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Building Permit # 10/28/2015
BUILDING PERMIT TOWN OF NORTH .ANDOVER '- APPLICATION FOR PLAN EXAMINATION ®� Date Received Permit NO: �ss�crsusti� Date Issued: I� P RTANT: ApOlicant must complete all items on this awe 1 11 LOCATION �"t 01 Print PROPERTY OWNER Print PARCEL ' ZONING DISTRICT: - Historic District_ yes MAP,NU: Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building FrrOne family ❑ Industrial ❑Addition ❑Two or more family ❑ Commercial z-Alteration No. of units: ❑ Repair, replacement [IAssessory Bldg [i Others: ❑ Demolition ❑ Other ❑Floodplain El Wetlands ❑ Watershed District ❑Septic ❑Well ❑Water/Sewer L ,s ,� Identification Please Type or Print Clearly) � .�� OWNER: Name: �� ` '� Phone: Address: A - � ��- Phone: X69 �0 - CONTRACTOR Name: —==---- 77, Address, * , Supervisor's�GoExp. nstruction,License: �.. Date , ( 1 ` Exp. Date: 'Home Improvement License: . 4 � I ARCHITECT/ENGINEER Phone: Reg. e: Address: FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. l{A Total Project Cost: $ 1-1 CAP CD FEE: $ Check No.: Receipt No.: � NOTE: Person contracting with unregistered contractors do not have ce s o the uaranty fun Signature of Agent/Owner � n � n �i� Signature''of contracto FORTH Town of ndover ® .` OA ® b2o-2,bi Z h ver, Mass, Col, .. ], COC KICKE WICK A00A7ED s BOARD OF HEALTH Food/Kitchen P �ER.. MIT T D Septic System THIS CERTIFIES THAT U .q .........0ur'.�S . . �d,SS.o r........................... BUILDING INSPECTOR .... .......................... ��/ Foundation has permission to erect .......................... buildings on ...� ..ei..l�.....&. Ix�w... ............... Rough to be occupied as ......... ........ ................................'..: �T12C... .... .... chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. — ® PLUMBING INSPECTOR No rRough VIOLATION of the Zoning or Building Regulations Voids this Permit. �A Final PERMIT EXPIRESI 6 MONTHS ELECTRICAL INSPECTOR -3 UNLESS CONSTRUCTION §7A Rough Service ....................Y ...................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. t%®RT H own of Andover 0 vim No. ® "*4qq-_v W. ,T LANE h h ver, Mass, ' A� COC MIc"aw.,K �• '7ies RAT E D /.Pa\��5 U BOARD OF HEALTH PER MIT T LD Food/Kitchen Septic System THISCERTIFIES THAT ............. „A�S.�./.........�.C.t.jIL�S. ..................................................... BUILDING INSPECTOR IV.—Lo // / C— Foundation has permission to erect .......................... buildings on ...d. �l�.....�C.L.I.'�1.Irl�....r�.,�,,,,,,,,,,,,,,, to be occupied as ..... ....... .. .... s� '17r11'1t/ C, C.l��S®2G !�-P Rouen .......... . ..................... .....�.......f.�. ....... .... ..... Chimney V provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. �'? '* PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. `* -•., Rough Final PERMIT EXPIRES IN 6 MONTHS « ELECTRICAL INSPECTOR r UNLESS C A'S'TRUCTION OVA Rough Service .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupv Buildinz Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Total Basement Finishing a Blackdog Affiliate - i www.blackdogbasementfinishing.com 603-898-0868 603-818-9829 IT �l Red Roof Lane,Unit 1,Jim Matthieu Salem,NH 03079 r �(�� ABlackdo9 Affiliate A FAX:603-898-0821 �i2'c {�sr,eu'trl,it rtrrfi/ir CSFA-048847 j rr PROPOSAL DATE: 09/16/2015 EMAIL: Iswanson222@gmail.com - SUBMITTED TO: Lisa SwansonHOME: - - ADDRESS: 1476 Salem Street North Andover MA 01845 WORK: 781-710-6291 JOB LOCATION: 1476 Salem Street North Andover MA 01845 CELL: 781-710-6781 t System Features FAX: - --- -- - --- - -- - ----- ---- l EverLast Perimeter Wall System White �72 2'x 2'Lay In Florescent Light APPROX.INSTALLATION DATE: -- - I-- EverLast Partition Wall w/Metal Studs 141 Nevada Window 1 APPROX.COMPLETION DATE: I f ---- --- -- -- -- -- - (weather&materials permitting) EverLast Insulated Partition Wall System Hand Rail Wall Mounted Left 1 --- - --- -- ----- ---- EverLast Non Insulated Wall White 4 Open Mahogany Stair Railing-White I ZenWall lBasement to Beautiful Panels Structurral Permit&Electrical Permit Nt EverLast Wall Restoration Basement Rip-out up to 700 sq ft 6 Panel Primed Door Levers �- Dumpster 1 p C { --- - - Louvered Door Knobs Access Panel 1 j Bi-Fold Door Knobs LDecorative Post Surrounds j t Exterior Door Levers 1 Modify Existing Ductwork ] t i Prestige Ceiling 2'x 2' Electric Baseboard Heat 500 S.F. 1 Finished Linen Ceiling 2'x 2' SaniDry XP Air System O s Box-out Ducts/Girders FloodRin g �r I Painted Ceiling 1 580 FloodChek Hoses { EverLast Basement Window � UltraSump Battery Backup Pump Egress Window System -� Full Bathroom Package i }i SunHouse Basement Window Half Bathroom Package i EverLast Window Insert J Sewage Ejector Installation DETAILED DRAWING ATTACHED Base Electrical 1 1 ThermalDry Carpeted Flooring-Charcoal SERVICES NOT INCLUDED - - - — -- - Electrical Sub Panel 1 ThermalDry Tiled Flooring-Sandstones 1.Moving of Drains,Gas Lines or oil Line IOutlets Switches&Jacks 19 MillCreek Flooring-Mahogany 2.Painting or staining(Unless spe f (- - -- -- 3.Modifications to Heating Ducts or Security Systems(Unless Specihe f) I Electrical Smoke Alarms q Plain ThermalDry 4.Carpentry or Closet shelving 5.Waterproofing(Unless Specified) ,t Recessed Can Lights 12 - 6.Work required by Building Officials not listed herein -_ 7.Any items or work not specifically listed herein k, The basement wall and finishing system is not a basement waterproofing system.Water problems are the responsibility of the Buyer.Mold,mildew,and fungal growth can occur under certain conditions.While the materials used in the basement wall system are mold Total Contract Price $ 29995.30 1 P resistant,the Contractor cannot control the conditions under which they occur.There are no Deposit With Order 30 % 8998°59 I warranties against mold,mildew,and fungal growth by the Contractor or Manufacturer Payment on `fe o/ r rrr- r Ftl other than the Manufacturers warranties,if an -_ o $ f r J q y,provided with the products installed under I pay nt o - % $ i } I this Agreement.The majority of the components of this basement finishing system are t`S constructed from mold resistant materials to eliminate a large part of the food source that BalancMe on Substantial Completion o f:3 = promotes mold growth.This system is mold,water,stain,and fire resistant.Buyer hereby p '__ /o $�.,t _ , requests,and Contractor,an independently owned and operated dealer,agrees to install Total Amount of the products and perform the services at Buyer's a ss provided herein.Buyer agrees to Balance to be Financed $ y sign a completion certificate upon completion of th services and installation of the y produets.THE TERMS AND CONDITIONS ON T ATTACHED ADDENDUM ARE If financed,balance is payable in monthly installments of approximately y per month.Owner will pay said I f INCORPORATED HEREIN IN FULL.BY SIGNIN BELOW,BUYER AGREES TO THE amount plus such interest and credit service charge of lending institution payable directly to the lending institution loaning such TERMS AND CONDITIONS OUTLINED A OVE AND�N THE ATTACHED ADDENDUM monies to`Owner"and will execute a Retail installment TO THIS AGREEMENT. l obligation and any documents required by such lending institution j in connection with said loan. Authorized signature: f' L� Date ( U. j 1 attacAccehed Addendtance of rumoara sat sf �oe and are heaebeaccece p' �,specifications,terms and conditions,and Customer has received a copy of the X i? ry y ped by Buyer. Contractor is hereby "Basement Finishing Science"book. 1 authorized to do the wo k ass ecified herein.Payment will be made as outlined above. Customer is aware of the Terms and X I Conditions. � A SaniDry Basement Air system was X J I Signature X: ' recommended Date /�°/ii Customer is aware of warranty X IN ` Signature X: ( 0 t b atV,,�,1a Date ��L��— a' Fal Basement Finishing TERMS AND CONDITIONS `I Nil The attached terms and conditions are incorporated into this Agreement and will govern the relationship between the Parties. In the event of a F conflict with the following,the provisions on page one of this Agreement will govern. s i AGREEMENT-This is a contract to perform certain remodeling services and supply those products specified on page one of this Agreement. rT Buyer agrees to provide Contractor with reasonable access to the premises and the area in which the work will be performed,as well as other necessary services such as electricity,light,and water. 1 �7 ADDITIONAL WORK-Contractor agrees to furnish only the work and materials set forth herein and no other goods or services regardless of what may be indicated or provided for in Buyer's plans. In the event additional work is required to be performed,including,without limitation, E additional work(a)to comply with any building codes or other laws or regulations,(b)to remedy existing violations,(c)to provide for electrical service where existing service is inadequate or fails to comply with local electrical code,or(d)to comply with modifications in the building code, all such additional work shall be at Buyer7s sole cost and expense. PAYMENT FOR ADDITIONAL WORK-Buyer agrees that any work,labor,or materials supplied by Contractor not specified in this Agreement !s but requested by Buyer,will be paid for by Buyer at the completion thereof without waiting for any approval of any kind from any governmental bureau,agency,or authority. Buyer further represents that should additional work,service,or products not provided for by this Agreement specifically be required by any governmental bureau,agency,or authority,Contractor is not required to perform such work or service or supply 111 such products. Buyer shall promptly cause such work or service to be done or products supplied,and this circumstance shall not be a condition z �. precedent to Contractor being paid by Buyer. CHANGE ORDERS-Upon ordering materials,any change orders must be ap-proved by Contractor after verifying that such order can be changed with the appropriate manufacturer,if possible. All costs associated with any changes will be the responsibility of Buyer. PAYMENT UPON COMPLETION-Each of the persons signing this Agreement as Buyer agree(a)to pay the outstanding balance immediately upon completion of the aforesaid work(unless Bank Plan is elected by Buyer and approved by Contractor),(b)to be jointly and severally obligated and liable hereunder,and(c)to be bound by all of the terms,provisions,and conditions on this Agreement. Buyer further agrees that i this Agreement may not be cancelled except as specifically set forth herein."BUYER REPRESENTS TO HAVE READ AND RECEIVED A a DUPLICATE ORIGINAL OF THIS AGREEMENT AND TO BE THE AUTHORIZED AGENT OF ALL"BUYERS"OF THIS PROPERTY UPON WHICH THE WORK OR THE MATERIALS ARE TO BE SUPPLIED. MATERIALS AND LABOR-This Agreement is not indefinite,incomplete,or uncertain,and in fulfillment of the foregoing,Contractor SHALL USE j3 ONLY NEW MATERIALS AND FIXTURES(if specified),and perform this Agreement in a GOOD AND WORKMANLIKE MANNER. Buyer hereby gives full and sole discretion and authority to Contractor to decide and specify the quantity,type,quality,size,color,position,grade,and name of material,fixtures,and equipment to be used or installed and also as to the method or manner of installation of same, unless specifically provided for or otherwise stated herein. ADDITIONAL MATERIALS-Additional or optional materials are occasionally delivered to the job site in case required. These materials are the 11 sole property of the Contractor,and Contractor is under not obligation to use them,unless required in Contractor's sole discretion. i r PRODUCT WARRANTY-Contractor is not responsible for any defects in the products. (See Manufacturer's Warranty for product coverage.) �? FULL THREE YEAR LIMITED WARRANTY-In lieu of all other representations and warranties,expressed or implied,Contractor warrants to the l Buyer that the work performed and materials provided hereunder shall be free from defects for a period of 36 months from the date of installation j thereof.Contractor agrees to repair or replace,at the Contractor's sole discretion,any such defective work or materials on the condition that written notice of any claimed defect shall be sent by certified mail and received by Contractor within said 36 months. Contractor specifically ,` disclaims all other warranties,express or implied,including,without limitation,the warranty of merchantability and fitness for a particular purpose. 