can serve as both. Drop locations b:tween supports are acceptable in any location as lona as st;pport spacing is in compliance with Table M. Examples of '-here this type of hanging is used include: concrete decks ,.:th rod and ring hangers, "pan decks" on I beams with C - :%amps, or concrete anchors, and under wood joists with s - aps or rod hangers. See Figure 0. I ayurr r, Olae view When the piping is supported by wood joists or trusses, the structure provides the support, especially 'when the joists are close together. The only requirement . v,lth this type of construction is to provide vertical restraint and hangers are not required. When supporting C?VC piping below the deck, and when the supporting members are spaced far apart, it is important to brace for upward restraint per Tables M and N. Drop location between supports are acceptable in any location as long as support spacing is in compliance `Nrith Tables M and N. Table H • Support Spacing to an End Line Sprinkler Head Drop Elbow Nominal Pipe Size Less than 100 psi (690 kPa) Greater than 100 psi (690 Val A uir;n 9' s. 1 inch 110, 9. 1G inch 114' 1' 1Y inch 2' 1 >1Y, inch 2' 1' Ma)dmum Table M A � B BarJoist (Reference Table M)' `�� (Ret. Table Ni' Any distance -� between sumorts Finished Ceiling Une • •v- w - mps A6, as sirup ripe naiacenr io t russ Wood France Construction in manufactured homes, additional hangers may be required to prevent pipe movement from thermal expansion. Please consult with your Authority Having Jurisdiction and Central's Technical Services Department for further clarification 7, r'C pipe or fitting must be supported near a spriniaer head as shown in Tables Id and K �4C �� ri 4 vov PEACH TREE DEVELOPMENT, LLC Town of North Andover �o+ au Building Permit 7/16/2004 1604 5,220.00 Cash Danvers 5,220.00 Date ai7-..�. z. If '.41 ...... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ........................ ...... . had permission to perform .,:� ....... I" ................................................................. wiring in the building of .... ................................................................. ') .. ........ . 7 at ....... ............... . N rth Andover, Mass. Fee..(-!—�k ......... Lic. No . ........... Check # / q911 5432 .......................................... I. ELECTRICAL ;4 61 6/ 1i THECOMMONWEUTHOFNLASSICHUSETIS Office Use only DEPAmfEN1'OFPm&s4FElY permit No. B0 ARD0 FFIREPREVEM701RFX>�I[11TIONS527C11212iAO y Occupancy & Fees Checked APPLICATTONFOR PERMIT O PERFORM ELECTRICAL WORK ALL WORK TO BE PERFORMED IN ACCORDANCE THE MASSACHUSSTS ELECTRICAL CODE, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORMA ON) Date U 3 Town of North Andover To the Inspector Aires: The undersigned applies for a permit to perform the el�ctiical work described Location (Street & Number) Owner or Tenant Owner's Address chin& C07 - 0'W Is this permit in conjunction with a building permit: Yes ED No (Check Appropriate Box) # / ,? Y O Purpose of Building 's, Utility Authorization No. Existing Service AmpsVolts Overhead Underground -® No. of Meters New Service �- AmpsI-fjVolts Overhead Underground ® No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work UUd L(7rM,4 C- 17) C OOH No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round 171 ground rl No. of Receptacle Outlets No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones No. of Ranges No. of Air Cond. Total Tons No. of Detection and No. of Disposals No. of Heat Total Total Pumps Tons KW Initiating Devices No. of Sounding Devices No. of Dishwashers Space Area Heating KW t No. of Self Contained Detection/Sounding Devices Local a Municipal Other No. of Dryers Heating Devices KW Connections a No. of Water Heaters KW No. of No. of Signs Bailasis No. Hydro Massage Tubs No. of Motors Total HP OTHER- ka==CoverdW- Pasuattlothetagl>i<aroaotl mmCcriaW aws ItmeaomertLiabhyhmmoeFb ymcixlrgCm4Aet CvvaageordsmbMWepvaiat YES NO ID IhavesubtndtadvafidpoofofswwiD he0lfim YES rid ff)mbawdnicedYS plewnic*drtypeofamWby NSU" BOND GRIM �—(P�*e ) ff-4 GEginfiDai Etmamdvakleot�7acttical Wcik $ Wtxi<roStat 0 )tWearOr,17I2egt>esmd Rough 0 30 Fuld RRMNAME / / �/% Licereee lnic-166% / � ?q—)y SigIVuIe( Limm No. _ M6 /a rl Lioawillb BushsTe<No. t i -).eV->CCA 51-> 1f1Q1'`L1<(y /V//A O I?r Y y AItTUNa OWNER'SINSURANCEWAIVfl;IamawaedrattheLioanedoesmthavetheirlaaarleecoverageorilsalbAalWetlilivalatasregl WbyNlassachisftCellaallaws a rtdthatmysigrla mcnthispeniaappkatimwaM* thisreglmanat. (Please check one) Owner Agent M Q �- Telephone No. PERMIT FEE signature of Owner or Agent Date ..... \............................. NORTF� °�t"'° :•�"� TOWN OF NORTH ANDOVER jifimftp PERMIT FOR WIRING �SSACHusE� This certifies that .......... ........ ...�...............<....................................................... has permission to perform J iilding of .�' ................. wiring in the bi�� fC /} j....v....