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SELECTIVE DEMO TO 10 HOUSING UNITS Certificate Number: B-18-3 Permit Number: B-18-3 Commonwealth of Massachusetts City of Salem This is to Certify that theResid/Commercial Building located at Building Type 104-106 LAFAYETTE STREET............................................................ in the .....................................Cly....of Salem ...................................................... ............................................... Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 10 Residential Apartments 2 Commercial Units SALEM POINT RENTAL PROP CORP This Permit is granted in conformity with the Statutes and Ordinances relating thereto, and expires Not Applicable unless sooner suspended or revoked. Expiration Date Issued On: Thursday, August 30, 2018 Commonwealth of Massachusetts i Citv of Salem 120 W,P.shington St°3rd Floor Salem,MA 01970(978)745-9595 x5841 Return card to Building Divisron for Certificate of Occupancy Permit No. B-18-3 FEE PAID: $1,430.00 PERMIT TO BUILD DATE ISSUED: 1/11/2018 This certifies that SALEM POINT RENTAL PROP CORP has permission to erect, alter, or demolish a building_ 1044.06.1-AFAYETTE STREET Map/Lot: 340488-0 as follows: Repair/Replace SELECTIVE 1NTERIOR"DEMO:W*400 RISPLACE., EXTER. IMPROVEMENT, INERIOR RENO OF TEN (i*),H0 SSG UW" COMM..80A t +GROUND FL., FIRE PROTECTION; ADD SPRMIRI:ER_HEMSIRELOCA'TE ASAEatfiftm NEW FINISHES, ELEC, MECH, PLUMB & FIRE ALARM. Contractor Name: ALLEN S. FAULKNER DBA: GROOM CONSTRUCTION Contractor License No: CS-065440 1/11/2018 13ttliding Off!4114Date This permit shall be deemed abandoned and invalid unless the wont authorized by thi3 pemilt Is eornmi ncdd wilhit six toofiftAafter issuance.The Building Official may grant one or more extensions not to exceed six months sect,uponwritten request. All work authorized by this permit shall conform to the approved appkatlon and the approved construction docurhe"iw title permit has been granted. All construction,alterations and changes of use of any ba Mk*and structures shall be in compliance with the locaf$6rft'bS and codes. This permit shall be displayed in a location clearly visible 000so cess street or road and shall be maintained opeAf-�" knpect on for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all app"Wsipnelure"s'by rte 111r 111g,erM Fbe,011JC1is sre,�ed on this permit. HIC#: 104999P tlirsve ,guaranty fund"(as set forth in MGL 042A). 77;,77,7 f,4$ rY . Restrictions: Building plans are to be available on site. All Permit Cards are the property of the PROPERTY OWNER. Commonwealth of Massachusetts , City of Salem 120 Washington S 3rd Floor Salem,AAA 01970 978 745-9595 x5841 n9 t, � ) Return card to Builgng Division for Certificate of Occupancy Structure CITY OF SALEM BUILDING PERMIT Excavation PERMIT TO BE POSTED IN THE WINDOW Footing INSPECTION RECORD Foundation Framing�.,�+ q r Mechanical 6 r n a et � 4p� x1 va cv p Insulation INSPECTION: DATE Chimney/Smoke Chamber Final 11- 36-11 /V� las♦ , Plumbing/Gas Rough:Plumbing Z Rough:Gas FinalMY Electrical Serwce } Rough V *�s 'r Final Fire partment *Cy k 'S IfI se e °� c® --nom �✓ 7 PreliminaryL3A Fin 7/Z11fx /mss Health Department Preliminary Final Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8'h edition of the V� Massachusetts State Building Code, 780 CMR, Section 107.6.4 Project Title: Harbor Lafayette Homes Date: 8-20-2018 Pen-mit No. B-18-3 Property Address: 104-106 Lafayette Street, Salem, MA Project: Check one or both as applicable: New construction x Existing Construction Project description: Renovation of 10 apartment units and commercial space. I Janis B Mamayek MA Registration Number: 7309 Expiration date: 8.31.2018 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project [X] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project. I certify that I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and that I or my designee: 1. 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. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. 