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6/3/2016 20516 This is an e -permit. To learn more, scan this barcode or visit northandoverma.viewpointcloud.com/#/records/20516 OF NORTH 4ti �2 OCG O {p 5 AC H Us�fi TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that Paul D Hoffman has permission to perform 3 toilets plumbing in the buildings of NORTH ANDOVER COUNTRY CLUB at 500 GREAT POND ROAD, North Andover, Mass. Lic. No. 11764 Date: June 03, 2016 EM ^ice ",p raYawe — 4 S Torn of North Andover. 'rt1A q i Heads up- Were made upgradesm the mli,, seMCe cettEn Please reiiesn the page to get Che latesc-10n. Reload 20516 •Phtmhing Permit - RMI--- pf F-Urraftpliante (Cam M.W m Reside[mali 77AIELINE 5I3A re ei:E3 mr request �progressPZ2016ei2a3pm Well L�YOuinvot uaetraff.ceEi;reemcteokare — Plumbing Permit Review SrMIK at any r$rE by c=hq hack m &ds page . , \ t�mR Rase SereroKeeeyW3RUEvJutpH 0 Per it I: -e CapyR�t : ESC C� .. . L {0 �./ ('emit 15wan_e NLEef Trs,Ymeei -� 1! pard Hoffman 500 GREAT POND ROAD, NORTH ANDOVER, MA Uxrt_r NORIAANDOY6t COtl MYCLUS ktarhmenls -07BGRWIOOIF Thujun 02 2016 1639:.PDF Thursday, Jun 02, 2016 12:39 PM �RBt6 1 \ Thursday, Jun 02, 2016 12:39 PM �RBt6 FO M_ OF ❑ FAX PHONE ❑ MOBILE M ESSAG DATE CKI E NUMBER ✓1 Nen 0 i �vU TIME ,SIGNED V110 10 SECOND NATURE- %-5 RECYCLED WFapS. FnRM 74Fan J NOTE _�& Final Construction Control Document W To be submitted at completion of construction by a ' Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 1.07 Project Title: North Andover Pool Deck Date: 09.29.15 Permit No. Property Address: 500 Great Pond Road, Andover, Massachusetts 01810 Project: Check one or both as applicable: lS New construction ❑ Existing Construction Project description: Pre-engineered floor deck above pool. i Jeffrey M. Reder MA Registration Number: 48535 Expiration date: 06.30.16 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural N Structural [ ] Fire Protection [ ] Electrical [ ] Mechanical [ ] Other: for the above named project. I, or my designee, have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 2. 3. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. .... _ Nothing in this document relieves the contractor of its responsibility regarding Enter in the space to the right a "wet" or electronic signature and seal: Phone number: 513-851-1223 Email: irederna clarkreder.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 07. 15 Date.... TOWN OF NORTH ANDOVER PERMIT FOR WIRING -T . . ............................................................ i� ...... '... This certifies that ............. '... .,/ ........ . has permission to perform ....... �%t7to ..... .... VJ .............. ............ ......... Cl wiring in the building, ....... ........... .................. at I.; ....... �?h ......................... , I North Andover Mass. .............. Fee.... Lic. No. ................. .. ............ bheck o (LECKRICAL INSPECTOR 12133 T:��s 0 A< 2 - z J- / q (..ommonw¢alt� o�cc�aeeachc�e� aUePavtmerci o� �tive �ervieee BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 1 2-b D 3 Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code C), 521 CMR 12.00 (PLEASE PRINT IN INK OR TYPEVLX= Date:City or Town of: To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to performjhe electrical work described below. Location (Street & Number) Owner or Tenant k1tZrki, d,,k-�fd C,o v1, Th,,! I U ,o Telephone No. Owner's Address �T Is this permit in conjunction with a building p it. Yes ❑ No(Check Appropriate Box) Purpose of Building Ct,� ��J Utility Authorization No. , Existing Service Amps �/ Volts ,' Overhead ❑ New Service Amps Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: I UAYl2 0,Al4 V, Undgrd ❑ Undgrd ❑ No. of Meters No. of Meters Com letion of the following table m be waived hy the Ins ector o Wires No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑In- E] rnd. grnd. No. of Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches. of Gas Burners o. of Detection and Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices g No. of Waste Disposers Heat Pump Totals: I.Number I Tons .......................' KW "' '"""" No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP TelecommunicationsWiring: No. of Devices or E uivalent OTHER: u l Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of E ctrical Work: (When required by municipal policy.) Work to Start: 71 .7D Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COV RAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cover office. ge is in force, and has exhibited proof of same to the permit issuing oce. CHECK ONE: INSURANCE [BOND ❑ OTHER ❑ (Specify:) I certify, under the pains enalttes of perjury, that th information on this application is true and complete. FIRM NAME: C3 U�pA LIC. NO.: 3-3 Licensee: S\�,,,Qj�i' qvt �Tu_Signature LIC. NO.: (If applicable, a exempt, ithe license n er line Bus. Tel. No.: Address: Alt. Tel. No.: *Per M.G.L. c. 147, s.-57-6 1, security 4ork requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $ Signature Telephone No. 230 Date TOWN OF NORTH ANDOVER PERMIT FOR MECHANICAL INSTALLATION This certifies that. (P-':'G�AMq 0 . • . has permission for mechanical installation t -y' tq • . .. PA. in the buildings of -CO.q/1 ct ................... • at ���. .. r;�i' •t• • • (*Y,//•.(• • . North Andover, Mass. Lic. No.. ........ Ak-.1 ---- GAS INSPECTOR WHITE: Applicant CANARY: Building Dept. PINK: Treasurer Commonwealth of Massachusetts Date: Febuary 4, 2014 Estimated Job Cost: $ 30,000 Plans Submitted: YES V NO Business License # Business Information: Name: Seidman Bros. Inc. Street: 25 Sixth Street Sheet Metal Permit Permit # Permit Fee: $ (� Plans Reviewed: YES d NO Applicant License # 5586 Property Owner / Job Location Information: Name: North Andover Country Club Street: 500 Great Pond Road City/Town: Chelsea, MA. 02150 City/Town: North Andover, MA. 01845 Telephone: 617-884-8110 Telephone: 978-687-7414 Photo I.D. required / Copy of Photo I.D. attached: YES NO Staff Initial J-1 / M -1 -unrestricted license M-1 J-2 / M -2 -restricted to dwellings 3 -stories or less and commercial up to 10,000 sq. ft. / 2 -stories or less Residential: 1-2 family Multi -family Condo / Townhouses Other Commercial: Office Retail V Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney / Vents Air Balancing Provide detailed description of work to be done: Remove the existing exhaust system and install a new rear discharge make-up air hood with fire suppression F system (By Others), and CO detection. New system will have two exhaust fans and one supply fan. Exhaust fans will be equipped with hinge kits and removable grease interceptors. Ducts will be wrapped in Zero Clearance Duct Wrap. INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes [' No ❑ If you have checked Yes, indicate the type of coverage by checking the appropriate box below: A liability insurance policy M Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box[(, I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Date Date Progress Inspections Comments Final Inspection Inspector Signature of Permit Approval Comments Signature of Licensee License Number: 5586 Check at www.mass.gov/dPI Type of License: B'i [� Master Title ❑ Master -Restricted City/Town ❑Joumeyperson Permit # ❑Journeyperson-Restricted Fee $ ❑ Inspector Signature of Permit Approval Comments Signature of Licensee License Number: 5586 Check at www.mass.gov/dPI The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations U1. 600 Washington Street Boston, MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lepibly Name (Business/organization/Individual): Seidman Bros. Inc. Address: 25 Sixth Street City/State/Zip: Chelsea MA 02150 Phone #: 617-884-8110 Are you an employer? Check the appropriate box: I am a employer with 15 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees working for me in any capacity. [No workers' comp, insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance reouired.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.W Other Kitchen Exhaust Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Fire Insurance Com Policy # or Self -ins. Lic. #: 08WECLJ4341 Expiration Date: 3/31/2014 Job Site Address: 500 Great Pond Road City/State/Zip: North Andover, MA 0184E Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature, 4ck skawwv Date February 4 2014 Phone #: 617-884-8110 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: SEIDBRO-01 CONNIE1 DATE (MMIDD/YYYY) ACRO° CERTIFICATE OF LIABILITY INSURANCE 4/112013 THISCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). r �IRnr.T PRODUCER Elliot Whittier Insurance Services, LLC 75 Sylvan Street, Suite B202 Danvers, MA 01923 INSURED Seidman Bros., Inc. 25 Sixth Street Chelsea, MA 02150 977-4884 (AIC NO: (978) 977-0850 A: Sentinel Insurance Co., LTD 11000 B: Hartford Fire Insurance Co. 19682 D: E: oovlclnNII NMRER: COVERAGES CERTIFICATE NUMBER: ' TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY POLICIES ED HEREIN IS SUBJECT TO ALL THE TERMS, MAY BE ISSUED OR MAY LIMITS SHOWN MAY HAN, THE INSURANCE OVE BEEN REDUCED BY PAID CLAIMS.RDED BY THE ECERTIFICATE XCLUSIONS AND CONDITIONS OF UCH POLICIES. POLICY EFF POLICY EXP LIMITS ADD UB INSRTYPE OF INSURANCE D POLICY NUMBER MM/DD MMIDD 1,000,000 EACH OCCURRENCE $ GENERAL LIABILITY 08SBAZV0579 9/15/2012 9/1512013 p 0 R TED PREMISES Ea occurrence $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 CLAIMS -MADE FKOCCUR PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ X1 POLICY[11 PEO LOC COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS OOWNED PROPERTY DAMAGE $ PER ACCIDENT HIRED AUTOS AUTOS $ EACH OCCURRENCE $ 1,000,000 X UMBRELLALIAB X OCCUR OBSBAZVO579 9115/2012 911512013 AGGREGATE $ 1,000,000 A EXCESS LIAB CLAIMS -MADE $ DEDTX RETENTION$ 10,000 WC STATU- OTH- X CRY WORKERS COMPENSATION LIMITS ER 500,000 AND EMPLOYERS' LIABILITY08WECU4341 3/31/2013 3/31/2014 Y E.L. EACH ACCIDENT $ B ANY PROPRIETOR/PARTNER/D? EXECUTIVE OFFICER/MEMBER EXCLUDEN / A E.L. DISEASE - EA EMPLOYE $ 500,000 (Mandatory in NH) If yes, lescn'e under E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) w TIA\I CERTIFICATE HOLDER I LIAVRICLL-m r "I SEIDMAN BROS., INC 25 Sixth St. ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD id Massachusetts - Department of Public Safety \ J Board of Building Regulations and Standards Construction Suivry sor j License. CS -072179 JACK P SEIDMAN• �• 25 SIXTH STREET. �jl :',`• CHELSEA MA 03150 �,•�,.. tJ/_. ,� ,,, �` Expiration Commissioner 11/02/2015 ,rT v- .COMMONWEALTH OF MASSACHUSETTS SHEET METAL WORKERS ASA MASTER-UNRESTRICTE® i ISSUffS THE AdWt LICENSE TO `JACK PSEIDt4AtJ 1 .SEIDMAN. BROS 'INC 'moi :25 SI,X H %SS- ET CHELSEA : MA 02150 E. DMBROS. INC. —to,,Fond Sen ice Fquipment Dealers, Design, Fabrication, h Installation oJKitchen E.rhaust SYsrems Custom .Stainless Steel Fabrication To: North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Voice 978-687-7414 Ext 9 Fax 978-686-0318 25 Sixth St. Chelsea, MA 02150 USA Voice: 617-884-8110 Fax: 617-884-4284 Sales Order Number: SO2014-0019 Sales Order Date: Jan 28, 2014 Ship By: Jan 28, 2014 Page: 1 To: North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Customer ID PO Number Sales Rep Name North Andover CC Jack P. Seidman Customer Contact Shipping Method Payment Terms Stephen Kohr Our Truck C.O.D. Quantity Item Description Unit Price Amount 14.00 se makeuphood Stainless Steel Rear Discharge Make-up air Hood 275.00 3,850.00 with Baffle Filters and removable Grease cup. Priced by the foot. 6.00 se hood Stainless Steel exhaust only Hood with Baffle Filters 185.00 1,110.00 and removable Grease cup, and angled end to fit next to existing hood. priced by the foot. Right Side 6.00 se hood Stainless Steel exhaust only Hood with Baffle Filters 185.00 1,110.00 and removable Grease cup, and angled end to fit next to existing hood. priced by the foot. Left Side 5.00 p 24h Hood light fixture complete with Globe. Mounting hole 45.00 225.00 cut into the hood. 2.00 se exsys Exhaust System with 18", 1 HP, 1 spd, 220 V, single 3,950.00 7,900.00 phase, upblast Fan, hinged roof curb, grease trap, and welded 17" X 17" duct. 3750 CFM, 7500 CFM total 120.00 infab 999 Zero Clearance Duct Wrap by the square Foot 9.50 1,140.00 1.00 se musys Make-up air System with 18" 1'/HP, single phase 4,650.00 4,650.00 Blower Fan, with a filtered housing, roof curb, and ductwork. 6000 CFM = 80% returned to room. 14.00 se ssrdpnl Stainless Steel wall panels mounted on wall under 45.00 630.00 rear discharge, by the foot. 12.00 se sshdpnl Stainless Steel wall panels mounted on wall under 65.00 780.00 Subtotal Continued Sales Tax conunued Freight Continued ,TOTAL ORDER AMOUNT Continued Finance Charge is computed at 2% monthly (24% APR) on all balance.- over alance:over 30 days old. aB�D&IL11 BROS. INC. Food Serrire Frptipment Deniers, Design, Fabrication. & Installation of Kitchen Exhaust Systems & Custom ,Stainless Steel Fabrication To: North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Voice 978-687-7414 Ext 9 Fax 978-686-0318 25 Sixth St. Chelsea, MA 02150 USA Voice: 617-884-8110 Fax: 617-884-4284 SALES +DNI Sales Order Number: S02014-0019 Sales Order Date: Jan 28, 2014 Ship By: Jan 28, 2014 Page: 2 Ship To: North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Customer ID PO Number Sales Rep Name North Andover CC Jack P. Seidman Customer Contact Shipping Method Payment Terms Stephen Kohr Our Truck C.O.D. Quantity Item Description Unit Price Amount hood or other areas up to 84" tall, by the foot. 1.00 Job -Fire UL -300 Fire suppression system to cover the hood, 3,550.00 3,550.00 duct, and listed appliances under the hood, using existing equipment. (Valves to be installed by others) 1.00 Job -CO CO Detection system with master and slave units and 1,250.00 1,250.00 testing materials. Installation by others. 1.00 Job -Print cnslt Consulting with Inspectional Services in your town. 550.00 550.00 Includes permit fee. 1.00 Job-engdrw Stamped engineered drawing of the exhaust system 750.00 750.00 for the Building Dept. (If required by the town) 1.00 Job -Labor Labor to remove and dispose of old hood and 1,000.00 1,000.00 equipment. Price includes delivery and setup of listed equipment. Unless specified, NO plumbing, electrical, carpentry, welding permits, FD Details, or subcontracted work is included in price. We will need approximately 4 days to do this project plus you will need an electrician to wire the new fans and deal with shut down of makeup air and electrical under the hood, and connect to alarm, and a plumber Subtotal Continued Sales Tax--------- Continued Freight Continued TOTAL ORDER AMOUNT Continued Finance Charge is computed at 2% monthly (24% APR) on all balance: over 30 days old. BROS.INC. Food Seri -ire Equipment Dealers, Design, Fabrication, & Installation of Kitchen Erhaust Sweats & Custom Stainless Steel Fabrication To North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Voice 978-687-7414 Ext 9 Fax 978-686-0318 25 Sixth St. Chelsea, MA 02150 USA Voice: 617-884-8110 Fax: 617-884-4284 SA LEM C] @I@ I R Sales Order Number: S02014-0019 Sales Order Date: Jan 28, 2014 Ship By: Jan 28, 2014 Page: 3 Ship To: North Andover Country Club 500 Great Pond Road North Andover, MA 01845 Customer ID PO Number Sales Rep Name North Andover CC Jack P. Seidman Customer Contact Shipping Method Payment Terms Stephen Kohr Our Truck C.O.D. Quantity Item Description Unit Price Amount to move and reconnect the cooking equipment and install the new valves. Planning on first week of February for installation. Subtotal 28,495.00 Sales Tax Freight 0.00 TOTAL ORDER AMOUNT 30,179.06 Finance Charge is computed at 2% monthly (24% APR) on all balance: over 30 days old. PERMIT FOR GAS INSTALLATION This certifies that .. ....+.�. .....�.. ? ..... has permission for gas installation.:` fA 4 c cs . ',X- c --<..r in the buildings of . � �� . "` '`�` � � `'� at. , North Andover, Mass. Fee ......... Lie. No .......... .... ...... . 3,2 W(p GAS INSPECTOR Check # 3 2-,3'7z- 8354 3?Z 1�v o ,Alv I MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITYLN, �aA,-, t— MA DATE I PERMIT # JOBSITE ADDRESS �dd�GOWNER'S NAME GOWNER ADDRESS ITELI IFAX TYPE PRINT OCCUPANCY TYPE COMMERCIAL EDUCATIONAL ❑ RESIDENTIAL ❑ CLEARLY NEW: ❑ RENOVATION: ❑ REPLACEMENT: [Q PLANS SUBMITTED: YES NO [] APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BOILER BOOSTER CONVERSION BURNER COOK STOVE DIRECT VENT HEATER DRYER FIREPLACE FRYOLATOR FURNACE GENERATOR GRILLE INFRARED HEATER LABORATORY COCKS MAKEUP AIR UNIT OVEN POOL HEATER ROOM / SPACE HEATER ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER WATER HEATER OTHER INSURANCE COVERAGE I have a current lii insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 YES ONO ❑ 1 IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICYQ OTHER TYPE INDEMNITY ❑ BOND ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. CHECK ON Y: OWNER AGENT f-1SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this are true nd to the of my knowledge and that all plumbing work and �tallations performed under the permit issued for this appy I comp) with it Pertirt�provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASATTER NAME Michael Bemasconi LICENSE # 5137 SIGNATURE MP 0 MGF ❑ JP ❑ JGF ❑ LPGI ❑ CORPORATION 0# 2806C PARTNER IP ❑#� LLC ❑#C� COMPANY NAME: Central Cooling & Heating, Inc. ADDRESS 19 North Maple Street CITY Wobum STATE ®ZIP 01801 TEL 781-933-8288 FAX 781-932-9017 CELL 781-844-3424 ]EMAIL[mbemasconi@(;entralcooling.com 1�v o ,Alv I q O n m ! y O m .. = N w � x b O CO) V 1 y $ � � � o � c El z K z r z n 0 z 0 y The Commonwealth ofMassachusetts Department of Indusbial Accidents Office of Investigations Map # . lot # kv 600 Washington Street Address: Boston, MA 02111 Permit # www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. /� ' 1 Please Print Legibly Name (Business/organization&dividual) C2 0. l + 1"f ea+ i ng T n C. Address: 9 AI d rob 61a,ol e Y4ree�- City/State/Zip: (:AJnblefn r in)4 6/t(11 Phone #: 7$1- M -T918 Are you an employer? Check the appropriate box: 1. ® I am a employer with i0 4• ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time). « have hired the sub -contractors 6 ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. Demolition working for me in any capacity. employees and have workers' insurance) 9. g addition [No workers' comp. insurance comp. 