^............. --:�- North Andover, Mass. Fee.. l:�.......... Lic. No./ � .......................................................... �� i� Zl ELECTRICAL INSPECTOR Check # 5439 . Commonwealth of Massachusetts Official Use Only pw $1 Permit No. wm Department of Fire Seres Occupancy and Fee Checked BOARD OF FIRE PREVENTIO/IT GULATIONS [Rev. 11/99] leave blank APPLICATION FOR PERO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC) 52 R 1 00 (PLEASE PRINT IN INK O P AL #FA TION) Date:City or Town of: e To the Inspecto of ires:By this application the undersigned gives n ' lher tnten4n to perform the electrical work described below. Location (Street & Owner or Tenant Owner's Address Is this permit in conjunction with 4. building permit? Yes . ❑ No Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone N (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Completion of the following table may be waived by the Insnertor nfWirec No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- E:1o. rnd. rnd. o mergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers . p Heat Pump Totals: Number Tons KW No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ElOther Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW Heaters No. of No. of I Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total I?P Telecommunications Wiring: No. of Devices or Equivalent OTHER: 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 the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify) � (Expiration Date) Estimated Value lectrical W rk:6av-11 (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion. I certify, under th pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: ces LIC. NO.: L6 q qC Licensee: John S. Bassett Signature LIC. NO.: 1533C (If applicable, enter "exempt" in the license number line.) Bus. Tel. No.• 603'S94 5928 Address: Alt. Tel. No.: OWNER'S INSURANCE WAIVER: I am aware that the Li see does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE: $ No Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that.... e.10.4 .... / 41.? ............................ has permission to perform ...............'(•4t1...... S, .................. wiring in the building of .......... /. (' C- .......................... 14 at ..... An ......................... ..... . .......... North Andover Mad. Fee ... .. .. Lic. No/M ............... .... .. ........... 17-,� 'o-�� ELECTRICAL INSPECTOR Check it 5247 i THE COMMOA WEALTHOFMASSACHUSETTS DEPARTMEN7'0FPUBLICS4 Y BOAROOFFIREPRLVEMONREGUTA7YONS527C P? APPLICATIONFOR PERMIT TO PERFORM EL ALL WORK TO BE PERFORMED IN ACCORDANCE WITH THE MASSACHUSSTS ELECTRICAL (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street &Number) L� may llpea- Alre6 Owner or Tenant Owner's Address a,!> I S u- 4-o t3 S•i, 0. A000kAeC Office Use only No. & Fees Checked WCAL WORK 527 CMR 12:00 4 a � 6 v Date / To the Inspector of Wires: Is this permit in conjunction with a building permit: Yes ® No r7 (Check Appropriate Box) (,/ Q Purpose of Building � (/..) Utility Authorization No. 1 Existing r ervice Amps / Volts Overhead Underground No. of Meters New Service4 0 Amps (a6 / ®Volts Overhead Underground ® No. of Meters NumberVf Feeders and Ampacity Location and Nature of Proposed Electrical No. of Lighting Outlets No. of Hot Tubs No. of Transformers Total KVA No. of Lighting Fixtures Swimming Pool Above Below Generators KVA round round No. of Receptacle Outlets No. of Oil Bumers No. of Emergency Lighting Battery Units No. of Switch Outlets No. of Gas Burners No. of Ranges No. of Air Cond. Total FIRE ALARMS No. of Zones Tons No. of Disposals No. of Heat Total Total No. of Detection and I Pumps Tons KW Initiating Devices No. of Dishwashers Space Area Heating KW Ny, of Sounding Devices No of Self Contained Detection/Sounding Devices No. of Dryers Heating Devices KW Local Municipal Other Connections No. of Water Heaters KW I No. of No. of No. Hydro Massage Tubs of Motors Total HP h>StnM=Covaage. PutstlanttothereqttitEnlerltsofMmwhjseMGeDeIWLaws thave aam ALiabllityhmum=PohcyiwkKhngComplei Cowworifssubswitialegrmlalt YES NO 1hav akmftdvaMp=fofsarWtothe0fflM YES IfyouhawchcdodYES, pkagaindic&thetypeof vetageby ircidngtheapp INSURANCE L J BOND OITIER F-1 (Please Spa*)AM d ll Pvrmatil- I V R %a � EsUlnl Vakle ofFlectdcal Walk $ °ugh fir/Fmal r LioenseNo. LicffWNO N, (, BusinessTelNo. 97? Ya3 9638 6dt krHTF-,R (—IFI c� 7� �r Le'/ rTy�-� ro 7 `l A]tTel.No. )WNER' S INSURANCE WAIVER; I am aware that the Lim does not have the insurance coverage or ifs substantial egtm-alalt as required by Massachusetts General Laws xl that my signaftm on this pemrit application waives this rg memalt ?lease check one) Owner ® Agent Telephone No. PERJMlT FEE $ ]gna ure o caner or gen The Commonwealth of Massachusetts Department of Industrial Accidents Office of investigations Boston. Mass. 02111 Workers' Compensation insurance Affidavit Name Please Print Name: Location: City Phone # F7 I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity y S I am an employer providing workers' compensation for my employees working on this job. Companv name: Address City: Phone #: Insurance. Co. Policv # Company name: Address City: Phone #: Insurance Co. Policv # Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment -as well_as_civil.penaltiesinThe form. iofA-STOP WORK.ORDER..and_a.fine_of.(.