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. Q d Enter in the space to the right a"wet"or �y� e :r f.` E electronic signature and seal: a �' �1 P.,1CrntJ. P4I,S3'tCFiJ:; TTS \`Qty► c� Phone number: �Qr'( � ,(�(trj '1: c Building Official Use Only Building Official Name:_ Permit No.: Date: _ Trial Version 10092012 Final Construction Control Document _AY To be submitted at completion of construction by a 4 Registered Design Professional > for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.4 Project Title: Harbor Lafayette Homes Date: 8-23-2018 Permit No, B-18-3 Property Address: 104-106 Lafayette Street, Salem,MA Project: Check(x)one or both as applicable: [ ] New Construction [X] Existing Construction Project description: Renovation of 10 apartment units and commercial space. I, Grzeyorz B. Wozny, MA Registration Number: 39170 Expiration date: June 30, 2020, am a registered design professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Architectural [ ] Structural [ )Mechanical [X] Fire Protection [ ] Electrical [ ] Other: Describe for the above-named project. 1,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: 1. 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. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. 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 the provisions of 780 CMR 107. Enter in the space to the right a"wet'or electronic signature and seal: Phone number: 781-826-4144 SFA OF A Email: gwozny@wbaengineers.com GRZEGORZ G B. Njt► O WOZNY v FIRE PROTECTION rn No.39170 L FIDAA E.BARBAR NOTARY Pt831.IC COMMONWEALTH OF MASS r1s Wy Comm Expires Oct 11,2021 Building Official Use Only Building Official Name: Permit No.: Date: J"A 5082 Harbor&Lafayette- Design\AffidavitslLafayette BuildinglFinal Affidavit Lafayette Homes FP 08-23-18.docx Final Construction Control Document To be submitted at completion of construction by a w Registered Design Professional > for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.4 r r Y Project Title: Harbor Lafayette Homes Date: 8-23-2018 Permit No. B-18-3 Property Address: 104-106 Lafayette Street, Salem, MA Project: Check(x)one or both as applicable: [ ] New Construction [X] Existing Construction Project description: Renovation of 10 apartment units and commercial space. I, Zbigniew M. Wozny, MA Registration Number: 34029 Expiration date: June 30. 2020, am a registered design professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Architectural [ ] Structural [X] Mechanical [ ] Fire Protection [ ] Electrical [X] Other: Plumbing for the above-named project. 1,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: 1. 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. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. 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 the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: Phone number: 781-826-4144 ,-1H Finail: zwozny@wbaengineers.com �� ZBIGNIEW M. WOZNY MECHANICAL No.34029 FIDAA E. BAR;32024M NOTARY PUBLIC COMMONY"TH OF M ASSA My Comm Expires OQ i Building Oficial Use Only Building Oficial Name: Permit No.: Date: J 1,15082 Harbor&Lafayette- Design\Affidavas\Lafayette BuildingWinal Affidavit Lafayette Homes MP 08-23-18.docx Final Construction Control Document 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 107.6.4 Project Title: Harbor Lafayette Homes Date: 8-23-2018 Permit No. B-18-3 Property Address: 104-106 Lafayette Street, Salem,MA Project: Check(x)one or both as applicable: [ ] New Construction [X] Existing Construction Project description: Renovation of 10 apartment units and commercial space. I, M. Salim Afsar, MA Registration Number: 39083 Expiration date: June 30,2020 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [X] Electrical [X] Other: Fire Alarm for the above-named project. 1,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: 1. 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. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. 