11 !j DAMAGE TO PREMISES-Contractor shall not be liable for any damage to the premises or to any articles of furniture,furnishings,or other r.� property unless caused by the gross negligence of the Contractor's employees,and Buyer assumes the risk of any such damage or loss. In the event of any claim for such damage or loss,Buyer shall not be permitted to offset said claim or any part thereof against any balance due under t this Agreement,it being understood that Contractor shall receive payment in full immediately upon completion of the work herein(unless financed),and that any such claim shall be handled as a separate matter. C EXISTING VIOLATIONS-Buyer represents and warrants that there are no existing violations of any building codes,ordinances,or statutes r pertaining to the premises,knowing that Contractor has not made an official search there for,and Contractor hereby relies on Buyer's representation and warranty.Buyer agrees to refrain from any work,act,or omission on Buyer's part that will or may constitute any such violation. i FINANCING-In the event Buyer elects and Contractor approves Bank Plan in lieu of cash payment upon completion of the work,Buyer shall, 2j upon request,promptly furnish all information necessary or deemed advisable by Contractor to secure loan financing for the work herein,and Buyer agrees to execute such additional agreements and instruments as may be required or appropriate to effect such extension of credit. Non-compliance will be deemed a breach of this Agreement,and Buyer agrees to pay the outstanding balance in full within 30 days or make rj other arrangements acceptable to Contractor in Contractor's sole discretion. SUBCONTRACTORS-Both Buyer and Contractor agree that Contractor has the right to subcontract all or any part of the work specified herein k to any contractor,firm,entity,person or persons,at the sole discretion of the Contractor. Therefore,it is not a breach of this Agreement nor a 'i1 defense to any action that Contractor is not a licensed plumber,heating contractor,architect,electrician,or other trades person. I f. �t t MUNICIPAL PERMITS,CERTIFICATES, BUILDING PERMITS,FEES-Due to normal delay by Municipal Departments,it is agreed that the issuance of a permit or certificate by any Municipal Department shall not constitute a valid reason for Buyer's failure to pay for the products t supplied and/or services rendered. Upon request by Buyer,Contrac-tor agrees to procure all permits as required to perform the work specified under this Aoreement. Buver aarees to orovide all cooperation necessary to obtain such permits.including.without limitation.sionino all EXISTING ELECTRICAL SERVICE-If the existing electrical service is inadequate to carry additional electrical work according to the applicable j electrical codes,then Buyer will install and pay for all additional charges necessary for any such additional work or electric service. PAINTING/DECORATING/CLOSET FINISH-No wood finishing,painting,or decorating shall be required to be done by Contractor unless specified on the first page of this Agreement. Interior closets do not include any shelving or closet rod. EXTERIOR LANDSCAPING-Any exterior work requiring alteration of landscaping does not include finish landscaping. Contractor will provide _ rough grading only. C"s i; BASEFLOORS-Buyer shall provide a proper base floor for laying any floor tiling provided for in this Agreement. 4 I^, INABILITY TO PERFORM-Performance of this Agreement on the part of Contractor,its successors and assigns and all subcontractors f engaged by it shall be subject to delay due to acts of God and other causes beyond the control of the Contractor,including,without limitation, strikes and other labor disturbances,fires,wars and civil insurrec-tion,inability to obtain materials or labor and orders by any government k agency,and Contractor shall not be liable therefore. Buyer's inability to qualify for or obtain financing,or other events resulting in delays in performance of this Agreement shall not constitute abandonment and are not included in calculating timeframes for performance by Contractor. `9 In the event Con-tractor determines that this Agreement cannot be performed as intended by the Parties due to unforeseen structural defects, unintentional errors by Contractors representative in calculating the project,pre-existing conditions at Buyer's property,or Buyer's inability to obtain financing,Contractor may cancel this Agreement within 30 days of its execution,notify Buyer of such cancellation in writing,and return all monies paid by the Buyer. is NOTICE OF COMPLETION-Time of completion is deemed to be NOT of the essence. j It RECISSION/CANCELLATION BY CONTRACTOR-Contractor reserves the right to rescind and/or cancel this sale without liability at any time prior to the actual commencement of the work specified herein,by providing written notice to Buyer by certified mail,return receipt requested. !-# tj BREACH OF AGREEMENT-Except as provided in the cancellation clause,Buyer shall have no right to cancel,prevent,or delay the work to be furnished by Contractor. Buyer agrees that in the event of any breach of this Agreement on Buyer's part,whether such breach be prior to a performance of this Agreement or at anytime after the signing hereof,Contractor may,at its option,receive,collect,and recover the sum equal to j 50 percent of the Total Contract Price on page one of this Agreement.The right to a trial by jury in any action wherein this Agreement may be !j involved,or be the basis of a suit,is hereby waived by Buyer. ARBITRATION-Any claim,dispute,or controversy(whether in agreement,regulatory,tort,or otherwise,whether preexisting,present or future and includingconstitutional,statutory,common-law,intentional tort and equitable claims arising out of or relating to this Agreement or the rY � � q ) 9 9 9 �j communications,negotiations,or representations preceding or subsequent to the date of the execution of this Agreement,the relationships a which result from this Agreement,or the validity,enforceability or scope of this arbitration provision or the entire Agreement shall be resolved, upon the election of the Parties,through binding arbitration pursuant to the provisions of the Federal Arbitration Act,9 U.S.C.§1 et.seq.(the FAA)and administered by the American Arbitration Association in accordance with its Arbitration Rules for Consumer Related Disputes and Consumer Due Process Protocol. If either Party have any questions concerning the arbitration organization or wish to obtain a copy of their rules and forms,they may call(800)778-7879. This election may be made at any time,regardless of whether a lawsuit has been filed,unless such a l f lawsuit has resulted in a judgment. Upon such an election,the Parties shall select an arbitrator from a panel of neutral arbitrators,all of whom are practicing attorneys with experience in and knowledge of the consumer credit industry. In the event that the Parties cannot agree on an arbitrator,the Parties will ask the American Arbitration Association to appoint one. If arbitration is chosen by any party with respect to a claim, r1 dispute or contro-versy,the Parties will not have the right to go to Court or to have a jury trial or to engage in pre-arbitration discovery,except as F may be provided for in the American Arbitration Association Rules.The arbitrator's decision will be final and binding.Other rights that either Party r' would have if they went to Court may also not be available in arbitration. SEPARABILITY-Should any clause,sentence,or part of this Agreement be declared to be illegal or against public policy,it shall not affect the enforceability of any other part of this Agreement. { i k J ENTIRE AGREEMENT-This Agreement,together with all limited lifetime warranties,Specifications,this Addendum,and all other accompanying i documents are incorporated herein by reference and set forth the entire Agreement between Buyer and Contractor. No representative of Contractor may make any promises or representations that alter the written terms of this Agreement. BUYER REPRESENTS AND CERTIFIES j THAT BUYER HAS READ EACH PART OF THIS AGREEMENT,THAT THIS AGREEMENT CONSTITUTES THE SOLE AND ENTIRE x AGREEMENT BETWEEN CONTRACTOR AND BUYER,AND NO MODIFICATIONS TO THIS AGREEMENT SHALL BE CLAIMED BY BUYER a NO PROVISION OF THIS AGREEMENT SHALL BE DEEMED TO HAVE BEEN WAIVED BY CONTRACTOR UNLESS SUCH WAIVER IS IN WRITING. BUYER AGREES THAT BUYER HAS HAD THE OPPORTUNITY TO REVIEW THIS AGREEMENT WITH AN ATTORNEY OF f BUYER'S CHOICE,AND BUYER IS SATISFIED WITH ALL OF THE TERMS AND CONDITIONS CONTAINE=D HEREIN. N REPRESENTATION-Buyer agrees that no other representations,promises,or understandings,oral or otherwise,have been made by i t Contractor to or relied upon by Buyer regarding this Agreement or the products and/or services supplied hereunder,and all agreements, } representations,promises,and understandings between the Parties are incorporated into this Agreement. r REPRESENTATION-Buyer agrees that no other representations,promises,or understandings,oral or otherwise,have been made by fi Contractor to or relied upon by Buyer regarding this Agreement or the products and/or services supplied hereunder,and all agreements, representations,promises,and understandings between the Parties are incorporated into this Agreement. a � �•I a tr � 7 A 'i _ i°FI���yr ` l I ���-tn,.•, ,s CVs t } ,t t �sG _. Y` I • • • • I / • l 1 • doIs • • / ", i I / i ii - ii/ i TSF & Basement Systems represents a better value.We include more features in our systems for your home that will improve your basement into the future.We look ahead and ask "What if this were to happen?" and build in a feature in our system to solve the problem before it ever becomes one.You may not realize all the benefits, but there are many features in our systems that are integral in improving your basement and keeping it that way. In addition to our unique approach to service,we are the ONLY company in the industry who thinks in this way regarding system design. As a result of our innovative thinking and product line, Basement Systems has received numerous awards for innovative design as well as customer service including: 7 TBF Finished Wall System Wins Innovation Award 2006 3 Silver Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership Voted "Top 10 Places to Work in CT" by employees 2005 1 Gold Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership 3 Silver Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership Web Site Marketing Award from the Connecticut Better Business Bureau 2 Superior Service Awards from the Connecticut Better Business Bureau 2004 Six Silver Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership 3 Superior Service Awards from the Connecticut Better Business Bureau 2003 Torch Award for Marketplace Ethics from the Connecticut Better Business Bureau Two Silver Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership 3 Superior Service Awards from the Connecticut Better Business Bureau 2002 Business/Consumer Education Award from the Connecticut Better Business Bureau Winner of the Connecticut Breakthrough Quality Award from the Connecticut Quality& Innovation Partnership Gold Innovation Prize from the Connecticut Quality & Innovation Partnership for FlexiSpan Wall Crack Repair Silver Quality and Innovation Awards from the Connecticut Quality& Innovation Partnership 11- ' otal BASEMENT �� Iinishing— Fireblocking - \\ Conve Tonally ' Fasten d Sglid r Crown. 4 VVl ryetal L-Channel Drywall Screws. y: j � ��� .ii ir•� ti's i C Metal Batten Sea - �'•''\.• ` N•:; Cover,and Vinyl ap •":: =%% :.: Metal Parcel Biscuit '•'�:�'#�:�:fJr '?;�;:�'' with!Arm :':;:f•' Fiberglass ,:;;:;•:>s::c.:" 2 Hour •� .,�;:.: �•,,. t Electril Boxes. •`"'�' •.