'required.) 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3. ❑ I am a homeowner do' all work � officers have exercised their 11. Phmnbin Q g repairs or additions. myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] -t c. 152, §. 1(4), and we have no employes. [No workers' 13.N Other-.,/ 4f— comp. insurance required.] `Any applicant.ffiat checks box #1 must also fill out the section below showing their workers' conrensation policy intbmration. t Homeowners who subnrit this affidavit indicating they aro doing all .work and the► hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the nine of the subcontractors and state whether or not those entities have employees. If the iub-cdnhacton: have employees, they must provide their workers' comp: policy number I ani an employer that isprovlftg workers' compensation insurance for my employees Below Ls thepolrcy aadjob site Inforiftadom Insurance, Company Name: G, L 6 R A L -TN SLLQ ANC . IJ£T WA P K , 7A/r Policy # or Self -ins.. Lic. #: 85r% e%V1) ,9 �g % Expiration Date: 1/ 36 la6 1,2 Job Site Address: 5-& ��(� _�(R�c City/SW&7-ip:1,/- /)rJrll-e-, M yft Attach a copy of the workers' compensation policy declaration. page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties .of a fine.up.to $ L500.00 andlor one-year imprisonmmtn as well as, civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised tliat a copy of this statement may be forwarded to the Office of hUestigations of the DIA for insurance coveraxe verification. Idocerci under and penalties ofpedury that the information provided above is true and correct fir-IC716= use area, 17 or town offlcraL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• Information and instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees`. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as ."an individual, partnership, association; corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C() states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workerscompensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contracior(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number.listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant: Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under -Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant.as proof that a valid affidavit is on file for fidure permits or licenses. A new affidavit crust be filled out each Year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would byre to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The eommonvAmIth of Massachu seW Dq airtment of Industrial Acci&nts Oe'of InvtatWns 6W WashingWri Sbvd Briton, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877 MASSAFE Revised 11-22-06 Fax # 617-727-7749 wwwmameov/dia COMMONWEALTH OF MASSACHUSETTS NACHUSFUT'S. DWISIOt, OF PROFESSIONAL HCENISURE BOARD OF PLUMBERS AND GASFITTERS MA REGISTERED AS A PLUMBING CORP ISSUES THE ABOVE LICENSE TO: 01-2611-.2011 -3"2 3 mi 1-1-02-2015 MICHAEL BER14ASCONI 9frEl T11 Rm ,Seats CENTRAL COOLING & HEATING INC . B 58 ALBATROSS RD IBERNASCONI 2 MICHAEL C RDTRoss QUINCY MA 02169"2658 a56 ALUC(L'.'j QLNNCY, MA 0210211511 006 05/01/14 .210316 5 W ti -V -21"l Rw 0745 -Un LICENSE NO. EXPIRATION DATE SERIAL NO. COMMONWEALTH OF MASSACHUSETTS nIVISION OF PROFESSIONAL LICENSURE - BOARD OF, AND GASFITTERS. LICENVED AS A JOURNEYMAN PL (IMBE ISSUES THE ABOVE LICENSE TO: I. MICHAEL C BERNASCONI 58 ALBATROSS RD Q . UINCY MA 0216-9-2658Q 26474 05/01/14 169601 COMMONWEALTH OF MAtSibftjW,,M 74J4 Date .//O/ i � ..... . TOWN OF NORTH ANDOVER PERMIT FOR GAS IN; This certifies that . .'r... /,14 �/,V ....�T� .... . has permission for gas installation .....� /A. ............ . in the buildings of V/16, .41', .4:% ....... atZorth Andover, Mass. No.;eLiC: J GAS INSPECTOR Check # cn uW� I' V FIXTURES MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town: MA. Date:' J 0 '' f ® Permit# _ Building Location:(SQo fo -RnL- Owners Name: a Type of Occupancy: Commercial V Educational ❑ Industrial ❑ Institutional ❑ Residential ❑ Y New: ❑ Alteration: ❑ Renovation: ❑ Replacement: [ Pians Submitted: Yes ❑ No ❑ V FIXTURES INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicat a type of coverage by checking the appropriate box below. A liability insurance policy IV Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent: By checking this box ; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumb in an hapten 142 of the General Laws. Typ license: By lumber rue _ ❑ G er Si nature of Licensed Plumber/Gas Fitter aster City/Town _ ❑Journeyman License Number: _1 3" o APPROVED (OFFICE USE ONLY) I ❑ LP Installer W Z W Y N QW V) Uj U O W Uj m z = t- Q z J o Y W Z x U) ,, W O a N a 0 Z v� w w m 0 a a a = v a Ix -i > z a w z ,- 0� rn r -' a s o z w o cWa z o o �, LU = W w '= z a w w a a w O U X o x M o LL a 0 W W 0 x W x Im a> O 0 a a x O IX W t- z W >> 01 - SUB BSMT. BASEMENT 1 FLOOR 2 NLFLOOIR 3mu FLOOR 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 m FLOOR ,r� �% Check One Only Certificate # Installing Company Name: l�c�l S/ _ / orporationAddress: State: ��i , Aityffown:- ❑ Partnership b` Business Tel: �o_�- 5�,�'�7y Fax: v ---- ❑ Firm/Company � nn OA Name of Licensed Plumber/Gas Fitter: 11 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes No ❑ If you have checked Yes, please indicat a type of coverage by checking the appropriate box below. A liability insurance policy IV Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent: By checking this box ; I hereby certify that all of the details and information I have submitted (or entered) regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and Installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumb in an hapten 142 of the General Laws. Typ license: By lumber rue _ ❑ G er Si nature of Licensed Plumber/Gas Fitter aster City/Town _ ❑Journeyman License Number: _1 3" o APPROVED (OFFICE USE ONLY) I ❑ LP Installer 7342 Date. /z . ? ......... 3? �'Oz. TOWN OF NORTH ANDOVER'. • PERMIT FOR GAS INSTALLATION �,SSACMUSEI This certifies that .............. has permission for gas installation ... r.4 /? !t e. _ ....... in the buildings of .A . Wim. � N./. ..... at. �. G U... C /I r .lfi. M. �, North Andover, Mass. Fee. . r . Lic. No.. � .. z?« .... ... .� �.. .... . GASINSPECTOR Check # SUE B—SMT, ffA—S E M A7 F-LOCk jf—FL06� 1p�'W-F-L06� ?7FL—OO� FLOOD K17TL-0-0� T"F LO- '0--R U... FLOOP FIXTURIES —T,11 —,�, FT W C6 to Ir 0 -J, re W LU 0. M 0 IL LU W 0 W= W Z U, -J 01 z -1 U. 1E x W M W 0 z U. 0 0 = -1 > 0 z z 1 —1 0 0- =) n < < z 0 0 5 W 0 0� =Pj > 0 ins td -fling Compajj,�,f NamL,:, Central Cooling & Heating, Inc. Address:. 9 North Maple Street BUS'111GSS Tel: 781-933-8288 Cftyffetun. Woburn Fax.' 781-932-9017 KWIIS of Licensed Piumber/Gas Fitter, Mlike Bernascont Check One only CertM V COrPoration 28060 State: MA Partnership Firrn/ConjPa,-T,y 4 INSLPRWC�E Cil EIRAGIF, i have a ctirrellf Yabliffminsurance policy Ott Its substan If FOU have checked YE.'s, ple .a,e ind NO A liability leate the 'WPG� Of COVerage by chCCV.Ipg the appropHaft bo,- belaw. Other type of Indemnify Bond I"4SURPANC liz tAkFAI'VER: t am aware that the Jpcejjsee doe, M"EaChusefts Genem.j Latr,�s, ands that my signatL; 's not-haxec- t1le lnsum'RGe COVeri9c Mquired by Cigar 142- tIlf's Pe;'Mlt aPPIlC2t;0n A—alklec this requirement. Sieck One oniv lqn�ture Of =Ovvn�r —orCvTn-------- 0,1"Vner. . . .1 Oy checking this ers Aqent Agent hereby certify that ail ai the detalis and information f have submitted (or er ared) rega g this:2- , accurate to the best Of my Knoviiedge and that ail plumbing work and Insta l8tions performed under e Wmit 1 are true and complian"'With all Pertlnvnt provision of the passachusetts Statv, sue or this application Will be in m n pode�Vnh ter , f the ee nemal La By,Type of License:' V- Plumber Title Gas Fffter Master ign terse f Licensed Plu be G . S F1 CitY/Town I APPROVED oumeyrnan (OFFIC USE 04LY) LP Installer License Ku icer: 15137M MiASSAC: V FOR PER IT �-5 -F r, Cly Toren. Ne -y., Anjo,"'C Date: Pern-im Building Locatic 5-66 & TYPe 19?, 411�- Gc rJf Occ"Pancl',- Commercial Hucational indusida! Institutional New:: Alteration- RC-IlovaVon:Replacement:,x Rosideritia.1 I tear Subrr)fffed: Yes No ie SUE B—SMT, ffA—S E M A7 F-LOCk jf—FL06� 1p�'W-F-L06� ?7FL—OO� FLOOD K17TL-0-0� T"F LO- '0--R U... FLOOP FIXTURIES —T,11 —,�, FT W C6 to Ir 0 -J, re W LU 0. M 0 IL LU W 0 W= W Z U, -J 01 z -1 U. 1E x W M W 0 z U. 0 0 = -1 > 0 z z 1 —1 0 0- =) n < < z 0 0 5 W 0 0� =Pj > 0 ins td -fling Compajj,�,f NamL,:, Central Cooling & Heating, Inc. Address:. 9 North Maple Street BUS'111GSS Tel: 781-933-8288 Cftyffetun. Woburn Fax.' 781-932-9017 KWIIS of Licensed Piumber/Gas Fitter, Mlike Bernascont Check One only CertM V COrPoration 28060 State: MA Partnership Firrn/ConjPa,-T,y 4 INSLPRWC�E Cil EIRAGIF, i have a ctirrellf Yabliffminsurance policy Ott Its substan If FOU have checked YE.'s, ple .a,e ind NO A liability leate the 'WPG� Of COVerage by chCCV.Ipg the appropHaft bo,- belaw. Other type of Indemnify Bond I"4SURPANC liz tAkFAI'VER: t am aware that the Jpcejjsee doe, M"EaChusefts Genem.j Latr,�s, ands that my signatL; 's not-haxec- t1le lnsum'RGe COVeri9c Mquired by Cigar 142- tIlf's Pe;'Mlt aPPIlC2t;0n A—alklec this requirement. Sieck One oniv lqn�ture Of =Ovvn�r —orCvTn-------- 0,1"Vner. . . .1 Oy checking this ers Aqent Agent hereby certify that ail ai the detalis and information f have submitted (or er ared) rega g this:2- , accurate to the best Of my Knoviiedge and that ail plumbing work and Insta l8tions performed under e Wmit 1 are true and complian"'With all Pertlnvnt provision of the passachusetts Statv, sue or this application Will be in m n pode�Vnh ter , f the ee nemal La By,Type of License:' V- Plumber Title Gas Fffter Master ign terse f Licensed Plu be G . S F1 CitY/Town I APPROVED oumeyrnan (OFFIC USE 04LY) LP Installer License Ku icer: 15137M I a. �21 I -\ The Commonwealth OfMassachusetts Department of Industria[Accidents ®rice ofInvestigations MaP # ---- Lot 600 Washington ,street Address: Briton, MA 02111 Permit # Www-mass.g-ovldia -�-- - Workers' Compensation Insurance Affidavit., Builders/Contractors/Electricians/Plumbers Mame (Business/organization/Individual)' Address: 1.2 1 ani a employer with ?'—_ 4. ® I am a general contractor and I employees (full and/or part-time}. * pity/State/Zig: {,�1��urY ��R G� �f l Phone #: Are you an employer? Check the appropriate box: 1.2 1 ani a employer with ?'—_ 4. ® I am a general contractor and I employees (full and/or part-time}. * have hired the sub -contractors 2. ❑ I am. a sole proprietor or partner_ listed on the attached sheet ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ required.] 5. [] We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t a 152, § 1(4), and we have'no employees. [No workers' comp. insurance required.) Type Of project (required): b. ❑ New construction 7. Q Remodeling 8. ® Demolition 9. C1 Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.® Roof repairs 13.&] Other WZda , ,ten <:- 4,-. Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. I homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. I am an employer that ispr6viding workers' compens information. ation insscrance for rely employees. Belowis the policy acrd fob site Insurance Company Name:— (;- La 6L, 1N 5-U K Ft N CL— Policy # or Self -ins. Lic. #: �, �; q 6 3 Expiration Date: 11 /6.0 Job Site Address:_ 9-60 Grea Qsm p .p City/State/Zip:� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration dale). Failure to secure coverage as required under Section 25A. of MGI, c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 andlor one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of I do herby certify ereer the pains aced penalties Phone #: i 4 i - °,3,3 - 8, FS rise oney. Do not write in this area, City or Town: that the information provided above is true and correct a by city or town official 1Per"t/License # /Z Issruing Authority (circle one): I. Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Massachusetts General. Laws chapter 152 requires all employers to provide workers' compensation for their employees, Pursuant to this statute; an employee is defined as "...every person. in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a ,point enterprise, and including the legalrepresentatives of a deceased employer, or the receiver or trustee of an, individual, partnership, association or other legal entity, employing employees. 'However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer," MGL chapter 152, §25C;(6) also states that "even' state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC;) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC; or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial.Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below, Self-insured companies should enter their self-insurance license number on the appropriate line.. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pertnit/license number which will be used as a reference number. In addition, an applicant that must submit multiple peimitllicense applications in any given year, need only submit one affidavit indicating current: policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)," A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a. license or permit not related to any business or con-unerci.al venture (i.e. a dog license or permit to burn leaves etc,) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax. number: !g The Commonwealth of Massachusetts department of Industrial Accidents office of Investigations 600 Washington Stet: Boston, MA 02111 Tel, ## 617-727-4900 exp 406 or 1-877-MASSAFE Fax ## 617-727-7749 Revised 1] -22-06 vpmassegemv/d1a t COMMONWEALTH OF MASSACHUSETTS IN PLUMBERS AND GASFITTERS LICEN SSE ,�py, �y AN PLUMBER MICHAEL C BERNASCONI 58 ALBATROSS RD QUINCY MA 02169-2658 . • COMMONIIVEALTH OF MASSACHUSETTS •.., IN PLUMBERS AND GASFITTERS .s LICE�VAe6j�IgT TLUMBER h � MICHAEL C BERNASCONI C m 58 ALBATROSS RD QUINCY MA 02169-2658 COMMONWEALTH OF MASSACHUSETTS 111'/e.¢��TMfr'1��'k'71•J�/:.1�d.1•9��F-'11:i�=f•7_I:isiU� BOARD OF SHEET METAL WORKERS AS A MASTER -UNRESTRICTED ISSUES THE ABOVE LICENSE TO: MICHAEL C BERNASCONI .m 58 ALBATROSS RD QUINCY MA 02169-2658 359 J�a8lll 773627 77 • 0 • L. 7-5,.8 Date.14 2 �// ...... p` .ao ,a•° O TOWN OF NORTH ANDOVER. p PERMIT FOR GAS JNSTAU;L TION J This certifies that.. has permission for gas installation .., � .!� C. < ........... in the buildings of .. S. f�-.�; U!. .1 ........................... at .. S .6.Q .. 6 -Ar. 44 ...�Z , North Andover, Mass. Fee. Q Lic. No../5./`?.,.7 .4� -is -u� ... . AS INSPECTOR Check # 7 0 t_ ? i 'r"a PA"nucr- r I a VAI IFUP,M APPLICATIO11 FOR PERI .IT TCS —DO—GAS FITTING CIty/Town:. N , ll i)d (date: 1 z 1.2I ro Permit# Building Locatio� U Owners Name: —TI rK SCOAM % AS a'p'e of OccupancY: Commercial Educational Industrial institutional Residential e( New: Alteration: Renovation; Replacement: X Plans Submitted: Yes No W UH 91, z 0 t- X Lua z a w w ILtLltU la z O O o`a t� a0 Installing Company fume: Central Cooling r3 Heating, Inc. Check One Only Certificate #/ Address: 9 North Maple Street C /Town: i0( Corporation . 2806C ItY Woburn State: MA Business Tel; 781-933-8288 Partnership Fax: 781-932-9017 Name of Licensed Plumber/Gas Fitter.Firm/Company Mike Bemasconi IN COVEfiAGE; ---- — 1 have a current Iiabii�r Insurance policy or its substantial equivalent which meet. the requlrerreenfs of MGL. Ch. 142 Yes ✓ No If you have checked Yes, please indicate the type of coverage by checking the appropriate box below. A liability Insurance policy Other type of indemnity Dona OWNER'S INSURANCE WAIVER: I am aware that the licensee does_ not he the insurance coverage required by Chapter 142 of the Massachusetts General Laws, and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owners ent O�t'ner Agent By checking this box ; ► hereby �nKy that aR of the details and Information t have submitted (or enteredl regarding this application are true and accurate to the best of my Knowledge and that all ptumbtng work and InsfaNations performed der e compliance with alt Perttnenl provision of the Massachusetts State Plumbing Code and p r f42 the eit Issued ad�for this application will be In By Type of License: �.._ Plumber Title Gas Fitter Slgnat a of Licen ed er/Gas Fitter Master City/Town Journeyman APPROVED IOPFlCE USF ONLY)LP Installer License umber: 15137M z ` \ v / 1 \ f \ � / � 0 § � � . \ < E § \ § o m § \ \ � _ !Pe a2 � t K 7 / § The Commonwealth of Massachusetts Department of Industrial Accidents Oj, juice of Investigations Map # Lot # 600 Washington Street Address: Boston, MA 02111 Permit # www mass gov/dia Workers' Compensation Insurance Affidavit: Bnilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name City/State/Zip: Phone #: -791-233-ELYT Are you an employer? Check the appropriate box: Type of project (required): 1.0 I am a employer with <5— 4. E] I am a general contractor and I 6. C] New construction employees (full pnrt-time). * have hired the sub -contractors .and/or 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have 8. E] Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance required.] comp. insurance.# 5. ❑ We. are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work offiers have exercised their 11.[] Plumbing repairs or additions myself. [No workers' comp. right. of exemption per MGL 12.0 Roof repairs insurance required.].t c. 152, § 1 4 , and we have no . O employees. [No workers' 13.� Po/ % - Othergg4& . Co�, comp. insurance required.l *Any applicant that checks box #1 must also fill out the section below showing their workers' coition .policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees, they must provide their workers' comp. policy number. I am an"employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: L©� �}L SN SkK6 N CE N &Wd kh TNC - Policy # or Self -ins. Lic. M $�5-600119 61365 Expiration Date: 1) 1,36 /Z b Job Site Address: SiS(S �l P�rv4.