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 the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: Phone number: 781-826-4144 PyTti OF Email: safsar@wbaengineers.com �aaE s O 9 M•SA rye U EAFSAA LECTRICAL -mi ,4 110.39083 Gi c/1SOTE A. ss�o11aL EN��� i�d�aa.•l� FIDAA E. BARBAR NOTARY PUBLIC COMMONWEALTH OF MASSACHUSETTS My Caren.Ezoes Oct It.2021 Building Official Use Only Building Official Name: Permit No.: Date: J:\15082 Harbor&Lafayette- Design\Affidavits\Lafayette Building\Final Affidavit Lafayette Homes ELEC 08-23-18.docx Final Construction Control Document IW F To be submitted at completion of construction by a Registered Design Professional V J � for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Harbor Lafayette Homes Date: 8/20/2018 Permit No. B-18-3 Property Address: 104-106 Lafayette Street,Salem,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovation of 10 apartment units and commercial space. 1, Terry A.Louderback, MA Registration Number:28641 Expiration date: 6/30/20, am a registered structural engineer, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural X Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1, or my designee, have performed the necessary professional services and was present at the constriction 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: 1. 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. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. 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 the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: �?y h * =Y r 'i1, #0' Phone number: 617-926-6100 Email: tlouderback@souzatrue.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 LYNCO FIRE PROTECTION, INC. CONTRACTORS—ENGINEERS—INSTALLATIONS Sales—Repairs—Inspections 19 Grant Avenue,Burlington,MA 01803 Telephone(781)221-0111 Fax(781)229-8323 FIRE SPRINKLER TEST REPORT Property Name1(2q -106 Z Date / r� Address d Y_` /0 G L S C111-111- C f-7L City <5c-t /e M State NL C� Zip System Identification/Location 1�`1(Se ********VALVE DESCRIPTION****** Size Z " Type: SER CHECK WET ALARM VALVE, DRY PIPE VALVE, PRE ACTION, DELUGE Drain Size(circle one) 2" 1 '/z" 1 4" 1" Long or Dort Make/Model `S k �L/ ') ^ —Year �CC ************ALL SYSTEMS********* TT Static Pressure N� PSI Residual Pressure 'r->V PSI Alarms Operating_ Tamper Switch Supervisory Operating yC�` ************ DRY SYSTEMS********** From a Standing Pressure of PSI(air)wi the valve 3 turns opened the dry valve Tripped in Min s onds at PSI (circle one) W H or IT O a Quick Opening Device. Operation was SATISFACTORY Valve reset Dry Q.O.D. Make/Model ************************************************************************************************** Comments �—Uc o e- If V- 7 Signat of Tester Aext inspection Date By signing this Test Report, Lynco Fire Protection, Inc. ("Lynco")certifies only the results of its testing as of the date hereof. Lynco makes no warranties or representations as to the condition, fitness or performance of the system itself. LYNCO FIRE PROTECTION, INC. cONTRAc"CORS—ENGINEERS—INSTALATIONS Sales—Repairs—Inspections Grant Avenue,Burlington,MA 01803 Telephone(781)221-0111 Fax(781)229-8323 8/17/18 RE: 104 Lafayette St Salem, ma To whom it may concern, We have completed the fire sprinkler installation at the above caption location. All work conforms to National Fire Protection Association standard 13 as required by Massachusetts State Building Code. Glenn Iozzo Lynco Fire Protection,Inc. LYNCO FIRE PROTECTION, INC. 19 Grant Avenue,Burlington, MA 01803 781-221-01.1.1 Contractor's Material and Test Certificate for Aboveground Piping PROCEDURE Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by the property owner or their authorized agent.