••��```�. i/2"�e Rated - ca !'Sheeting ,...;,:::<s k Conventionally - i i. Fastened `.>` :�ii�°:�i� rk•• - ':� �i�>��`� aseboard s v� . r R-13lnsul6ted - >•:::;: ThermgIDry Flooring Wall Panel ,::•:;;:;::;:_:: :::: Drywall Screws Metal U-Channel `•i`' ?; Ifie simplicity licit of the TBF System For <lasonaryAnchor �< Basement Wall Fin,ii �® Total BASEMENT Finishing_ �ronc�Snirr2rrtto B�vj�,�Q/" *`a:arlf C r ;F i�r4Et! N �yyytJp i 1+i {u F ! ��ll�lf Y ri j n rr i f�, 1 y<<• J � O a•a,� I: u,,l 1, d rr.9 si+aE�fl�t'`*j,}it t , i 1 ISG'{ +,_ {��✓ciFi2ttPµ i /� i Ln 75 Fr3�Pkl��t� t �.1 �,f 191S�•.tln, r� f Ear�E' � } 1 y I X55 . I f � , r'rt..,,x"K 1'sYtt7Ytnff/t'e'"NTmlr rhrrml/ntt f>�'i7t°Y1�j"`6�)�iXff'77r°Jn�I�4"F'�y1"�,}�hd�M'`a�`"i { d F JS{ :{jL r` 11+ r 1 fllllll 7(9 it f (I+tf{r ti f`f N j U i cw ,Q CO Vi - m r i t PFS Corporation Assurance you can build on' ,An Employee-Owned Company PFS Test Report: #06-29 Test Date: 5/03/06 Headquarters Report Date: 5/12/06 2402 Daniels Street Page 1 of 2 Madison,WI 53718 Phone:608.221,3361 PFS TEST REPORT#0629 Fax: 608.223.5560 UL-1715 FIRE TEST OF Website INTERIOR FINISH MATERIAL www.pfscorporation.com FOR Michael J.Slifka,PE TOTAL.EASEMENT SOLUTIONS President PHILIPSBURG PENNSYLVANIA rnslifka@pfscorporation.com 9 James A.Rothman,PE GENERAL Vice President Senior Vice President,CC jrothman@pfscorporation.com On 5/03/06, PFS certified subcontractor National Gypsum Company, Buffalo, NY, conducted a room fire test in accordance with Test Method UL-1715,"Fire Test of Interior Finish Material"on materials supplied by the client and identified as being manufactured by Total Basement Solutions. The test specimen consisted of two 8-ft. x 8-ft. wall sections Regional offices evaluated together in a room corner burn test. Northeast Bloomsburg,PA 570.784.8396 SAMPLE DESCRIPTION South Central Dallas,Tx The 48-in.-wide-by-96-in.long,composite interior wall panel system,consisted of nominal 214.221.5585 V2-in. thick Mold Resistant Fiber Rock board with 6 mil., vinyl laminated to the exposed Western surface. Nominal 2-1/2-in thick extrudedof st rene closed cell foam insulation was Los Angeles,CA p y y 310.559.7287 adhered to the back of the fiber rock board. The composite resulted in a nominal 3-in.thick Midwest building unit to be utilized as a wall panel in the system developed by Total Basement Madison,WI SOIllt10IIS 608.221.3361 Southeast Raleigh,NC SUMMARY 919.845.8450 Sales office The test specimen utilizing the composite Interior Wall Panels manufactured b Total Mentone,AL p b p y 256.634.4071 Basement Solutions,described in the data presented and located in the attached report,and installed in the described application in this report, meets the acceptance criteria of test method UL-1715. Detailed results are available in the formal National Gypsum Company report (See attached). r s 1 z b 77 1 q. �T , � �� �• ' r� PFS Test Report # 06-29 UL-11 715 FIRE TEST E INTERIOR FINISH MATERIAL FOR TOTAL BASEMENT SOLUTIONS PHILIPSBURG PA PFS Corporation r 2402 Daniels St. E r:rdslt��,�rt�ti�4e, .Madison, WI 53718 A(xRF.»rrVV,0NSE-WR:t',INC TL-109 RCB-0605 5/3/2006 UL-1715 NC-C X-859 PFS/TOTAL BASEMENT SOLUTIONS Time(min) TC1 T02 TC3 TC4 TC5 TC6 TC7 TC8 TC9 -1.00 70 70 70 71 72 70 69 70 71 -0.75 70 69 71 70 71 69 69 70 70 -0.50 70 70 70 71 71 70 69 70 70 -0.25 70 70 71 71 71 70 69 70 70 0.00 70 69 70 71 71 70 69 70 70 0.25 80 74 81 78 75 80 69 73 70 0.50 87 78 91 86 80 88 70 78 72 0.75 97 87 104 97 87 98 71 86 73 1.00 117 103 134 122 100 117 73 97 74 1.25 162 136 194 175 128 171 75 125 84 1.50 233 188 277 247 175 242 81 169 104 1.75 304 257 376 315 223 329 90 233 137 2.00 366 357 501 397 278 375 97 279 185 2.25 412 495 611 463 320 418 102 324 200 2.50 456 627 716 527 361 457 112 356 241 2.75 504 766 821 600 408 505 120 397 278 3.00 552 915 929 668 462 537 130 426 298 3.25 577 1050 1042 749 513 559 138 453 320 3.50 591 1165 1176 873 578 615 146 490 335 3.75 615 1294 1293 1057 664 662 155 510 340 4.00 615 1336 1317 1149 757 680 158 525 345 4.25 626 1437 1436 1267 863 693 162 537 348 4.50 637 1460 1452 1298 948 687 165 544 338 4.75 615 1459 1358 1142 885 652 164 524 337 5.00 599 1462 1343 1087 850 662 163 524 338 5.25 606 1528 1392 1123 842 666 165 519 348 5.50 601 1545 1415 1151 871 673 169 527 360 5.75 608 1571 1427 1179 904 674 172 538 363 6.00 607 1601 1450 1217 928 670 176 531 354 6.25 593 1624 1456 1205 938 653 176 522 .349 6.50 615 1625 1451 1173 941 673 179 544 367 6.75 593 1657 1452 1166 930 669 185 545 369 7.00 591 1661 1454 1185 938 689 186 546 359 7.25 605 1653 1468 1205 955 675 186 539 374 7.50 606 1651 1438 1159 947 669 188 548 377 7.75 612 1673 1465 1193 964 676 190 543 377 8.00 613 1685 1486 1215 974 688 192 550 372 8.25 616 1699 1492 1229 990 676 192 539 368 8.50 626 1709 1523 1257 1017 695 195 562 369 8.75 620 1705 1502 1246 1020 683 198 556 372 9.00 622 1710 1494 1235 1028 714 198 566 369 9.25 621 1710 1500 1230 1044 710 201 565 392 9.50 626 1712 1504 1244 1061 717 210 577 391 9.75 620 1712 1490 1235 1052 723 212 573 38.4 10.00 626 1727 1521 1272 1076 739 207 585 405 10.25 621 1741 1525 1289 1081 706 207 562 389 10.50 622 1739 1528 1281 1099 735 207 582 397 10.75 633 1749 1542 1282 1096 725 207 582 394 11.00 632 1761 1579 1313 1118 737 209 580 385 11.25 637 1764 1591 1354 1151 730 211 579 376 11.50 632 1763 1591 1342 1177 767 218 595 385 11.75 649 1763 9593 1 51 1298 753 224 600 397 12.00 645 1769 1609 1372 1221 777 230 611 413 12.25 658 1776 1623 1389 1230 760 233 598 406 12.50 632 1775 1616 1370 1232 774 236 615 400 12.75 654 1783 1613 1359 1225 756 231 602 414 13.00 655 1781 1620 1357 1210 761 235 601 410 13.25 641 1778 1598 1340 1207 765 226 612 416 13.50 627 1754 1539 1271 1179 769 227 612 413 13.75 624 1753 1536 1247 1159 732 232 597 415 14.00 622 1761 1564 1285 1151 748 234 592 412 14.25 592 1747 1533 1245 1126 700 231 574 396 14.50 607 1727 1494 1210 1102 690 226 559 382 14.75 564 1687 1430 1150 1070 684 225 563 392 15.00 553 1671 1395 1104 1036 659 234 536 393 Total Basement Solutions Interior mail Panel Product Saecifications Overall Thickness: 3 Thickness Tolerance: +or- 1/16" Width: 48^ Width Tolerance: +1/32/-3/32" Length: 8' Length Tolerance: +or- 1/4" Weigle,nominal: 2.65 lb./sq.ft Thermal"R" Value R-13 Insulating Foam Type: Extnided Polystyrene closed cell foam Thickness: 2-1/2" Density, min: 1.5 Ib./cu, ft- ASTM 131622 K Factor(at 180 days, 75 mean): .20 ASTM C518 Compressive Strength: 20 psi ASTM D1621 Water Vapor Penneance,max: 1.5 perm ASTM E96 Fire Rating: Class 1 *ASTM E84 Flame Spread: 5 *ASTM E84 Smoke Developed: 165 *ASTM E84 Interior Facer Type: Mold Resistant Fiber Rock Board Thickness: 1/2" Mold Resistance: 10 ASTM D3272 Water Absorption: 5% ASTM C473 Flame Spread: 0 *ASTM EBI Smoke Developed: 5 *ASTM E84 Interior Finish Type: Vinyl Laminate Thickness: 6 mil Color&Texture: Various 'ASTM E-34 is not necessarily a representation of performance in an actual fire.Class I is the highest rating available for combustible materials. Notes: 1)Product is not inicnded to be used in a structural and/or load bearing application RCB 006 05 /7 %OCn PFS Coro. Tot-;l Basement 301uti0rlls Pace 11 of 11 CONCLUSION The test specimen utilizing the composite Interior Wall Panels manufactured by Total Basement Solutions, described in the data presented , and installed in the described application in this report , meets the acceptance criteria of test method UL-1715. NGC TESTING SERVICES Test Conducted -. and Report by Richard A. Costolnick Senior Test Engineer Report Reviewed by' Robert J Menchetti Director; Laboi�'tory Facilities and Testing Services RCB 06055 5/7I2006 PFS Corp. Total Basement Solutions Page 9 of 11 TEST OBSERVATIONS TIME (min:sec) NOTES 0045 Flames to the top of crib-light smoke from doorway. 01:20 Flames 3' frons floor. 01:45 Flames 5' from floor 02.15 Flames 7' from floor- vinyl blistering. 02:45 Ignition of vinyl on side wall 03:00 Flames at ceiling- light smoke from doorway. 04:00 Blisters on vinyl 3' from corner on both walls- vinyl batten strips fell from retainer on back wall 05:00 Some blisters enlarging- full flame extension to ceiling char out to 16" at crib location. 05:50 Vinyl batten strip falls from side wall. 06:00 No change. 06:30 Smoke increasing. 07:00 Full flame extension to ceiling- blisters out to 7' from corner on both walls-. 08:00 Vinyl charred out to 20" on back wall and 22" on side 09:00 Full crib extension-flames off ceiling radiating 1-1/2' from corner. 10:00 No change. 11:00 Full crib extension- char out to 23' on back wall and 22" on side wall- vinyl burned away in direct proximity of crib. 12.00 Full crib extension- char out to 24" on both walls. 12:30 Small blisters out to 8' on both walls. 13:00 Full crib extension. 14:00 Full crib extension- char at ceiling out to 52" on back wall and 52" on side wall- char at crib location out to 26" on back wall and 26:' on side wall. 15:00 Crib extension reduced to 7'- no changes- test terminated. N C?l RCB (D 6 C., W 1,Z' CIS PFS Corp. Total Basern&nt Soli,.1lion-s- Page- THERMOCOUPLE LOCATIONS lir. limr-6 �lp (L- 4t-nn) FIGURE 1 l f RCB 0605 PFS Corp. Total Basement Solutions Page 5 of 11 TEST ROOM CONSTRUCTION A test room was constructed inside the laboratory utilizing nom. 20 ga galvanized steel studs, 3-5/8" x 8'. The studs were spaced 24° on center for the `vall construction and 16" on center for the ceiling. The room consisted of four walls, the north and south walls 8 ft. (+/- '/2 in.) wide and the east and west walls 12 ft. (+/- '/2 in.) long. The north wall had a door opening 2 ft 6 inches ,vide by 7 ft. high located at the center and opposite the south wall The walls and ceiling framing were covered with non-combustible cement board. 1l2 in. thick by 48 in. by 96 in.. vertically applied and fastened with 1-1/4 in. self drilling screws 12 in. on center. The south (back) wall and the 8 ft. wall section on the 12 ft. west (side) wall of the test room were utilized to mount the subject wall panels. 1U ., RCB 0605 5/7i2006 PFS Coro. Total Basement Solutions Page 3 of 11 MATERIAL SPECIFICATION Sample Description: Composite interior wall panel system, consisting of nom. 112 in. thick Mold Resistant Fiber Rock board, with 6 mil vinyl laminated to the exposed surface. Nom. 2-112 in. thick Extruded Polystyrene closed cell foam insulation was adhered to the back of the fiber rock board. The composite resulted in a nom. 3 in. thick building unit to be utilized as a wall panel in the system developed by Total Basement Solutions. Dimensions: Wall Panels- 48 in. wide x 96 in. long. Accredite,.l Testing Labo,, r! i TEST REPORT OF UL-1715 FIRE TEST OF INTERIOR FINISH MATERIAL PFS CORPORATION 2402 DANIELS STREET MADISON WI, 53718 Por TOTAL BASEMENT SOLUTIONS 118 ENTERPRISE DRIVE PHILLIPSBURG, PA 16666 REPORT PREPARED BY NGC TESTING SERVICES 1650 MILITARY ROAD BUFFALO, NY 14217 TEST REPORT NO. RCB 0605 TEST DATE: MAY 3, 2006 REPORT DATE: MAY 7, 2006 The results reported in this document apply to specific samples submitted for measurement No responsibility is assumed for performance of any other specimen. This report may not be reproduced, except in full vathout the written approval of the laboratory The laboratory's test reports in no way constitutes or implies product certification, approval or endorsement by this laborarory Ii ii:i IR d ;ff%ii). !' r 1 -SG } 11° 5 c;^ r.3 r. Rib 0"Z L Page 2 of VI Un flay 3, 2006 NGC ,icco,rdance vMh Test iNlolhod 5 (We Test of Inijoric)c Finish Material} This rel--iort doCLIMMS the findngs of an evalti-atiol-1 Of tl'Wt P eFf'O larlo8 Of a coi*nposita building pand, Med in a on ass,I,f)h a �:? , ly ancl tTonmxecl by PFS) Ccrpofaiion, ivlacfl!on, VVI on Whad of ToWl Basement SNutins, MOM, PA. -ri-ip- test N,4/ias conducted at the We test laboratories of [',JGC Testing Ser-viceS A Buffalo, New York. r 'J SAIMPLE PREPARATION 1-1 ie sPecimen consisted of two 8 ft. x 8 ft. se,(Alo-r-is avalualed together in _Fhe ulbjexf wall were applie:,d to a suhstraie. cc)nsisting of 3-5/8 in. steel lraniing to which '1/2 in. thick rion-combustible concrete back-of board was lfastene6 sui.