$1Do..OD)-day-against.me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature Date Print name Phone # Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing ❑Check d immediate response is required Contact Building Dept p Licensing Board r-1 Selectman's Office I] Health Department r-, Other Peachtre 'FA M To: Robert Nicetta Building Commissioner Town of North Andover 27 Charles St North Andover, MA 01845 From: John Crawford Peachtree Development, llc 231 Sutton St North Andover, MA 01845 Subject: Construction Supervisor Change Dear Mr. Nicetta, This letter is to inform you that Michael Mammola will be our on site construction supervisor for all lots at the Peachtree farm subdivision. He has assumed the duties from Mark Venti, as supervisor, on all houses under construction including all active permits, which he is the supervisor of record. This includes 16, 441 65, 71, 81, 105, and 124, Peachtree Lane, 12, 20, 26, and 32 Lavender Circle. Enclosed is a copy of his construction supervisor's license. Thank you for your help in this matter, John Crawford Peachtree Development, llc CC: Brian Darcy Mike Mammola Thomas Laudani Peachtree Development, LLC P.O. Box 907 • North Andover, MA 01845 • 978.327.6540 Fax/ 978.327.6544 • www.Peachtreefarm.net x 1 7ize i�o�rvrsto�zu�eci a�,/�iaaauciu�aeka BOARD OF BUILDING REGULATIONS, License: CONSTRUCTION SUPERVISOR Number` CS 088997 Bir.t#da%..A9./0 /1969 Ezni es `OgL09/2'007 Tr. no: 88997 MICHAEL V MA 7 SENECA ST METHUEN, MA 34 Commissioner // � Date.................................. TOWN OF NORTH ANDOVER This certifies that ................... has permission to perform PERMIT FOR WIRING ....................... wiring in thefuilding of. Z2 4:n A. at, A'- North Ando Fee.'Z/'�;)' to ......... Lic. No. Zgw ...... :4 /— ELECTRICAL INSPEcroR Check # 5449 Commonwealth of Massachusetts/ otficiall Use Only Permit No. b Department of Fire Services Occupancy and Fee Checked � l BOARD OF FIRE PREVENTION REGULATIO S [Rev. 11/991 leave blank APPLICATION FOR PERMIT TO PE ORM ELECTRICAL WORK All work to be performed in accordance with the assac usetts Electrical Co� yyyEC), 527 CMR 12.00 (PLEASE PRINT IN INK PE INF RNIATIO) Date: // 6) Q — City or Town of: To the Inspector of Wires: By this application the undersigned_gives notice of his or her intention to peform the elp,'ctrical work described below. Location (Street & Nu her) Owner or Tenant Z' Owner's Address Is this permit in conjunction with a building permit? Purpose of Building Existing Service Amps / Volts New Service Amps / Volts Number of Feeders and Ampacity Telephone No. :.Yes.. ❑ No (Check Appropriate Box) Utility Authorization No. Overhead ❑ Undgrd ❑ No. of Meters Overhead ❑ Undgrd ❑ No. of Meters Location and Nature of Proposed Electrical Work: Installation of Security system Com letion of the fbllowin table maybe waived hv the Ins ector of Wires No. of Recessed Fixtures No. of Ceil.-Susp. (Paddle) Fans No. of Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑ In- ❑ i o. o Emergency Lighting rnd. rnd. Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o Detection and o. Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices b No. of Waste Disposers ..__ ; Heat Pump Number Tons KW No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers.. Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances 1; pp KW Security Systems: No. of Devices or E uivalen No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: 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 the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) (Expiration Date) Estimated Value of Electrical Work: (� (When required by municipal policy.) Work to Start: Inspections 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: AnT Cor-it,i+v Corviroc 10 r14+r'in LIC.NO.: jriir Licensee: John S. Bassett Signature (If applicable, enter "exempt" in the license number line.) Address: I/ OWNER'S INSURANCE WAIVER: I am aware that the Licl9hsee does required by law. By my signature below, I hereby waive this requirement. Owner/Agent Signature Telephone No. LIC. NO.: 1533C Bus. Tel. No.: 603 594 5928 Alt. Tel. No. not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE: $ r C O 4J N I . c o m c 0 C r V f m C �, � Ea pISo o O ' .oc 41E { c •.• v✓ p� e�pp =c c N O O �Em ro •2`�• O avCM • J�• y0me m = o os 4.0 Q '9m �` � `moi • � � uZ `o ' o ` o cm C a e • y O C +O N mom~ O H to = m w LAJ C N dt W C O W .E �m�� aCIO �_ g e.00 c F- z 8a�m C [� z� Qz oz 0 � U - I R! :7 G C ICD CA C CA '� m 0 .FE m m JN IN �3CD zip% lo L o a ZE cmcc o C� O 'O C.3 M O O C Z � • Occ C.t� CI cc CO3 o o a olo a p. W ; s . t04 w v ,0 0 92 cn cn I . c o m c 0 C r V f m C �, � Ea pISo o O ' .oc 41E { c •.• v✓ p� e�pp =c c N O O �Em ro •2`�• O avCM • J�• y0me m = o os 4.0 Q '9m �` � `moi • � � uZ `o ' o ` o cm C a e • y O C +O N mom~ O H to = m w LAJ C N dt W C O W .E �m�� aCIO �_ g e.00 c F- z 8a�m C [� z� Qz oz 0 � U - I R! :7 G C ICD CA C CA '� m 0 .FE m m IECD �3CD zip% O cc L o a ZE cmcc o C� O 'O C.3 M O O C Z � • Occ C.t� CI cc CO3 0 LLI LLI cc oe W W W 0) 11/23/2004 17:19 9783276544 NORTH POINT REALTY PAGE 02/03 '.down of Nortb.Andover of N° roof q� Building Department 3? 4b`; °'•°c 27 Charles Street North Andover., Massachusetts 01845 (978) 688-9545 Fax (978) 688-9542 �MAYO CH APPLICATION I~OR CERTIFICATE OF OCCUPANCY ! INSPECTION ADDRESS a0 `,j=Aer C,cc-te UYr NUMBER �{, SUBDIVISION fC� lt. F DATE REQUEST FILED 11 t 1u I 0 q DATE READY FOR .INSPECrON .1. TEN (101 DAYS NOTICE PRIOR M CI..OSING DATE XS REOUM= ALL WORK AND SIGN-OFF'S MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE -INSPECTION• FEE OF TWENTY -FINE ($25.) DOLLARS WILL BE CHARGED IF TBE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. y OFFICAL USE ONLY ROUTmVC D.P.W. — WATER METER L�1/�.(� DATE __ t1h110g D.P.W. MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO THE INSPECTION REQUEST DATE. )640,Wax x SIGNATURE / DPW AUTHORIZATION s 1.1 Property Address:(t_o } 4a y 1.1 Assessors Map and Parcel Number: '90 l..o.ye-.1e, C'Z. S � \Pct�.� eee ram �� +�a� /+s eeco cdeJ 0.4 law,eyeuce Al O 9 yS Map Number Parcel Number De - Vr-+,ea vn a -- f � �V rOd 1.3 Zoning lnfomudim: 3,g(/(/s. . 