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 representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship,or failure to comply with approving authority's requirements or local ordinances. Property name 104 Lafayette Date 8/17/18 Property address 104 Lafayette St Salem,Ma Accepted by approving authorities(names) Salem Fire Dept Address Plans Installation conforms to accepted plans ®Yes ❑No Equipment used is approved ®Yes ❑No If no,state deviations Has person in charge of fire equipment been instructed as to location of ®Yes ❑No control valves and care and maintenance of this new equipment? If no,explain Have copies of the following been left on the premises? Instructions 1.System components instructions ®Yes ❑No 2.Care and maintenance instructions ®Yes ❑No 3. NFPA 25 ®Yes ❑No 4.With whom have the copies been left? Location of Supplies buildings system Year of Make Model manufacture Orifice size Quantity Temperature rating Globe upright 2017 1/2 21 155 Sprinklers Globe pendant 2017 1/2 21 155 Globe sidewall 2017 1/2 44 155 Pipes and Type of pipe steel fittings Type of fittings Cast iron Maximum time to operate through test Alarm device connection Alarm valve or flow Type Make Model Minutes Seconds indicator vain flow Potter VSR-F 0 35 For individual use. No other reproduction or transmission in any form permitted. 1 of 3 LYNCO FIRE PROTECTION, INC. 1.9 Grant Avenue,.13urlinb on,MA 01803 781-221-01.1.:1 Dry valve Q.O.D Make Model Serial No. Make Model Serial No. N/A Time to trip through Water Air- Trip point air Time water reached Alarm operated Dry pipe test connection a,b pressure pressure pressure test outlet a,b properly operating Minutes Secondssi test P psi psi Minutes Seconds Yes No Without Q.O.D. With Q.O.D. If no,explain Operation ❑Pneumatic ❑Electric ❑Hydraulics Piping supervised ❑Yes ❑No I Detecting media supervised ❑Yes ❑No Does valve operate from the manual trip,remote,or both control stations? ❑Yes ❑No Deluge and Is there an accessible facility in each circuit If no,explain for testing? preaction valves ❑Yes ❑No Does each circuit operate Does each circuit operate Maximum time to operate Make Model supervision loss alarm? valve release? release Yes No Yes No Minutes Seconds N/A Location and Make and Pressure- floor model Setting Static pressure Residual pressure(flowing) Flow rate reducing Flow valve test Inlet(psi) Outlet(psi) Inlet(psi) Outlet(psi) m N/A Hydrostatic: Hydrostatic tests shall be made at not less than 200 psi(13.6 bar)for 2 hours or 50 psi(3.4 bar) above static pressure in excess of 150 psi(10.2 bar)for 2 hours.Differential dry pipe valve clappers shall be left Test open during the test to prevent damage. All aboveground piping leakage shall be stopped. description Pneumatic: Establish 40 psi(2.7 bar)air pressure and measure drop,which shall not exceed 1`/z psi(0.1 bar)in 24 hours. Test pressure tanks at normal water level and air pressure and measure air pressure drop,which shall not exceed 1'/� si 0.1 bar in 24 hours. All piping hydrostatically tested at 200 psi( bar)for 2 hours If no,state reason Dry piping pneumatically tested ❑Yes ❑No Equipment oerates properly ®Yes ❑No Do you certify as the sprinkler contractor that additives and corrosive chemicals,sodium silicate or derivatives of sodium silicate, brine,or other corrosive chemicals were not used for testing systems or stopping leaks? ®Yes ❑No Drain Reading of gauge located near water supply Residual pressure with valve in test connection Tests test test connection: 75psi( bar open wide: 70psi( bar Underground mains and lead-in connections to system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material and Test ❑Yes ❑No Other Explain Certificate for Underground Piping. existing service Flushed by installer of underground srinkler piping ❑Yes ❑No If powder-driven fasteners are used in concrete, has ❑Yes ❑No If no,explain representative sample testing been satisfactorily completed? N/A a Measured from time inspector's test connection is opened. b NFPA 13 only requires the 60-second limitation in specific sections. For individual use.No other reproduction or transmission in any form permitted. 