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23B-046 (125) OPERATION: [] PNEUMATIC ELECTRIC HYDRAULIC PIPING SUPERVISED YES NO ETECTING MEDIA SUPERVISED? YES NO DOES THE VALVE OPERATE FROM THE MANUAL TRIP AND/OR REMOTE CONTROL? YES NO DELUGE W. IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT FOR TESTING? E]YES. NO PREACTION IF NO,EXPLAIN: VALVES Does each circuit operate Does each circuit Maximum time to MAKE MODEL supervision loss alarm? operate valve release? operate raisese YES NO YES NO MIN, SEC. HYDROSTATIC:Hydrostatic tests shall be made at not less than 200 psi 113.6 bars)for two hours or 50 psi(3.4 bars)above static pressure in excess of 150 psi(10.3 bars)for two hours.Differential dry-pipe valve clappers shall be left open during test to prevent TEST: damage. All aboveground piping leakage shall be stopped. DESCRIPTION- PNEUMATIC:Establish 40 psi(2.7 bars)au pressure and measure drop which shall not exceed 1-1/2 psi(0.1 bars)in 24 hours.Test pressure tanks at normal water level and air pressure and measure air pressure drop which shall not exceed 1-112 psi(0.1 ban)in 24 hours. ALL PIPING HYDROSTATICALLY TESTED AT 200 PSI FOR 2 Hre. IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED? YES NO TnTe constraints 200 lbs 2 hr!;. only. EQUIPMENT OPERATES PROPERLY? [I YES ONO TESTS DRAIN EADING OF GAGE LOCATED NEAR WATER SUPPLY TEST PIPE: RESIDUAL PRESSURE WITH VALVE IN TEST PIPE TEST PSISee report of inspection. OPEN WIDE PSI Underground mains and lead-in connections to system risers shag be Hushed before connection made to sprinkler piping. VERIFIED BY COPY OF THE FORM NUMBER 850? [M YES F]NO OTHER EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKLER PIPING? ([Z YES ❑NO BLANK NUMBER USED LOCATIONS NUMBER REMOVED i TESTING GASKETS 0 i WELDED PIPING? YES NO IF YES....... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS 010.9, LEVEL AR-3? }YES ❑NO WELDING DO YOU CERTIFY THAT THE WELDING WAS PERFORMED BY WELDERS QUALIFIED,IN COMPLIANCE WITH THE REQUIREMENTS OF AT LEAST AWS D10.9, LEVEL AR-3? X1 YES ❑NO DO YOU CERTIFY THAT WELDING WAS CARRIED OUT IN COMPLIANCE WITH A DOCUMENTED QUALITY l CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED.THAT OPENINGS IN PIPING ARE SMOOTH, THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT INTERNAL DIAMETERS OF PIPING ARE NOT PENETRATED? ®YES []NO - HYDRAUUC NAMEPLATE PROVIDED? W YES ONO DATA IF NO,EXPLAIN: NAMEPLATE DATE LEFT IN SERVICE WITH ALL CONTROL VALVES OPEN: 2-10-03 REMARKS NAME OF INSTALLING CONTRACTOR M.J.Moran Inc. Fire Protection Division TESTS WITNESSED BY - SIGNATURES FOR PERTY O i red! T1 _ 6ATt 211rh, I FOR INSTALLING CONTRACTOR(Signed) TITLE DA General Manager 2-10-03 ADDITIONAL EXPLANATION AND NOTES: I i t I i 85A BACK CONTRACTOR'S MATERIAL & TEST CERTIFICATE FOR ABOVEGROUND PIPING Ado7donal capies of this form are Loss Preventlon PubRcadons-Training Resource Center avaitah&to inured*train. Factory Mutual Engineering and Research, 1151 Boston-Providence Turnpike,P.O. Box 9102.Norwood MA 02062 PROCEDURE: Upon completion of work,inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative.All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by both representatives.Copies shall be prepared for approving authorities,owners and contractor. It is understood the owner's representatives signature in no way prejudices any claim against the contractor for faulty material,poor workmanship, or failure to comply with approving authority's requirements or local ordinances. PROPERTY NAME DATE Cooley Dickinson Hospital-Physical Therapy2-10-03 PROPERTY ADDRESS 30 Locust Street Northam ton, MA ACCEPTED BY APPROVING AUTHORITY'IS)NAMES