� ��c� City/State/Zip: ,LAnd�e- /7/� Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coveraee verification. I do her ertify under the pains and penalties of perjury that the information provided above is true and correct: Phone #: `7 � 1 - 933 ` gd-ofS Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # . Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An emtployevis defined as "an individual; partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in.a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. however the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the. commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, .are not required to .carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the avvrovriate liner City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permittlicense applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts I gwtment of hadustdal.Accidents Qwice of Invesftations 6W Washington Streot Boston, MA 02111 Tel.' ## 617-727-4900 ext 406 or 1-877•MASSAFE Fax # 617-727-7749 Revised 11-22-06 VAM.mass.gov/dia Date ......1.. . Z, TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............. Tt ZZ&67- .. .3 ..z7............................................................. has permission to perform ....w b(��f��5 wiring in the building of. kA., ...... 601'1f.'1'Xr'*'.-C ...................... at........::57:5—D ................ le(I .. ......... ............ &J. ........ North Andover, Mass. FeeJ ................. Lic. No. OZ&s= Check # .... J7;2 10735 ConunonwealUi o/ Madsac/iueelb Official Use Only gErgEm cc�/ Permit No. Lp -7 3 5 2,parlmotst' of -7i,. Saruicio OccupancBOARD OF FIRE PREVENTION REGULATIONS [Reve]/0y and Fee Checked 7] (leaveblank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 517 CMR 12.00 (PLEM PRINT W INK OR TME ALL INF IZIlM City or Town of: Pk By this application the undersigned gives notice of his or Location (Street & Number) , SYd Owner or Tenant Owner's Address Is this permit in conjuncts n with a buildinrTy it" YesPurpose of Building v Existing Service Amps / Volts Overhead ❑ New Service Amps / Volts Overhead ❑ Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Date: , GQ 6 To the bzs ectot of Wires: xfsrm the electrical work described below. No utility, Telephone No. (Check Appropriate Box) ition No. Undgrd ❑ No. of Meters Undgrd ❑ No. of Meters Completion ofthe following table ntav be waived by the Inspector of li'ires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans o. of Tota Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Above In- ❑ITE. Swimming Pool rad. 11rnd. o cy Lighting BatteryUnits No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS I No. of Zones No. of Switches No. of Gas Burners o. o etectioa an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices eat Pump umber ons o. ofSelf-Contained No. of Waste Disposers p Totals: Detection/Alerting Devices No. of Dishwashers S ace/Area Heating KW P g Local ❑ unci ❑ Other Connection No. of Dryers ry Heating Appliances Key Security Systems:* No. of Devices or Equivalent No. of Vater KW o. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent TelecommunicationsNofDeier Wuiv'ai No. Hydromassage Bathtubs No. of Motors Total HP No. of Devices or E uivalent f7ayl OTHER:yyw, (ji` f ' M3 Attach aaartronat aeratt y aesrrea, ur w requu ru uy uic u(jF.--j ....amu. Estimated Value of Electrical Work: e..r (When required by municipal policy.) Work to Start: 1-%— Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability ' surance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such cov ge is in force, and has exhibited proof Aseo the pe it issuing o ce. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:)� .4 z1 certify, carder lite ants apd pen tf' of erjury, t/ t the ilt rtnation onltcatt t u true anti ont elm , FIRM NAME: v �i/� /� LIC. NO.: Licensee: <�.PAe h Q C-)6 Signature _ -t LIC. NO.: (Ifapplicable� "eYem t" in the license number li ��� �v `{ Bus. Tel. No.• Address: t Aft. Tel. No.: ' *Per M.G.L. c. 147, s. 57-61, security w requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: t am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a enL Owner/Agent PERMIT FEE: $ Signature Telephone No. r_-rl e9e 3 - -�-5 - / 7- x 0 .......... TOWN OFr-,NORTH ANDOVER PERM'15- FOR WIRING A This certifies that ............ /A has permission to perform .............................................. ...... �/- ............................ wiring in the building of77�`.. i. ... ................................... ......... ......... at 145. try ................................................................... . North Andover, Mass. .. .... ... Fee� ...... Lic. No . ...... 1� ELECT CAL INSPJ� Check# 0 91 7r, 4688 L01 • •efssacnusetts r Oficial Use Only y Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked -=S_ v. 1/07) APPLICATION FOR PERMIT TO PERFOR (leave blank All work to be performed in accordance with the MaAC°chusett$ �R Mcal �ELECTRICAL WORK (PLEASE PRINTW INK OR TYPE ALL ORM14T10), -527 CMR 12.00 City or Town of. NORTH ANDOVER Date: By this application the undersigned gives notice of his or her'.To the Inspector o Wires. . Location (Street & Number) �(�� � ° to P °rm electrical work des cnbed below. Owner or Tenant Owner's Address `f Telephone No. Is this permit in conjunctio with building permit? Purpose of Building lCi Yes No (Check Appropriate Boa) Eaistino S Utility Authorization No. Service Amps / _Volts Overhead'[] Undgrd No. of Meters New_ Serv_ce `d'mPs /----_Volts . Number of Feeders aad Ampacity Overhead Uncle d 0 No. of Meters Location and Nature of proposed Electrical Work: Iwo No. of Recessed Luminaires No. of Luminaire Outlets No. of Luminaires No. of Receptacle Outlets No. of Switches i No. of Ranges No. of Waste Disposers No. of Dishwashers No. of Dryers No. of ater Heaters KW No. Hydromassage Bathtubs Co lesion -Of -the o. of CeL-Susp. (Paddle) Fans D. of Hot Tubs Swimming Pool .so ove ED No. of Oil Bjrrners . of Gas Bou-ners of Air Cond. Totals: 'Area Heating KW tg APp"nces KW No. of Ms Ballasts. o. of Motors I Total Hp wire •table may be waived by the o No. of Total Transformers KVA Generators KVA o. o mergency !g �g Batte units FIRE ALARMS No, of Zones o. of iietPrt;n. —4 o. of Alerting Devices o. ofelf: Contained etection/Ale bo mice mal a Mnmcipal Connection 11 Other, .curity Systems; * No. of Devices or Equivalent ita W No. o� Devices or E valent lecommtuaications No. of Devices or Eou�iva Pn+ Estimated Value of Electricaj yj7�1r}�-- '4uach additional detail if desiret� or as �' ('hen required by municipal policy.).required by the Inspector of Wires. Work to Start Inspections to be requested in accordance with MEC Rul0, and upon co letio INSURANCE COVERAGE: Unless waived b the o mp rL the licensee provides proof of liability y =° Il0 Permit for the performance of electrical work may issue unless undersigned certifies that such cov ty insurance including "completed operation" coverage or its sub rs in force, and has exhibited proof of s to the substantial equivalent The CHECK ONE: INSURANCE BOND ❑. 0 ermit issuing office.. I �fy, under the pains Sand per of p jury, that the 0 (Specify:) FIRM NAME: �(Jp e l-� anon on this aPptcation is true and complxsa Licensee: LIC. NO,araPp licable, enter " Signature Pt f Ie number li ) LIC. NO.: Address: Ci Bus. TeL No.:5�iii� *PerM.G Lc.147,s.57-61,secity wo Alt TeL No:OWNER'S INSURANCE W qsDePerrt fPubIic S ety "S" License: RIVER: I am aware that the Licensee does not have the liability Lic. No. required by law. By my signature below, I hereby waive this re ty insurance coverage normally Owner/Agent requirement I am the (check one) ❑owner Signature ❑ owner's agent Telephone No. PERMIT FEE: ,$S-°= ,, , .. ,. '+r .;. Date .... 4n..' 3............... TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ......... ........ ..... .. . ..... .... ... ... ... ... has permission to perform wiringin the building of ............................................................... ,6 .............. 52>3- 6APE Ro at ............................................................................... . North Andover' Mass. s. Fee....7. No..... ............ O.A ELECTRICAL INSPECT Check # 7971 Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. 797/ Occupancy and Fee Checked tev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFOTION) Date: l i Q —y5� City or Town of: Ubyl % 4%.� d6(5 J5i_ To the Inspector of Wires: By this application the undersigned gives notice of his or her intentioMo perform Ae electrical work described below. Location (Street & Number) Owner or Tenant 1. C k,! lr%n /1. Owner's Address il Telephone No: Is this permit in conjunction with a building permit? Yes No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service J 9bD Amps I o 0 Volts OverFeadD Undgrd No. of Meters New Service Amps Volts ver Undgrd No. of Meters Number of Feeders and Ampacity Location 9,nd Nature of Proposed Electrical Work Completion of the follbwinQ table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No. of Total Transformers KVA No. of Luminarie Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ In- ❑ No. of Emergency Lighting rnd. grnd. Battery Units No. of Receptacle Outlets a D No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of Detection and 4 Initiating Devices No. of Ranges otal No. of Air Cond. ons No. of Alerting Devices No. of Waste Disposers Heat Pump Number Tons ;; KW No. of Self -Contained Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances Kir Security Systems: No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER:` l 1 6 G, i Attach additionhl detail if desired, or as required by t6 Inspector of Wires. Estimated Value of Electrical Work: $ (When required by municipal policy.) Work to Start Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee pro- vides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) GENERAL ACCIDENT INS. 8/l/08 *Per M.G.L. c. 147, s 57-61, security work requires Department of Public Safety "S" License (Expiration Date) I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: REILLY ELECTRICAL CONTRACTORS, INC / RELCO LIC. NO.: Licensee: JAMES 7. RFILLY Signature 4yt_� LIC. NO.: 16666 A (If applicable, enter "exempt" in the license number line) Bus. Tel. No.: 508-230-8001 Address: 14 NORFOLK STREET, EASTON, MA 02375 Alt. Tel OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's a ent.FAX-508-230-85555 Owner/Agent PERMIT FEE. Signature Telephone No. 50 I qlwti4 Cc-( a_P.6^d0 Pte, Ra-ujv, evlc �-27-eo P/7-1 -rt V, i ew &-., av-og p e P Feb 26 08 07:03a Kohlhase Electric Inc 603 964 5890 p.2 CHARLES E. COTE, P.R. , LLC ELECTRICAL ENGINEERS P.O. Sox 499, Hampstead, NH 03841 Tel. 603-329-4540 Fax. 603-329-7832 P.E-NH-ME-MA E-MAIL: eleclengrrna.comcast.net North Andover CC, our project #2726 RFI #1 1/23/08 The item: "Good morning Charlie, After reviewing the NEC Art. # 334.10 and confirming with Emanuel Engineering the building is a Class 513 combustible unprotected structure it is clear that type "NM" cable is a permissible wiring method. I placed a call to Peter Murphy the N. Andover electrical inspector and he does not have an objection to the use of type "NM" cable for this project. He would like to see a letter at the rough inspection that indicated Type "NM" cable meets the electrical design intent. Would you please send a short letter indicating type "NM" cable is acceptable on this project? Thank you, Steve Lafond" Answer: Per our electrical drawing E1, wiring methods inside finished walls shall be NM or MC. CHARLES E. COTE, P. E. RF'I#1.doc f Feb 26 09 07:03a Kohlhase Electric Inc 603 964 5890 p.1 Reilly Electrical Contractors, Inc. Kohlhase Division 121 Lafayette Road North Hampton, NH 03862 Tel 603-964-7700 * Fax 603-964-5890 WWW.GORELCO.COM Date. Company: A. �j k ti h 6 To: OA r Phone Number. Fax Number: From. ;LL. v�9 Regarding:IL pCC1, Total Panes ,'T . inrluriina this cover sheet. Comments -4 (6ftk 1 A�AW W�BfOjVQONSR1ClJf: ra rPOWER 86MND 121 LAFAYETTF ROAD. NORTH HAMPTO!V A`H 03861 STEPHEN J. PILLING Director of Operations 603-964-7700UX log 00 -8g 4 L &G L DO - FAX `r 603 9c4m890 Eadable, please contact our office CELL 6 Electrical Contracting 0 Design 0 Service* Maintenance CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 274(10/1212007) Date: Aug X 2008 THIS CERTIFIES THAT THE BUILDING LOCATED ON 500 Great Pond Road MAY BE OCCUPIED AS North Andover Country Club — Barn IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: North Andover Country 7u, b 500 Great Pond Road North Andover MA 01845 Building Inspector I M rA w <y x o v 0 U Wp w w � •� w z uo x o � a c G a w� w � � o ,, v EC4 o o o n,,cv cx c� r� Cf) Cf) •= •m o �c 0 0 C � Y y O_ C � O V V a'o CL co ca m C = O •~ L Co 7 Ea o c m 5 a V! • -Ra; E c .0 m , cc � cc ca w. �.: cm e 1c o c E m� a � L fA y y C. 3 cm Q CD LJ y E m w � o oo CL m .; cm V o,ct p Can vvio L - . •Z "c ao. C Q ` x C2 C G o moo N a F- o .. U; D CRO C O LiJ C 2 ar W Z W C3 -W la O LLS m V'O COD a g O O L' O Z °3 Q. O CO3 O � I CC O•— y CO2 m O .0 m m CD 0 CD CL~_ Z O� O �O Cc o � CL ora H 'O O C v J .fl CO2 C Z 03 0 CL C c C R CLCOD W W W W CA Anderson Consulting Engineers 194 Fort Point Road Alton Bay, NH 03810 June 30, 2008 Project: North Andover Country Club Location: 500 Great Pond Road, North Andover, MA Name of Buildings: Main Barn & Barn Extension In accordance with the requirements of the Massachusetts State Plumbing/Gas Code, the Massachusetts State Building Code including the Building Code Provisions for Energy Conservation and any amendments thereto, the plans and specifications for the mechanical, plumbing/gas, heating and ventilation systems were designed and prepared under my direct supervision. To the best of my knowledge, the design of the systems meets all the requirements of the above referenced codes. Further, and also in accordance with referenced regulations, I have reviewed the submittals for the systems and have personally inspected this project on site. In my opinion, the mechanical systems have been installed in accordance with the plans, specifications and per code. The mechanical systems have been completed with professionalism. ,a,,W—W- ,A Sincerely; Dennis M. Anderson, PE (# 40773) President Anderson Consulting Engineers NFPX Members CHARLES E. COTE, P.E., LLC ELECTRICAL ENGINEERS 46 Cambridge Road, P.O. Box 499, Hampstead, NH 03841 Tel. 603-329-4540 Fax. 603-329-7832 P.E-NH-ME-MA PROJECT: North Andover Country Club PROJECT LOCATION: 500 Great Pond Road, North Andover, MA BUILDINGS: Main Barn and Barn Extension PROJECT: 2726 In accordance with Section 116.0 of the Massachusetts State Building Code, 780 CMR. I, Charles E. Cote, P.E., being a registered professional Electrical Engineer, hereby certify that I have provided electrical services and site visits on behalf of the owner. To the best of my knowledge, and belief, the work of the project has been executed in conformity with the documents approved for the building permit. To the best of my knowledge, information, and belief, the work of; CHARLES E.COTE for Charles E. Cote, P.E.,LLC DATE Michael J. K e a n e A R C H I T E C T S PLLC' architecture preservation planning design 101 kent place newmarket, ne.w hampshire 03857 tel 603/292-1400 fax 603/292-1402 mail@ mjkarchitects.com August 19, 2008 Mr. Fred Emanuel Emanuel Engineering, Inc. 118 Portsmouth Avenue, Suite 202A Stratham, NH 03885 RE: North Andover Country Club North Andover, MA Dear Fred: Based on my observations during 2 follow-up site visits to review outstanding issues from my July 10th letter on the completion of the construction at the above referenced property, to the best of knowledge and belief the work is substantially complete in general conformance with the permit drawings. On August 1, 2008, I noted that the soffit venting in the dormers was added by cutting round vents in the underside of the dormer soffits. The, vents appeared to be spaced to allow air movement in each rafter bay. I also noted that the exterior stair handrails were modified to provide the code required handrail projections at the top and bottom of each new stair. No further action was required on the stair gate at the top of the exterior stair. On August 19, 2008 I found that the sidewalk leading to the main entrance door had been modified as discussed with the owner and building inspector on August 1, 2008 and outlined in my August 5, 2008. To the best of my knowledge and belief, the work is at this door is complete in general conformance 521 CMR governing accessible entrances. It was determined in our August 1, 2008 meeting that these improvements provide the greatest benefit to the greatest number of people who may wish to enter and use the facility by establishing barrier free access to all public areas and levels via the existing foyer. Date .� . .` .. . "oRTM TOWN OF NORTH M /DOVER ot,.o as PERMIT FOR PLUMBING This certifies that ... «`!` c .... 1h. "!.< ."� ........... • • • ... . has permission to perfortIP). IA. I ................ plumbing in the buildings of at ...3-P G . 4A y9. IT. � .......... , North Andover, Mass. Fee. ??..... Lic. No.3!! t .'!. ,....... /.. .......... x ' PLUMBIA40' ECTOR Check 7674 A 0 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building P--tD Co u, 7 C-lL/Q of Occuvancv ( o Date 3 — 7 % --o�— Permit #� 7 Amount i:;2 7 a New 13 Renovation El" Replacement Plans Submitted Yes No FTYTT ii2 Fc i I NZEIRIEWIMMIRM ee' 11I012101mum ism MIN 5NNNNSIMM WINNOWWOMWEIMIN � -t WNMMWWON e' 0 1W W W WOMMON Ismer �01001010101MMWINNIEWNMINNO��� i ee' ommmmmommmmoommoo®mmoom�� (Print or type) Check one: Certificate Installing Company Name_ kA V� M iCg- Cv (Corp. sr Address�Oh-\ r/z-t,A-� ,;_ 1❑•� Partner. Rn 4 J -A " I usmesselephone�, 67g_ 2r�31 Finn/Co. Name of Licensed Plumber: Insurance Coverage: Indicate the ty insurance c erage by checking the appropriate box: Liability insurance policy Other type of indemnity ❑ Bond Insurance Waiver. I, the undersigned, have been made aware that the licensee of this application does not have any one of the above threeinsurance Signature Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Pt Issued for this application will be in compliance with all pertinent provisions of the Mass tts State Plumbing Code anter 142 of the General Laws. Title (APPROVED (OFFICE USE ONLY Type of Plumbing License 3 �2-�_ icense um er Master EX Journeyman ❑ TOWN OF Date VORTH /ANDOVER PERMIT FOR 4 S INSTALLATION This certifies that. i o ...... ... I has permission for gas installation . in the buildings of ...... ........ at . ��.pq. North Andov6r, Mass. 0', %, Fee...... Lic. No.q�q GAS 6N S PEi�C T, I Check # GSe& 6337 MASSACHUSETTS UNIFORMAPPUCATONFORPERMTTTODO GASFITTING -17 (Type or print) Date Q NORTH ANDOVER, MASSACHUSETTS Building Locations IJi' C e G Permit # New ❑ Amount Owner's Name Renovation Replacement Plans Submitted (Print or type Name Name of Licensed Plumber or Gas Fitter �10 tJP Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 0 No If you have checked Les, please indicate the type coverage by checking the appropriate box. Liability insurance policy ® Other type of indemnity ❑ Bond Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work d installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Mas'&Zbsos State Gas Code and Chapte\-M-3.Qf the General Laws. By: Title City/Town (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter 0 Plumber Gas Fitter License Nurnoer Master Journeyman EMANUEL ENGINEERING, INC. ENGINEERING CONSULTANTS 118 PORTSMOUTH AVENUE, SUITE A202 STRATHAM, NEW HAMPSHIRE 03885 603-772-4400 Fax: 603-772-4487 www.emanuelengineedng.com PROJECT NAME: North Andover Country Club PROJECT LOCATION: 500 Great Pond Road, N. Andover, Ma NAME OF BUILDING(S): Main Barn & Barn Extension ENGINEERS PROJECT NO: 07-108 IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING CODE, 780 CMR. I, FRED S. EMANUEL, P.E., REGISTRATION NUMBER 39634, BEING A REGISTERED PROFESSIONAL STRUCTURAL ENGINEER, HEREBY CERTIFY THAT I HAVE PROVIDED CONSTRUCTION OBSERVATION SERVICES ON BEHALF OF THE OWNER, THAT I WAS PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS AND THAT TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF, THE WORK OF THE PROJECT HAS BEEN EXECUTED IN CONFORMITY WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT. TO THE BEST OF MY KNOWLEDGE, INFORMATION, AND BELIEF, THE WORK OF; ® Structural Framing ❑ Foundations HAS BEEN SATISFACTORILY COMPLETED IN ACCORDANCE WITH THE CONSTRUCTION DOCUMENTS, WITH THE FOLLOWING EXCEPTIONS (IF ANY): Shearwalls requiring an interior layer of sheathing will be completed after the completion of the electrical work and after the completion of the insulation. These shearwalls will be reviewed for conformance to the construction documents. FRED S. EMANUEL STRUCTURAL No. 39634 FRED S. EMANUEL FOR EMANUEL ENGINEERING, INC. bATE CIVIL - STRUCTURAL - SITE AND LAND PLANNING - CONSTRUCTION MANAGEMENT P:12007 JOBS107-108 Moreau & WelcM07-108 N. Andover CC - Structural Affidavit 2-28-08.doc TMANUEL ENGINEERING, INC. ENGINEERING CONSULTANTS Document Transmittal TO: Moreau & Welch 37 Beach Hill Rd Exeter, NH 03833 118 PORTSMOUTH AVENUE, SUITE A202 STRATHAM, NEW HAMPSHIRE 03885 603-772-4400 Fax: 603-772-4487 DATE: February 28, 2008 EEI JOB #: 07-108 RE: North Andover CC SENT VIA: Z US MAIL ❑ FEDEX ❑ UPS ❑ PICK UP ❑ HAND DELIVERED ❑ OTHER ATTACHED: ❑ DRAWINGS ® DOCUMENTS ❑ SPECIFICATIONS ❑ SHOP DRAWINGS ❑ DISKETTE(S) ❑ COPY OF LETTER(S) _.- ❑ CHANGE ORDER ❑ SAMPLES TRANSMITTED AS CHECKED BELOW.• STATUS. ® FINAL ❑ APPROVED ❑ PROGRESS ❑ APPROVED AS NOTED ❑ PRELIMENARY ❑ REVISE AND RESUBMI ❑ FOR PERMIT ❑ NOT APPROVED ❑ RESUBMIT copy for records REMARKS: COPY(S): File PLEASE NOTE: ❑ REVISIONS ❑ COMMENTS ❑ ONUSSiONS ❑ CORRECTIONS P:\2007 :IOBS\07-108 Moreau & Welch\07-108 N Andover CC - Transmittal 2-28-08.doc SENT FOR YOUR: ❑ APPROVAL ® USE ❑ FILES ❑ REVIEW AND COMMENT ❑ INFORMATION SIGNED: Robert H. Gould Senior Engineer Date Size Description —Copies 2 2/28/08 Letter Structural Affidavit TRANSMITTED AS CHECKED BELOW.• STATUS. ® FINAL ❑ APPROVED ❑ PROGRESS ❑ APPROVED AS NOTED ❑ PRELIMENARY ❑ REVISE AND RESUBMI ❑ FOR PERMIT ❑ NOT APPROVED ❑ RESUBMIT copy for records REMARKS: COPY(S): File PLEASE NOTE: ❑ REVISIONS ❑ COMMENTS ❑ ONUSSiONS ❑ CORRECTIONS P:\2007 :IOBS\07-108 Moreau & Welch\07-108 N Andover CC - Transmittal 2-28-08.doc SENT FOR YOUR: ❑ APPROVAL ® USE ❑ FILES ❑ REVIEW AND COMMENT ❑ INFORMATION SIGNED: Robert H. Gould Senior Engineer All State Abatement [professionals, inc. 4 Wilder Drive, Suite 12 Plaistow, NH 03865 October 11, 2007 Town of North Andover Board of Health 120 Main Street North Andover, MA 01845 Phone #: (978) 688-9540 Fax #: (978) 688-9542 Re: Asbestos Abatement @ To whom it may concern: North Andover Country Club 500 Great Pond Road 866 -565 -ASAP Fax: 603-378-0610 All State Abatement Professionals, Inc. (ASAP) is scheduled to perform work for the above referenced project on the following dates: Start Date: 10/26/07 End Date: 10/26/07 All appropriate agencies have been notified for the above referenced project. If you have any questions or need additional information, please do not hesitate to contact me. Sincerely, J 1 . Scott Curley President JSC Jab Enclosures Asbestos • Masonry Cleaning • Selective Demolition • Shot/Sand Blasting • Mold Remediation The Commonwealth of Massachusetts . UqFDepartment of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): p\,Y\ Kp,e rw -k-k 1.V 14 Address:�'1 b3� 3 3 City/State/Zip: 6 C6 3 Phone.#: (L b -,S -1 Are you an employer? Check the appropriate box: I. I am a employer with & 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.# required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' msurance Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. [1 Roof repairs 13.❑ Other Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 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 -contractors have employees, they must provide their workers' comp, policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company V Policy # or Self -ins. Lic. #: (_0 � Co LA Expiration Date: Laaio% Job Site Address: �-e �A , �► "�d City/State/Zip: y,do? 4,L_ Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance covera-ze verification. I do hereby gertify under the pains andipenaliles of perjury that the information provided above is true and correct use City or Town: area, to or town official, Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 6. Other 4. Electrical Inspector 5. Plumbing Inspector Contact Person: Phone #: Information and Instructions Massachusetts General Laws chapter 152 requires all employdrs to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for. the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under `Job Site Address" the applicant should write "all locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate. to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext.406 or 1-877-MASSAFE Fax # 617=-727-7749---.. _ Revised 11-22-06 www.mass.gov/dia t CQMcheck Software Version 3.4.2 Envelope Compliance Certificate Massachusetts Commercial Code Report Date: 09/18/07 Data filename: Q: Program Files\Check\COMcheck\NACC.cck Section 1: Project Information Project Title: North Andover Country Club Construction Site: Owner/Agent: Section 2: General Information Building Location (for weather data): North Andover, Massachusetts Climate Zone: 13a Heating Degree Days (base 65 degrees F): 5641 Cooling Degree Days (base 65 degrees F): 678 Project Type: Addition Vertical Glazing / Wall Area Pct.: 27% Building Type Floor Area Dining: Bar Lounge/Leisure 2052 Section 3: Requirements Checklist Envn I P ?f7AS ES, �es3g 19°ro be r I}an ca e. Designer/Contractor: MOREAU & WELCH Climate -Specific Requirements: Component Name/Description Gross Area Cavity Cont. Proposed Budget or Perimeter R Value R -Value U -Factor U -Factor Roof 1: All -Wood Joist/Rafter/Truss 2160 30.0 0.0 0.035 0.065 Exterior Wall 1: Wood Frame, Any Spacing 2617 19.0 0.0 0.068 0.091 Window 1: Wood Frame:Single Pane, Clear, SHGC 0.56 236 -- — 0.450 0.603 Door 1: Glass, Clear, SHGC 0.52 461 — — 0.720 0.603 Floor 1: All -Wood Joist/Truss 2052 30.0 0.0 0.033 0.056 (a) Budget U -factors are used for software baseline calculations ONLY, and are not code requirements Air Leakage, Component Certification, and Vapor Retarder Requirements: 1. All joints and penetrations are caulked, gasketed, weather-stripped, or otherwise sealed. I] 2. Windows, doors, and skylights certified as meeting leakage requirements. 3. Component R -values & U -factors labeled as certified. 4. Insulation installed according to manufacturer's instructions, in substantial contact with the surface being insulated, and in a manner that achieves the rated R -value without compressing the insulation. ❑ 5. Vapor retarder installed. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application. The proposed envelope system has been designed to meet the Massachusetts Commercial Code requirements in COMcheck Version 3.4.2 and to comply with the mandatory requirements in the Requirements Checklist. North Andover Country Club Page 1 of 4 Name - Title Signature Date Project Notes: BARN RE -MODEL & ADDITION North Andover Country Club Page 2 of 4 COMcheck Software Version 3.4.2 Lighting Compliance Certificate Massachusetts Commercial Code Report Date: 09/18/07 Data filename: C:1Program Files\ChecklCOMchecklNACC.cck Section 1: Project Information Project Title: North Andover Country Club Construction Site: Owner/Agent: Section 2: General Information Building Use Description by: Project Type: Addition Building Type Floor Area Dining: Bar Lounge/Leisure 2052 Section 3: Requirements Checklist Interior Lighting: 0 1. Total actual watts must be less than or equal to total allowed watts. Allowed Watts Actual Watts Complies 3078 0 YES Designer/Contractor: MOREAU & WELCH Exterior Lighting: 0 2. Comply with Sections 401.3.1 and 401.3.1.1 of 90.1-1989 Code and attach documentation. Controls, Switching, and Wiring: 0 3. Master switch at entry to hotel/motel guest room. 4. Minimum of one manual control for each space with no task activity (i.e. storage). Multiple manual controls, occupancy sensor, automatic timer, or dimmer in other spaces. Exceptions: Lighting for emergency or exit egress or intended for continuous operation. O 5: Photocell/astronomical time switch on exterior lights. Exceptions: Lighting intended for 24 hour use. I] 6. Tandem wired one -lamp and three4amp ballasted luminaires (No single -lamp ballasts). Exceptions: . Luminaires with three lamp ballasts (or electronic high -frequency single -lamp ballasts). North Andover Country Club Page 3 of 4 COMcheck Software Version 3.4.2 Lighting Application Worksheet Massachusetts Commercial Code Report Date: Data filename: C:1Pmgram Files\ChecMCOMcheck\NACC.cck Section 1: Allowed Lighting Power Calculation A B C D Floor Area Allowed Allowed Watts Watts /ft2 Dining: Bar Lounge/Leisure 2052 1.5 3078 Total Allowed Watts = 3078 Section 2: Actual Lighting Power Calculation A B C D E Fixture ID : Description / lamp / Wattage Per Lamp / Ballast Lamps/ # of Fixture (C X D) Fixture Fixtures Watt. Dining: Bar Lounge/Leisure (2052 sq.ft.) Total Actual Watts = 0 Section 3: Compliance Calculation If the Total Allowed Watts minus the Total Actual Watts is greater than or equal to zero, the building complies. Total Allowed Watts = 3078 Total Actual Watts = 0 Project Compliance = 3078 North Andover Country Club Page 4 of 4 HYDRAULIC AND SEISMIC CALCULATIONS NORTH ANDOVER COUNTRY CLUB GREAT POND ROAD - NORTH ANDOVER, MA REMOTE AREA #1 -ASSEMBLY -.10/ENTIRE AREA REMOTE AREA #2 - STORAGE - A S/ENTIRE AREA SEISMIC CALCULATIONS APPROVED / NATHANIEL R. PHILLIPS FIRE PROTECTION NO. SOW , N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 a DIRAUyIC DESIGN 1NFORMAT1ON SHEET Job Name: N. ANDOVER COUNTRY CLUB Location: GREAT POND ROAD NORTH ANDOVER, MA L'ta"Niny Dale: 06/26/0 Contractor: BEANE MECH. CONTRACTORS 25 Commercial Drive, Unit 6A- Brentwood, ABrentwood, NH 03033 61126107 14: 39 ReinoLe Aea iv LL![ )e r': i Telephone:603-679-2031 L'e J1CJ. Llet . S`pL.i illi CA Calculated By-:SprnkCAD wiw.sorinkc-ad.com 451 N..Cannon Ave. Lansdale, PA 19446 Construc-tion: Wood Joist Occupancy:ASSEMBLY Reviewing Authorities -:Local Auth6 rities/FPE SYSTEM DESIGN Code:NFPA 13 Hazard:LIGHT System Type:DRY Area a of Sprinkler Oper. 1939 sq ft I Sprinkler or Nnzzl P_. Density (gpm/sq ft) 0.100 I Make: VIC- Area per Sprinkler 120.0 sq ftl Model: V2704 Hose Allowance Inside 0 gpm I K -Factor: 5.60 Hose Allowance Outside 100.gpm I Temperature Rating: 155 CALCULATION SUMMARY 131 Flowing Outlets gpm Required: 650.3 psi Required: 93.1 @ City Supply WATER SUPPLY Water Flow Test i Pump Data Date of Test 04/2003 f Rated Capacity 0 gpm I' Statl - Press'ure_. 108.0 psl I Rated Rres'stirP_. - 0,0 psi I Residual Pres 98.0 psi I Elevation 0 I At a Flow of 1710 gpm I Make: I Elevation 0" I Model: I Location: Source of Information:,N. Andover Water & Sewer SYSTEM VOLUME 153 Gallons Notes: Entire area taken as remote area N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 HYDRAULIC CALCULATION DETAILS QTY DESCRIPTION HYDRAULIC LENGTH C ID Hydr.Ref W Required at Hyd Area 1 6 3" Grvd 90 Ell 42' 100 3.068 1 Pipe 3" 10x21 100' 100 3.260 1 4" Grvd Dry -Valve Tyco DV -1 CHART LOSS 1 4" Fingd Tee 20' 120 4.026 1 4" Fingd Gate Valve "722U" 2' 120 4.026 2 4" Fingd 90 Ell 20' 120 4.026 1 4" Fingd Back Flow Valve Wilkins "9 CHART LOSS 1 6" x 4" Fingd 90 Ell 14''120 6.065 Elevation Change 16'2" Total Loss for Riser - Hydr Ref Rl Required at Base of Riser 1 6" MJ 90 Ell 14' 120 6.065 1 Pipe 6" DIx18 Cl 350 40' 140 6.338 1 6" Fingd Gate Valve "7.22U 3' 120 6.065 1 6" MJ Tee 30' 120 6.065 Fixed Flow Outside Hose Stream Total Loss for Underground 6/26/07 12:40 FLOW LOSS gpm .psi TOTALS 550 19.4 psi 550 21.1 550 33.6 550 0.3 550 1.8 550 0.2 550 1.8 550 7:0 550 0.2 7.0 72.9 psi 550 92.3 psi 550 0.2 550 0.3 550 0.0 550 0.4 100 gpm 0.9 psi Hydr Ref R2. Required at City Supply 650 93.1 psi Water Source108.0 psi .static, 98.0 psi residual @ 1710 gpm 650 gpm 106.3 psi SAFETY PRESSURE 13.2 psi Available Pressure of 106.3 psi Exceeds.Required Pressure of 93.1 psi This is a safety margin of .13.2 psi or 12 % of Supply Maximum Water Velocity is 21.4 fps 4 f N. ANDOVER COUNTRY CLUB Drawing Date:06126107 FITTING NAME TABLE ABBREV. NAME C Coupling E 90' Standard Elbow F 45' Elbow S Straight Flow Thru Tee T 90' Flow Thru Tee V Valve LEGEND 6/26/07 12:40 HYD REF Hydraulic reference. Refer to accompanying flow diagram. _ K FACTOR Flow factor for open head or path where Flow (gpm) = K x -\/P Qa Flow added or subtracted Qt Total flow DIA Actual internal diameter of pipe C Hazen Williams pipe roughness factor Pf/ft Friction loss per foot of pipe PIPE Length of pipe FTNG'S Number of fittings. See table above. TOTAL Total length (PIPE + FTNG'S) Pt Total pressure (psi) at fitting Pe Pressure due to change in elevation where Pe = 0.433 x change in elevation Pf Friction loss (psi) to fitting. where Pf = 1 x 4.52 x (Q/C)^1.85 / ID^4.87 Pv Velocity pressure (psi) where Pv. = 0.001123 x Q^2/ID^4 Pn Normal pressure (psi), where Pn = Pt - Pv NOTES: - Pressures are balanced to 0.01 psi. Pressures are listed to 0.1 psi. Addition may vary by 0.1 psi due to accumulation of round off. - Calculations conform to NFPA 13. Velocity Pressures are not considered in these Calculations Page 3 9 1 N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Page 4 NODE ELEVATION SPRINKLER PRESSURE ACTUAL MINIMUM ACTUAL NUMBER K -FACTOR FLOW FLOW DENSITY (FT) (GPM/(PSI^'�)) (PSI) _ (GPM) (GPM) (GPM/SQ.FT) 10 21.00 7.7 11. 16.17 12.2' 12 16.17 11.8 13 16.17 11.5 14 16.17 11.4 15 - 19.75 12.5 16 19.75 12.5 17 24.83 9.3 19 16.17 16.4 20 16.17 15.8 21 16.17 15.5 22 16.17 15.4 31 16.17 15.3 Al 16.17 10.9 A2 16.17 10.9 A3 16.17 11.2 A4 16.17 13.3 A5 16.17 14.2 A6 16.17 14.7 A7 16.17 18.0 B1 - 16.17 17.9 B2 16.17 18.2 C7 16.17 12.8 S1 16.17 5.60 9.2 17.0 14.8 0.14 S2 16.17 5.60 9.3 17.0 14.8 0.14 53 16.17 5.60 9.4 17.1 14.8 0.14 S4 16.17 5.60 9.6 17.3 14.8 0.14 S5 16.17 5.60 10.0 17.7 14.8 0.15 S6 21.00 5.60 7.0 14.8 14.8 0.12 S7 21.00 5.60 7.0 14.8 14.8 0.12 S8 21.00 5.60 7.1 14.9 14.8 0.12 S9 21:00 5.60 7.3 15.1 14.8 0.13 S10 21.00 5.60 7.6, 15.5 14.8 0.13 S11 16.17 5.60 9.5 17.3 14.8 0.14 S12 16.17 5.60- 9.5 17.3 1-4.8 0.14. S13 16.17 5.60 9.7 17.4 14.8 0.15 S14 16.17 5.60 9.9 17.6 14.8 0.15 S15 16.17 5.60 10.3 18.,0 14.8 0.15 S16 16.17 5.60 11.3 18.8 14.8 0.16 S17 16.17 5.60 10.7 18.3 14.8 0.15 S18 16.17 5.60 10.8 18.4 14.8 -0.15 S19 16.17 5.60 11.1 .18.6 14.8 0.16. S20 16.17 5.60 11.5 19.0 14:8 0.16 S21 19.75 11.6 S2 -1S 21.33 5.60 10.5 18.1 14.8 0.15 S22 24.83 5.60 8.4 16.3 14.8 0.14 S23 24.83 5.60 8.5 16.3 14.8 0.14 S24 24.83 5.60 8.5 16.4 14.8 0.14 S25 24.83 5.60 8.7 16.6 14.8 0.14 S26 24.83 5.60 9.1 16.9 14.8 0.14 S27 16.17 5.60 14.4 21.3 14.8 0.18 I N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Page 5 NODE ELEVATION SPRINKLER PRESSURE ACTUAL MINIMUM ACTUAL NUMBER K -FACTOR FLOW FLOW DENSITY (FT) (GPM/(PSI"'-�)) (PSI) (GPM) (GPM) (GPM/SQ.FT) S28 16.17 5.60 14.5 21.3 14.8 0.18 S29 16.17 5.60 14.6 21.4 14.8 0.18 S30 16.17 5.60 14.9 21.6 .14.8 0.18 S31 16.17 5.60 15.4 22.0 14.8 0.18 W 16.17 19.4 Max.velocity of 21.36 occurs in the pipe from W TO B2 Nodes with "S" indicate a node at the top of a sprig or bottom of drop pendent. The node without an "S" is on the branch. UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Tyco Fire Products Page 6 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 1 FROM HYDRAULIC REFERENCE S6 TO W (PRIMARY PATH) 14.82 2.157 6.65 7.0 7.0 K = 5.60 S6 C=100 0.00 0.0 0.0 14.82 0.003 6.65 0.0 7.0 Vel = 1.31 14.84 2.157 7.23 7.0 7.0 K = 5.60 S7 C=100 0.00 0.0 0.0 29.65 0.011 7.23 0.1 7.0 Vel = 2.63 14.92 2.157 7.7.5 7.1 7.1 K = 5.60 S8 C=100 0.00 0.0 0.0 44.58 0.024 7.75 0.2 7.1 Vel = 3.95 15.12 2.151 8.00 7.3 7.3 K = 5.60 S9 C=100 0.00 0.0 0.0 59.70 0.041 8.00 0.3 7.3 Vel = 5.29 15.46 2.157 1.31 7.6 7.6 K = 5.60 S10 C=100 0.00 0.0 0.0 75.15 0.063 1.31 0.1 7.6 Vel = 6.66 2.157 lE 4.83 7.7 7.7 10 C=100 1T 13.17 2.1 0.0 75.15 0.063 18.01 1.1 7.7 Vel = 6.66 86.26 3.260 7.68 10.9 10.9 A2 C=100 0.00 0.0 0.0 See PATH 2 161.41 _0.035 7.68 0.3 10.9 Vel = 6.26 87.54 3.260 1T 5.78 11.2 11.2 A3 C=100 14.39 0..0 0.0 See PATH 3 248.95 0.077 20.16 1.6 11.2 Vel = 9.66 3.260 7.35 12.8 12.8 C7 C=100 0.00 0.0 0.0 248.95 0.077 7.35 0.6 12.8 Vel = 9.66 93.26 3.260 6.05 13.3 13.3 A4 C=100 0.00 0.0 0.0 See PATH 4 -342.21 0.139 6.05 0.8 13.3 -Vel = 13.28 18.15 3.260 3.58 14.2 14:2 A5 C=100 0.00 0.0 0.0. See PATH 10 360.36 0.153 3.58 0.5 14.2 Vel = 13.99 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 18.2 6/26/07 12:40 0.00 0.0 0.0 See PATH 11 550.29 0.336 Tyco Fire Products Page 7 HYD. Qa DIA. FITTING PIPE Pt Pt 34.04 REF 8.00. "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft 9.4 TOTAL Pf Pn 5.60 S3 C=100 0.00 0.0 0.0 PATH 1 FROM HYDRAULIC REFERENCE S6 TO W (PRIMARY PATH) 6.98 0.2 82.37 3.260 1T 1.21 14.7 14.7 2.157 A6 9.6 C=100 K = 14.39 0.0 0.0 See PATH 9 C=100 442.73 0.224 0.0 15.60 3.5 14.7 Vel = 17.18 107.56 3.260` 3.55 18.2 18.2 B2 C=100 0.00 0.0 0.0 See PATH 11 550.29 0.336 3.55 1.2 18.2 Vel = 21.36 W 550.29 19.4 K = 124.89 PATH 2 FROM HYDRAULIC REFERENCE S1 TO A2 17.01 2.157 6.65 9.2 9.2 K = 5.60 S1 C=100 0.00 0.0 0.0 17.01 0.004 6.65 -0.0 9.2 Vel = 1.51 A2 86.26 10.9 K = 26.09 PATH 3 FROM HYDRAULIC REFERENCE Sll TO A3 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) 17.03 2.157 8.00 9.3 9.3 K = 5.60 S2 C=100 0.00 0..0 0.0 34.04 0.015 8.00. 