2 of 3 LYNCO FIRE PROTECTION,INC. 19 Grant Avenue,Burlington,MA 01803 781-221-0111 Blank testing Number used Locations Number removed gaskets 0 Welding piping ❑Yes ®No If es... Do you certify as the sprinkler contractor that welding procedures used complied with the ❑Yes ❑No minimum requirements of AWS B2.1,ASME Section IX Welding and Brazing Qualifications, or other applicable qualification standard as required by the AHJ? Do you certify that all welding was performed by welders or welding operators qualified in ❑Yes ❑No accordance with the minimum requirements of AWS B2.1,ASME Section IX Welding and Welding Brazing Qualifications,or other applicable qualification standard as required by the AHJ? Do you certify that the welding was conducted in compliance with a documented quality ❑Yes ❑No control procedure to ensure that(1)all discs are retrieved; (2)that openings in piping are smooth,that slag and other welding residue are removed;(3)the internal diameters.of piping are not penetrated;(4)completed welds are free from cracks, incomplete fusion,surface porosity greater than 1/16 in.diameter,undercut deeper than the lesser of 25%of the wall thickness or 1/32 in.;and(5)completed circumferential butt weld reinforcement does not exceed 3/32 in.? Cutouts (discs) Do you certify that you have a control feature to ensure that all cutouts discs are retrieved? ®Yes ❑No Hydraulic Nameplate provided If no,explain data nameplate I ®Yes ❑No Sprinkler contractor removed all caps and straps? ®Yes ❑No Date left in service with all control valves open Remarks 8/17/18 Name of sprinkler contractor LYNCO FIRE PROTECTION Tests witnessed Signatures The property owner or their authorized agent(signed) Title Date For sprinkler contra igned) Title Date PM 8/17/18 Additional explanation and n es For individual use.No other reproduction or transmission in any form permitted. 3 of 3 NFPA 7: To CCO SYSTEM RECORD Ol Fire Alarm& INSPECTION AND TESTING Security Integration Report No: 1808-1411 Inspection/Test Start Date: Tuesday, August 14, 2018 Start Time: 11:00 AM Inspection/Test Completion Date: Tuesday, August 14, 2018 Completion Time: 2:00 PM Supplemental Form(s)Attached [Form (no. of pages)]: 1 PROPERTY INFORMATION Name of property: HARBOR/Lafayette Homes LLC Address: 104 LAFAYETTE ST SALEM MA Description of property: APARTMENT BUILDING Name of property representative: Ilene Vogel Address: 96 Lafayette St Salem MA Phone: 978-219-5088 Fax: E-mail: 2 TESTING AND MONITORING INFORMATION Testing organization: TOCCO FIRE ALARM & SECURITY INTEGRATION Address: 29 COOK STREET, UNIT A, BILLERICA, MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: firealarm@toccocorp.com Monitoring organization: CENTRALARM Address: 994 Candia Rd, Manchester, NH 03109 Phone: (800) 639-4068 Fax: E-mail: Account number: 70005936 Phone line 1: Phone line 2: Means of transmission: AES RADIO Entity to which alarms are retransmitted: SALEM FIRE DEPT Phone: (978) 744-1235 3 DOCUMENTATION On-site location of the required record documents and site-specific software: NEXT TO FRCP 4 DESCRIPTION OF SYSTEM OR SERVICE 4.1 Control Unit Manufacturer: SIEMENS Model number: FC901 4.2 Software and Firmware Firmware revision number: 4.3 System Power 4.3.1 Primary(Main)Power Nominal voltage: 120V Amps: 20 Location: HP-1-B-22- Overcurrent protection type: BRKR Amps: 20 Disconnecting means location: BASEMENT NFPA 7' To Cro SYSTEM RECORD Of Fire Alarm& INSPECTION AND TESTINC Security Integration Report No: 1808-1411 4 DESCRIPTION OF SYSTEM OR SERVICE (continued) 4.3.2 Secondary Power Type: BATTERY Location: IN PANEL Battery type(if applicable): 12V18AH Calculated capacity of batteries to drive the system: 24V In standby mode(hours): 24HR In alarm mode(minutes): 5 5 NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: CENTRA LARM Time: 11:00 AM Building management Contact: N/A Time: Building occupants Contact: N/A Time: - Authority having jurisdiction Contact: N/A Time: Other, if required Contact: N/A Time: - 6 TESTING RESULTS 6.1 Control Unit and Related Equipment Visual Functional Description j Comments Inspection Test 1 - -- Control unit O PASSED - � ❑ � Lamps/LEDs/LCDs ❑ PASSED Fuses ❑ 0 !PASSED Trouble signals ❑ O PASSED Disconnect switches ❑ ❑ --l-PASSED Ground-fault monitoring ❑ 0 PASSED Supervision ❑ ! ❑ PASSED Local annunciator ❑ ED PASSED Remote annunciators fi ❑ 0 _PASSED Remote power panels i ❑ ❑ (PASSED 6.2 Secondary Power - - - Visual - -- - ---- Description -VFunctional Comments Inspection j Test Battery condition ❑ ❑ j BRAND NEW Load voltage ❑ 0 )73V --- - - Discharge test ❑ ❑ 100% Charger test - ❑ j ❑ - 100% Remote panel batteries ❑ ❑ j N/A NFPA 7TO CCO : SYSTEM RECORD 01 Fire Alarm& INSPECTION AND TESTIN( Security Integration Report No: 1808-1411 6 TESTING RESULTS (continued) 6.3 Alarm and Supervisory Alarm Initiating Device Attach supplementary device test sheets for all initiating devices. 