Local Authorities and Owners Insurer ADDRESS PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS YES ❑NO EQUIPMENT USED IS APPROVED(IF NO,STATE DEVIATIONS BELOW) Q YES ❑ NO HAS PERSON IN CHARGE OF FIRE EQUIPMENT BEEN INSTRUCTED AS TO LOCATION OF CONTROL YES ❑ NO VALVES AND THE CARE AND MAINTENANCE OF THIS NEW EQUIPMENT? IF NO,EXPLAIN: INSTRUCTIONS HAVE COPIES OF APPROPRIATE INSTRUCTIONS AND CARE AND MAINTENANCE CHARTS BEEN YES ❑ NO LEFT ON PREMISES? IF NO, EXPLAIN: I � I LOCATION OF SUPPLIES BUILDINGS SYSTEM Physical Therapy YEAR OF TEMPERATURE MAKE MODEL ORIFICE SIZE QUANTITY MANUFACTURE RATING . Viking 2001 half 96 165 deg. SPRINKLERS Viking M 1 2001 half 3 165 deg. PIPE CONFORMS TO NFPA STANDARD ®YES ❑NO PIPE AND FITTINGS CONFORM TO NFPA STANDARD ®YES ❑NO FITTINGS: IF NO,EXPLAIN: ALARM ALARM DEWCE. MAXIMUM TIME TO OPERATIE THROUGii:TESI`PIPE VALVE OR TYPE MAKE MODEL MIN. SEC. FLOW vane flow Potter VFS 0 50 INDICATOR DRY VALVE: : MO.D MAKE MODEL SERIAL NUMBER MAKE MODEL SERIAL NUMBER Tuna Waite T)ME:TOTRIP WATER AIR> TRIP POINT AIR'? Ahem Operated' Reached Test THRU TEST PIPE' PRESSURE: PRESSURE PRESSURE ?Outlet PrePedY' DRY PIPE: _. OPERATING MIN. SEC. PSI PSI PSI MIN. SEC. MIN. SEC. TEST WITHOUT Q.O.D. WITH Q.O.D. IF NO,EXPLAIN: BSA (3.94)FMRC PRINTED IN USA AM.J. M O RAN, INC. LETTER OF TRANSMITTAL FIRE PROTECTION DIVISION 4 SOUTH MAIN STREET TELEPHONE: FAX: HAYDENVILLE, MA 01039 (413)268-7251 (413)268-9375 TO: Northampton Building Inspector DATE: 2-10-03 1 JOB NUMBER: 01-595 212 Main Street ATTENTION: Mr. Tony Patillo Room 100 Building Dept. RE: Fire Sprinklers at Cooley Dickinson Northampton, MA 01060 Hospital Physical Therapy WE ARE SENDING YOU ® ATTACHED ❑UNDER SEPARATE COVER VIA THE FOLLOWING ITEMS: ❑SHOP DRAWINGS ❑PRINTS ❑PLANS ❑SAMPLES ❑SPECIFICATIONS ❑COPY OF LETTER ❑CHANGE ORDER ❑ COPIES DATE NUMBER DESCRIPTION 1 2-10-03 Copy Contractors Material and Test Certificate THESE ARE TRANSMITTED AS CHECKED BELOW: ❑For approval ❑Approved as submitted ❑Resubmit copies for approval ®For your use ❑Approved as noted ❑Submit copies for distribution ❑As requested ❑Retumed for corrections ❑Retum corrected prints ❑For review and comment ❑ ❑FOR BIDS DUE: ' 1998 []PRINTS RETURNED AFTER LOAN TO US REMARKS: Copies have been sent to: Cooley Dickinson Hospital- Mr. Scott Johnson Factory Mutual Insurance- Ms. Suzanne C. Brunetti Northampton Fire Dept. -Chief Brian Duggan Northampton Building Inspector- Mr. Tony Patillo COPY TO: Job File pp SIGNED: Date: f s g Z Of �jMlltIt - -• B �iassscltuscttf _ DEPARTMENT OF BUIL)ZNG INSPECTIONS INSPECTOR 212 Main Street • Municipal Building ` Northampton,MA 01060 v . CONSTRUCTION CONTROL DOCUMENT y (for professional Engineers/Architects responsible for Entire Project) Project Title: Date: 1-141¢•,► ryb I 1 C"Wlr a Project Location: p: Parcel: Zone: Scope of Project: WPAX In accordance with the sixth edition Massachusetts State Building Code,780 CMR SECTION 116.0: I, Mass.Registration Number 4W Being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: []Entire Project for the above named project and that to the best of my knowledge,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,all acceptable engineering practices and all applicable laws for the proposed project. ' Furthermore,I understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction documents as submitted for the building permit,and approval for the conformance to the design concept. 