1.4 PrgpeRy 1)imensioas 2-3 5 7 -ming lurid se IA Area r R 1.6 BUILDING SETBACKS ft Front Yard Sim Yard Rear Yard red Provide Pmvided Provided (z oro' 5I.a t.8' Saw�aDisposd 3yseam: Muni¢ d � On she D s Wd SYMM 0 L7 W ttor S�pfyM.al.Gd4. 34) 1.3. Piaod 7.ema ir�oanrtio¢a: ?Aon Outs Flood Z�oee pal I.7 Privuo 0 I SECTION 2 -PROPERTY OWNKRStUF/AUvlllUM_ LLV AVER A i 2.1 Owner of Record ke/j,ue,fk 12'eo, RegS'-1- gel. Awdatae, in A• o18yS Name (Print) Address for Service - T— 5ee A-c.L�.978) CO- )9/V 21 Owner of Record: Name Print SECT ON 3 - CONSTRUCTION SERVICES t 3.1 Licensed Construction Supervisor: Licensed Construction Supervisor. Ro VA�AA(e5y "bu2")M0, olsol Addy t-qo S%gnature Telephom 3.2 Registered Horn Improvement Contractor Company Name Address for Service: C5 osstil9 License Number 1046144�( Expiration Date Not Applicable 0 Reostration Number Expiration Date 4 SECTION 4 - WORKERS COMPENSATION (KC -L, C 152 § 25c(6) Workers Compensation Insurance affidavit must be complaW and submitted with this application. Failure to provide this affidavit will result in the denial of tho isauancc of the builk& rmit. Signed affidavit Attached Yes .. —,E No ....... 0 SECTION 5 Dticripamof Fto sed Work dredcstl New Construction kT Existing Building ❑ Repair(s) D Alterations(s) D Addition D Accessory Bldg. 0 Demolition 0 Other 0 Specify Brief Desaription of Proposed Work: CO AJ a 150�1le rhA1'lu /-AJZp I qw-rrnN rw _ uc'rnu ATRn rnntc'rr um. nN rmTs . I Item Estimated Cost (Dollar} to be t Completed by permit tcent "z I . Building (a) Building Permit Fee 0 Multiplier 2 Electrical (b) Estimated Total Cost of � p o Consttuction 4 & ocx�, 3 Plumb' Building Permit fee (•) x. (b) 1 4 Mechanical HVAC 5 Fire Protection LTK7 6 Total 1+2+3+4+5 «, Check Number SECTION 7a OWNER AUTHOk 17ATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT t/ L , as Owner/Authorized Agent of subject property Hereby authorize to act on My behalf, in all matters relative to work authorized by this building permit application. SECTION 7b OWNBR/AUTHORIZED AGENT DECLARATION b ,as Owner/Authorized Agent of subject preppy Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief 1-nnt Name Signature of Date BASEMENT OR SLAB SIZE OF FLOOR TI NIBERS I 2 3 SPAN DI1vIENSIONS OF SILLS DW NSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHDv[NEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE 0 0 DO Lave,�� C.'ecle Building Permit Check List Lot # —a '- Date (Q a9 o y ® 1 Building Penult Application completely tilled out a Signed by Construction Super t/ �d(z b Signed by Peachtree .Represenative CXX � c Square footage of house on permit✓ LZ 2 Form U signed off a DPW (check for sewer tic in) ✓ b Fire Department V/ c Planning Department t/ d Conserv4tion (check for Nvetland bond, where applicable) ✓ ® ) Growth Management Foran a4 Certified Plot Plan as built foundation plan required for construction permit a-5 Copy of Construction Supervisor's License 6 Workman's Comp Affidavit Q/7 2 Copies of Building plans include a copy of the sprinkler plans 7 N� a--8 Copy of the contract (if applicable) 9 Copy of the Mascheck (energy audit) ✓�10 Copy of the Form J F] 11 Check for Permit a Foundation Permit b Building Permit AAgeJ IIP M61-� NI AFFIDAVIT I, SCOTT L. MASSE, attorney for KENNETH W. REA do hereby depose and state: 1. 1 represent Kenneth W. Rea, owner of a certain parcel of land located on Rea Street, North Andover, MA and more specifically described in a plan of land recorded with the Essex North .Registry of Deeds as instrument/plan number 14502. 2. 1 am duly authorized by Kenneth W. Rea to act on his behalf regarding furtherance of the above stated instrument/plan. 3. Authorization is hereby given that Gerry -Lynn Darcy, and/or Peach Tree Development LLC be allowed to act as the agent for Kenneth W, Rea regarding any and all matters relative to a certain Building permit(s) issued by the Town of North Andover for any lots affiliated with the above stated plan. Signed under the pains and penalties of perjury this 14 day of J e 2003. SCOTT L. MA SE , . -1 ., r -, .... - I ., r , , . , - - ^ , , r r .. ... .. .... .. . . , ., .. O L -o4- a� O ao GROWTH MANAGEMENT BYLAW EXEMPTION STATEMENT TOWN OF NORTH ANDOVERBUILDING DEPARTMENT This form shall be used to assist the Building Department in their determination of exemption under section 8.7.6 of the Town of North Andover Growth Management Bylaw. The applicant shall provide all of the necessary information as requested below. Ytctnl?etJe60nCutch ��fd4l Permit Applicant Property address J Map / Parcel (y 78) t� 7-6s�v 0 Applicant's Phone Number Single Family Two Family I the undersigned applicant for the above property attest that the attached building permit for which this form is completed does comply with the EXEMPTION section 8.7.6 of the Growth Management Bylaw. I also understand providing this form does not absolve me or any party to this permit from the requirements of obtaining other permits required prior to the issuance of the building permit. Further I understand that my interpretation of the exemption status is subject to review, by the Building Department and is only officially accepted when the building permit, is issued. Based on section 8.7.6 of the North Andover Growth Bylaw the above lot and the work as applied for on the above lot, in thebuilding. permit application and associated attachments, complies with one or more of the following sections as indicated by a check mark- 'Ibis arkThis is an application,for a building permit for the enlargement, restoration or reconstruction of a dwelling in existence as ofthe:effective date of this bylaw; provided that no additional residential unit is created. The lot(s) was/ were created prior to May 6, 1996 and are exempt from the provisions of section 8.7 ofthe Zoning Bylaw. This application is for dwelling units for low and or moderate income familiesor individuals, where all of the conditions of 8.7.6 are met and or represents dwelling units for senior residents, where occupancy ofthe units is .restricted to senior citizens through a properly executed and recorded deed. restriction running with theland. For purposes ofthis, section ,`.