6 Manual Station Rate/Rise Heat Detector Tamper 21 Smoke Detector Fixed Temp Heat Detector Low Pressure Duct Smoke Detector Water low 1 Carbon Monoxide 6.4 Notification Appliances Attach supplementary appliance test sheets for all notification appliances. 6 Hom/Strobe Speaker/Strobe 16 Low Frequency Sounder 2 Strobe Speaker 1 Beacon Horn Mini Horn Bell 6.5 Interface Equipment Attach supplementary interface component test sheets for all interface components. Circuit Interface/Signaling Line Circuit Interface/Fire Alarm Control Interface 6.6 Supervising Station Monitoring Description Yes No Time Comments Alarm sinal g �- - 0 - - F-1 11:30- 11 30 AM PASSED - Alarm restoration ❑ ❑ 2.00 PM PASSED Trouble signal ❑ ❑ 11:00 AM PASSED Trouble restoration ! ❑ 2:00 PM PASSED Supervisory signal D ❑ I 12:00 PM PASSED Supervisory restoration ❑ ❑ 2:00 PM PASSED 6.7 Public Emergency Alarm Reporting System Description Yes No Time Comments Alarm signal ❑ D Alarm restoration ❑ O Trouble signal } ❑ ❑ Trouble restoration ❑ ❑ t f Supervisory signal ❑ F11 _ I � Supervisory restoration 1 ❑ O NFPA 72 To Cro SYSTEM RECORD OF Fire \l a rn,& INSPECTION AND TESTING 5e:uritt (nteyratton Report No: 1808-1411 7 NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: CENTRA LARM Time: 2:00 PM Building management Contact: N/A Time: Building occupants Contact: N/A Time: Authority having jurisdiction Contact: N/A Time: Other,if required Contact: N/A Time: 8 SYSTEM RESTORED TO NORMAL OPERATION Date: Tuesday,August 14,2018 Time: 2:00 9 CERTIFICATION This system as specified herein has been inspected and tested according to NFPA 72,2013 edition, Chapter 14. De re-k mll� uni Signed: Printed name.. Date: 08114/18 Organization: Tosco Fire Ala &Security Integration Title: Phone:978-408-5313 Qualifications(refer to 10.5.3): Qrol t-A+ Alc.'O co=r 10 DEFECTS OR MALFUNCTIONS NOT CORRECTED AT CONCLUSION OF SYSTEM INSPECTION, TESTING,OR MAINTENANCE 1 10.1 Acceptance by Owner or Owner's Representative: The undersigned accepted the test report for the system as specified herein: Signed: ` Printed name; i'�1j 6`'J;( � Date: `��� Organizatior NA, lwy SOC r Title: jr / jG C Phone: i ' SYSTEM RECORD OF COMPLETION This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets, data, or calculations as necessary to provide a complete record. Form Completion Date: 8-14-18 Supplemental Pages Attached: 0 1. PROPERTY INFORMATION Name of property: HARBOR/Lafayette Homes LLC Address: 104/106 LAFAYETTE ST SALEM MA Description of property: APARTMENT BUILDING Name of property representative: Ilene Vogel Address: 96 Lafayette St Salem MA Phone: 978-219-5088 Fax: E-mail: 2. INSTALLATION, SERVICE, TESTING, AND MONITORING INFORMATION Installation contractor: TOCCO FIRE ALARM AND SECURITY INTEGRATION Address: 29 COOK ST. UNIT A,BILLERICA MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Service organization: TOCCO FIRE ALARM AND SECURITY INTEGRATION Address: 29 COOK ST.UNIT A,BILLERICA MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Testing organization: TOCCO FIRE ALARM AND SECURITY INTEGRATION Address: 29 COOK ST. UNIT A, BILLERICA MA,01821 Phone: 978-663-0292 Fax: 978-663-9366 E-mail: FIREALARM@TOCCOCORP.COM Effective date for test and inspection contract: 8-20-18 Monitoring organization: CENTRA ALARM Address: 994 Candia Rd,Manchester,NH 03109 Phone: (800)639-4068 Fax: E-mail: Account number: 70005936 Phone line 1: Phone line 2: Means of transmission: AES RADIO Entity to which alarms are retransmitted: SALEM FIRE DEPT Phone: 978-744-1235 3. DOCUMENTATION On-site location of the required record documents and site-specific