0.1 9.3 Vel = 3.02 17.14 2.157 -6.98 9.4 9.4 K = 5.60 S3 C=100 0.00 0.0 0.0 51.18 0.031 6.98 0.2 9.4 Vel = 4.54 17.34 2.157 8.50 9.6 9.6 K = 5.60 S4 C=100 0.00 0.0 0.0 68.52 0:053 8.50 0.5 9.6 Vel = 6.07 17.74 2.157 1T 1.31 10.0 - 10.0 K = 5.60 S5 C=100 8.78 0.0 0.0 86.26 0.081 10.09 0.8 10.0 Vel = 7.65 3.260 7.10 10.9 10.9 Al C=100 0.00 0.0 0.0 86.26 0.011 7.10 0.1. 10.9 Vel = 3.35 A2 86.26 10.9 K = 26.09 PATH 3 FROM HYDRAULIC REFERENCE Sll TO A3 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) Y ' N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Tyco Fire Products Page 8 HYD. Qa DIA.. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 3 FROM HYDRAULIC REFERENCE Sll TO A3 CONTINUED 17.27 2.157 6.65 9.5 9.5 K = 5.60 S11 -C=100 0.00 0.0 0.0 17.27 0.004 6.65 0.0 9.5 Vel = 1.53 17.29 2.157 8.00 9.5 9.5 K = 5.60 S12 C=100 0.00 0.0 0.0 34.56 0.015 8.00 0.1 9.5 Vel = 3.06 17.40 2.157 6.98 9.7 9..7 K = 5.60 S13 C=100 0.00 0.0 0.0 51.96 0.032 6.98 0.2 9.7 Vel = 4.61 17.60 2.157 8.00 9.9 9.9 K = 5.60 S14 C=100 0.00 0.0 0.0 69.56 0.055 8.00 0.4 .9.9 Vel = 6.17 17.99 2.157 1T 1.81 10.3 10.3 K = 5.60 S15 C=100 8.78 0.0 0.0 87.54 0.084 10.59 0.9 10.3 Vel = 7.76 A3 87.54 11.2 K = 26.16 PATH 4 FROM HYDRAULIC REFERENCE S17 TO A4 18.35 1.049 1T 0.73 10.7 10.7 K = 5.60 S17 C=100 3.57 0.0 0.0 18.35 0.155 4.29 0.7 10.7 Vel = 6.88 18.84 2.157 7.00 11.4 11.4 14 C=100 0.00 0.0 0.0 See PATH 7 37.19 0.017 7.00 0.1 11.4 Vel = 3.30 18.44 2.157 7.00 11.5 11.5 13 C=100 0.00 0.0 0.0 See PATH 5 55.63 0.036 7.00 0.3 11.5 Vel = 4.93 18.65 2.157 7.00 11.8 11..8 12 C=100 0.00 0.0 0.0 See PATH 6 74.28 0.062 7.00 0.4 11.8 Vel = 6.59 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Tyco Fire Products Page 9 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt - Pf/ft TOTAL Pf Pn PATH 4 FROM HYDRAULIC REFERENCE S17 TO A4 CONTINUED 18.99 2.157 1T 3.17 12.2 12.2 11 C=100 8.78 0.0 0.0 See PATH 8 93.26 0.094 11.95 1.1 12.2 Vel = 8.27 A4 93.26 13.3 K ='25.54 PATH 5 FROM HYDRAULIC REFERENCE S18 TO 13 18.44 1.049 1T 0.73 10.8 10.8 K = 5.60 S18 C=100 3.57 0.0 0.0 18.44 0.157 4.29 0.7 10.8 Vel = 6.91 13 18.44 11.5 K = 5.43 PATH 6 FROM HYDRAULIC REFERENCE S19 TO 12 18.65 1.049 1T 0.73 11.1 11.1 K = 5.60 S19 C=100 3.57 0.0 0.0 18.65 0.160 4.29 0.7 11.1 Vel = 6.99 12 18.65 11.8 K = 5.43 PATH 7 FROM HYDRAULIC REFERENCE S16 TO 14 18.84 2.157 1T 7.73 11.3 11.3 K = 5.60 S16 C=100 8.78 0.0 0.0 18.84 0.005 16.51 0.1 11.3 Vel = 1.67 14 18.84. 11.4 K = 5.58 PATH 8 FROM HYDRAULIC REFERENCE S20 TO 11 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) w N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 i 12:40 Tyco Fire Products Page 10 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 8 FROM HYDRAULIC REFERENCE S20 TO 11 CONTINUED 18.99 .1.049 1T 0.73 11.5 11.5 K =. 5.60 S20 C=100 3.57 0.0 0.0 18.99 0.166 4.29 0.7 11.5 Vel = .7.12 11 18.99 12.2 K = 5.43 PATH 9 FROM HYDRAULIC REFERENCE S22 TO A6 16.26 2.157 7.00 .8.4 8.4 K = 5.60 S22 C=100 0.00 0.0 0.0 16.26 0.004 7.00 0.0 8.4 Vel = 1.44 16.28 2.157 7.00 8.5 8.5 K =. 5.60 S23 C=100 0.00 0.0 0.0 32.54 0.013 7.00 0.1 8.5 Vel = 2.89 16.37 2.157 7.00 8.5 8.5 K = 5.60 S24 C=100 0.00 0.0 0.0 48.92 0.028 7.00 0.2 8.5 Vel = 4.34 16.56 2.157 7.00 8.7 8..7 K = 5.60 S25 C=100 0.00 0.0 0.0 65.48 0.049 7.00 0.3 8.7 Vel = 5.81 16.88 2.157 3.17 9.1 9.1 K = 5.60 S26 C=100 0.00 0.0 0.0 82.37 0.075 3.17 0.2 9.1 Vel = 7.30 2.157 1E 8.67 9.3 9..3 17 C=100 1T 13.17 3.8 0.0 82.37 0.075 21.84 1.6 9.3 Vel = 7.30 A6 82.37 14.7 K = 21.47 PATH 10 FROM HYDRAULIC REFERENCE S21 TO A5 18.15 1.049 1E 1.58 10.5 10.5 K = 5.60 S21S C=100 1.43 0.7 0.0 18.15 0.152 3.01 0.5 10.5 Vel- 6.80 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) t f N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Tyco Fire Products Page 11 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 10 FROM HYDRAULIC REFERENCE S21 TO A5 CONTINUED 1.049 1T 1.92 11.6 11.6 EqK = 5.32 S21 C=100 3.57 0.0 0.0 18.15 0.152 5.49-- 0.8 11.6 Vel = 6.80 2.157 13.17 12.5 12.5 16 C=100 0.00 0.0 0.0 18.15 0.005 13.17 0.1 12.5 Vel = 1.61 2.157 lE 3.58 12.5 12.5 15 C=100 1T 13.17 1.6 0.0 18.15 0.005 16.76. 0.1 12.5 Vel = 1.61. A5 18.15 14.2 K = 4.82 PATH 11 FROM HYDRAULIC REFERENCE 827 TO B2 21.26 1.049 1T 0.83 14.4 14.4 K = 5.60 S27 C=100 3.57 0.0 0.0 21.26 0.204 4.40 0.9 14.4 Vel = 7.97 2.157 7.00 15.3 15.3 31 C=100 0.00 0.0 0.0 21:26 0.006 7.00 0.0 15.3 Vel = 1.88 21.29 2.157 7.00 15.4 15.4 22 C=100 0.00 0.0 0.0 See PATH 12 42.55 0.022 7.00 0.2 15.4 Vel = 3.77 21.40 2.157 7.00 15.5 15.5 21 C=100 0.00 0..0 0.0 See PATH 13 63.94 0.047 _ 7.00 0.3 15.5 Vel = 5.67 21.62 2.157 7.00 15.8 15.8 20 C=100 0.00 -0.0 0.0 See PATH 14 85.56 0.080 7.00 '0.6 15.8 Vel = 7..59 22.00 2.157 1T 3.17 16.4 16.4 19 - C=100 8.78 0.0 0.0 See PATH 15 107.56 0.122 11.95 1.5 16.4 Vel = 9.54 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:40 Tyco Fire Products Page 12 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 11 FROM HYDRAULIC REFERENCE S27 TO B2 CONTINUED 3.260 6.16 17.9 17.9 B1 C=100 0.00 0.0 0.0 107.56 0.016 6.16 0.1 17.9 Vel = 4.18 3.260 1T 1.79 18.0 18.0 A7 C=100 14.39 0.0 0.0 107.56 0.016 16.18 0.3 18.0 Vel = 4.18 B2 107.56 18.2 K = 25.20 PATH 12 FROM HYDRAULIC REFERENCE S28 TO 22 21.29 1.049 1T 0.83 14.5 14.5 K = 5.60 S28 C=100 3.57 0.0 0.0 21.29 0.205 .4.40 0.9 14.5 Vel = 7.98 22 21.29 15.4 K = 5.43 PATH 13 FROM HYDRAULIC REFERENCE S29 TO 21 21.40 1.049 1T 0.83 14.6 14.6 K = 5.60 S29 C=100 3.57 0.0 0.0 21.40 0.207 4.40 0.9 14.6_ Vel = 8.02 21 21.40 15.5 K = 5.43 PATH 14 FROM HYDRAULIC REFERENCE S30 TO 20 21.62 1.049 1T 0.83 14.9 14.9 K = 5.60 S30 C=100 3.57 0.0 0.0 21.62 0.211 4.40 0.9 14.9 Vel = 8.10 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) I 'A N. ANDOVER COUNTRY CLUB Drawing Date:06126107 6/26/07 12:40 Tyco Fire Products Page 13 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn 20 21.62 15.8 K = 5.43 PATH 15 FROM HYDRAULIC REFERENCE S31 TO 19 22.00 1.049 1T 0.83 15.4 15.4 K = 5.60 S31 C=100 3.57 0.0 0.0 22.00 0.218 4.40 1.0 15.4 Vel = 8.25 19 22.00 16.4 K = 5.43 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) O LOr- r V 0 0 L- n.LO CL IM Y T LL d' 0 iO L- 0 U) Ln r - CD C C d a a a) a) O 00 O U) Q � p' � d N C O p _ sO O O r C .� aa)a O N C6 LO C6 O aiQ LO vi _ a N Ln p ? 0 L :3 U N CY N O (6 E Q.Q 0) O Ln O O O O c ~ p M p O N N to d O Ln ti Q" fQ J M L fC N p M W LL C - LM O O D J M - U Q _ ZQ� 0 0 N O � CO N 0 LU r L' J Z F- c6 OdQQ LO Z Q F=- o )ZCDZw v o OD N a(n- N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07. .—s-i-DA L1V D�ci—lr7xs iN—F^dld 1--1 fix S1EET Job Name: N ANDOVER COUNTRY CLUB Location: GREAT POND ROAD NORTH ANDOVER, MA ...a viiiy Ddle: v6[1265 / 07 Contractor_: BEANE 1,dECH. CONTRACTORS 25 Commercial Drive, Unit 6A Brentwood, NH 03833 Designer : Sprin' CAT Calculated By:SprinkCAD www.sprinkcad.com 451 N. Cannon Ave. Lansdale, PA 19446 Construction: Wood Joist Reviewing Authorities:Local Authorities/FPE SYSTEM DESIGN 6126107 14:40 eiilUle.AL'ed i'v11ii1Je: Telephone:603-679-2031 Occupancy STORACE Code:NFPA 13 Hazard:ORDINARY 1 System Type:DRY Area of Sprinkler Oper. 148.3 Gq ft 1 Sprinkler .or No77.l e Density (gpm/sq ft) 0.150 I Make: VIC Area per Sprinkler 120.0 sq ftl Model: V2704 Hose Allowance Inside 0 gpm I K -Factor: 5.60 Hose Allowance Outside 250 gpm 1 Temperature Rating: 155 CALCULATION SUMMARY 18 Flowing Outlets gpm Required: 616.8 psi Required: 86.4 @ City Supply WATER SUPPLY Water Flow Test I Pump Data I. Date of Test 04/2003 I Rated Capacity 0 gpm 1 Stati :-: Pressi:re 1 08. 0 psi Rated Pressure 0.0 psi Residual Pres 98:0 psi I Elevation 0 At a Flow of- 1710 gpm I Make: I Elevation 0" I Model: I Location: Source of Information: N. Andover Water & Sewer SYSTEM VOLUME 153 Gallons Notes: Entire area taken as remote area N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 HYDRAULIC CALCULATION DETAILS QTY DESCRIPTION HYDRAULIC LENGTH C ID Hydr Ref W, Required at Hyd Area 2 6 3" Grvd 90 Ell 42' 100 3.068 1 Pipe 3" 10x21 100' 100 3.260 1 4" Grvd Dry Valve Tyco DV -1 CHART LOSS 1 4" Fingd Tee 20' 120 4.026 1 4" Fingd Gate Valve "722U" 2' 120 4.026 2 4" Fingd 90 Ell 20' 120 4.026 1 4" Fingd Back Flow Valve Wilkins 119 CHART LOSS 1 6" x 4" Fingd 90 Ell 14' 120 6.065 Elevation Change 16'2" Total Loss for Riser Hydr Ref R1 Required at Base of Riser 1 6" MJ 90 Ell 14' 120 6.065 1 Pipe 6" DIx18 C1 350 40' 140 6.338 1 6" Fingd Gate Valve "722U" 3' 120 6.065 1 6" MJ Tee 30' 120 6.065 Fixed Flow Outside Hose Allow. Total Loss for Underground 6/26/07 12:44 FLOW LOSS gpm psi TOTALS 367 45.5 psi 367 10.0 367 15.8 367 0.1 367 0.8 367 0:1 367 0.8 367 5.7 367 0.1 7.0 40.5 psi 367 86.0 psi 367 0.1 367 0.1 367 0.0 367 0.2 250 gpm- 0.4 psi Hydr Ref R2 Required at City Supply 617 86.4 psi Water Source108.0 psi static, 98.0 psi residual @ 1710 gpm 617 gpm 106.5 psi SAFETY PRESSURE 20.1 psi Available Pressure of 106.5 psi Exceeds Required Pressure of 86.4 psi This is a safety margin of 20.1 psi or 19-% of Supply Maximum Water Velocity is 21.8 fps f r N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:44 FITTING NAME TABLE ABBREV. NAME C Coupling E 90' Standard Elbow F 45' Elbow S Straight Flow Thru Tee T 90' Flow Thru Tee V Valve, LEGEND HYD REF Hydraulic reference. Refer to accompanying flow diagram. _ K FACTOR Flow factor for open head or path where Flow (gpm) = K x -\/P Qa Flow added or subtracted Qt Total flow DIA Actual internal diameter of pipe C Hazen Williams pipe roughness factor Pf/ft Friction loss per foot of pipe PIPE Length of pipe FTNG'S Number of fittings. See table above. TOTAL Total length (PIPE + FTNG'S) Pt Total pressure (psi) at fitting Pe Pressure due to change in elevation where Pe = 0.433 x change in elevation Pf Friction loss (psi) to fitting where Pf = 1 x 4.52 x (Q/C)^1.85 / ID^4.87 Pv Velocity pressure (psi) where Pv = 0.001123 x Q^2/ID^4 Pn Normal pressure (psi), where Pn = Pt - Pv NOTES: - Pressures are balanced to 0.01 psi. Pressures are.listed to .0.1 psi. Addition may vary by 0.1 psi due to accumulation of round off. - Calculations conform to NFPA 13. - Velocity Pressures are not considered in these Calculations Page 3 N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07_ 6/26/07 12:44 Page 4 NODE ELEVATION SPRINKLER PRESSURE ACTUAL MINIMUM ACTUAL NUMBER K -FACTOR FLOW FLOW DENSITY (FT) (GPM/(PSI-1�)) (PSI) (GPM) (GPM) (GPM/SQ.FT) 30 9.00 20.8 A4 16.17 41.0 A5 16.17 41.9 A6 16.17 42.5 B2 16.17 45.0 Cl 16.75 14.5 C2 16.75 14.5 C3 16.75 14.7 C4 16.75 15.1 C5 16.75 15.8 C6 16.17 22.2 C7 16.17 39.8 Dl 11.42 19.7 D2 11.42 19.7 D3 16.17 20.3 E1 16.17 19.7 E2 16.17 19.8 S40 22.00 5.60 10.3 18.0 18.0 0.15 S41 18.91 5.60 12.2 19.5 18.0 0.16 S42 22.00 5.60 10.4 18.0 18.0 0.15 S43 18.91 5.60 12.2 19.6 18.0 0.16 S44 22.00 5.60 10.5 18.2 18.0 0.15 S45 18.91 5.60 12.4 19.7 18.0 0.16 S46 22.00 5.60 10.9 1-8.5 18.0 0.15 S47 18.91 5.60 12.7 .20.0 18.0 0.17 S48 22.00 5.60 11.5 19.0 18.0 0.16 S49 18.91 5.60 13.4 20.5 18.0 0.17 S50 18.00 14.2 S50S 21.75 5.60 11.7 .19.1 18.0 0.16 S51 14.87 5.60 16.2 22.5 18.0 0.19 S52 18.00 14.2 S52S 21.75 5.60 11.7 19.2 18.0 0.16 553. 14.87 5.60 16.2 22.6 18:0 0.19 S54 9.00 5.60 16.7 22.9 18.0 0:19 S55 9.00 5.60 17.3 23.3 18.0 0.19 S56 9.00 5.60 16.7 22.9 18.0 0.19 S57 9.00 5.60 17.3 23.3 18.0 0.19 W 16.17 45.5 Max velocity of 21.79 occurs in the pipe from C6 TO C7 Nodes with "S" indicate a node at the top of a sprig or bottom of drop pendent. The'node without an "S" is on the branch. 3.260 37.60 2.635 8.00 14.5 14.5 0.0 0.0 C2 N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 0.0 6/26/07 12:44 75.12 0.024 8.00 Tyco Fire Products Vel Page 5 HYD. Qa DIA. FITTING PIPE Pt Pt C3 REF C=100 "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft 14.7 TOTAL Pf Pn 38.47 2.635 PATH 1 FROM HYDRAULIC REFERENCE S40 TO W (PRIMARY PATH) C4 18.00 1.380 2E 7.95 10.3 10.3 K = 5.60 S40 8.00 C=100 15.1 4.28 1..3 0.0 39.45 2.635 lE 28.01 18.00 0.039 12.24 0.5 10.3 Vel = 3.90 0.3 19.52 1.380 1T 4.73 12.2 12.2 K = 5."60 S41 Vel C=100 4.28 0.9 0.0 22.2 22.2 37.52 0.154 9.01 1.4 12.2 Vel = 8.13 . PATH 5 2.635 0.447 8.00 14.5 14.5 Vel = 21.79 Cl C=100 0.00 0.0 0.0 37.52 0.007 8.00 0.1 14.5 Vel = 2.23 3.260 37.60 2.635 8.00 14.5 14.5 0.0 0.0 C2 7.35 C=100 0.00 0.0 0.0 See PATH 2 75.12 0.024 8.00 0.2 14.5 Vel = 4.46 37.88 2.635 8.00 14.7 14.7 C3 C=100 0.00 0.0 0.0 See PATH 3 113.00 0.051 8.00 0.4 14.7 Vel = 6.71 38.47 2.635 8.00 15.1 15.1 C4 C=100 0.00 0.0 0.0 See PATH 4 151.47 0.087 8.00 0.7 15.1 Vel = 9.00 39.45 2.635 lE 28.01 15.8 15.8 C5 C=100 1T 17.64 0.3 0.0 See PATH 7 190.93 0.134 45.65 6.1 15.8 Vel = 11.34 175.83 2.635 1E 33.58 22.2 22.2 C6. C=100 5.88 0.0 0.0 See PATH 5 366.76 0.447 39.46 17.6 22.2 Vel = 21.79 3.260 7.35 39.8 39.8 C7 C=100 0.00 0.0 0.0 366.76 0.158 7.35 1.2 39.8 Vel = 14.24 3.260 6.05 41.0 41.0 A4 C=100 0.00 0.0 0.0 366.76 0.158 6.05 1.0 41.0 Vel = 14.24 3.260 3.58 41.9 41.9 A5 C=100 0.00 0.0 0.0 366.76 0.158 3.58 0.6 41.9 Vel = 14.24 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:44 Tyco Fire Products Page 6 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv' ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn .PATH 1 FROM HYDRAULIC REFERENCE S40 TO W (PRIMARY PATH) 3.260 1T 1.21 42.5 42.5 A6 C=100 14.39 0.0 0.0 366.76 0.158 15.60 2.5 42.5 Vel = 14.24 3.260 3.55 45.0 45.0 B2 C=100 0.00 0.0 0.0 366.76 0.158 3.55 0.6 45.0 Vel = 14.24 W 366.76 7.95 10.5 45.5 K = K = 54.36 PATH 2 FROM HYDRAULIC REFERENCE S42 TO C2 0.0 18.18 0.040 18.04 1.380 2E 7.95 10.4 10.4 K = 5.60 S42 12.4 C=10-0 4.28 1.3 0.0 C=100 4.28 0.9 18.04 0.040 12.24 0.5 10.4 Vel = 3.91 12.4 19.56 1.380 1T, 4.73 12.2 12.2 K = 5.60 S43 C=100 4.28 0.9 0.0 37.60 0.154 9.01 1.4 12.2 Vel = 8.14 C2 37.60 14.5 K = 9.86 PATH 3 FROM HYDRAULIC REFERENCE S44 TO C3 18.18 1.380 2E 7.95 10.5 10.5 K = 5.60 S44 C=100 4.28 1.3 0.0 18.18 0.040 12.24 0.5 10.5 Vel = 3.94 19.70 1.380 1T 4.73 12.4 12.4 K = 5.60 S45 C=100 4.28 0.9 0.0 37.88 0.156 9.01 1.4 12.4 Vel = 8.20 C3 37.88 14.7 K = 9.87 PATH 4 FROM HYDRAULIC REFERENCE S46 TO C4 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) 83.40 2.635 1T 4.94 20.3 2.0.3 D3 N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 0.0 6/26/07 12:44 PATH 8 175.83 0.115 Tyco Fire Products 20.3 Vel Page 7 HYD. Qa DIA. FITTING PIPE Pt Pt C6 REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn 22.90 1.380 PATH 4 FROM HYDRAULIC REFERENCE S46 TO C4 CONTINUED K = 5.60 S54 18.48 1.380 2E 7.95 10.9 10.9 K = 5.60 S46 10.00 C=100 16.7 4.28 1.3 0.0 18.48 0.041 12.24 0.5 10.9 Vel = 4.00 19.99 1.380 1T 4.73 12.7 12.7 K = 5.60 S47 C=100 4.28 0.9 0.0 38.47 0.161 9.01 1.4. 12.7 Vel = 8.33 C4 38.47 15.1 K = 9.89 PATH 5 FROM HYDRAULIC REFERENCE S56 TO C6 22.90 1.380 10.00 16.7 16.7 K = 5.60 S56 C=100 0.00 0.0 0.0 22.90 0.062 10.00 0.6 16.7 Vel = 4.96 23.32 1.380 1E 9.01 17.3 17.3 K = 5.60 S57 C=100 1T 6.42 0.0 0.0 46.21 0.226 15.43 3.5 17.3 Vel = 10.01 46.21 2.067 2E 8.07 20.8 20.8 30 C=100 1T 14.27 -3.1 0.0 See PATH 6 92.43 .0.114 22.35 2.5 20.8 Vel = 8.92 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) 83.40 2.635 1T 4.94 20.3 2.0.3 D3 C=100 11.76 0.0 0.0 See PATH 8 175.83 0.115 16.70 1.9 20.3 Vel = 10.45 C6 175.83 22.2 K = 37.34 PATH 6 FROM HYDRAULIC REFERENCE S54 TO 30 22.90 1.380 10.00 16.7 16.7 K = 5.60 S54 C=100 0.00 0.0 0.0 22.90 0.062 10.00 0.6 16.7 Vel 4.96 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 6/26/07 12:44 Tyco Fire Products Page 8 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv, **-***** NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 6 FROM HYDRAULIC REFERENCE S54 TO 30 CONTINUED 23.32. 1.380 lE 9.01 17.3 17.3 K = 5.60 S55 C=100 1T 6.42 0.0 0.0 46.-21 0.226 15.43 3.5 17.3 Vel = 10.01 30 46.21 20.8 K = 10.13 PATH 7 FROM HYDRAULIC REFERENCE S48 TO C5 18.98 1.380 2E 7.95 11.5 11.5 K = 5.60 S48 C=100 4.28 1.3 0.0 18.98 0.044 12.24 0.5 11.5 Vel = 4.11 20.47 1.380 1T 4.73 13.4 13.4 K = 5.60 S49 C=100 4.28 0.9 0.0 39.45 0:169 9.01 1.5 13.4 Vel = 8.55 C5 39.45 15.8 K = 9.92 PATH 8 FROM HYDRAULIC REFERENCE S50 TO D3 19.13 1.049 lE 3.75 11.7 11.7 K = 5.60 S50S - C=100 1.43 1.6 0.0 19.13 0.168 5.18 0.9 11.7 Vel = 7.17 1.380 2E 10.73 14.2 14..2 EqK = 5.08 S50 C=100 4.28 1.4 0.0 19.13 0.044 15.02 0.7 14.2 Vel = .4.14 22.53 1.380 2E 6:28 16.2 16.2 K = 5.60 S51 C=100 4.28 1.5 0.0 41.66 0.186 10.57 2.0 16.2 Vel = 9.02 1.380 lE 4.75 19.7 19.7 Dl C=100 1T 6.42 -2.1 0.0 41.66 0.186 11.17 2.1 19.7 Vel = 9.02 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) PATH 9 FROM HYDRAULIC REFERENCE S52 TO E2 19.17 1.049 1E 3.75 11.7 11.7 K = 5.60 S52S C=100 1.43 1.6 N. ANDOVER COUNTRY CLUB Drawing Date:06/26/07 5.18 6/26/07 12:44 Vel = 7.19 1.380 2E 10.73 Tyco Fire Products EqK = 5.08 Page 9 4.28 1.4 0.0 19.17 0.044 15.02 0.7 14.2 HYD. Qa DIA. FITTING PIPE Pt Pt REF "C" TYPES FTNG'S Pe Pv ******* NOTES ******* POINT Qt Pf/ft TOTAL Pf Pn PATH 8 FROM HYDRAULIC REFERENCE S50 TO D3 CONTINUED 2.635 10.00 19.7 19.7 E1 C=100 0.00 0.0 0.0 41.66 0.008 10.00 0.1 19.7 Vel = 2.47 41.75 2.635 1E 11.51 19.8 19.8 E2 C=100 5.88 0.0 0.0 See PATH 9 83.40 0.029 17.39 0.5 19.8 Vel = 4.96 D3 83.40 20.3 K = 18.53 PATH 9 FROM HYDRAULIC REFERENCE S52 TO E2 19.17 1.049 1E 3.75 11.7 11.7 K = 5.60 S52S C=100 1.43 1.6 0.0 2.0 16.2 Vel = 9.04 19.17 0.169 5.18 0.9 11.7 Vel = 7.19 1.380 2E 10.73 14.2 14.2 EqK = 5.08 S52 C=100 4.28 1.4 0.0 19.17 0.044 15.02 0.7 14.2 Vel = 4.15 22.57 1.380 2E 6.28 16.2 16.2 K = 5.60 S53 C=100 4.28 1.5 0.0 41.75 0.187 10.57 2.0 16.2 Vel = 9.04 1.380 lE 4.75 19.7 19.7 D2 C=100 1T 6.42 -2.1 0.0 41.75 0.187 11.17 2.1 19.7 Vel = 9.04 E2 41.75 19.8 K = 9.39 UNITS - DIAMETER (INCH) LENGTH (FOOT) FLOW (GPM) PRESSURE (PSI) EE d o. a U C) 0) moo N O Q d aj O7 =50 _ E . _ rn aa�a 00NC; .