`senior'.' shall mean. . persons over the age of 55. This application is partof a development project which.voluntaiily agreed to am -munum* % permanent reduction in density (buildable lots) below the"density permitted under. zoning An&feasible given the environmental conditions of the tract :with the surplus land equal to at least ten buildable acres and permanently designated as open space or farmland: The land to be preserved shall be protected from development by an-Agricuhural Preservation Restriction, Conservation Restriction, dedication to the Town, or other similar:mechanism approved by.the planning board that will ensure its protection. This application represents a trail of land existing and-notheld by a Developer in common ownership with an adjacent parcel on the effedive date of this. Section 8.7 and shall receive a onetime exemption from the Planned. Growth Rate and Development Scheduling provisions for thepurpose of constructing one single family dwelling unit'on the parcel. This, application represents a.lot which is ready fora building permit ( all other permits from all other boards and commissions have been received and the projectis in compliance with those permits), and the Development Schedule does not accommodate issuing a building permif in that year. One bdilding permit will be issued per year per Development until such time as the development schedule accommodates issuing building permits. Applicant must submit an approved FORM U with this ENF-MPTION. PLEASE PROVIDE ANY AND ALL. INFORMATION THAT WOULD ASSIST THE BUILDING DEPARTMENT IN MAKING A DETERMINATION THAT THIS.APPLICATION IS ALLOWED UNDER ONE OR MORE OF-,= ABOVE EXEMPTIONS. BY SIGNING BELOW I ATTEST TO THE ACCURACY OF. THE INFORMATION PROVIDED AND THAT THE ATTACHED BUILDING PERMIT IS ALLOWED AN EXEMPTION AS CITED ABOVE. FURTHER I UNDERSTAND THAT THE SUBMITTAL OF MISLEADING OR INACCURATB'INFORMATION OR THE CHECKING OFF OF A ABOVE EXE WHICH DOES NOT COMPLY, WHETHER_ DONE TO MY KNOWLEDGE OR NOT IS`G FUS BUILDING DEPARTMENT TO ISSUE A BUILDING PERMIT. DGa/_6y APPL S NA TFUS FORM TO BE A AC D TO THE BUILDING PERMIT APPLICATION 0 The Commonwealth of MassachZr�etts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Name vLLL ' Please Print Name: Location: City Phone # I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ® I am an employer providing workers' compensation ff ormy em ployeesworking on this job. (-mmnnnv nnmp• Pea6hf"-p I)PVY ofmt1/ Address City V ., tnd �`� 4 -i 1 "l U T Phone #: 5Lv Insurance. Co. �Y� 102 erg Policy # (2 (i3 '71ob &A 71/� 3 Company name: M664—A d sri)-f ItL/ l� f/P_.�'�2� j71� 1 f �J!E Address Jl t Con c-�? t- Cit}: Phone Insurance Co. ��rr'-7 / `"t u a Policy # W G 5-- 3 S-3 37 226 :--C.),3 Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of,a fine up to $1,500.00 and/or one years' imprisonment as_well.as_civ.ii.penaftiesinihetnrmof-a_STOP WORKORDER..and_afine.cf.(.$].DOM.).adayagainst.me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of pe, that the information provided above is true and correct. Signature C Date 1 6� Print name A�pt-an CC) t'1 Phone Official use only do not write in this area to be completed by city or town official' City or Town Permit/Licensing 0 Building Dept ❑Check if immediate response is required 0 Licensing Board F-1 Selectman's Office Contact person: Phone #: n Health Department I] Other 06/16/2003 14:59 197821517 WILLOWS 0 NOTICE OF ASSIGNMENT EMPLOYER: PEACHTREE DEVELOPMENT LLC COMBOI.D_ 231 SUTTON ST SUITE 2E -F 000139954 NORTH ANDOVER, MA 01845 COVERAGE GROUP 0139954 The Waiver of Our Right to Recover from Others Endorsement is available on Pool policies. Contact your agent for details. PAGE 02 STATUS OF EMPLOYER Limited Liability Coln Coverage under this assignment applies to Massachusetts operations only, For Coverage outside of Massachusetts, Contact the appropriate Pool or Plan for that state. AGENT wzLLows INS AGCY INC INSURANCE COMPANY: OR 522 CHICKERING RD TRAVELERS INDEMNITY CO PRODUCER: N ANDOVER, MA 01845 MS JACKIE DENNIS P 0 BOX 3556 ORLANDO, FL 32802 (800) 443-4404 AGENCY FEIN: 223 856664 CLASSIFICATION OF OPERATION - CLASS ESTIMATED RATE ZSTZMATED CODE TOTAL ANNUAL PREMIUM REMUNERATION -------------------------------------- --------------------------------------- RPENTRY-DETACHED PRIVATE RESIDENCES 5645 $0 10.62 $0 _tPENTRY-DWELLINGS-3 STORIES OR LESS 5651 $0 10.62 $0 EMPLOYERS LIABILITY 100/100/500 9845 LOSS CONSTANT 0032 $50 STANDARD PREMIUM $50 EXPENSE CONSTANT 0900 $122 TERRORISM CHARGE 9740 S0 RISK MINIMUM PREMIUM 0990 $500 ESTIMATED ANNUAL PREMIUM $500 DTA ASSESS, 4.5% OF STANDARD PREM. $17 EST. ANNUAL PREM. PLUS