software: NEXT TO FIRE ALARM PANEL 4. DESCRIPTION OF SYSTEM OR SERVICE This is a: ®New system ❑Modification to existing system Pen-nit number: NFPA 72 edition: 2013 4.1 Control Unit Manufacturer: SIEMENS Model number: FC901 4.2 Software and Firmware Firmware revision number: 01.03.06(67) 4.3 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds Copyright©2012 National Fire Protection Association This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution (p "I of.3) SYSTEM RECORD OF COMPLETION (continued) 5. SYSTEM POWER 5.1 Control Unit 5.1.1 Primary Power Input voltage of control panel: 120V Control panel amps: 5 Overcurrent protection: Type: BREAKER Amps: 20 Branch circuit disconnecting means location: HPI B Number: 22 -5.1.2 Secondary Power Type of secondary power: LEAD ACID BATTERIES Location,if remote from the plant: IN PANEL Calculated capacity of secondary power to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 5.2 Control Unit ❑ This system does not have power extender panels ® Power extender panels are listed on supplementary sheet A 6. CIRCUITS AND PATHWAYS Pathway Type Dual Media Pathway Separate Pathway Class Survivability Level Signaling Line Device Power Initiating Device X A Notification Appliance X A Other(specify): 7. REMOTE ANNUNCIATORS Type Location N/A 8. INITIATING DEVICES Addressable or Type Quantity Conventional Alarm or Supervisory Sensing Technology Manual Pull Stations 6 ADDRESSABLE ALARM MANUAL Smoke Detectors 21 ADDRESSABLE ALARM AUTOMATIC Duct Smoke Detectors 0 Heat Detectors 0 Gas Detectors 1 ADDRESSABLE SUPERVISORY AUTOMATIC Waterflow Switches 1 ADDRESSABLE ALARM AUTOMATIC Tamper Switches 2 ADDRESSABLE SUPERVISORY AUTOMATIC Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution (p 2 of 3) SYSTEM RECORD OF COMPLETION (continued) 9. NOTIFICATION APPLIANCES Type Quantity Description Audible Visible 3 2 STROBE ONLY, 1 BEACON Combination Audible and Visible 22 6 HORN STROBE, 16 LOW FREQUENCY W/STROBE 10. SYSTEM CONTROL FUNCTIONS Type Quantity Hold-Open Door Releasing Devices 0 HVAC Shutdown 0 Fire/Smoke Dampers 0 Door Unlocking 0 Elevator Recall 0 Elevator Shunt Trip 0 11. INTERCONNECTED SYSTEMS ® This system does not have interconnected systems. ❑ Interconnected systems are listed on supplementary sheet 12. CERTIFICATION AND APPROVALS 12.1 System installation Contractor This system as specifiedherein as been installed according to all NFPA standards cited herein �,tk Signed: Printed name: T Date: 8-20-18 Organization: Tocco Buil g Systems Title: Phone: 978-408-5313 12.2 System Operational Test J This system as specified herein tested according to all NFPA standards cited herein.—V)ettk meg. %0A }� Signed: Printed name: T Date: /8-20-18 Organization: Tocco Buildl Systems Title: ' Phone: 978-408-5313 {d�ecr 14��lytt' 12.3 Acceptance Test J Date and time of acceptance test: 08-14-18 2:OOPM Installing contractor representative: Testing contractor representative: Or Property representative: AHJ representative: Copyright©2012 National Fire Protection Association.This form may be copied for individual use other than for resale It may not be copied for commercial sale or distribution (p 3 of 3) NOTIFICATION APPLIANCE POWER PANEL SUPPLEMENTARY RECORD OF COMPLETION This form is a supplement to the System Record of Completion. It includes a list of types and locations of notification appliance power extender panels. This form is to be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Form Completion Date: 8-14-18 Number of Supplemental Pages Attached: 1 1. PROPERTY INFORMATION Name of property: HARBOR/Lafayette Homes LLC Address: 104/106 LAFAYETTE SALEM MA 2. NOTIFICATION APPLIANCE POWER EXTENDER PANELS Make and Model Location Area Served Power Source SIEMENS PAD4 2ND FL HALLWAY CABINET 2ND AND 3R FL HPI B-22 See Main System Record of Completion for additional information,certifications,and approvals. Copyright©2012 National Fire Protection Association This form may be copied for individual use other than for resale.it may not be copied for commercial sale or distribution (1) 1 of I