—E U 'cn a a a 0) 000 orn� aj M 0 �. 0 a ,N N co U) O d O O 7 o.2 N O 79 �cnlyLL0 m D J U Q UO LLj m N p J WZ� - N o << Zo )Z(DZrr 0 r N O co CVO �l N r � (L U) LO I- CD Im LO N t1y O LO 0 0 M LO N N 0 LO r, LL 1 of 2 Size and Type of Pipe Total Length Total Calculated Load 3" 75mm Schedule 10 Pie Tol-Brace Seismic Calculations 60 lbs. (28Kq.) 2" 50mm Schedule 10 Pie 80 ft. 24.4m Project N. ANDOVER COUNTRY CLU Freedom Fire Protection, In OTOLCOv Address: 34 lbs. 15.54K . 157 Main.St., Unit #7 apd 1 Great Pond Road Blackstone, MA 01504' North Attleboro, MA 508-876-9718 Job # Calculations based on 2002 NFPA Pamphlet #13 with TIA 02-1 Brace Information Tolco Brace Components Total Adjusted Load of all pipe within Zone of Influence 263 lbs. 120K . Tolco Component Fig. Number Adjusted Load Maximum Spacing 15'-0" (4.62m� Fig.4 Clamp 308 lbs. (140 Kg.) Length of Brace 9 '- 0 "(2.8m) Fig. 980 Universal Swivel 1955 lbs. (887 Kg.) Bracing Material 1%" Sch.40 `Calculation Based on CONCENTRIC Loading "Please Note: These calculations are for Tolco components only. . Angle from Vertical 45° Min. Use of any other components voids these calculations and the listing of the assembly. Least Rad. of Gyration 0.54"(14mmj Assembly Detail UR Value 200 TOLCO FIG. 980 Maximum Horizontal Load 3382 lbs. (1534Kg.) UWERSAL SWAY BRACE FITTING TYP. STEEL PIPE LATERAL Fastener Information BRACE TOLCO FIG. 4A PIPE CLAMP FOR Fastener Orientation NFPA Type B SWAY BRACING t Type, Laq-Screw Diameter 1/2in. (13mm) 45° Min. From Vertical Detail #2241 Length 4%in. (114mm) Brace Identification on Plans LAT 1 Maximum Load 355 lbs. (161Kp-) Orientation of Brace Lateral Load Information Size and Type of Pipe Total Length Total Calculated Load 3" 75mm Schedule 10 Pie 15 ft. 4.6m 60 lbs. (28Kq.) 2" 50mm Schedule 10 Pie 80 ft. 24.4m 169 lbs. (77Kq.) Percents a added for Fittings and Sprinklers 15% 34 lbs. 15.54K . Total Adjusted Load of all pipe within Zone of Influence 263 lbs. 120K . {Tol-Brace Version 5.1.52} Brace Identification Brace Type (Per NFPA#13) Spacing of Brace Orientation of Brace Bracing Material Length of Brace Slenderness Ratio used for Load Calculation True Angle of Brace for Calculation Type of Fastener Length of Fastener LAT 1 NFPA Type B 15 Ft.(5m) Lateral 1'/" Sch.40 9Ft. (3m) 200 45° 1l2in. (13mm) In. Lag -Screw 4'hin. (114mm) In. Summary of Pipe within Zone of Influence 3 inch Sch. 10 15 Feet (5m) 2 inch Sch. 10 80 Feet (24m) Allowance for Heads and Fittings 0.15% Conclusions Total Adjusted Load of Pipe in Zone of Influence 263 Ibs.(119Kg.) Material Capacity 3382.38581231995 Ibs.(1534Kg.) Fastener Capacity 355 lbs '(161 Kg.) Fig.4 Clamp ;308 lbs.(140Kg.) Fig.980 Universal Swivel 1955 Ibs.(887Kg.) Structural Member: Wood Joist* Calculations prepared by D LOVEJOY .The description of the Structural Member is for informational purposes only. Tol-Brace software calculates the brace assembly only, not the structure it is attached to. Calculated with Tol-Brace 5.1 visit us at w .tolm.com 1 of 2 Size and Type of Pipe Total Length Total Calculated Load 3" 75mm Schedule 10 Pie Tol-Brace Seismic Calculations Project Percents a added for Fittings and Sprinklers .y Freedom Fire Protection, In TOLC N. ANDOVER COUNTRY CLU . Address: 157 Main St., Unit #7 asand ai Great Pond Road Blackstone, MA 01504 North Attleboro, MA 508-876-9718 ,lob # Calculations based on -2002 NFPA Pamphlet 913 with TIA 02-1 Brace Information Tolco Brace Components Total Adjusted Load of all pipe within Zone of Influence 137lbs. 63K . Tolco Component Fig. Number Adjusted Load Maximum Spacing 30'-0" (9.24m) Fig.4 Clamp 308 lbs. (140 Kg.) Length of Brace 9 '- 0 " i2.8m) Fig. 980 Universal Swivel 1955 lbs. (887 Kg.) Bracing Material 1'4" Sch.40 *Calculation Based on CONCENTRIC Loading "Please Note: These calculations are for Tolco components only. Angle from Vertical 450 Min. Use of any other components voids these calculations and the listing of the assembly. Least Rad. of Gyration 0.54" (14mm) Assembly Detail UR Value 200 TOLCO FIG. 980 UNIVERSAL SWAY Maximum Horizontal Load 3382 lbs. (1534Kg.) BRACE FITTING TYP. STEEL PIPE LATERAL BRACE TOLGO FIG. 4A Fastener Information PIPE CLAMP FOR ° BRACING SWAY BRACING Fastener Orientation NFPA Type B Type Lag -Screw Diameter 1/2in. (13mm) 45° Min. From Vertical Detail #1241 Length 4%in. (114mm) Brace Identification on Plans LONG 1 Maximum Load 355 lbs. 061 K.q.) Orientation of Brace Longitudinal Load Information Size and Type of Pipe Total Length Total Calculated Load 3" 75mm Schedule 10 Pie 30 ft. 9.1m 119 lbs. (55Kq.) Percents a added for Fittings and Sprinklers 15% 18 lbs. 8.1 K . Total Adjusted Load of all pipe within Zone of Influence 137lbs. 63K . {fol -Brace Version 5.1.52} Brace Identification LONG 1 Brace Type (Per NFPA#13) NFPA Type B Spacing of Brace 30 Ft.(9m) Orientation of Brace Longitudinal Bracing Material 1'/" Sch.40 Length of Brace 9Ft. (3m) Slenderness Ratio used for Load Calculation 200 True Angle of Brace for Calculation 450 Type of Fastener 1/2in. (13mm) In. Lag -Screw Length of Fastener 4'/2in. (114mm) In. ,Summary of Pipe within Zone of Influence 3 inch Sch. 10 30 Feet (9m) Allowance for Heads and Fittings 0.15% Conclusions Total Adjusted Load of Pipe in Zone of Influence 137 Ibs.(62Kg.) Material Capacity 3382.38581231995 Ibs.(1534Kg.) Fastener Capacity 355 Ibs.(161 Kg.) Fig.4 Clamp 308 lbs.(140Kg.) Fig.980 Universal Swivel 1955 Ibs.(887Kg.) Structural Member: Wood'Joist* Calculations prepared by .D LOVEJOY *The description of the Structural Member is for informational purposes only. Tol-Brace software calculates the brace assembly only, not the structure it is attached to. Calculated with Tol-Brace 5.1 visit us at ~v.tolco.com EMANUEL ENGINEERING, INC. CIVIL & STRUCTURAL CONSULTANTS 118 Portsmouth Avenue, Suite A202 Stratham, NH 03885 Tel: 603.772.4400 Fax: 603.772.4487 www.emanuelengineering.com Moreau & Welch Company 37 Beech Road Exeter, NH 03833 Architectural Code Review for Barn Remodeling North Andover Country Club Great Pond Road North Andover, MA Date: September 26, 2007 EEI Job # 07-108 Prepared by: Michael J. Keane Architect, PLLC Michael J. Keane, AIA MA. Registration #7384 Reviewed by: Fred S. Emanuel, P.E. MA. Registration #39634 Michael J. K le a n le A R C H I T E C T S PLLC architecture preservation planning design 101 kent place newmarket, new hampshire 03857 tel 603/292-1400 fax 603/292-1402 mail@mjkarchitects.com September 26, 2007 Mr. Fred Emanuel Emanuel Engineering, Inc. 118 Portsmouth Avenue, Suite 202A Stratham, NH 03885 RE: Code Review Barn Remodeling North Andover Country Club North Andover, MA Dear Fred: As requested, we have reviewed the plans for the "North Andover Country Club Proposed Renovations to the Existing Barn and Barn Extension" prepared by Emanuel Engineering. This report documents my findings relative to the requirements of 780 CMR Massachusetts State Building Code 6t' Edition. These finding are based on my professional opinion and interpretation of applicable code provisions based on my understanding of the project, my knowledge and belief. The North Andover Building Inspector as the "Authority Having Jurisdiction" will have the final say on how the code applies. Documents: Information on the existing conditions is based on our preliminary field visit; drawings 1, through 7 inclusive dated 5-12-93 prepared by Hermit Woods Designs, North Andover MA.; and "Cart Shed" drawings CS -1, CS -2 and CS -3 dated 10-21-04 prepared by Emanuel Engineering, Inc. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 2 of 17 The proposed work is shown on drawings T, A-1 A-2, A-3, A-4, S-1, S-2, S-3 and S-4 dated 09-26-2007 prepared by Emanuel Engineering; Project Summary: The North Andover Country Club is located on Great Pond Road in North Andover, MA. It is an existing one story wood frame building with mezzanine and walk -out partial basement. The building appears to be a conversion of an original single family residence and barn with a series of renovations and additions having been completed at various times. The building is partially protected with automatic fire suppression, occupant notification and alarm and emergency lighting. The Existing main level is a split level with the main entrance at the barn level and an existing kitchen and dining room a half level above. The barn and barn extension are currently open floor function rooms and will continue to be open function rooms after reconstruction. There is also an existing second floor storage area in the barn extension that will be eliminated by this project. The barn, barn extension and porches are at various floor elevations. The barn extension is currently not barrier free from the interior of the building. A series of exterior decks and porches are located at the barn extension level serving as circulation and outdoor sitting space. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 3 of 17 The lower level is occupied by existing locker rooms, pro shop, storage areas and a snack bar area serving the outdoor pool deck. An existing wheelchair lift provides wheelchair access to each of the three main levels, the barn, kitchen/dining and walk -out basement.. Scope of Work: The. scope of work in this phase of the project will include: 1. Selective demolition of the roof and first floor walls in area indicated as the "Main Barn"; 2. Selective demolition of the roof, first floor walls and the first and second floor framing in the area indicated as the "Barn Extension"; .3. Selective demotion of porches, rails and stairs associated with the "Existing Porches" serving the Barn and Barn Extension". 4. Reframing the Barn, Barn Extension, and Porches in the same footprint and approximately the same volume as the existing structures. 5. Miscellaneous fire, thermal and moisture separations between new and existing construction. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 4 of 17 6. Mechanical, Electrical, Plumbing and Fire Suppression improvements as required and as indicated by the consulting engineers' drawings and documents. Automatic Fire Suppression: It is my understanding that the automatic fire suppression system in the building will be extended and maintained throughout the building to comply with NFPA 13. All height area and egress calculations are based on this understanding. Chapter 34 Repair, Alteration, Addition, and Change of Use of Existing Structures: The State Building Code includes provisions in Chapter 34 to determine equivalent code compliance in existing buildings without bringing the entire building up to code. The proposed work does not involve additions or change of use. The building code classifies the work as an alteration, since the work involves the structural changes. Section 3400.3:6 states that alterations "within an assembly use group shall comply with the requirements of the code for new construction except that earthquake requirements need only to conform to 780 CMR 3408. " Therefore no portion of the building that is affected by the Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 5 of 17 proposed work or that is required to make the new work fully code compliant can benefit from the provisions of use Chapter 34. Use and separation of uses: The primary Use is Assembly (A-3) with some incidental office (B). Completion of fire rated assemblies in the cart storage area is required to separate the cart storage (enclosed garage S-2) from the Assembly Use. No change or expansion of Use is proposed. Construction Classification: The construction classification is Type 5B combustible unprotected. The proposed work will not change the construction type. Height and Area: The main level is the largest story. The existing main level is approximately 6,250 S.F. gross floor area. The proposed work will not change the floor area. There is a fire rated wall separating the main building from the barn and barn extension dividing the first floor into two fire areas. The main building is approximately 4,100 S.F. and the barn area is approximately 2,150 S.F. Both areas are within the allowable area for the construction type and occupancy. The 1993 design plans indicate a concrete masonry unit wall noted to be two- Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 6 of 17 hour rated and the opening is protected with a self closing metal door. It is assumed the wall provides the indicated two-hour rating but should be verified in the field during the work. Once the sprinkler system is complete the allowable area will increase to 12,600 S.F. per floor. The existing building is one story and approximately 23 `-0 in height. The proposed work will not change the building height. The height is within the allowable limits. Occupancy: The design occupant load for Assembly uses is determined by the larger number determined by the actual number or based on the maximum floor area per occupant listed in Table 1008.1.2 of the State Building Code. It is assumed the floor area calculation will determine the larger occupant load and will be used as the design occupant load for the purposes of this review. The maximum floor area allowance for assembly uses with tables and chairs (un -concentrated) is one person per fifteen square feet of net assembly area. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 7 of 17 Lower level: The lower level is not involved in the proposed work and has a negligible occupant load compared with the main level. For the purposes of this review it is assumed that the lower level stands alone and meets or exceeds code requirements for the existing occupant load of the locker rooms, pro shop and pool areas. Main Level: The main level is currently divided into two fire areas as noted above. The net assembly area of function rooms proposed in this phase of the work is approximately 2,050 square feet. The porch areas were not included in the area assuming that the porches would be occupied by the same people using the function space or pool area and have been accounted for in those areas. The design occupant load for the function rooms is 136 persons. The net area of the Dining Room, Grille, Library and Card Room is 1,875 square feet. The design occupant load for the dining area is 125 persons. The net area of the seasonal exterior Dining Deck is approximately 585 square feet and has a design occupant load of 39 persons. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 8 of 17 Total design occupant load of the interior main level spaces is 261 persons and the potential of 39 persons on the seasonal dining deck. Egress: Existing egress relies heavily in exterior doors leading directly to the exterior or to exterior porches and decks that have stairs to grade. The use of these doors eliminates dead end corridors and common path of travel and reduces total travel distance to exit to well within limits. None of these exterior steps are protected against the accumulation of snow and ice and most do not discharge to the street front as required by 1006.2.2 for Assembly Uses. They do discharge to yards that are large enough to hold the occupant load provide a way to the street except in the winter when snow cover is likely. The interior main lobby is dominated by an unenclosed stair connecting the lower level, the main level and the dining room level. This stair and the unprotected vertical opening are separated from the dining area only by a series of glass doors that are not self-closing. This open stair and unprotected opening are permitted only when they are not part of a required means of egress. It appears the interior stair is required to provide a second means of egress for the lower level and is currently signed as an exit for the function rooms and dining rooms. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 9 of 17 It will be up to the Building Inspector to determine whether these existing egress conditions provide adequate life safety exiting for the areas not included in the barn reconstruction and if they can continue to be accepted as elements of the means of egress for the function rooms. Function Room Egress: The reconstructed function rooms are proposed to duplicate the existing function room and will not increase the design occupant load. The Function room is required to have two means of egress. One means of egress is provided by an exterior door discharging at grade at the front of the Barn Extension building. The existing second means of egress will rely on one of the two non- conforming egress conditions, the uncovered exterior stairs discharging to the side yard or the main lobby with open stair. Egress improvements may be required by the Building inspector to meet the current code. One of the following options would meet the requirement for a second means of egress. One option is to continue to discharge the second egress to the exterior porch. Since the porch has two sets of stairs, fire rating of the exterior wall is not required. The exterior stairs would need to be reconstructed to provide dimensional uniformity; meet rise and run provisions of the Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 10 of 17 code; should be protected against the accumulation of snow and ice; and should discharge to path that is maintained to provide access to the right of way at the street. The second option would be to use the door leading to the main lobby which then discharges either to the main courtyard or to an exterior deck. Since this lobby then becomes part of a required means of egress, enclosure and protection of the stairs may be required. It may be possible to provide an alternative to stairway enclosure by increased sprinkler protection at the existing glass doors leading to the dining room and at the lower level. This alternate approach would likely require a variance to be granted by the State Board of Building Regulations Board. Function Room egress capacity based on a design occupant load of 136 persons is 20.5 inches and is exceeded by two 36" wide doors. Egress doors from the function room should swing in the direction of egress and should have panic opening hardware. Interior Finishes: Interior finishes within the required egress are limited to Fire Class I. Class III is allowed within the assembly area with a design occupant load up to 300persons. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 ------"'— Page 11 of 1.7 Accessibility: All public areas are required to be accessible to persons with disabilities. The existing main entrance is at grade and an existing platform lift connects each of the public levels and the elimination of floor level changes in the function room and porches will correct the current non-conformance. The stage area in the function room is required to be accessible so a ramp or lift is required if the stage area is raised above the Barn Extension floor level.. Doors are required to be 36" wide. Door operating hardware, signage and signaling devices are to comply with ANSI A117.L Accessible toilet facilities are required. Currently there are two unisex single user toilet rooms to serve the main level. Generally these are accepted by the code when they are in the same general location as the other separate gender toilet facilities. In this case one of the unisex Toilet Rooms is in the same core as the other Men's and Women's Toilet Rooms. The other is located in the upper main level remote from the core. While this second unisex Toilet Room is not located near the others, there is a benefit to having it available to the upper dining room patrons without the need to use the wheelchair lift..(See additional information on toilet rooms below). Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 12 of 17 Fire Alarm and Emergency Lighting: A fire alarm signaling system is required. The existing system is being reviewed and will be modified as required to meet the current code as determined by the electrical engineer. Exit signage and emergency lighting with emergency power will be provided as required by the code. Plumbing Fixtures: The code requires plumbing fixtures to be provided based on the design occupant load for the Use and that with the exception of some unisex accessible toilet rooms, they are provided in separate gender toilet rooms. As mentioned above, the lower level locker rooms include toilet facilities for club members using the pool and golf course. It is assumed the fixture count in the locker rooms is adequate for those uses but since they are located areas used primarily by club members and guests, they are not included in this review of the public facilities located on the main level. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 13 of 17 Existing Plumbing Facilities: Public Toilet Rooms are currently located on the main level at the main lobby. One single -user unisex Toilet Room (Toilet Room #1) is provided at the core to meet the need for accessible facilities and includes one water closet and one lavatory. Separate Men's and Women's toilet rooms are also located in the Main Lobby. The Men's room has one water closet, one urinal and two lavatories. The Women's room has two water closets and two lavatories. An additional single user Toilet Room (Toilet room #2) is located on the upper dining level and has one water closet and one lavatory. The code requires 1 water closet for each 30 female occupants and one water closet for each 60 male occupants. Urinals are permitted in place of water closets in the men's room for up to 50% of the required fixtures. One lavatory is required for each 200 occupants. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 14 of 17 Capacity Based on Existing Configuration Since it is assumed that the occupant load is equally divided among the genders, the women's water closet capacity will govern. Therefore the existing capacity is 180 persons (90 females and 90 males). An increase in existing capacity can be achieved by designating the upper level single user toilet as female increasing the female water close count by 0.5 fixtures. Men's Women's Toilet Toilet Total Room room Rm. Rm. (x) #1 #2 No. of Fixtures XXX Occupants Served Women's WC (0) (2) (0.5) (0.5) (3.0) Capacity 60 15 15 90 1/30 Men's (2) (0) (0.5) (0.5) (3.0) WC/Urinal 120 30 30 180 Capacity 1/60 Men's Lay. (2) (0.5) (0.5) (3.0) Capacity 400 100 100 600 1/200 Women's Lav (2) (0.5) (0.5) (3.0) Capacity 400 100 100 600 1/200 Since it is assumed that the occupant load is equally divided among the genders, the women's water closet capacity will govern. Therefore the existing capacity is 180 persons (90 females and 90 males). An increase in existing capacity can be achieved by designating the upper level single user toilet as female increasing the female water close count by 0.5 fixtures. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 15 of 17 Capacity Based on Revised Configuration The women's water closet capacity still governs but the revised capacity is increased to 210 (105 females and 105 males). Based on the design occupant load, two additional water closets are required for female use to meet the code requirement. The Owner should consider adding the additional fixtures. In lieu of adding the fixtures you will need to consult with the building inspector to see if he will allow the owner to post the upper level for a maximum occupancy of 210 people and allow the design occupant load to be determined by the actual posted occupant load, or to see if he will Men's Women's Toilet Toilet Total Room room Rm. Rm. (x) #1 #2 No. of fixtures XXX Occupants Served Women's WC (0) (2) (0.5) (1.0) (3.5) Capacity 60 15 30 105 1/30 Men's (2) (0) (0.5) (0) (2.5) WC/Urinal 120 30 150 Capacity 1/60 Men's Lay. (2) (0) (0.5) (0) (2.5) Capacity 400 100 500 1/200 Women's Lay. (2) (0.5) (1.0) (3.5) Capacity 400 100 200 700 1/200 The women's water closet capacity still governs but the revised capacity is increased to 210 (105 females and 105 males). Based on the design occupant load, two additional water closets are required for female use to meet the code requirement. The Owner should consider adding the additional fixtures. In lieu of adding the fixtures you will need to consult with the building inspector to see if he will allow the owner to post the upper level for a maximum occupancy of 210 people and allow the design occupant load to be determined by the actual posted occupant load, or to see if he will Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 16 of 17 allow the two water closets in the women's locker room to be included in the fixture count. Conclusion: Based on this review, we find that egress improvements and additional toilet rooms are required to make the alteration fully code compliant unless variances are granted by the authority having jurisdiction. The egress improvements include either enclosing the main lobby stair and vertical opening; or protecting the exterior stairs from the accumulation of snow and ice and providing a maintained walk way to the street from the back of the building. These opinions are based on my professional judgment based on my knowledge, belief and understanding at the time of the review. Code provisions are subject to interpretations and ultimately it is up to the code official to determine code compliance. Emanuel Engineering, Inc. North Andover Country Club Code Analysis September 24, 2007 Page 17 of 17 Please let me know if you have any questions regarding this review or if I can be of any additional assistance. 04 Si cerely,a1 MICHAEL Ec JOHN KEANE « No. 7384 « NEWMARKE , Michael J Keane Architects PLLC NH Michael J. Keane, AIA ��� x ®f Registered Architect —. MA.. Registration 73 8�4 r .Za EMANUEL ENGINEERING, INC. CIVIL & STRUCTURAL CONSULTANTS 118 Portsmouth Avenue, Suite A202 Stratham, NH 03885 Tel: 603.772.4400 Fax: 603-772.4487 www.emanuelengineering.com Ir f 'Own of North Andover Community Development and Services Division 400 Osgood Street North Andover, Massachusetts 01845 Planniiig Department November 17, 2004 c/o ivir. Thomas 0. Childs North Andover Country Club 500 Great Pond Road North Andover, MA 01845 C�Sttao 6�anrC Telephone (978) 688-9535 Fax (978) 688-0 ^ C X17 ��/d 7� RE: Renovation of existing barn at North Andover Country Club Dear Mr. Childs, At the November 16, 2004 Planning Board meeting the Board heard the following proposed construction relative to premises located at North Andover Country Club, 500 Great Pond Road, North Andover, MA 01845. The proposed project is a renovation of the existing barn at North Andover Country Club. The structure is used for functions and gatherings of the membership. After the renovations, its use will remain the same. The footprint of the existing building will not be changed and all work will be within that footprint. The scope of the work will include rebuilding the roof and walls of the barn as well as the cart shed. A 20'x20' storage room will be added above the existing cart shed. This will require the replacement of three existing piers as well as construction of a new footing & concrete wall to support the existing fieldstone wall. This earthwork will take place within the existing cart barn. The barn will receive new HVAC, electric, and plumbing system as well as new doors and windows. The number of plumbing fixtures will remain the same. The entire structure will be brought up to building code and the barn area will have sprinklers. A silt fence and hay bales will be placed as shown on the drawings to protect the wetland area. All construction supplies and equipment will get access to the building through the existing parking lot bordering the building. There will be no disturbance to permeable surfaces or plantings and the asphalt parking lot will remain as is. page 1 of 2 RO:^-c13 OI' .-1111" 1 >LS 688-9541 BL-ITLDI\G 68S-9545 CONSLRVATION 688-9530 HDi-\LTH 6H-951'10 PLAN ING 688-91535 V. At the regularly scheduled Planning Board meeting on November 16, 2004 the Planning Board voted unanimously to � .�,1�, A a WE fnr a Watershed Protection District Special Permit from Section 4.136 (8) with the following conditions, the applicant should provide drywell specs for downspouts and written construction scheduling sequencing, and that the project be monitored and that the "as built plan" is adhered to. Plan as drawn by Frank S. Giles, II; PE 4 48793, plan dated August 2, 2004. We wish you the best of luck with your project and if you have any questions, please feel free to contact me. Sincerely, A j '�;�� ; C Heir Griffin, Director CoziSmunity Development and Services mi/siteplanwaivers page 2 of 2 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. I If erwn Massachusetts Department of Environmental Protection Bureau of. Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information From: Nnrth Anrinver Conservation Commission To: Applicant North Andover Cou Name P. 0. Box 99 Mailing Address Mailing Address North Andover MA. 01845 City/Town State Zip Code City/Town State Title and Date (or Revised Date if applicable) of Final Plans and Other Documents: Renovation of Existing Barn 9/21/04 Date Title 1 Club Property Owner (if different from applicant): Narne Title Date uaie Title 2. Date Request Filed: 10/22/04 B. Determination Zip Code Pursuant to the authority of M.G.L. C. 131, § 40, the Conservation Commission considered your Request for Determination of Applicability, with its supporting documentation, and made the following Determination. Project Description (if applicable): Renovation of an existing barn and cart barn within existing footrprint in the Buffer Zone to a borderinq veqetated wetland and within Riverfront Area. Project Location GnJVnV t�.. Great Pond Roan Street Address Map 63 Assessors Map/Fiat Number North Andover City/Town Parcel 12 Parcel/Lot Number Page 1 of 5 wpaform2.doc • rev. 12/15/00 Massachusetts Department of Environmental Protection LlBureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) The following Determination(s) is/are applicable to the proposed site and/or project relative to the Wetlands Protection Act and regulations: Positive Determination Note: No work within the jurisdiction of the Wetlands Protection Act may proceed until a final Order of Conditions (issued following submittal of a Notice of Intent or Abbreviated Notice of intent) has been received from the issuing authority (i.e., Conservation Commission or the Department of Environmental Protection). ❑ 1. The area described on the referenced plan(s) is an area subject to protection under the Act. Removing, filling, dredging, or altering of the area requires the filing of a Notice of Intent. ❑ 2a. The boundary delineations of the following resource areas described on the referenced plan(s) are confirmed as accurate. Therefore, the resource area boundaries confirmed in this Determination are binding as to all decisions rendered pursuant to the Wetlands Protection Act and its r egiiiatione regarding such boundaries for as long as this Determination is valid. ❑ 2b. The boundaries of resource areas listed below are not confirmed by this Determination, regardless of whether such boundaries are contained on the plans attached to this Determination or to the Request for Determination. ❑ 3. The work described on referenced plan(s) and document(s) is within an area subject to protection under the Act and will remove, fill, dredge, or alter that area. Therefore, said work requires the filing of a Notice of Intent. ❑ 4. The work described on referenced plan(s) and document(s) is within the Buffer Zone and will alter an Area subject to protection under the Act. Therefore, said work requires the filing of a Notice of Intent. ❑ 5. The area and/or work described on referenced plan(s) and document(s) is subject to review and approval by: Name of Municipality Pursuant to the following municipal wetland ordinance or bylaw: Name Page 2 of 5 wpaform2.doc • rev. 12/15/00 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 6. The following area and/or work, if any, is subject to a municipal ordinance or bylaw but not subject to the Massachusetts Wetlands Protection Act: ❑ 7. If a Notice of Intent is filed for the work in the Riverfront Area described on referenced plan(s) and document(s), which includes all or part of the work described in the Request, the applicant must consider the following alternatives. (Refer to the wetland regulations at 10.58(4)c. for more information about the scope of alternatives requirements): ❑ Alternatives limited to the lot on which the project is located. ❑ Alternatives limited to the lot on which the project is located, the subdivided lots, and any adjacent lots formerly or presently owned by the same owner. ❑ Alternatives limited to the original parcel on which the project is located, the subdivided parcels, any adjacent parcels, and any other land which can reasonably be obtained within the municipality. ❑ Alternatives extend to any sites which can reasonably be obtained within the appropriate region of the state. Negative Determination Note: No further action under the Wetlands Protection Act is required by the applicant. However, if the Department is requested to issue a Superseding Determination of Applicability, work may not proceed on this project unless the Department fails to act on such request within 35 days of the date the request is post -marked for certified mail or hand delivered to the Department. Work may then proceed at the owner's risk only upon notice to the Department and to the Conservation Commission. Requirements for requests for Superseding Determinations are listed at the end of this document. ❑ 1. The area described in the Request is not an area subject to protection under the Act or the Buffer Zone. ❑ 2. The work described in the Request is within an area subject to protection under the Act, but will not remove, fill, dredge, or alter that area. Therefore, said work does not require the filing of a Notice of Intent. ® 3. The work described in the Request is within the Buffer Zone, as defined in the regulations, but will not alter an Area subject to protection under the Act. Therefore, said work does not require the filing of a Notice of Intent, subject to the following conditions (if any). coo affnrheri rnnriitinn ❑ 4. The work described in the Request is not within an Area subject to protection under the Act (iiiCilidiiiy the Buffer 7nne) Therefore said work does not require the filing of a Notice of Intent, unless and until said work alters an Area subject to protection under the Act. Page 3 of 5 wpaform2.doc • rev. 12/15/00 Negative Determination of Applicability 500 Great Pond Road Conservation Conditions Record Documents: Request for Determination of Applicability, received dated October 22, 2004; Plan entitled "Renovation of Existing Barn , prepared for North Andover Country Club, prepared by Giles Surveying, dated September 21, 2004. Plans stamped 9- signed by Frank S. Giles ll, P.L.S. T., ..