ASSESSMENT $517 INSTALLMENT BASIS: Annual REQUIRED DEPOSIT PREMIUM $517 COMMENTS Coverage effective 12:01 AM on 05/23/03 DATE OF NOTICE: 05 /24 /03 PREPARED BY: Joanne Shea EXT 530 * * SERVICING CARRIER ASSIGNMENT * * LETTER ID: 419982 COPY: AGENCY The Workers' Compensation Rating and Inspection Bureau of Massachusetts 101 Arch Street • Boston, MA 02110 (617)439-9030 • FAX (617)439-6055 • www.wcribma.org Q 0 FORNI J LOT RELEASE '. The undersigned, being a majority of the Plarining Board of the Town of North A»dover, Essex County, Massachusetts, hereby certify that: a. the requirements for the construction of ways and municipal services called for by the Performance Bond or Surety and dated and/or by the Covenant dated May 20, 2003 and recorded in the Districts Deeds, Book 7827, Page 143; or registered in Land Registry District as Document No. and noted on Certificate of Title No. in Registration Book Page ; has been completed/partially completed, to the satisfaction of the Planning Board to adequately serve the enumerated lots shown on Plan entitled "Definitive Subdivision and Special Permit Plan Peachtree Farm in North Andover Massachusetts" Plan dated October 24, 2002, last revised May 16 2003 recorded by the Essex North District Registry of Deeds, Plan No. 14502 or registered in said Land Registry District, Plan Book , and said lots are hereby released from the_.restrictions as to sale and building specified thereon. Lots designated on said Plan as follows: (Lot Number (s) and street (s)) Lots 1 — 9 and 20.— 28 inclusive Peachtree Lane and Lavender Circle b. (To be attested by a Registered Land Surveyor) Ui W 1 hereby certify that lot number (s) Lots I — 9 and 20 — 28 inclusive, on Peachtree Lane and Lavender Circle do confonn to layout as shown on Definitive Plan entitled "Definitive Subdivision and Special Permit Plan Peachtree Farm in North Andover, Massachusetts". Registered Land Surveyor c. The Town of North Andover, a municipal corporation situated in he County of Essex, Commonwealth of Massachusetts, acting by its duly organized Planning Board, holder of a Performance Bond or Surety dated 20 and/or Covenant dated May 20, 2003 from Big Kahuna Properties LLC of the City/Town of North Andover, Essex County, Massachusetts recorded with the Essex North District Registry of Deeds, Book 7827, Page 143, or registered in Land Registry District as Document No. and noted Certificate of Title No. in Registration Book Page acknowledges satisfaction of the terms thereof and hereby releases its right, title and interest in the lots designated on said plan as follows: Lots 1 — 9 and 20 — 29 inclusive EXECUTED as a sealed instrument this Majority of the Planning Board of the Town of North Andover COMMONWEALTH OF MASSACHUSETTS ESSEX, ss. November -A, 2003 Then personally appeared bth", rY.'�' , -one--o the above-named members of the Planning Board of the Town of North Andover, Massachusetts, and acknowledged the foregoing instrument to be the free act and deed of said Planning board, before me, 2 of 2 ;K()259892.11 Notary'Puljlic u l My C201 -emission Expires FROM O a �.o REScheck Compliance Certificate Massachusetts Energy Code REScheckSo[tware Version 3.5 Release Id Data filename: K:\Laudani\Peachtree\HouscD\housed.rck PROJECT TITLE: House "D" CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 01/21/04 DATE OF PLANS: 4-10-03 PROTECT DESCRIPTION: Peachtree Farm DESIGNER/CONTRACTOR- Peachtree Development LLc. COMPLIANCE: Passes Maximum UA — ,549 Your Home UA _ 548 0.2% Bcttcr Than Code (UA) Ceiling 1: Flat Ceiling or Scissor Truss Ceiling 2: Cathedral Ceiling (no attic) Skylight 1: Wood Framc:Double Pane with Low -E Wall 1: Wood Frame, 16" o.c. Window 1: Wood Frame:Double Pane with Low -E Door 1: Solid Door 2: Glass Floor 1: All -Wood Joist/Truss:Over Unconditioned Space Funtace 1: Forced Hot Air, 80 AFUE (WED)JAN 21 2004 6:23/ST. 6:18/No.6802897118 P 4 d Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -factor ILIA 1468 30.0 0.0 51 521 30.0 0.0 18 6 0.420 3 2998 11.0 0.0 229 323 0.320 103 42 0.180 8 62 0.340 21 2457 19.0 0.0 .115 COMPLTANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has bccn dmigncd to meet the Massachusetts Energy Code requirements in REScheckVersion 3.5 Release I (formerly MECehecl and to comply with the mandatory requirements listed in the RES checkInspection Checklist. The heating load for this building, and the cooling load if appropriate, has been determined using the applicabic Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 78OCMR 1310 and 14.4. FROM (WED)JAN 21 2004 6 /ST. 6:18/No.6802897118 P 5 0 Rnilder/Desig 0 0 ✓!� ��1,owl BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 055419 �+ Birthdate: 10/18/1965 _ ` = Expires: 1.0/18/2004 Tr. no: 3206 Restricted: 00 MARK J VENTI 90 MIDDLE STey WOBURN, MA 01801 Administrator TOWN OF NORTH ANDOVER L� APPLICATION FOR PLAN EXAMINATION Permit NO: _ I Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATIONZ0 LU Dl C-tp--cr1g PROPERTY OWNER F-HI44 i I MAP NO: PARCELPI '7 C OY-lw N tiU? K I u t Print ZONING DISTRICT: 100 Year Old Structure Historic District yes no yes no Residential Non- Residential Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �ne family ❑ Addition ❑ wo or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: L S ' Cc*JwA PoyV 10.1 Phone: �J 8 1878 ArlrIrPsc- CONTRACTOR Name: N9--UlN.4R-.Wzz � d-uS Phone: 41 -7 -36i -K2-31 t Address: 3S SPAM(-00- Supervisor's PA (-ANS Supervisor's Construction License: GS-bi `,BOSS- _ Exp. Date: _ 3 2 Home Improvement License: 1 ?