%jeca 1' x 8' vjall r- r)ariels were fastened (C) the 8LIb_q11'a'uD as In fia application, with 4 in. long 'rapcon screws into thiel concrete backer, with screws located at the top, bottom and mid panel. The center seam of each wall section was covered with a steel batten retainer, screwed 12 in. o.c. with 1 in. dryviall screws and a decorative vinyl batten strip was snapped over the retainer. The, inside comer was finished with -a pre-formed vinyl section, friction. fitted behind the back wall corner and adjacent to the side wall. The 4 ft. x 8 ft. panels were positioned vertically The samples were allo,,vecl to set and condition at 7 1 -F (+/- 4--F) and '1510% (.+1/- 5%) RH to equifibriUrn prior to testing. The material dlata can be fni ind in Appendix A. THERMOCOUP'LE LOCATIONS 1--,laced in a I The th-rj-)o�,( . I I Up pj,oj*j�,cj,',,j I enc! insulo-lion. and 3 in. beyond -tile end of 11--ie pipe. The ttheraiocoupk-- asse,,rribliasz, were fixed to tj f,-Il support an(I i re seg. to ti c; requifed elevalions. TC #15 - '1'* below ceiling. 3" from intersecting ,vall cornar TC #4 - 121" below ceiling, 3' from intersecting wall corner TC #3 - 36" below ceiling. 3° from intersecting wall corner TC #2 - 60" below ceiling. 3" from intersecting wall corner Test measurement thermocouples consisted of 5-490 ga. glass coated type J thefMOCOLIPIeS. TC #1 - 1" below ceiling and 4' frorri each wall. TC #6 - 1" below ceiling. 4' from back wall and 3" from side wall. TC #7 - 3' below ceiling, 4: from side wall and 3" frorn back wall. TC #8 - 'I" below ceiling. 8' from sample wall and 3" from side wall. TC #9 - Center of doorway header, V below top of opening. A diagram of the thermocouple locations is 1`01-Ind in Figure 1 on page 7 Pis C, F Sao 1 of ROCINI FIRE: TEST j Cril.), Composed of 50 stills, runi 2" x 2' x 1 in 10 altarnmng Ws, -F , x)nsirocted Il-01-11 lumber.ber. Each layer`:`:gas secui -1 Lo 0 --iP layC- bc:)'n.,v 11.cl common nad into each end of eadi 9W Re cuvOaWd CKID v,,as at F 0, F) and 20% (+A 510 FUA and aqubad to ci nwAght of 30 lb 00. 1 lb). One pawyl Maddel Hu Ted , wood EWC010or ww; plared :anus ind Iii;; of 'the v.,,00d crib fl-ie crib was then 19aced on 4 hal bNcks W positiored 1 ' kam each, NOM 1'0l. The cacelsiur was soaked Wh 4 oz. et1h, WIl except V a I 6" area diametrically opposite the wall intersection. The test We commenced when the excelsior was ignited. Observations were recorded for the 15 min. duration of [he test and temperature data %,as aummeMy recaded every '15 S+?C. Using Ntional Instruments LabView software programmed for this IS The temperature data can be found in Appendix B, A video carnera recorded the entire duration of the test. Digital photographs were taken at intervals to illustrate the flame propagation and smoke generation and are found in Appendix C The room conditions at the start of the test were 70"IF and 49% RH POO-a P--,)-ST TEST OBSEF,VA-FJOi".IS Aber the teW was .`:r vvere taken lo deterrnin' the maxknum dame, propig,91i(vl and discoloration of tam Specimen. Back ThA at uAD IoWon 26 in Nun! cOrne Mat awni Hame flopagalion )Ida JAaH at nib location 26 in hun, con"S' Majawni Docobulan Back VdaH ;A GeMng-- 5? in from cc-,nler Disodomow Cl F' 52 ind fron I corner. ACCEPTANCE GRITE-RdA ULA715 "3.2 During the test, we observed sur-face burning sh�lll not extend to the extremities of the test specimen nor shall flame project through the doorway opening at any time". TER'ls:,A„ it Xf fik LEGACY REPORT M Issued September 1, 2003 ICC Evaluation Service, Inc. SusinesslRegional Office®5360 Wod nan Mill Road,Whittier,Caftnfa 90601 n(562)6930543 Regional Office a 900 Montclair Road,Suite A,Birmingham,Alabama 35213-a(205)599-9800 www•icc-es•org I Regional Office a4051West FlossmcorRoad,Country Club Hills,Illinois 60478®(708)799.2305 Legacy report on the 2000 International Building Code®,the 2000 International Residential Code®for One-and Taro-Family Dwellings,the 2002 Accumulative Supplement to the International Codes-,the 19tII8 International®ne-and Two-Family Dwelling Code®,the BOCA®National Building Code/1999,the 1999 Standard Building Code®and the 1997 Uniform Building Code- DIVISION 09®FINISHES FIBEROCK@ panels are intended for use as an alternative Section 09250—Gypsum Board to gypsum board on interior walls and ceilings and as sheathing in combustible and noncombustible construction. FIBEROCKO BRAND GYPSUM PANELS FIBEROCKO panels as described in this report,are also Intended foruse as a 15-minute thermal barrier for separat- UNITED STATES GYPSUM COMPANY ing foam plastics from the interior of a building. 125 SOUTH FRANKLIN STREET 3.1.1 FIBEROCK@ Brand Sheathing Panels Aqua. CHICAGO,ILLINOIS 60606 Tough USG4YOU@usg.com WWW.usQ.COM Panels are available in thicknesses of 112 and 5/8 inches (12.7 and 15.9 mm), width of 48 inches (1219 mm)and lengths of 8 to 12 feet(2438 and 3658 mm).The panels are 1.0 SUBJECT core-treated and surface-coated on both sides for water resistance.The 5/8 inch(15.9 mm)thick panels are permit- 1.1 FIBEROCK@ Brand Sheathing Panels Aqua-Tough ted to be used as an alternative to Type"X"gypsum board 1.2 FIBEROCK@ Brand Interior Panels Aqua-Tough components in fire-resistance-rated wall assemblies. 1,3 FIBEROCKO Brand Panels-Abuse-Resistant 3.1.2 FIBEROCK@ Brand Interior Panels Aqua- 1.4 FIBEROCK@ Brand Panels-VHI Abuse-Resistant Tough 1.7 1 IVLI\VVI\YY VI OIIU f QIIQIJ-V 111 liV YOQ'i\QOIOIQIIt _ - Panels are available in thicknesses of 112 and 5/8 inches 1.5 FIBEROCK@ Brand Panels-XL (12.7 and 15.9 mm),widths of 36 and 48 inches(914 and 1219 mm) and lengths from 4 to 12 feet (1219 to 3658 mm).The long edges of the interior panels are tapered to 2,0 PROPERTY FOR WHICH EVALUATION IS SOUGHT facilitate finishing of the joints.The panels are core treated 2.1 Gypsum Wallboard and surface coated on both sides for water resistance.The 5/8 inch(15.9 mm)thick panels are permitted to be used 2.2 Gypsum Sheathing Board as an alternative to Type"X"gypsum board components 2.3 Water-Resistant Gypsum Board in fire-resistance-rated wall assemblies. 2.4 Interior Finish Classification 3.1.3 FIBEROCK@ Brand Panels-Abuse-Resistant 2.5 Thermal Barrier Panels are available in thicknesses of 112 and 5/8 inches 2.6 Fire-Resistance (12.7 and 15,9 mm), a 48 inch (1219 mm) width and lengths of 8 , 9, 10 and 12 feet(2438, 2743, 3048 and 2.7 Noncombustible Construction 3658 mm).The long edges of the panels are tapered and the short ends have a squared edge,The panels have a 3.0 DESCRIPTION face coating for abrasion resistance, The 5/8 Inch (15.9 3.1 General mm)thick panels are permitted to be used as an alternate to Type"X"g'y'psum board components In fire-resistance- FIBEROCK@ panels are manufactured from gypsum, rated wall assemblies. cellulosic fibers and other additives. The panels are 3.1.4 FIBEROCK@ Brand Panels-VHI Abuse- homogeneous,with the cellulose fibers dispersed evenly Resistant throughout the panel thickness.Unlike traditional gypsum board, FIBEROCK@ panels do not have paper facings, Panels are available in a thickness of 112 and 518 inch(12,7 and the strength and deflection performance of FIB- and 15.9 mm), a 48 inch (1219 mm)width and lengths of EROCK@ panels are non directional relative to their width 8 , 9, 10 and 12 feet(2438, 2743, 3048 and 3658 mm). and length. FIBEROCK@ panels have a Class 1 or A The long edges of the panels are tapered and the short intedorfinish classification,in accordance with the applica- ends have a squared edge. The panels have a face ble code. coating for abrasion resistance and are reinforced with a ICC-ESlegacy reports are not to be construed as representing aesthetics or any other attributes not spectflcally addressed nor are they to be construedas an endorsement of the subject of the report or a recommendation for its use.There is no warranty by ICCEvaluation Service,Inc.,express or implied.as to arty finding or other matter in this report,or as to any product covered by the report Copyright©2003 Page 1 of 4 Page 3 of 4 NER-684 6.4 Underwriters Laboratories Inc., File No. R4615, 7.0 CONDITIONS OF USE Project No.98NK4591,dated June 4, 1999,contain- ing results of testing in accordance with ASTM E84 to The IMES Subcommittee for National Evaluation Service determine the surface-burning characteristics of finds that FIBEROCK® panels described in this report FIBEROCK®panels, comply with or are acceptable alternatives to those specified in the 2000 International Building Code®, the 6.5 Underwriters Laboratories Inc., File No. R4615, 2000 International Residential Code'for One-and Two- Project No. 99NK18562, dated June 17, 1999, con- Family Dwellings,the 2002 Accumulative Supplement to taining results of testing in accordance with UL 1715, the International Codes',the 1998 International One-and NFPA 259 and ASTM El 354 to determine the equiva- Two-Family Dwelling Code®,the BOC9 National Building lent fire performance of 1i2 inch (12.7 mm) and 5/6 Code/1999, the 1999 Standard Building Code®and the inch (15.9 mm) FIBEROCK® Brand Sheathing and 1997 Uniform Building Code", subject to the following FIBEROCK® Brand Panels-Water Resistant as conditions: compared to 1/2 inch (12.7 mm) and 5/8 inch (15.9 mm) gypsum wallboard and Type "X" gypsum wall- 7.1 FIBEROCKO panels shall be installed in accordance board,gypsum sheathing board and water-resistant with the manufacturer's published installation instruc- gypsum backing board. tions, and this report. Where the manufacturer's published installation instructions differ from this 6.6 Southwest Research Institute, Report No. 01-2305- report,this report shall apply. 308C[l),dated August 18,1989,containing results of testing in accordance with ASTM Ell 19 to establish tie 7.2 FIBEROCKO panels for interior use and the areas inch(12.7 mm)FIBEROCKO Brand Sheathing panels within buildings where panels are installed, shall be as an equivalent 15-minute thermal barrier material. protected from all exterior weather elements. 6.7 SGS U.S. Testing Company, Inc., Report Nos. 7.3 Use of FIBEROCK® panels as a component of an 125613-1,and-2, dated August 9, 1999, containing assembly providing sound transmission resistance results of testing 1/2 and Sia inch (12.7 and 15.9 mm) has not been evaluated and is outside the scope of FIBEROCK®panels,respectively,in accordance with this report. ASTM C36. 7.4 FIBEROCKO Brand Interior Panels-Aqua-Tough used 6.8 SGS U.S. Testing Company, Inc., Report Nos. as a base for tile in wet areas shall not be installed 125613-3,and-4, dated August 9, 1999, containing over a vapor retarder or on a wall acting as a vapor results of testing 1/2 and 518 inch(12.7 and 15.9 mm) retarder. The panels shall not be installed in areas FIBEROCK®Brand Sheathing panels, respectively, subject to constant moisture or high humidity such as in accordance with ASTM C79. saunas,steam rooms,gang showers or indoor pools. 6:9 SGS U.S_. Testing Company, Inc., Report No. 7.5 FIBEROCKO panels shall not be exposed to sus- 125613-6R1,dated August 9,1999,containing results tained temperatures of 125 degrees F(51.6 degrees of testing Sia inch (15.9 mm) FIBEROCK® Brand C),or higher. Panels-Water Resistant in accordance with ASTM C630, 7,6 Allowable shearvalues for walls utilizing FIBEROCKO panels shall be limited to those values shown in the 6.10 SGS U.S. Testing Company, Inc., Report No. applicable code for gypsum wallboard and gypsum 125613-5,dated August 9,1999,containing results of sheathing board, testing of 1/2 inch (12.7 mm) FIBEROCKO Brand 7,7 A weather resistive barrier in accordance with the Sheathing panels in accordance with ASTM E72. applicable code shall be installed over FIBEROCK® 6.11 SGS U.S. Testing Company, Inc., Reports Nos. Brand Sheathing panels used in exterior wall applica- 138985-01 and-02,dated April 17,2000 and April 7, tions. 