__.... i.e ,.r + ,c jecision does not negate or supercede the existing Order of Conditions (242-1187) associated with the same property. Pre -Construction Conditions the applicant shall ➢ Prior to the commencement of any work activities on site, install erosion controls in the locations depicted on the above approved site plan. Said erosion controls shall be installed in accordance with the erosion control aetau. ➢ The applicant shall have on hand at the start of any soil disturbance, removal or stockpiling, a minimum of 10 hay bales and sufficient shall be used only for the kes for staking these bales (or an equivalent amount of silt fence). Said control of emergency erosion problems and shall not be used for the normal control of erosion. ➢ Immediately following completion of the above, the applicant shall contact the Conservation Department, at least 72 hours in advance, to schedule an on-site pre -construction meeting. During Construction Conditions ➢ All waste generated by, or associated with, the construction activity shall be contained within the construction area, construction materials nd away from any tior disposal of and resource area. There shall be no burying of spent waste on the site by any other means. The applicant s (or other suitable means) at the site for thestorage and removal of such spent construction materials off-site. However, no trash dumpsters shall be placed within 50' of the wetland resource area. Further, the applicant and/or contractor shall ensure that all construction debris associated with the work is properly disposed of on a daily basis. Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Form 2 — Determination of Applicability 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 B. Determination (cont.) ❑ 5. The area described in the Request is subject to protection under the Act. Since the work described therein meets the requirements for the following exemption, as specified in the Act and the regulations, no Notice of intent is required: Exempt Activity (site applicable statuatorylregulatory provision s) ❑ 6. The area and/or work described in the Request is not subject to review and approval by: Name of Municipality Pursuant to a municipal wetlands ordinance or bylaw. Ordinance or oyia'vv vitativn Name C. Authorization This Determination is issued to the applicant and delivered as follows: ❑ by hand delivery on 2/by certified mail, return receipt requested on Date Date This Determination is valid for three years from the date of issuance (except Determinations for Vegetation Management Plans which are valid for the duration of the Plan). This Determination does not relieve the applicant from complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. This Determination must be signed by a majority of the Conservation Commission.'A copy must be sent to the approp�ate DEP Regional Office (see Appendix A) and the propertyfo&er (If different from the applicant).gnature� - liJ, 'Y Date / t Page 4 of 5 wpaform2.doc • rev. 12115/00 Massachusetts Department of Environmental Protection ' Bureau of Resource Protection -Wetlands WPA Form 2 — Determination of Applicability 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 D. Appeals The applicant, owner, any person aggrieved by this Determination, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate Department of Environmental Protection Regional Office (see Appendix A) to issue a Superseding Determination of Applicability. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form (see Appendix E; Request for Departmental Action Fee T ransmittal Form) as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Determination. A copy of the request shall at the same 1me be sent by certified mail or hand delivery to the Conservation Commission and to the applicant if he/she is not the appellant. The request shall state clearly and concisely the objections to the Determination which is being appealed. To the extent that the Determination is based on a municipal ordinance or bylaw and not on the Massachusetts Wetlands Protection Act or regulations, the Department of Environmental Protection has no appellate jurisdiction. Page 5 of 5 wpaform2.doc • rev. 12/15/00 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands WPA Appendix A - DEP Regional Addresses 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments, payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden P Monroe Montague g Pittsfield Plainfield . Tyringham Wales 436 Dwight Street g Agawam g Conway in ton Cummington Hancock Hatfield Monterey Richmond Ware Warwick Suite 402 Alford Amherst Calton y Montgomery Rowe Russell Washington Springfield, MA 01103 Ashfield Deerfield Heath Hinsdale Monson Mount Washington Sandisfield Wendell Lone: A A 7 70A 110n Becket Easthampton Holland New Ashford Savoy Westfield Phone: `F 1 J-1 ., Belchertown East Longmeadow Holyoke New Marlborough Sheffield Westhampton Fax: 413-784-1149 Bernardston Egremont Lunenburg Marlborough New Salem Shelburne West Springfield Blandford Erving Huntington Lanesborough North Adams Shutesbury West Stockbridge g Brimfield Florida Lee Northampton Southampton Whalel y Buckland Gill Mendon Northfield South Hadley Wilbraham Chnt Goshen Lenox Leverett a Orange Southwick Williamsburg Cheeshireshire Granby Medford Otis Springfield Williamstown Chester Chesterfield Granville Great Barrington Leyden Longmeadow Palmer Stockbridge Sunderland Windsor Worthington Chicopee Greenfield Ludlow Pelham Pent Tolland Clarksburg Hadley Middlefield DEP Central Region Acton Charlton Hopkinton Millbury Millville Rutland Shirley Uxbridge Warren 627 Main Street Ashburnham Clinton Douglas Hubbardston Hudson New Braintree Shrewsbury Webster Westborough Worcester, MA 01605 Ashby Athol Dudley Holliston Northborough Southborough Southbridge West Boylston Phone: 508-792-7650 Auburn Dunstable Lancater Leicester Northbridge North Brookfield Spencer West Brookfield Fax: 508-792-7621 Ayer Barre East Brookfield Fitchburg Leominster Oakham Sterlin g Westford Westminster TDD: 508-767-2788 Bellingham Gardner Littleton Oxford Paxton Stow Sturbridge Winchendon TDD: 508-946-2795 Berlin Grafton Lunenburg Marlborough Pepperell Sutton Worcester Blackstone Groton Harvard Maynard Petersham Templeton Yarmouth Bolton Boough Hardwick Medway Philli Ston Townsend Tyngsborough Wilmington Boylston Holden Mendon Princeton Royalston Upton P Winchester Brookfield Hopedale Milford Plympton P Scott Winthrop Woburn DEP Southeast Region Abington Dartmouth Freetown Gay Head Mattapoisett Middleborough Provincetown Raynham Tisbury Truro 20 Riverside Drive Acushnet Attleboro Dennis Dighton Gosnold Nantucket Rehoboth Rochester Wareham Wellfleet Lakeville, MA 02347 Avon Duxbury Halifax NewBedford North Attleborough Rockland West Bridgewater 9 Phone: 508-946-2700 Barnstable Eastham Hanover Hanson Norton Sandwich Westport Fax: 508-947-6557 Berkley East Bridgewater Easton Harwich No well Scituate West Tisbury TDD: 978-661-7679 Bourne Dracut Kingston Oak Bluffs Seekonk Whitman TDD: 508-946-2795 Brewster Edgartown Lynn Lynnfield Orleans Sharon Wrentham Bridgewater h Fairhaven Lakeville Mansfield Pembroke Somerset Yarmouth Brockton Fall River Falmouth Marion Plainville Stoughton Wilmington Carver Chatham Foxborough Marshfield Plymouth y Swansea Taunton Winchester Chilmark Franklin Mashpee Plympton P Scott Winthrop Woburn DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Methuen Quincy Randolph Wakefield Walpole 205 Lowell Street Andover Arlington Chelsea Cohasset Holbrook Hull Middleton Reading Waltham Watertown Wilmington, MA 01887 Ashland Concord Ipswich Millis Milton Revere Rockport Wayland Phone: 978-661-7600 Bedford Danvers Lawrence Lexington g Nahant Rowley y Wellesley Fax: 978-661-7615 Belmont Beverly Dedham Dover Lincoln Natick Salem Salisbury Wenham West Newbury TDD: 978-661-7679 Billerica Dracut Lowell Needham Newbury y Saugus Weston Boston Essex Lynn Lynnfield Newburypo t Sherborn Westwood Boxford Everett Malden Newton Somerville Weymouth Braintree Framingham Manchester -By -The -Sea Norfolk Stoneham Wilmington Brookline Georgetown Marblehead North Andover ury Salam Winchester Burlington Gloucester Groveland Medfield North Reading P Scott Winthrop Woburn Cambridge Hamilton Medford Norwood Tewksbury Canton Carlisle Haverhill Melrose Peabody To P sfield Page 1 o 1 Wpaform2.doc •'Appendix A • rev. 11/22/00 Massachusetts Department of Environmental Protection •- Bureau of Resource Protection - Wetlands 1 WPA Appendix —Request for Departmental Action Fee Transmittal Form 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. Request Information Important: 1 When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. Cityiiown State Zip Code r� Phone Number Fax Number (if applicable) ILA Project Location rer� Mailing Address City;Town State Zip Code 2. Applicant (as shown on Notice of Intent (Form 3), Abbreviated Notice of Resource Area Delineation (Form 4A); or Request for Determination of Applicability (Form 1)): Name Mailing Address City/Town State Zip Code Phone Number Fax Number (if applicable) 3. DEP File Number: Person or party making request (if appropriate, name the citizen group's representative): Name Mailing Address S. instructions 1. When the Departmental action request is for (check one): ❑ Superseding Order of Conditions ❑ Superseding Determination of Applicability ❑ Superseding Order of Resource Area Delineation Send this form and check or money order for $50.00, payable to the Commonwealth of Massachusetts to: Department of Environmental Protection Box 4062 Boston, MA 02211 wpaform2.doc • Appendix E • rev. 2100 Page 1 of 2 d "°N':� OFFICE OF BUILDING INSPECTOR TOWN OF NORTH ANDOVER CONSTRUCTION CONTROL e+c,ms PROJECT NUMBER: PROJECT TITLE: 9_ 9NDyd-nO hl TO E X15 i 1 r16n Pacd A 013 RAe�hj LXT:r4-P51 o I, PROJECT LOCATION:_ -go Q R�541— 1020P 1eOAD NAME OF BUILDING: M)P74 14tyP V99 QUAJiP-Y Cl --U6 IN ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, I, FOFD 1:mANU>~t_ REGISTRATION NO. 3M3 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLAW, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ho l ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL MECHAN S y SEL STRLCTUM FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for conformance to the design concept, shop drawings, samples and other submittals which are submitted by the contractor to accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become, generally familiar with6the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. "AT- INTECUilL$ /9PPeW,e1,-7:E ?a S' 6,C of Cr1rV5'rR(zcit6AJ PURSUANT TO SECTION 116.2.2 1 SHALL SUBMIT, A PROGRESS REPORT TOGETHER WITH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, l SHALL SUBMIT A FINAL REPORT AS TO THE n SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OCCUPANCY. n. SUB 7:DANI SWO N TO BEFORE ME THIS �t DAY OF C o Ej r 17 NOTARY PUBLIC MY COMMISSION EXPIRES�L69 Oct 10 07 04:03p Cote 603-329-7832 p.1 ..... w acrvi •v•lc rrcun C1'1U11`r_MML1'4U 1141— lu )e7ra.3e l�.IOe/k9G s' Y. OFFICE OF BUILDING INSPECTOR • TOWN OF NORTH ANDOVER ' CONSTRUCTION CONTROL PROJECT NUMBER: PROJECT TITLE:_ AN0tfA-Tfop1 To EXIST -11461 6AcdqK3FAe� � s1.0 PROJECT LOCATION: , r_67 -0 C Q e_�jr– fi6Np 1:i4W NAME OF BUILDINGAn'woe C4v u CL 4 6 NATURE OF PROJECT: IN ACCORDAI I, C!4/4p_`,rS WITH ARTICLE 118 OF THE MASSACHUSETTS STATE BUILDING CODE. C'aT t� REGISTRATION NO. BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECH HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ �CTRICAL OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 1113.0 1. Review, for Conformance to the design concept, shop drawings. samples and other submittals which are submitted by the contractor In accordance with the requirements of the construction documents. 2. Review and approval of the quality control procedures for all code -required controlled materiels. 3. Be present at intervals OPproprlate to the stage of oomhutttion to become, generally familiar wlthOft progress and quality of the work and to determine, in general, if the work is being Psdormed in a manner consistent with the corWucbon documents. w T 1N7ErtfA1-f hAAvPR,4m -ro S-7Ug OF it PURSUANT TO SECTION 110.2 2 I SHALL SUBMIT , A PROGRESS REPORT c oK�au TOGETHER WrTH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR. UPON COMPLETION OF THE WORK, t SHAD. SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READINESS OF THE PROJECT FOR OC UPANCY. SU IBED AND SW TO BEFORE ME THIS ata TURF _ _DAY OF P r a OOli JJ NOTARY PUBLlC MY COMMISSION EXPIRE S_ /i/0� __ TOTAL F:02 Oct 10 07 03:47p Michael J. Keane 1 603 292 1402 p.2 UlJ-1b—[YJr]'r' 1a;v4 rKUi tlIHNUtL tNu1NttK1NU INC. IU 21jdlquG P. 02/02 f %" 9 gwb V/ OOVM w t We% TOWN OF NORTH ANDOVER . CO� uCTIONCOMQL PROJECT NUMB��• PROJECT TrTLE• 9NoVA-T10q To exl 5T I r{ 61 13xeP A NL0 FAeq. t-KTJEW;1 c� PROJECT LOCATIOI+k NA . l ME OF BUMNO• NDS A'NWbe CE! 7 CL u 6 NATURE OF PROJECT: I' ' SII V ACCORDANCE WITH ARTICLE 116 OF THE MASSACHUSETTS STATE BUILDING CODE, ar o REGISTRATION NO._°;� ��,;� t.eE1NG A REGISTERED ARCHITECH HEREBY CERTIFY THAT ! HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL ®/ STRUCTURAL CI FIRE PROTECTION Q ELECTRICAL. u OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEGE, SUW PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE PROVISION OF THE MASSACH ,,f J -%-'STATE BUILDING CODF ACCEPTABLE ENGINEERING PRATICES. AND APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. MICHAEL JOHN KEANE No. 7384 fT1 1 FURTHER CERTIFY THAT I SMALL PERFORM THE NECESSARY PROFESSIONAL. SERVICES AND B EPRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORE{ IS PROCEEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.0 1. Review, for corrtormance to the design concept. shop drawings, o mplea and other subinMSIe which am submitted by the contractor In amordance with, Me mquimments of the sWIstructlon documents. 2. Review alnd approval of the qual ty coftef pmoedures for all code-MuM conVolled materials. 3. Bi pleseet at "ovate Wpropdab to the atage of construction to become. generally famiNar. vrtthe progmse end quelte of the work end to determine, In penerel, If the work is being performed In a manner torr Ment with the construcWn documents. . _ . pursuant to Section 116.2.2, 1 shall submit, "at intervals appropriate to the stage of I construction ", a progress report together with pertinent comments, to the North Andover Building Inspector. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO THE SATISFACTORY COMPLETION AND READN ESS OF THE PROJECT FOR C1,CCU�AN,CnY. SU FUSED AND SWORN TO BEFORE ME THIS DAY OF I ksic"o"Y NOTARY PUBLIC MY COMMISSION EXPIRE8 , '7 OF , TOTAL P. r' s� . OCT -10-2007 16:30 FROM EMANUEL ENGINEERING INC, TO 8?58383 P-02/02 OFFICE EW f31AR.L)IF66 n*orci• o vR TOWN OF NORTH ANDOVER Q0Wffi C�,CONML PROJECT Wad - PROJWTscore• ggd of/44104 --12 Ext sz Ili 6s Eib&4 A• FW ?Ae k=�5160 IN ACCORDANCE WiTH ARTICLE 116 OF THE MASSACHUSE"iTS STATE HUitDING CODE, ,--ew u 15 H, A u G 3e= 6x!-1 REGib'M'nON NO -7 BEING A REGISTERED PROFESSIONAL 5NGINEZWARCHITE0H HI M8Y..CERTiFYTHAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPWATIONS AND SPECiFICATiONS CONCERNING: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ FRE PROTECTION ❑ ELECTRICAL ❑ OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KMVLEGE COMPUTATIONS AND BPECIF"TION8 MEET THE APPUCABLE PROVISION OF ' STATE BUILDING CODE,; ALL ACCEPTABLE E"NFEi2M PRATICES. AND APPLICABLE LAWS AND ORDWANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERYIFY TKAT I SKALL PERFORM THE NECESSARY PROFESSIONAL SERViCES AND 8 EPRESENT ON THE CONSTRUCnON BRE ON A REGULAR AND PERIODfC W13 TO DETERMINE THAT THE WORK 18 PROCEEMNO IN ACCORDANCE WiTH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND 8NALL BE RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 118.0 1. Review, br wibrmtmos to the dm* oomoept, shop dra:wkKm samples and other submittals which ars submitted by the aonUaieW in socondaNl x* w th the mquimmwft of Itis constrvdW doc uffm ts. 2. Review and oppmvd of the quailty oont d p=Wums fbr all oodersqukllld om*oAed materials. 3. Be prewd at htirrvsb appropriate to the steps of oorsaftdlon to become, gerwally famlllar wit ft propreas and quality of the work end to determine, In peneraf, If the work Is b ft perhmne0 in a monnof oonshiwd w0h the cons6vol5an docun uhL �` r i A/ TFedi�.S f! PA�'PttrprlE= 7v S�qB� D � �' PURSUANT TO SECTION 11 Q.2.2 I SHALL. SUi W , A PROGRM itEPORT TOGETHER WiTH PERTINENT COMMENTS TO THE NORTH ANDOVER BUILDING INSPECTOR, UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT A8,T0 THE SATISFACTORY COMPLETiON AND READINESS OF THE PROJECT FOR CUPANCY. TUR ` 767R=sw BWQRN TO BEFORE ME THIB�0 Or Gc o 'f1�� ` NOTARYPUBLIC MY COMMIWtON DIRE J TOTAL. P.02 FROM 1 11 2007Pool. r v` OFFICE OF 1NG INSPECTOR TOWN OF 14ORTHW- CONMUCMONi 9281(\fir PROACTIdu PWA.rrF .r.....o1•" �����F I I•I—IIP_r NATtAiE of PRO1 W: RW 29&A(jzwc a�1 d puf4r'7144 UANMCE2 6 1 M 0 lie OF THE IWAI"HUSEWsSTATE WILDING CODE, f A REGISM11ON NO,. - soggso INEING A REGIST D PROl±MONAL E 4114IR IARDHITECF1 MP.RMY CERTIFYTHAT I HAVE PREPARED M DIREC'T'LY SUPERVISED THE pnpARAT" OF AL.L MION RirAN$, COMPUTATIOM AND SPWIFICATIONS WNCERNING: ENTME CT +,ARcMIYI:MRAL D STRUCTURAL ❑ MEC�iAhtICAL [J FIRE PROTECTION ELECTRICAL E] 071ER (SpECim FOR THE AWn NAMW PROUECT ANO THAT, To THE MST OF MY K�foW4 =' auCti PLANS, COMPUTAMNS AND 8ft0IFICAYiONg MEET TI•2 ABPUCABLE VROVIOION OF EJ 3}S H PLAC`Hl?$E1T5 AND APPU l�.E LAWS AND ORDIINNANCE.S ABLE FOR ERIN USE AND 0=1PANCY. 1 FURTHER C'FJMFY THAT I SHALL PUS -ORM THE NECESSARY PROFESSIONAL w"c% B RPREBENT ON THE C.C*MTRuOMON SITE ON A REGULAR AND PMWIG 15M28 TO DETERMINE THAT THE WORK 1$ RROCEREDING IN ACCOROANCE WITH THE DOCUMENTS APPROVEp FOR THE SUILDING PM041TAM $HALL BE KSPONSISLE FOA THE FOLLOWING AS 8MIFIED IN SECTION 116.0 1. f; vlew, for cwdomumm to OW daslpn 001104K dmMngs, samplea sw odw submittab which 8M sub"M by the a1 njmcbcr In aooardp� with the Mqu emonts of tine cWMIMcon Z. Revtaw and approval of the qu8I#y adr W MWdUlWforap mired omh Dw mmerift. 3. Be preeeht at )rrUirVeN appeoP'* tQ the 98P c(+ODnshttotiorl to bs=ft, Oedema famAlar ' M+o D 1aea quRuty of the worrk and to detem*w, 1. Ithe work is being cm*K nt wb the cwwuucft do Amwft PE TC7 8ECT10d*I t 18.E .Z ! eHALL SU THE A P E131IVfTH RTR►kENT COf1 ENTg TO THE NORTH ANDOVERR 8U6.DING 1INSMCTOFL Com w u� gvMPLeT7f3M Ole' Tim WORK,1 S� L L SUEIMf T A FINAL REPORT AS TO 711E °I CTQiRY WMPiOM Mb REAOMW OF THE M,IECT FOR 0=F Y, Ltd v�: s � �1I1lI�j jt11�1� SM� TO B INE TH1B_�tiAYOrF-� TO NGrT'MY FtMLIO / C/ MY COMMISSION EXPIRESUG TMPL P-02