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 with the 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. I shall submit periodically,in a form acceptable to the building official,a progress report together with pertinent comments.Upon completion of the work,I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. Signature and Seal of registered professional: �n^RCti,,. �5 JENt)RyFo� v 140.4105 Go A,n Fax 413-587-1272 -phone 413-587-1240 June 26,2001 L/A HEALTHCARE Fire Narrative ARCHITECTS INC. Renovations to the Physical Therapy Department Cooley Dickinson Hospital CORPORATE DIRECTOR EdwazdL.lendry,A.I.A. Northampton,Massachusetts SENIOR PRINCIPAL C.J.R'hitham Under the proposed renovations,the following improvements will be made to the fire protection systems: PRINCIPALS Don Hdner Richard E.Katsanos A. Sprinkler System Ann Lawrence Knox Richard eWilk This area is currently unsprinklered. The entire department will receive a new wet sprinkler system designed in accordance with N.F.P.A. guidelines. Copies ENGINEERING ASSOCIATES of the stamped sprinkler shop drawings will be filed with the building William M.Barry,P.E. department prior to start of construction of the sprinkler system. Ronald G.Stenlund,P.E. B. Fire Alarm System The existing fire alarm system will be replaced with a new addressable system that is compatible with the Hospitals new system. HEALTHCARE ARCHITECTS INC. 64 GOTHIC STREET NORTHAMPTON, MASSACHUSETTS 01060 413-585-1512 Version 1.7 Commercial Building Permit May 15,2000 �EGTION A STRUCTUF0At PEER REVIEW(760 CMR 1101]) ndependent Structural Engineering Structural Peer Review Required Yes......❑ No...... ;ECTION 11=OWNER AUTHORIZATION -T0"BE`COMPLET.ED'WHEN )WNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT' as Owner of the subject property ereby authorize to act on ny behalf, in all matters relative to work authorized by this building permit application. ignature of Owner Date as Owner/Authorized Agent iereby declare that the statements and information on the foregoing application are true and accurate, to the best of my mowledge and belief. Signed under the pains and penalties of perjury. 6E64 L5 &'Kt IJ/2G� df/-�ftGi��G�t� Tint Name k nature A OAer/Agento Date 3ECTIO,N 12:',-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: // Not Applicable ❑G; Jame of License Holder:��0 �e �V f)/a 4!? �/ —/ License Number address Expiration Date Sig ature Telephone SECTION 13 4O' RKERS' COMPENSATION INSURANCE Q, IDAVIT(M,G.I:. c,152, §,25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of e building permit. Signed Affidavit Attached Yes....... No...... ❑ Versionl.7 Commercial Building Permit May 15,2000 SECTION b-",PROFESSIONAL QESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTtlRES.SUBJECTTCI ONSTRUCTION CONTR©4 PURSUANTI'0�780;'CMR,1.1f CCO,IVTA,INING MORE THAN"35,000 C?F, OF E„IV;CCQSE��SI��CE); U Registered Architect: I I A AA In', ZA&K _ Not Applicable ❑ ,,// lame(Registrant): MWWA(�� #�' 1K Registration Number (04 lub ddress Amvp�t I, Expira o Date igna re Telephone fl )2 Registered Professio al gi s): lame Area of Responsibility ,ddress Registration Number :ignature Telephone Expiration Date Jame Area of Responsibility ;ddress Registration Number ;ignature Telephone Expiration Date lame Area of Responsibility ddress Registration Number ;ignature Telephone Expiration Date Jame Area of Responsibility address Registration Number Signature Telephone Expiration Date ).3 General Contractor COO/C 61 / /!mil 6 0 14 / T-It Not Applicable ❑ ,ompany Name: / ) ��6& �67 N I esponsible In Charge of Construction 3a L o c- u6 T ST /Uor����►��ra� address a 30- nature U Telephone Version 1.7 Commercial Building Permit May 15,2000 SECTION 4 . ONSTROCT ON 5ERV(. S FOR PROJECTS LESS THA14 35,000;, C Nr T 0>l" ;UBi NC"UD SPACE 3 , 7 nterior Alteration Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ .xterior Alterations Demolition New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] th�c DECK Piz ,� rp C Q ( ,5A ECTION15 ­USE GROUR AND; Version 1.7 Commercial Building Permit May 15,2000 thampton u i partment i 21 i Street } .100 !! 