`'f 14, Z- Exp. Date: U' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ �� FEE: $ Check No.: " I o� Receipt No.GL NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agerit/Ovvn Plans Submitted 11 Plans Waived 11 Certified Plot Plan ❑ Stamped Plans ❑ 0 _. l Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF. SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Ari ❑ . . 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 COMMENTS HEALTH ` COMMS"NTS Reviewed on Signature Reviewed on Signature r Zoning Board of Appeals: Variance, Petition No: *"Planning Board Decision: Comments Conservation Decision: Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Toiv;. Engineer: Signature: Located 384 Osgood Street FIREDEPARTM :Nt =Temp Dumpster on site yes no Located at 124 Mair; Street Fire Department signature/date'' COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The folio. wing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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 apot-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application Doc: Doc.Bui?ding permit Revised 2012 The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orgmizatiordlndividual): � t P ceu W �0 V) J ` Address: 3S SfPCULt1iU4 ST, X1 '[1 • (tetA _ OZ I Y -g City/State/Zip: R Phone #: Are ,yyoou an employer? Check the appropriate box: 1. 1 am a employer with I� 4. ❑ I am a general contractor and I employees (full and/or part-time.),* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ 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 a're 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. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name; Policy # or Self -ins. Lie. #: _ Expiration Date: Job Site Address: 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 requiredunder 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 cer-tto under the pains andpenaldes ofperjury that the information provided above is true and correct. Sim re: ` - �" �-�' Date: '7 17,3 I 11 Phone #: •`o U - 39_11- !9 Z31 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other - - Contact Person: Phone 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 employeils defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced -acceptable evidence of compliance with the insurance coverage required" Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "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. Anew 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: The Commonwealth of NiassachvsPtts Department of Industrial Accidents Office of Investigations 600 Washington. Street Boston, MA 02111 Tel, # 617-7274900 ext 406 or 1-877r,MASS.A.FE Revised 5-26-05 Fax 0 617-727-7749 www.mass.gov1dia �N O N O = O O D y � � c CO O =- 00 O O <D n m p Cl) CLC) z p O = 0 CL m �.=t S ca m CD F N S p 'a y COD Z cD ; „S ' _ 0 CQ n (C ._.r y O O doom v r CD C _ CD .a co CO o=� c o °, 3 a � CDn 0 0 < CaD c �jb _ 3 CD CD `` CD � r D on o :s IC) U3 T N O O �0 C �� T n :)D T LI) y � Cf CD y O C O O d C yCDto � of d O (D O 0 m > - (D Z m S � S CL 7 m S O O_ n O_ \ O N n O CD O n zy O C n D O Z: z 'O CL m mA r rn C as c rn ;a C CL- N �- W >cQ m D nrn 10 �' 0 M D O 10CD Z W C O -�-I� O ;urn A CL C :3 Z Cl) � C t0 D Z CD �' —i oCD o O rn CD m O c°m ca 9 -rz Nm CD _ C o m S• =3N m m CO CD Z —I NO W: C 0 CD 0 r v O � coz < 0 CD o O N O = O O D y � � c CO O =- 00 O O <D n m p Cl) CLC) z p O = 0 CL m �.=t S ca m CD F N S p 'a y COD Z cD ; „S ' _ 0 CQ n (C ._.r y O O doom v r CD C _ CD .a co CO o=� c o °, 3 a � CDn 0 0 < CaD c �jb _ 3 CD CD `` CD � r D on o :s U3 T N O O �0 C �� T n :)D T LI) y � Cf CD y O C O O d yCDto A of d O (D O 0 m > - (D Z m S � S CL 7 NLA co T A T N S T x T n :)D T LI) -n O C O d OC) of d O (D O m > - (D Z m S d S m S 7 m S O O_ n O_ \ CD O O n m mA C C W m D A F D cn X W O A Z D H r O m Nm m O m m m —I 0 0 :',ham 4 • y 0 4( 64 0 c JUL-23-2013 09:04 FROM: /i�r=1/lli�(l lig%(i� • , , 35 SPAULDING STREET* EVERETT, MA 02149 617-369-5234 Fax: 617-389-5652 TO:19786889542 P.3/3 Joe _ c"?"AS e 6vdwd 14dr , ye SHEETNO. OF CALCULATED BY DATE CHECKED BY SCALE ))s s DATE www.DeVincenzoAndSons.com ; I7: 1 `f� r • • � � I I �� I I I ,� � i I f 1 ' _ _ — _ L. 1 � — __ _C7 I ••_—_.—_.—ice _.. - T — _ —...__'--__.—.—. ..,.%--r•�— I .. - _.....—...—�_.-...._o.+.r.d—J..... x..1...1 —•.__...—{,J i r I o—��.�... -- ......_....��-... T. i — — - I I � r i_ ... 1 Il"L i t i __ f b ^ I -�-t i• I i 1- -- - - ...�.-`� - __.._.......................... ..._.. r-- - - - t— i I _ i .. - - -__ �.1-.__ 1' r -. �._, . _.__.._M1,. I '_._._.— '- _� 1_.•.._. .. ... 7 _ I .......:. __ —._... ' . T!� I .. .. i .... _ f ` I 1� IT ¢I i -. --T - (� - - - �� -- -- - I _ I i I ; y i h I www.DeVincenzoAndSons.com JUL-23-2013 09:04 FROM: 35 SPAULDING STREET 6 EVERETI; MA 02149 617-389-5234 Fax: 617-389-5652 TO:19786889542 P.2/3 JOB MR/w SHEET NO. OF CALCULATED BY DATE CHECKED BY DATE SCALE Al 1.5 www.DeVincenzoAndSons.com -7 - L -t J4.1 L I- . . ....... . I i4 -f- - T 7 T1.7i I j t LA �d .. . . . ...... -T 7 7 i, �4 4 7' T _j il-"*14T'-' 777-7- I T . ....... . . . ...... 4 - -T i --±TT-q IV ..... .. .... . .... . ...... 