2000,respectively,containing results of negative wind 7,8 Use of FIBEROCKO panels as a nailing base has not load testing in accordance with ASTM E330. been evaluated and is outside the scope of this 6.12 Hughes Associates, Inc.,Fire Science and Engineer- report. ing report, dated October 6, 1999, containing an 79 WhereFIBEROCKOpanelsareusedasacomponent engineering analysis the results of fire testing of a load-bearing fire-resistance-rated wood-framed FIBEROCK® panels to tti determine their use as an , alternative noncombustible material. wall assembly,the compression parallel to grain(F.) under design load shall be!imbed to 78 percent of the 6.13 Progressive Engineering, Inc.,Reports 99-840-A and allowable compression parallel to the grain for the 98-840-B, dated April 23, 1999, revised September framing member,as indicated in the American Forest 20, 2002, containing testing comparing the ultimate and Paper Association's,National Design Specifica- ceiling dead load of 1/2 in. (12.7 mm) FIBEROCKO tion for Wood Construction/with 1997 Supplement, panels using 1 im inch(32 mm),16 gage staples with Design Values for Wood Construction(NDS-97). a 1 inch (25 mm)crown,spaced 4 inches (102 mm) 7,10 This report is subject to periodic re-examination, For spaced at 12 inches (3055 mm)on center for attach- on center and 1 inch mm)long drywall screws information on the current status of this report, con- ment to wood framing members. tact the ICC-ES. 6.14 Progressive Engineering, Inc., Report 99-840-C, dated April 26, 1999, revised September 20, 2002, containing ceiling dead load tests for 1n in.(12.7 mm) FIBEROCKO panels using Foamseal F2100 adhesive for attachment to the framing members. ll Ffl TArs1 B �l C���'L'1'/�1J_ia';i'1 MATERIALTTr foie — Fibrous Cement Board �rorre L�SPJrr2/!t t0 L4P�l�� Total Basement Finishing Product Safety: 800-816-9766 60 Silvermine Road www.totalbasementfinishing.com Seymour, Ct 06483 Version Date: October 9, 2003 Version: 1 SECTION 1 CHEMICAL PRODUCT AND IDENTIFICATION PRODUCT: Fibrous Cement Board Panels SYNONYM: Gypsum SECTION 2 COMPOSITION, INFORMATION ON INGREDIENTS MATERIAL WT% TLV(mg/m) PEL( mg/m) CAS NUMBER Gypsum (CaSO4.2H2O) >80 10 15(T)/5(R) 13397-24-5 Cellplose <15 10 15(T)/5(R) 9004-34-6 Parrafin Wax <2 2(fume) 2(fume) 8002-74-2 Crystalline Silica <1 0.05(R) 0.1(R) 14808-60-7 (T)—.Total (R)—Respirable (NE)—Not Established Respirable crystalline silica: IARC: Group 1 carcinogen, NTP: Known human carcinogen. The weight percent for silica represents total quartz and not the respirable fraction. The concentration of respirable crystalline silica measured in bulk samples of TBF gypsum was less than 0.1 wt.%. Industrial hygiene testing, following the NIOSH Method 7500, did not detect respirable crystalline silica in dust created during the cutting of TBF gypsum wallboard panels by both the recommended score and snap technique and with the use of a power saw in a 1 Oft by 10ft room. The weight percent for fibrous glass (continuous filament) represents total fibrous glass and not the respirable fraction. Food and Drug Administration (CFR Title 21, v.3, sec 184.12301—Calcium Sulfate is Generally Recognized as Safe (GRAS). All ingredients of this product are included in the U.S. Environmental Protection Agency's Toxic Substances Control Act Chemical Substance Inventory. All components of this product are included in the Canadian Domestic Substances List (DSL). SECTION 3 HAZARD IDENTIFICATION INFORMATION FOR HANDLING AND IDENTIFICATION OF CHEMICAL HAZARDS ---- 0 0= Minimal Hazard NFPA Ratings: HIMS Ratings: 0 1 =Slight Hazard Health: 0 ® Health: *0 -PHYSICAL HAZARD 2= Moderate Hazard Fire: 0 Fire: 0 HE =Serious Hazard Reactivity: 0 Reactivity: 0 PERSONAL PROTECTION® 4 = Severe Hazard Personal Protection: Use eye protection. Use gloves and NIOSH/MSHA-approved respiratory protection when required. *Respirable crystalline silica can cause lung disease and/or cancer. f T. j �� y+ TIS T T ° is Leo_ Fibrous Cement Board I 011&-ftre d 69 BWAV/ SECTION 5 FIRE FIGHTING MEASURES General Fire Hazards: Not expected to burn. Extinguishing Media: Water or use extinguishing media appropriate for surrounding fire. Special Fire Fighting Procedures: Wear appropriate personal protective equipment(See section 8). Unusual Fire and Explosion Hazards: None Hazardous Combustion Products: Above 1450°C -decomposes to calcium oxide (CaO)and sulfur dioxide (SO2). Organic material in the panels can produce oxides of carbon. Flash Point: None Known Auto Ignition: Not Applicable Method Used: Not Applicable Flammability Limited combustible Upper Flammable Limit(UFL): Not Applicable Classification: Lower Flammable Limit(LFL): Not Applicable Rate of Burning: Not Applicable SECTION 5 ACCIDENTAL RELEASE MEASURES CONTAINMENT: No special precautions. Wear appropriate personal protection (See Section 8). Collect the material from spillage and if not damaged or containated by foreign material, gypsum panels may be reclaimed. Contain the spill by keeping it dry and away from incompatibles (See Section 10). CLEAN-UP: Use normal clean up procedures. Wear appropriate protective equipment. If dry, shovel or sweep up material from spillage and place collected material into a container for recovery or waste disposal. Avoid dust generation. Avoid inhalation of dust and contact with eyes and skin. Maintain proper ventilation. If vacuum is used to collect dust, use an industrial vacuum cleaner with a high efficiency air filter. If sweeping is necessary, use dust suppressant. Do not use compressed air for clean up. These procedures will help minimize potential exposures. If washed down, may plug drains. DISPOSAL: Follow all local, state, provincial and federal regulations. Never discharge large releases directly into sewers or surface waters. Trace amounts of residue can be flushed to a drain, using plenty of water. SECTION 7 HANDLING AND STORAGE HANDLING: Avoid dust contact with eyes. Wear the appropriate eye protection against dust (See Section 8). Avoid breathing dust. Wear the appropriate respiratory protection against dust in poorly ventilated areas and if TLV is exceeded (see Sections 2 and 8). Minimize dust generation and accumulation. Use good safety and industrial hygiene practices. When moving board with a forklift or similar equipment, it is essential that the equipment be rated capable of handling the loads. The forks should always be long enough to extend completely through the width of the load. Fork spacing between supports should be one half the length of the panels or base being handled so that a maximum of 4' extends beyond the supports on either end. Follow traditional building practices; such as management of water away form the interior of the structure to avoid the growth of mold, mildew and fungus. Remove any building products suspected of being exposed to sustained moisture and considered conducive to mold growth from the jobsite. Gypsum panels are very heavy awkward loads posing the risk of severe back injury. Use proper lifting techniques. MBASENI-LNI-1 MATERIAL SAFETY DATA SHEET " � '"��' l'n— Fibrous Cement Board r Y m&&d'P mae m B l SECTION 10 CHEMICAL STABILITY AND REACTIVITY STABILITY: Stable in dry environments. CONDITIONS TO AVOID: Contact with incompatibles. INCOMPATIBILITY: None known. HAZARDOUS POLYMERIZATION: Will not occur. HAZARDOUS DECOMPOSITION: Above 1450° C - calcium oxide(CaO)and sulfur dioxide SO2. Oxides of carbon. SECTION 11 TOXICOLOGICAL INFORMATION ACUTE EFFECTS: Gypsum paste applied experimentally to the eyes of rabbits was not an irritant. Gypsum dust particulate has shown an irritant action on mucous membranes of the respiratory tract and eyes. There have been anecdotal reports of conjunctivitis, chronic rhinitis, laryngitis, pharyngitis, impaired sense of smell and taste, bleeding from the nose, and reactions of tracheal and bronchial membranes in exposed workers. The sulfate ion has caused gastro-intestinal disturbance in humans following large oral doses. Limited studies involving the repeated inhalation of an (unspecified) calcium sulfate failed to identify any particular target organs in monkeys, rats and hamsters. No evidence of mutagenicity was found in Ames bacterial tests. LD50: Not Available for product. LC50: Not Available for product. CHRONIC EFFECTS/CARCINOGENICITY: Crystalline silica: The concentration of respirable crystalline silica measured in bulk samples of TBF gypsum was less than 0.1 Wt.%. Industrial hygiene testing, following the NIOSH Method 7500, did not detect respirable crystalline silica in dust created during the cutting of TBF gypsum wallboard panels by both the recommended score and snap technique and with the use of a power saw in a 10ft by 1 Oft room. Gypsum wallboard panels do not release respirable dust in their installed state and therefore do not present any known health hazards when installed and properly maintained. Prolonged and repeated exposure to airborne free respirable crystalline silica can result in lung disease(i.e., silicosis) and/or lung cancer. The development of silicosis may increase the risks of additional health effects. The risk of developing silicosis is dependent upon the exposure intensity and duration. Exposures to respirable crystalline silica are not expected during the normal use of this product; however, actual levels must be determined by workplace hygiene testing. In June, 1997, IARC classified crystalline silica (quartz and cristobalite) as a human carcinogen. In making the overall evaluation, the IARC Working Group noted that carcinogenicity in humans was not detected in all industrial circumstances studied. Carcinogenicity may be dependent on inherent characteristics of the crystalline silica or on external factors affecting its biological activity or distribution of its polymorphs. IARC states that crystalline silica inhaled in the form of quartz or cristobalite from occupational sources is carcinogenic to humans (Group 1). SECTION 12 ECOLOGICAL INFORMATION ENVIRONMENTAL TOXICITY: This product has no known adverse effect on the ecology. A large discharge directly into waterways would not be expected to kill aquatic life. Ecotoxicity Values: Not determined. IBASB f EN iL TY TT F;�, _ Fibrous®us Cement Board SECTION 15 REGULATORY INFORMATION (continued) CANADIAN REGULATIONS This product has been classified in accordance with the hazard criteria of the Controlled Products Regulations and the MSDS contains all the information required by the Controlled Products Regulations. All components of this product are included in the Canadian Domestic Substances List (DSL). MATERIAL WT% IDL Item# WHMIS Classification: Gypsum (CaSO4.2H2O) >80 Not Listed Not Listed Cellulose <15 Not Listed Not Listed Parrafin Wax <2 Not Listed Not Listed Crystalline Silica <1 1406 D2A IDL Item#: Canadian Hazardous Products Act— Ingredient Disclosure List Item# WHMIS Classification: Workplace Hazardous Material Information System CARCINOGENICITY CLASSIFICATION OF INGREDIENT(S) All substances listed are associated with the nature of the raw materials used in the manufacture of this product and are not independent components of the product formulation. All substances, if present, are at levels well below regulatory limits. See Section 11 : Toxicolo Information for detailed information MATERIAL +1ARC NTP ACGIH CAL-65 Respirable C 1 stalline Silica A2 Listed IARC—International Agency for Research on Cancer(World Health Organization) 1-Carcinogenic to humans 2A—Probably carcinogenic to humans 213—Possibly carcinogenic to humans 3-Not classifiable as a carcinogen 4—Probably not a carcinogen NTP—National Toxicology Program (Health and Human Services Dept., Public Health Service, NIH/NIERS) 1- Known to be carcinogen 2-Anticipated to be carcinogens ACGIH—American Conference of Governmental Industrial Hygienists Al —Confirmed human carcinogen A2—Suspected human carcinogen A3—Animal carcinogen A4- Not classifiable as a carcinogen A5—Not suspected as a human carcinogen CAL-65—California Proposition 65 "Chemicals known to the State of California to Cause Cancer" MATERIAL SAFETY DATA Basement Systems,Inc.