120 j L `'` '`' 2 • MJAa MA 01060 phone 413-587- 24 Fax 413.587-1272 bite: DEFp OF BUILDING INSPECTIONS S?., As'4011 MA 01060 APPLIC T©=CSNSTRQCT NOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO-FAMILY DWELLING R 6AAUvA v n 70 CX iS-Fi V6 �i_A -"--KPY 'ECTION 1-=SITE INFORMATION .1 Property Address: This sectio o be completed btr o#fic , C I ✓'� 'may— d �' I_ol . 1 •J J S J pa gs.S, a ai ,2w A�© k4_11 cl{�!/ A7 �U b Overlay£ �5trict li x 3ECTION:2- PROPERTY OWNERSHIP/AUTHORIZED AGENT `.1 Owner of Record: Lo cy Di'c l-% d' 6-0 1 fl)5RlrA I O `oLV /wiv"r Jame(Print) Current Mailing Address: (,L//j D S�Z- 23 / 2 signature Telephone '-.2 Authorized Agent: 6,CU_.�jL5 /Uahk) L CMG V S S lam (P n rint) Current Mailing Address: gnature L)1)gpMX PA PA61&IEZ6n Telephone SECTION 3 - ESTIMATED CONSTRUCTION COSTS tem Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building 3 7 7 �, �. a� (a) Building Permit Fee 2. Electrical .00 (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee ' X00 60 4. Mechanical (HVAC) �, �l 5. Fire Protection /j� f 00. 0 V If AA o. Total =(1 + 2 + 3 +4+ 5) 000 - 00 -Check Number dr This Section For Official'Use Onl Bui}ding Permit Number: Date Issued: Signature; ,"BuiIdiiig Commissioner/Inspector of Buildings gate File#BP-2001-1121 APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL THE ADDRESS/PHONE 30 LOCUST ST (413)582-2312 Q 4(�, 7--b4t, PROPERTY LOCATION 30 LOCUST ST-PHYSICAL THER MAP 23B PARCEL 046 ZONE M THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: INTERIOR RENOVATIONS TO PHYSICAL THERAPY-SECTION 116 New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 042199 3 sets of Plans/Plot Plan Al�&k THE OLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presented/based on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § _w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservat' Commission Permit from CB Architecture Committee Signature of Building Official Date Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning requirements and obtain all required permits from Board of Health,Conservation Commission,Department of public works and other applicable permit granting authorities. �— A 7 # U •+,-f' Jam!`'-' Arce r �- `." 5A^ hom F2 L RE 4 �'�'� t_ '� � •' t'�'k � �� � ; F rY��j� � ,, "rho 3���#� ���� ���� � N � r a ' ; IL low 5 XPIP wp- CTW r � k #r �� �vs,�= � •„ %, .��� -s�€_" -d��.M r�"*e £ rays�` ' s' 'A�, taY.+r'� 'cl' „ �" v t *' `3 °:i' @ k� xi a ✓ "`. " 4 low '7 ., }ate x f SM001 b BP- Q41 1121 } �F TH OF MASSACHI SETTS ; OF NORTHAMPTON � � ILDING E' IT low 4 4. isAW4WBY GRANTED TO: , License: ITAL 042199 PITAL: C .. " ON H ITAL THE . LOCUST ST - PHYSICAL T-HER , is ant A d ss: Phnne: Insurgnre: =' LOCUST 9T f413) 582-2312 f) carer satiori M� ' NOA** PTONMA01060 �, LI EI?ON:7125/01 thQD:QO TOPERF'ORMTHE FOLLOWING WORK.-INTERIOR RENOVATIONS TO PHYSICAL THOMPY SECTION 116 i F '. ViS OM THE STREET luatbin Intspector of Wiruig D.P.W.` Inspector Qf Baildiags A end Service: Meter. Footings: H RouglK , ,' House# Foundation: , final; ' ,Final: �ftfa3 Rough Fram`,�./ = ,6 - 2 :s `Fire piart3nent Fireplace/Cl�imney: Insulation: h Pi�arl: S o : l� Final R el a � R PRA MAY BE REVOKED BY THE CITY OF NORTHAMPTON UP©N VIOLATION(��!' � 4OE ITS RULES AND REOULA-TION r Cate # Oc—cupancloo Si nature` Rece o:; _D Ate Paid; heck Nv: ©Unk, x < Ruilg 7/25/010:00:00 506792 $2790.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner.-Anthony Patillo