14-1 i T. 7.1 7-7--, t --T 4 -- H4 L 1 4 4 T —T J. . . . .. . www.DeVincenzoAndSons.com L-23-2013 09:03 FROM: TO:19786889542 P.1/3 R� CERTIFICATE OF LIABILITY INSURANCE 6/10/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOEA THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement s - PROouCHR SOnaoOralo Insurance Agency, Inc. 83 Cambridge street P.O. Dox 1$02 Burlington MA 01803 lds►ro Apada N (781) 273-3200 F (7911279-0600 ,marc@bonaoorsoine.00m INSURERS AFFOROMSCOVRRAGO NAZCA INSURERA :Travelers Xndemn:Lty of A nejc�.ca 5666 INGURRr1 DEVINCENZO AND SONS, INC. SPALIMING STREET EVERETT MA 02149 IN5URER6:Trav01e7:r! Cao F. Sur of Illinic 9046 INSURER C :Travelers Indemnity Co. S6S8 IN URIN a INSURER 0: INSURER COVERAGES CERTIFICATE NUMBER:13/14 NNSTER REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, im TYPE OF INSURANCE POLICY NUMBER LI P UNITS A GENERAL 4.1ANUTY X COMMeRCIALOFNERALLIABILITY CLAIMS -MADE OCCUR -600-6C897971-T11a-12 2/14/2012 2/14/2013 EACH OCCURRENCE 11 1#000,000 $ 800,000 MED EXP (Any one reon f 5,000 PERSONAL A ADV INJURY E 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER. X POLICY PR LOC PRODUCTS • COMPIOP AGO E 2,000,000 = AUTOMOBILE X LIABILITYike ANY AUTO ALL OWNED SCHEDULED AUTOS X AUTOS HIRED AUTOS X NON-om 0 AUTOS -6C890144 -12 -SEL 2/14/2012 2/i4/2019 I I 11000,000 BODILY INJURY (Par parson) b 80DILY INJURY (PeretCldent) $ ift esgiognil 3 Medleal a menta S S 000 C X UMBRELLA LUIS BXCE28 LIAR OCCUR CLAIMS -MADE D-BCB37497-12-42 2/14/20).2 2/14/2033 EACH OCCURRENCE j 1,000,000 AGGREGATE S 1,000,000 DED I I RETENTION $ WORNERa COMPENSAnOH AND EMPLOYERS' LIABILITY ANY PROPRIQTOR/PARTNERMXECUTIVE YINfollow OFFICER/MEMBER EXCLu0E07 ❑ (Manasmry In NN) II e, deeanbe under SCRIPTEON OP OPORATIDN below NIA COrCitiaate ri] 7 direatly Xrom the Insurance Carrier. A v' I•I' E.L. EACH ACCIDENT a E,L. DISEASE - EA EMPLOYEE S E,L, DISEASE - POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Ausch ACORD 101, AddIdonal Remarks Schedule, If mom space to „ q„I,ad) Evi"noe Of ZneuranCm. rrVHIC Torn of North Andover Attn: Building Department 120 Marin Street North Andover, MA 0.845 25 (201alOS) SHOULD ANY OF TME ABOVE DESCRIBED POLICIES IDE CANCELLED BEFORE! THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPREEENTATrvE nonaoorso/TSS ®1 INR112517nlnnFt n4 Tka anno 1 noma anri Inns ars raniet»rart maria n1 ar'npn Massachusetts - Department of Public Safety Board of Building Regulations and Standarak Construction Supervisor. License: CS038055 DANTE DEVIN ENZ 'Y P 45 HIGH ST 1 3 EVERETT NSA 02149 y �O Expiration Commissioner 03/0212014 i Vfie,�panvnernzwecalG� o���ac�cc6eCl�,' Ofrice .of Consumer Affairs & Busibess Regulation.. FOME IMPROVEMENT CONTRACTOR r, ,&gistration: :;174162 TYpe: xpiration 1/2%2015 , Private Corporatic DEVINCENZO & SONS INC. D�NTE QEUINCEN2( a` 35 SPAULDING ST EVERETT, MA 02149, Undersecretary r registration valid for individul use only .License or before the expiration date. If found return t0ulation Office of Consumer Affairs and Business Reg i 10 Park Plaza - Suite 5170 Boston, MA Q2116 I' N ao Vt lid without signature GENERALCONTRACTORS PROPOSAL Proposal Submitted To: Name: Kris and Corina Hopkins Address: 20 Lavender Circle City: North Andover State:MA Zip: 01845 DeVincenzo and Sons, inc. hereby propose to furnish all material and labor for the complete installation of custom block bulkhead in garage: Saw cut existing concrete floor in garage as needed, all necessary excavation required, saw cutting a 40" wide opening in foundation. Furnish and install 8" block walls, 8" risers with 10" treads, finish treads with concrete, backfilling of unit with appropriate existing soils, remaining spoils to be removed from site and repairing floor with new concrete (Steps will be 120" from foundation wall). Install 36" width metal/fireproof door to code with metal frame. All material and workmanship is guaranteed to be as specified and the above work to be performed in accordance with all manufacturers' specifications and local building code regulations. Installation and material is guaranteed for (1) full year from date of installation against any defects arising from poor workmanship or product defects. All work described above to be completed in a workmanlike manner for the sum of: $6,875.00 with payments to be made as follows: $2,000.00 deposit to be mailed along with fully executed original Proposal and Proposal Addendum. $4,875.00 final payment due at time of completion with no holdbacks or retainages to be applied. Any alteration or deviation from above specifications involving extra costs, will be executed only upon written orders, and will become an extra charge over and above the original estimate. All agreements contingent upon accidents or delays beyond our control. Owner to carry all necessary insurance on above property. Workmen's compensation and public liability insurance on above work to be carried by DeVincenzo and Sons, Inc. Respectfully submitted by: Dante DeVincenzo Date: 6/19/2013 (Note: This proposal may be withdrawn by us if not accepted within 10 days) ACCEPTANCE OF PROPOSAL The above prices, specifications and conditions are satisfactory and are hereby accepted. DeVincenzo and Sons inc. is authorized to do the work as specified. Payments will be made as outlined above. Owners Signature: Dante DeVincenzo: 1� L____1, Date: 6/19/2013 (President) 35 SPAULDING STREET-E'VERETT, MA 02149 -(617) 389-5234 FAX (617) 389-5652 www.devincenzoancisons.com Location &D �/O G,' 4�.. (f //2- No. 11—No. 4- �? 13 5, - -� Date IMM -<C ,% Check #w 2 6 6b 2 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL W( $ Building Inspector