-Seymour,CT 06483 EMERGENCY We consider our products are articles as defined in OSHA 29CFR Part 1910,12CO'Hazard Communication Standard°. NUMBERS We consider these products to he safe under traditional industry processing conditions.If you need additional copies at any time or have esbons concemin the information please call Toll-Free:800.541-0487. TRADE NAME DIVERSIWALL CI-115MICAL NAME Polyvinyl chloride with ester,Plas3ticizars, i want, Ink end more SYNONYMS Serra-Ri id Films CAS NO. NA-MIxture DATE SUPERSEDES M$DS DATED 10/18/01 5118198 Material CAS NO % ACGIHLV�- OSHA PEL-TWA Stabilizer. Ba/Zn Organophosphate as Barium 7440-39-3 -2 0.5 Mg/M3 0.5 mg/M3 —7tnc oxide 1314-13.2 5 mg/M3 R 5 mg/M3 R T m Total dust R=Respirable dust U=Dust F_Fume NA FLASH POINT t3 METHOD FLAMMABLE LIMITS NA LEL NA UEL NA EXTINGUISHING MEDIA Carbon dioxide,foam, d chemical,water fog SPECIAL.FIRE FIGHTING PROCEDURES NFPA FIRE During emergency conditions overexposure to thermal decomposition products HAZARDS may cause a health hazard. Use an approved self-contained breathing apparatus, IDENTIFICATION SYSTEM HEALTH 2 UNUSUAL FIRE AND EXPLOSION HAZARDS FIRE 1 REACTIVITY 0 H drochlonc acid HCI as is liberated as a combustion product, SPECIFIC Tradomork NE NOT ESTAC�LISI.I17B NA NOT APPLICAMI! PAGE 1 OF 4 R.:•` .IF4:-f :ImA '�f4J+�Qdd�o�f'" 4d'fY A lid •v,}'htr 3.pJ 'l� 11� '.a:l. •�r.1; a r•.{�xj>; �.Si STEPS TO BE TAKEN IN CASE MATERIAL IS SPILLED OR RELEASED Recycle if p®ssible WASTE DISPOSAL METHODS Incinerate, treat or landfill in accordance with applicable environmenlal control regulations. Recycle if possible. �p' 'i 1s i�r, •• .. •r.. . . ?:FI'f;�cy��'i� .ili' 'r.�. . .,.tibr,.�i .�� •r.%,�gLMK , i tGl��:�:;':r.,';:f�•::r' .. 'S'd'1+,:I'J�:� I, t:?.''• When heated enough,fresh air should flow past the user to maintain exposure levels VENTILATION below those listed in Section 1. RESPIRATORY if exposure levels exceed these listed in Section 1,approved respiratory protection should be worn. EYE PROTECTION If cutting,sawing etc„wear safe lasses. PROTECTIVE GLOVES NA OTHER NA Ar 1� l.Y i Atm SAT A "; ,�'' ` �� `9a`��ti +P' � � � 3 5, ,r' r7i9"L 'v,. - ^'r.. - Jig:,. .: �.i>`1+ —n + ibl�. Rt`='t;`.' s ',,.•" 1 APPEARANCE ODOR MELT POINT SPECIFIC GRAVITY Slight Vinyl Sefteras 300"F 132-140 VAPOR DENSITY %VOLATILE BY VOLUME BULK DENSITY NA NA NA BOILING POINT VAPOR PRESSURE %SOLUBILITY(HI O) OTHER NA NA Insoluble PAGE.1OF 4 TOTAL BASEMENT SOLUTIONS INTERIOR WALL PANEL Product Specifications Overall Thickness: 3 Thickness Tolerance: +or- 1/16" Width: 48" Width Tolerance: +1/32/-3/32" Length: 8 Length Tolerance: +or- 1/4" Weight,nominal: 2.65 lb./sq. ft. Thermal"R"Value R-13 Insulating Foam Type: Extruded Polystyrene closed cell foam Thickness: 2-1/2" Density,min: 1.5 lb./cu. f1. ASTM D1622 K Factor(at 180 days, 75 mean): .20 ASTM C518 Compressive Strength: 20 psi ASTM D1621 Water Vapor Permeance,max: 1.5 perm ASTM E96 Fire Rating: Class 1 *ASTM E84 Flame Spread: 5 *ASTM E84 Smoke Developed: 165 *ASTM E84 Interior Facer Type: Mold Resistant Fiber Rock Board Thickness: 1/2" Mold Resistance: 10 ASTM D3272 Water Absorption: 5% ASTM C473 Flame Spread: 0 *ASTM E84 Smoke Developed: 5 *ASTM E84 Interior Finish Type: Vinyl Laminate Thickness: 6 mil Color&Texture: Various 'ASTM E-84 is not necessarily a representation of performance in an actual fire.Class I is the highest rating available for combustible materials. Notes: 1)Product is not intended to be used in a structural and/or load bearing application. Structural Tes-fln 9 NGC La boratory Testing Services Basement Syste VERTICAL TRANSVERSE LOAD TEST ASTM E 72-05 4 ft, X 8 ft. Panels Constructed of 25 gauge steel C-Studs,24 in. o.c. with a layer of 1/2 in. gypsum wallboard 2 in. x 3 in. SPF wood studs, 24 in. o.c. with a layer of/z gypsum wallboard Everlast Partition Wall Panels ®Vinyl coated fiber cement board sandwiching closed cell polystyrene board Everlast Basemen Wall Panels -Vinyl coated fiber cement board adhered to closed cell polystyrene board Test Date: October 30 and 31, 2007 Report Issue Date: November 9, 2007 Report Number: NGC- WL-07005 Prepared for: Basement Systems, Inc. 60 Silvermine Road Seymour, CT 06483 Mark Domogala / 1-800-640-1500 Prepared by: NGC Testing ServicesSm 1650 Military Road Buffalo, NY 14217-1198 IF COPIED,THIS REPORT SHOULD BE COPIED IN ITS ENTIRETY. EXCERPTS FROM THIS REPORT SHOULD NOT BE PRINTED OR DISTRIBUTED. lVationalAwl 1650 Military Road - Buffalo, NY 14217- 1198 Gypswn (716)873-9750 - Fax (716)873-9753 - nget est@ nationalgypsurn,corn U ni Structural a `j�{ �'° Testing Pale 3 of 15 � Laboratory NGC Testing Services 1. INTRODUCTION On October 30 and 31, 2007 NGC Testing Servicessm conducted vertical transverse load tests for Basement Systems, Incorporated of Seymour,CT. Demountable, prefabricated wall panels nominally 4 feet wide by 8 feet high were tested in accordance to ASTM E 72-05 Standard Test Method of Conducting Strength Tests of Panels for Building Construction. Construction of all framing and panel assemblies was performed by Basement Systems, Inc. and shipped to NGC Testing Servicessm. Testing was performed on four different wall panel assemblies. Three samples of each test specimen were tested. The testing was comparing of different types of wall panel construction materials. The four standard panel types were: 25-gauge steel studs,2 in, x 3 in,wood studs, single insulated panel and double insulated panel. Construction of all framing was performed by Basement Systems Inc, and sent to NGC Testing Service0m. The panels were tested as received. Testing was conducted by Steven Armenia,Test Technician, and Gerard Van Wie,Test Technician,both of NGC Testing Servicessm. Present and witnessed from Basement Systems, Inc. were Mark Domogala and Robert Card. 2. T'ES'T APPARATUS The test apparatus utilized met the criteria outlined in test standard ASTM E 72- 05 for vertical transverse strength testing of panels utilizing a uniform load with the air chamber method. The test chamber can accommodate samples up to 4 feet wide and up to 16 feet long. Air was exhausted from the chamber with a 6.5 HP vacuum and pressure readings were measured utilizing a differential pressure transmitter with a digital meter. Lateral deflections were recorded at the test sample center lines via a digital indicator. Nati nsla m� 1650 Military road • Buffalo, NY 14217-1198 (716)873-9750 • Fax (716)8739753 , ngctest@nationalgypsiim.com Page 5 of 15 RICTur l Testing NGC Laboratory Testing Services 4, TEST PROCEDURE Testing was conducted in general accordance to ASTM E 72, Section 12, transverse Load- Specimen Vertical, Chamber Method. The test criterion is an L/120 deflection limitation at a live load of 5 PSF. The first test assembly was stood in test frame as described in Section 3 of this report. A continuous sheet of 4 mil polyethylene was placed over the entire assembly and seal to test frame to aid in creating an airtight chamber and to ensure uniform application of test loads. A Digital indicator was placed at the vertical and horizontal centerline of the specimen to measure the lateral deflection under live load and the set after the release of the load. All indicators were then zeroed. A small pre-load of 0.25 in. of water was applied to the assembly, and then the load was released, allowing the assembly to rest until all set deflections stabilized. The indicators were again zeroed and the test commenced. Loads were applied at 2.5 PSF(0.48 in. water)increments up to 10 PSF. Each load increment was held for 5 minutes and then released for 5 minutes. Deflection readings were recorded at f?re beginning and end of both the 5 minute load period and the 5 minute load release period. after the 10 PSF load and release increment, the load was increased till deflectional failure was reached,unless failure occurred prior to 10 PSF. All indicators were then removed. The final sample of each of the 4 different assemblies was then taken to ultimate structural failure. Failure pressure was then recorded and noted. A total of three tests were conducted according to the above mentioned procedure. Se TEST RESULTS Test Criterion: L/120 deflection limit at 5 PSF live. Where L=distance between sample contact points, in this case L= 90 in. for the steel stud,wood stud and Everlast Partition Panel assemblies. Everlast Basement Wall panel had a brace at panel mid point, so the greatest distance between contact points was decreased to 45 in., therefore L=45 in. NationalAwn G'ypst6i 1650 Military Road . Buffalo, NY 14217-1198 (716)873-9750 • Fax (716)873-9753 > ngetest@national 9yPsLsrn,C0n, Page 7of15 ei9 r,!" \ Laboratory A `/- Testing Services % f So Test Data Pages Steel Stud Assembly ACTUAL INDICATOR LOAD READING LOAD INCREMENT#1 (Inches of H2O) (Inches) 2.6 PSF(0.48 IN. H20) Load Aapplication 0.5 0.337 After 5 min. of load application 0.5 Load release 0.349 0.0 0.179 After 5 min_of load release 0.0 0.008 LOAD INCREMENT#2 5.0 PSF(0.96 IN.H20) Load Aapplication 1.0 0.468 After 5 min. of load application 1.0 Load release 0.482 0.0 0.165 After 5 min. of load release 0.0 0.025 LOAD INCREMENT#3 7.6 PSF(1.44 IN..H20) Load Aapplication 1.5 0.624 After 5 min. of load application 1.6 Load release 0.66 0.0 0.1611 After 5 min. of load release 0.0 0.037 LOAD INCREMENT#4 10.0 PSF(1.92 IN. H20) Load Aapplication 2.0 0.789 After 5 min, of load application 2.0 Load release 0.939 0.0 0.330 After 5 min. of load release 0.0 0.021 Deflectional Failure Load, PSF 8.32 Ulitmate Failure Load,,PSF 14.05 Test Criterion U120 Deflection Limitation at 5 PSF live load 90/120=0.750 inches TEST RESULT 0.482" Of deflection at 5 PSF Live load PASS Gypsum 1650 Military (load • Buffalo, NY 14217-1198 (716)873.9750 - Fax (716)873-9753 ° ngctest@nationalgypsuj-n,com Page 9 of 15 Structural 'If-esting Laboratory , - Testing Servicas Everlast Partiton Wall Panel ACTUAL INDICATOR LOAD READING LOAD INCREnAEN'T# 1 (Inches of H2O) (Inches) 2.5 PSF(0.4.8 IN. HZO) Load Aapplication 0.5 0.032 After 5 min, of load application 0.5 0.037 Load release 0.0 0.013 After 5 min. of load release 0.0 0.004 LOAD INCREMENT 2 6.0 PSF(0.96 IN. H20) Load Aapplication 1.0 0.057 After 5 min. of load application 1.0 0.062 Load release 0.0 0.011 After 5 min, of load release 0.0 0.007 LOAD INCREMENT 3 7.5 PSF(1.44 IN. Hz®) Load Aapplication 1.5 0.080 After 5 min.of load application 1.6 0.086 Load release 0.0 0.023 After 5 min. of load release 0.0 0.011 LOAD INCREMENT#4 10.0 PSF(1.92 IN. Hz®) Load Aapplication 2.0 0.100 After 5 min.of load application 2.0 0.109 Load release 0.0 0.025 After 5 min.of load release 0.0 0.013 Deflectional Failure Load, PSF 69.71 Ulitmate Failure Load, PSF 125.89 Test Criterion U120 Deflection Limitation at 5 PSF live load 90/120=0.750 inches TEST RESULT 0.062" Of deflection at 5 PSF Live load PASS Nali®na6 n Gypsums 1650 Military Road • Buffalo, NY 14217-1198 (796)873-9750 • Fax (716)873-9753 • ngctest@nationaigypsum.com Page I I of 15 i3 StruCtUral Testin L a b o ra t o ry NGC Testing Services Tested and witnessed by: Reviewed bv: Steven M. Armenia .J Obert Menchetti 0��rt J. M Test Technician Director NGC Testing Services Gerard Van Wie Test Technician Attachments: Nationalmv Gypswn 1650 Military Road Buffalo, NY 14217.1198 (716)873-9750 • Fax (716)873-9753 - ngctest@nationaigypsuin.com Page 13 of 15 .- , stin NGC Testing Services PIS®T®#2 Everlast Basement Wall Panel Assembly Mounted in Test Frame H=am a � t lilatG psum 1650 Military Road Buffalo, NY 14217-1198 (716)873.9750 Fax (716)873-9753 • ncgctest(-t-),Iationalgs7psum.corn j•' Page 15 of 15 Structural Testinq Laboratory NGC X. Testing Services Deflection of Partition Wail I 0.16 _ 0.14-- Partition#1 - Partition#2 ---- - 0.12 Partition#3 --.---. ---- --- c I - Partition#1 0.1 Partition#2 c ® 0.08 - — Partition#3 - -- — —0.06- 0.04 - 0.02 .06 0.04 0.02- 0 ---- - - 2.5 5 7.5 10 Force, Lbs/ Sq ft Deflection of Basement Wall 0.500 --Basement#1 _..__ 0.450 - —Basement#2 - 0400 Basement#3 0.350 - - Basement#1 0 0.300 —Basement#2 u 0.250 - —Basement#3 — -- 0,200 - 0.100 - 0.050 .2000.100 0.050 - - --- 0.000 - - --- -�- 2.5 5 7.5 10 Force,Lbs!Sq ft lVati n�,tien 1650 Military Road - Buffalo, NY 14217-1198 (716)873-9750 - Fax (716)873-9753 - ngctest@natiOnalgypsuni.com Fire S t i n ,�/ Accredited Z Testing Laboratory NGC Laboratory /%i TL-216 Testing Services ` %= Page 1 of 9 TEST REPORT for EASEMENT® SYSTEMS 60 Silvermine Road Seymour, CT 06463 Surface Burning Characteristics of Building Materials ASTM E-84-07 Test Report No: FH-1780 Assignment No: H-411 Test Date: 10/16/2007 Report Date: 10/26/2007 Subject Material: Zenwall drainage panels Prepared by: ichard A. Costol Senior Test Engineer 1 Reviewed by: 11�ob J. Menchetti Dir or, Laboratory Facilities a Testing Services The results reported in this document apply to specific samples submitted for measurement. No responsibility is assumed for performance of any other specimen. This report may not be reproduced,except in full,without the written approval of the laboratory. The laboratory's test reports in no way constitutes or implies product certification,approval or endorsement by this laboratory. 1650 Military Road - Buffalo, NY 14217-1198 (716)873-9750 - Fax (716)873-9753 • www.ngctestingservices.com FII-1780 BASEMENTO SYSTEMS /012612007 Page 3 of 9 RESULTS: SIDE CALCULATED CALCULATED TEST NO. MATERIAL TESTED EXPOSED SUPPORT FLAME SPREAD SMOKE DEVELOPED 1 IZENWALL drainage panel I VINYL SELF 27.51 272.78 2 IZENWALL drainage panel VINYL SELF 25.02 139.90 3 ZENWALL drainage panel VINYL SELF 27.46 167.05 SIDE FLAME SPREAD SMOKE DEVELOPED MATERIAL TESTED EXPOSED SUPPORT INDEX* INDEX" RED OAK FLOORING NA DECKS 100 100 REINFORCED CEMENT BOARD NA SELF 0 0 ZENWALL drainage panel VINYL SELF 25 195 _ FSI SDI CLASS 'W' <25 0-450 CLASS"B" . 26-75 0-450 CLASS"C" 76-200 0-450 " Flame Spread/Smoke Developed Index is the result(or average of the results of multiple tests),rounded to the nearest multiple of 5. Smoke Developed in excess of 200,rounded to the nearest 50. FFH- 17 3' GGserne C'Systems 10i?6/?00` Paye � o;9 I I ; If it '. I I'' i ! ! i ! I ' 1ilflil� .. 11111Ij ! ; 11 � !Illi III ' 7 ! i � I i II I �,! ' i ' '.Ili ! II ! 11 _ , I I 1 I I I _ii 11 l' ii lf, 111111 { 11 . I ,..� Ii' Il II � I ' I I •. 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TIF i J) � i � I ( II li , 1i � , —A JOT 11 TT I I LL TI , SSTc Material Safety Data Sheet 0 Section I®Chemical Product and Company Identification MSDS Effective Date: August 03,2006 Rev.008 MSDS Last Revision: May 17,2004 Product Name: Cured Fiberglass Products Generic name: Cured fibrous glass wool insulation,faced or unlaced. Manufacturer: Basement Systems,Inc 60 Silvermine Drive®Seymour,CT 06,483 Phone: 300-541-0487®Local:203-481-5090 3:00am-5:00pm Eastern Time w ww.base mentsystems.corn Section H -Component Data Component C.A,S# % Fibrous Glass 65997-17-3 83-97 Urea extended phenol- 25104-55-6 3-17 formaldehyde resin Formaldehyde 50-00-0 <0.1 Carbon Black(Black 1333-86-4 0-2 Product only) Non-Woven Facing I Not Available <tA Section III—Hazards Identification Appearance and Odor: Amber/Yellow,or black fibrous glass blanket.Slight Formaldehyde odor. Under normal conditions of use,this product is not expected to create any unusual emergency hazards. Inhalation of excessive amounts of dust from the product may cause temporary upper respiratory irritation and/or congestion-- Remove affected individuals to fresh air. Skin irritation may be treated by gently washing affected area with soap and warm water. Eye irritation may be treated by flushing eyes with large amounts of water.If irritation persists,contact a medical professional. In the event of fire,use normal fire fighting procedures to prevent inhalation of smoke and gases. Potential Health Effects Summary Breathing dust from this product may cause a scratchy throat,congestion,and slight coughing.Getting dust or fibers on the skin,or in the eyes may cause itching,rash,or redness.Additional health and safety information is provided in Section XI of this material safety data sheet. Other irritating vapors such as formaldehyde from the Urea phenol-formaldehyde resin system may also be released in very small amounts. Emergency Overview: The International Agency for Research on Cancer(IARC)has classified fiber glass wool as a 1 , Irritation.No chronic effects are expected following ingestion. First Aid:Eyes Do not rub or scratch your eyes.Dust particles may cause the eye to be scratched.Flush eyes with large amounts of water for 5-15 minutes.If irritation persists,contact a medical professional. First Aid:Notes to Physician Irritating gases may be released under conditions of high heat or humidity. These could cause severe Upper Respiratory and eye irritation.Formaldehyde gas is a skin and respiratory sensitizer.Treatment should be directed toward removing the source of irritation with symptomatic treatment as necessary. Section V r Fire Fighting Measures Flash Point:Not applicable Method Used:Not applicable Upper Flammable Limit(UFL):Not applicable Lower Flammable]Limit(LFL):Not applicable Auto Ignition:Not determined Flammability Classification:Not determined Rate of Burning:Not determined General Fire Hazards There is no potential for fire or explosion. Extinguishing Media Carbon dioxide(CO2),water,water fog,dry chemical. Fire Fighting Equipment/Instructions No special procedures are expected to be necessary for this product.Normal fire lighting procedures should be followed to avoid inhalation of smoke and gases. Section V1 m Accidental Release Measures Containment Procedures Pick up large pieces.Vacuum dusts.If sweeping is necessary,use a dust suppressant such as water.Do not dry sweep dust accumulation or use compressed air for clean-up.These procedures will help to minimize potential exposures. Clean-Up Procedures Avoid the generation of dusts during clean-up. Section VII-Handling and Storage Handling Procedures Use protective equipment as described in Section VIII of this material safety data sheet when handling uncontained material. Storage procedures Warehouse storage should be in accordance with package directions,if any.Material should be kept dry,and protected from the elements. Section VIII-Exposure Controls/Personal Protection Exposure Guidelines A:General Product Information Glass wool fiber,OSTIA voluntary Health and Safety Partnership Program(HSPP):1 floc TWA for fibers longer than 5 µm with a diameter less than 3 µm. B:Component Exposure Limits Fiber Glass Wool(6599717-3) ACGIH: 1 floc TWA for fibers longer than 5 um with a diambter less than 3 um;(Listed under'Synthetic vitreous fibers')(related to Glass Wool Fiber) OSHA:5 mg/m3 TWA respirable fraction(OSTIA.) 15 mg/m3 TWA total dust(OSHA) (related to Glass Wool fiber) Carbon black(1333-56-4) (Only used with black color material,not Yellow/Tan Material) ACGIH:3.5 mg/m3 TWA OSHA:3.5 mgtm3 TWA 3 A:General Product Information Dust from this product is a mechanical irritant,which means that it may cause temporary irritation or scratchiness of the throat, and/or itching of the eyes and skin. Gases released under conditions of high heat and humidity can cause severe eye and respiratory irritation. B:Component Analysis-LDSOILC50 Urea extended phenol-formaldehyde resin('5104-55-6) Oral LD50 Rat:7 gm/kg Oral LD50 Mouse:7 gm/kg Carbon black(1333-86-4) Oral LD50 Rat:>15400 mg/kg Dermal LD50 Rabbit:>3 gm/kg Formaldehyde(50-00-0) Inhalation LC50 Rat:203 mg/m3 Inhalation LC50 Mouse:454 mg/m3/4H Oral LD50 Rat: 100 mg/kg Oral LD50 Mouse:42 nmglkg Dermal LD50 Rabbit:270 u1/kg Carcinogenicity A:General Product Information No data for this product as a whole. B:Component Carcinogenicity Fiber Glass Wool(65997-17-3) ACGIH:A3 -Animal Carcinogen(related to Glass wool fibers) NTP:Suspect Carcinogen(related to Glasswool)(Possible Select Carcinogen) IARC:Monograph 81,2002(related to Glasswooi)(Group 3(not classifiable as to its carcinogenicity to humans)) Carbon black(1333-86-4) ACGIH:A4-Not Classifiable as a Human Carcinogen IARC:Monograph 65, 1996(Group 2B(possibly carcinogenic to humans)) Formaldehyde(50-00-0) ACGIH:A2-Suspected Human Carcinogen OSHA:0.75 ppm TWA PEL;2 ppm STEL;0.5 ppm TWA action level;Irritant and potential cancer hazard(29 CFR.1910.1048) NTP:Suspect Carcinogen(Possible Select Carcinogen) IARC:Monograph 62,1995(Group 2A(probably carcinogenic to humans)) Chronic Toxicity Exposure to formaldehyde gas(released under conditions of high heat or humidity)may cause eye and upper respiratory irritation,and possible respiratory or skin sensitization(allergy).If sensitization occurs,subsequent exposures to formaldehyde may worsen asthma or other respiratory problems,and cause allergic type reactions. Exposure to formaldehyde gas has been associated with the development of nasal tumors in laboratory animals. Formaldehyde has been classified as a probable human carcinogen,Group 2A,by the International Agency for Research on Cancer(IARC),and the Occupational Safety and Health Administration(OSHA),and National Toxicology Program(NTP) considered formaldehyde to have carcinogenic potential.OSHA specifically regulates formaldehyde under 29 CFR 1910.1048. Fiber Glass Wool:In October 2001,URC classified fiber glass wool as Group 3,"not classifiable as to its carcinogenicity to humans."The 2001 decision was based on current human and animal research that shows no association between inhalation exposure to dust from fiber glass wool and the development of respiratory disease.This is a reversal of the IARC finding in 1987 of a Group 2B designation(possibly carcinogenic to humans)based on earlier studies in which animals were injected with large quantities of fiber glass.NTP and ACGIH have not yet reviewed the IARC reclassification or the most current fiber glass health research;at this time,both agencies continue to classify glass wool based on the earlier animal injection studies. Ecological Information Ecotoxicity A:General Product Information No data available for this product. B:Component Analysis-Ecotoxicity-Aquatic Toxicity Formaldehyde(50-00-0) 5 V,A Member of the R:yal Group of Companies wvn .yaimouldmgs.com Page: 1 of 4 MSDS Revision Date: March 2004 Section 1 PRODUCT AND COMPANY INDENTIFICATION Manufacturer: Royal Mouldings Limited Address: Highway 11 and Bear Creek Road Marion, VA 24354 Phone: (276)—783-8161 or(800)368-5520 Emergency: (800)—424-0300 (CHEMTREC) Trade Name: PVC, Polyvinyl Chloride Chemical Name: PVC/Acrylic Copolymer Section II HAZARDOUS INGREDIENTS Ingredient CAS Reg. No. Max. OSHA PEL ACGIH Percent TLV Limestone 1317-65-3 17.5% 15 m /m (total)" 10 mg/m 5 m /m (respirable)* Crystalline Silica 14808-60-7 0.4% 10 mg/m'+�.2+%&02)-as respirable dust 0.05 mg/m" 30 m /m - 2+%SiO2 -as total dust (respirable) Calcium Stearate 1592-23-0 1 1.10% 1 NE I NE Titanium Dioxide 13463-67-7 1 7.8% 1 15 mg/m"1 10 m /m Ingredients are considered hazardous under OSHA Hazard Communication Criteria, but are generally bound in the polymer matrix of the profile. Some release of ingredients may occur when subjected to processes such as sawing, sanding, or abrading. Release of silica particles by physical methods such as sawing during installations would not be expected to present significant exposures compared to established exposure limits,as airborne concentrations of total product dust would have to exceed 10 mg/mato exceed the TLV for crystalline silica.This also presumes all of the silica dust particles would be in the respirable dust size range. 4 Exposure limits for calcium carbonate, the main constituent of limestone. Section III HAZARDS IDENTIFICATION Emergency Overview: None identified for product as purchased in plastic profiles in various colors. Symptoms of Overexposure: None identified for product as purchased. Processing such as sawing,sanding, and abrasive applications that could release dust, or heating the product,could result in dust, vapor,or gas emissions that may cause eye,skin, or respiratory tract irritation. Potential Health Effects: Dust from product may contain crystalline silica, a cause of silicosis and a substance identified as an occupational carcinogen; and linked to other health effects. Heating of the product could result in release of methyl methacrylate monomer,which may also cause health effects such as skin sensitization in susceptible individuals,and with sufficient exposure may affect kidneys, central nervous system, and liver. (See Section XI for additional health information). Potential Environmental Effects: None identified. Material is not a RCRA Hazardous Waste. Ouc�® s l 16 A Member of the Royal Group of Compan,es www.royalmouldir,ys.xm Page: 3 of 4 MSDS Revision Date: March 2004 Section VII HANDLING AND STORAGE No specific safety precautions are necessary for the storage of materials. Keep product clear of walkways and floors to prevent tripping hazards. Other Protective Measurers: Should dusting occur from material handling or processing,dust accumulation and potential sources of ignition such as static discharge should be addressed by the user,to prevent fire or explosion from suspended,finely divided particles. Section VIII EXPOSURE CONTROLS/PERSONAL PROTECTION Engineering Controls: Effective local exhaust ventilation should be provided to capture dust generated during processes such as sanding or cutting, and to remove gas or vapor emissions from the work area should polymer breakdown begin from elevated temperatures. Respiratory Protection: Select respirators based on potential exposures if engineering controls are not sufficient to maintain airborne concentrations below applicable exposure limits. Utilize only NIOSH approved respirators,selected and used in accordance with the OSHA Respiratory Protection Standard(29 CFR 1910.134). Eye/Skin Protection: When cutting, sanding, or processing with dust generation,wear safety glasses with side shields or goggles. General purpose work gloves are acceptable. Select personal protective equipment(PPE) based on adherence to PPE Hazard AssessmentCertification as required by 29 CFR 1910.132(d)(2). SECTION IX PHYSICAL AND CHEMICAL DATA Appearance: Solid plastic profiles in various colors Melting Point: Not Determined Odor: No Specific Odor Specific Gravity: .50- .80 g/cm3 Water Solubility: Not Applicable Vapor Density: Not Determined Percent Volatile: Not Determined SECTION X STABILITY AND REACTIVITY Stability: Stable under normal conditions. Decomposition products under high heat or fire conditions may include hydrochloric acid, carbon monoxide, carbon dioxide, methyl methacrylate monomer, aldehydes, ammonia, hydrogen cyanide, hydrocarbons and other potential toxics dependent on specific conditions. Conditions to Avoid: Temperatures above 350 degrees F, Materials to Avoid: Oxidizers Hazardous Polymerization: Will not occur. MATERIAL SAFETY DATA SHEET Mineral Wool Ceiling Tile Date: 03116/09 ISSUED BY: Total basement Finishing 60 Silvermine Road Seymour,CT 06483 ACGIH=American Conference of Governmental Industrial Hygienists C.A.S.=Chemical Abstracts Service HMIS=Hazardous Material Identification System IARC=International Agency for Research on Cancer N/A=Not applicable or Not Available N/K= None Known or Not Known NIOSH=National Institute for Occupational Safety and Health NTP=National Toxicology Program OSHA=Occupational Safety and Health Administration OSHA PEL=OSHA Permissible Exposure Limits TLV=Threshold limit Value LEL=Lower Exposure Limit UEL=Upper Exposure Limit Department of Transportation Information HMIS (0=minimal hazard,4=severe hazard ) Shipping name :Not Classified Health=1 Hazard Class : N/A Flammability=0 ID No :N/A Reactivity=0 L Product Information A.Product Name : Mineral fiber acoustic ceiling panel B.Chemical Name and Synonyms : N/A C.Chemical or Product Family : Mineral wool 11. Ingredient Information A.Hazardous Components C.A.S No. % OSHA PEL ACGIH TLV (Chemical Identity;Common Name) Respirable: Respirable: Mineral Wool Fiber N/A 0-80 1 f/cc 1 f/cc This product formulation does not contain asbestos. Ill. Physical Data A.Appearance and Color:White,pressed man-made vitreous fiber panel of various colors B.Boiling Point(degrees F): N/A C.Vapor pressure(mm Hg @ 20 degrees C) : N/A D.Vapor density(Air=.1 ): N/A E.Solubility in Water :N/A F.Specific Gravity(H2O=11 ) : N/A G.Percent Volatile by weight(30 min.@ 276 degrees F ): N/A H,Evaporation Rate(Butyl Acetate=1 ): N/A I. PH : N/A IV. Fire and Explosion Data A.Flash point: N/A B.Flammable Range :LEL=N/A ; UEL= N/A C.Extinguishing Media :Water fog,dry chemical ABC rated D.Special Fire Fighting Procedures : None E. Unusual Fire and Explosion Hazards : None V. Health Data Ceiling tile 1 of 2 1 Testing Laboratory TL-216 Pspe 1 of 15 TEST REPORT for TOTAL 18 ASE E T FINISHING 60 Siivermine Road Seymour, CT 06483 Surface Burning Characteristics ®f Building Materials ASTM E-84-09a Test Report No: FH-1967 Assignment No: H-635 Test Date: 7/29/2009 Report Date: 8/5/2009 Subject Material: CEILING TILES Prepared by: Richard A. Costolrii Senior Test Engineer Reviewed by: Robert J 'enchetti Direct aboratory Facilities and ting Services The results reported in this document apply to specific samples submitted for measurement. No responsibility is assumed for performance of any other specimen. This report may not be reproduced,except in full,without the written approval of the laboratory. The laboratory's test reports in no way constitutes or implies product certification. approval or endorsement by this laboratorv. !650 Military Road , Buffalo, NV '14217-1198 (716)373-9750 , Fax (716)873-9753 • www.ngctPstingservic es.corn FH-1967 Total Basement Finishing RESULTS: 81512009 Page 3 of 15 MATERIAL CALCULATED CALCULATED TEST NO. TESTED SUPPORT FLAME SPREAD SMOKE DEVELOPED 1 JPRESTIGE CEILING TILE SELF 0 00 n 05 - -- V. 2 PRES�'IGE CEILING TILE SELF 1 0.00 0.11 3 PRESTIGE CEILING TILE SELF 0.00 1.32 4 LINEN CEILING TILE SELF 0.00 N D * 5 LINEN CEILING TILE SELF 0.00 1 164 6 LINEN CEILING TILE SELF 0.00 2.01 Cell malfunction MATERIAL TESTED SUPPORT FLAME SPREAD SMOKE DEVELOPED INDEX* INDEX* RED OAK FLOORING (calib) self 100 100 CEMENT BOARD calib self 0 0 PRESTIGE CEILING TILE SELF 1 =LINEN CEILING TILE SELF CLASSIFICATION FSI SDI A 25 or less 450 or less B 26-75 450 or less C 76-200 450 or less *Flame Spread Index/Smoke Developed Index is the result(or average of the results of multiple tests) rounded to the nearest multiple of 5. Smoke values in excess of 200; are rounded to the nearest 50. ® TM perTrack (Suitable for Viper20Tm and Viper25TM studs) Yield Strength ® 50 ksi Design Thickness ® 0.015597 Minimum Thickness s ® 0.0147 Coating G40 or Equivalent per AST C-64.5 R Track Web Sizes (inside dimensions) 1 -5/3", 2-1/2", 3-5/3", 4" and 699 Viper20STm Track ® Design Thickness 0.0200", G40 or equivalent coating Viper20DTm Track 9 Design Thickness 0.0245", G40 or equivalent coating The Commonwealth of Massachusetts zDepartment oflndustrialAccidents . : 1 Congress Street, Suite 100 v Boston,MA 02114-2017 www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERI4IITTING AUTHORITY- Applicant Information f_p Please Print Legibly Name(Business/Organization/Individual): 0 etc Address: City/State/Zip: Phone#: �n '" ( Are you an employer?Check the appropriate box: Type of project(fegnired): 1. I am a employer with e employees(full and/or part-time).* 7. [1w construction 2.Q I am a sole proprietor or partnership and have no employees working for me in $. Remo delirig any capacity.[No workers'comp.insurance required.] • 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[J Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F]Roof repairs These sub-contractors have employees and have workers'comp.insurance,t 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[�Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit#his affidavit indicating they are doing all work and then hire outside contractors must si bmit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-confracfors have employees,they must provide their workeis'comp.policy number. X am an employer drat is pi•ovidiiig workers'compensation insurance for my employees.'Below is the policy and joh site information. Insurance Company Name: r",` , ,('0�`1�� ���t2"���� Policy#or S elf-ins.Lic.#: W V co 6�3 ( `� I Expiration Date: vI U �� Job Site Address: 1� S �) •J\ "'--City/State/Zip:^M/''G l J Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL o. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. p do hereby certdf der t�epains and venalties ofperjury that the information provided ahove is true and correct, Signature. Date: 02� Phone# ^cam' SOS- C�9-�22 Official use only. Do not write in this area,to he 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#: > � L DATE IMMrool r 1"r;CERTIFICATE UABILI T Y IN:�'�������j� C 007/09/2011-5 — 1 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFOMATION ONL f AND CONF�R� �d0 RIGHTS UPON THE CERTIFICATE HOLDEN f1-11:6 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR 'ALTER THE COVERAGE AFFORDED t3`( THE POL1C1' :a BcLOW. THIS CEPTIFICA`IE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETldtl'rEN THE- 15SU1iJG 1NSU;;cT?(S), AUTHORIZED REP ESENTATIVE 01?PRODUCER,AND THE CERTIFICATE HOLDER. 1>>1Pr�RTANT: if tha cer#ificate holder is an ADDITIONAL ENSURED,the policy(ies) must be en+dors�:d. 1f SJBROG�iT1CAd 15'J'/AI'/=t�,stahjec T 1 the terms and conditions of the policy,certain policies may require art endorsernan`t. A staiarriant on this certificate does not conifer rights Icertificate holder in lieu of such andorsement(s). ^ 0-- 1,CON?ACI y?ROCUCcft Phone:v:DJ*.'03- 24 , ��0•':I NAME: Srown&Brown(Merrimack PL NONE FA't (PJC __-- ax:v 76�8E18-1223 'C Alo Eat: _ idol: 309 Daniel Webster Highway E-MAIL Merrimack,NH 03054 ADDRESS: Chris McPhail INSURER(S)AFFORDING COVERAGE NAILt___._ iIJSORERA:Peerless Indemnity Ins Co 18's33 INSURED Biackdog Builders, Inc, INSURER B:Peerless Indemnity Ins Co1$333 - Blackdog Builders INSURER C: Ell' Investment Holdings,LLC INSURER D: — - 7 Red Roof Lane Unit 8#1 Salem,NH 030792984 INSURER E: INSURER F: -----YO COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: _ __ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY ITH RESPECT TO WHICH THIS CERT FICATENMAY/BESISSUEDDIOR MAY PERITAIN, THE TINSURANCE ERM OR OAFFORDED Y THE OPOLCIES DESCRIBED NTRACT ORTHER OCUMENT n HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRADDL SUBR POLICY EFF POLICY EXP LIMITS � LTR TYPE OF INSURANCE g POLICY NUMBER MMiDD/YYYY MM/DD/YYYY — GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 A X COMMERCIAL GENERAL LIABILITY BKSa"5511514 07/01/2015 07101/2016 PREMISES Ea occurrence —_ MED EXP(Any one person) S 15,000 CLAIMS-MADE OCCUR - PERSOIJALB.ADVINJURY $ '1,00(),000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS.COMP/OP AGG S 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ POLICY PRO- LOC ---- COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident $ .— A X ANY AUTO BAS55511514 07/01/2015 07/0'1/2016 BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS X AUTOS PROPERTY DAMAGE y NON-OWNED Peraccidenl _ ----- X HIRED AUTOS X AUTOS S X UMBRELLA LIAR 7X OCCUR s EACH OCCURRENCE S `1,000,0()0 B EXCESS LIAB CLAIMS-MADE US055511514 07/01/2015 07/01/2016 AGGREGATE S _ DED X RETENTION5 10000 �XWVO SWC STATU- 0TH- WORKERS COMPENSATION TORY LIMITS _ERAND EMPLOYERS'LIABILITY YIN 55511514 07101/2015 07/01/201G L.EACH ACCIDENT s r,00,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE � N 1 A 500),000 OFFICERWEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE S (Mandatory in NH) 500000 If yes,describe under E.L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) *David Bryan is excluded from Worker's Compensation coverage. CERTIFICATE HOLDER CANCELLATION — SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Insured's Reference ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE AIS ©1988-2010 ACORD CORPORATION, All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD lit n 011 S CS-1 0, -R VE M j R -173403 I P ID 3 E R T GAS?RAi\J T P.O.SOX 37A POBERT LE.GAR-RAMT 11 HANIP—1 CN EX' 143 3 14 RCSFRT 14*1 DRH\1K WATER ROAD HAMPTON FALLS, NH 03844 Undersecretary �� Co'mrnissjoner Construction Supervisor Restricted to: License or registration valid for individul use only Unrestricted-Buildings of any use group which contain before the expiration date. If found return to: less than 36,000 cubic feet(991 cubic meters)of enclosed Office of Consumer Affairs and Business Regulation space. 10 Park Plaza-Suite 5170 Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not validcVv/it'hout signature DPS Licensing information visit: WWW.MASS.GOV/DPS