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39 NORMAN ST - BUILDING INSPECTION (7) G� S, --I cog NO ✓ The Commonwealth of Massachusetts Department of Public Safety 2016 NOV -3 P 1= 1 b Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) I Building Permit Number: Date Applied: Building Official: n SECTION 1:LOCATION(Plce�ase indicate Block#and Lot#for locations for which a street address is not available) No.and Street City/Town Zip Code 4ame of Building(if applicable) _ fl SECTION 2:PROPOSED WORK. Edition of MA State Code used_ If New Construction check here❑or check all that apply in the two rows below [L Existing Building(a Repair❑ Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes `!J No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No Brief Description of Proposed Work: JI DuQ- o ABC/ -t-vo.L �fiacri�D D/�ivS SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT.AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable)- A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA 17 IIIB ❑ 1 IV ❑ 1 VA VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal Site❑ Public❑ Check if outside Flood Zone❑ Indicate municipal❑ required❑or trench or specify: Private❑ or indentify Zone: or on site system❑ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No❑ Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building contain an Sprinkler System?: Special Stipulations: 1� �'l C_--�A.U=9D q p 0 SECTION 9: PROPERTY OWNER AUTHORIZATION ame and Ad Aess of Property Owner naM o o>v "VMVg tr�f`dKPAKL[ 7 307' Nft"9N S +- Name(Print) No.and Street City/Town Zip Pro erty Owner Contact Information:p" tame d �� 9 _- - �o p a 61 6rawn y" Title Telephone No.(business) Telephone No. (cell) e-mail address I applicable, e property owner hereby authorizes 4ftyybNo 1 i 5 f3vot. -w ST • dsr" omv Nam4 Street Address City/Town State Zip to act on the properry owner's behalf,in all matters relative to work authorized by this building permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control 1t A" (��us)2 07 VI 439u /INArJ a �arutt-lbw. /b7Z9 Name(Registrant) Telepr�ne No. e-mail address Registration Number fA Tn.» tins<• $+cc 2 CIIAac�s� w /� vats 2,NIlf(1y44L ?61_h7 Street Address City/Town State Zip Discipline Expiration Date 102 General Contractor //'' pAt n Jtrtci1/7'V 6'F 1AlG . Co pa y Name a ,Lt,9 Ls yG/ eG / Name of Person Responsible for Construction License No. and Type if Applicable lS9 �n�f�ti sr • fwn^^�aScrrr oI d Street Address City/Town State Zip fir/lt(zl 3P/ 7�-S� - &0D Te n G4ma4l�noG��su.rc oN 'ro�.. Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No 17 SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ o tb (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this a lication i ue and accurat o e est o knowledge and understanding. Please print and sign name Title Telephone No. Date Zi Street Address Cit Town State p Municipal Inspector to fill out this section upon application approval: Name. Date t Massachusetts Department of Public Safety IFBoard of Building Regulations and Standards ' License: CS-061061 Construction Supervisor 1,11 IN CARLO E CAPON 159 BURRILL ST% SWAMPSCOTT ty1A - Expiration: Commissioner 0 712 5/2 0 17 i V Nc�oranan/raeraflEi n�l�J��aauec�Qeael� Ali Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR _ Registration;,. -421999 Type: Expiration_"__, 1201¢ DBA CAPONIGRO CONStTR13CT O CARLO CAPONIGRf� ;`,.._ 159 BURRILL ST — SWAMPSCOTT, MAOt907�' Undersecretary ne '�`� CERTIFICATE OF LIABILITY INSURANCE 5/2/2`�1o6WM THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLOER.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 artiflate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. N SUBROGATION IS WANED,subject to the terms and conditions of the polity,certain policies may require an endorsement A statement on this DerBBate does not confer rights to the certificate holder In lieu of such endorsemen s. ►Roouem Commercial Lines Prescott and Son Insurance Agency,Inc. PHHoxa (781)322-2350 PAX 963 Rastern Avenue WSURE s AFFORONG COVERAGE NAIC0 Malden MA 02148 WSURERAArbella Protection Ins Co 1360 INSURED SUMMERS: Caponigro Construction Co Inc. R43URERC, 159 Burrill St. Na RD: NfURFIr F ISwanipscott MA 01907 N uRER F: COVERAGES CERTIFICATE NUMBERCL1471018938 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADMUOU INUR TYFEOFSUURANCE Y ABER P w FF POLKYFIP UIRrs OFNEIIALLWIL/rY EACH OCCURRENCE f 1,000,000 X COMMERCIAL GENERAL LIABILITY f 50,000 A CwMSMADE O OCCUR X 300061820 /27/2016 /27/2017 MED EXP Wy ee f 5,000 PERSONAL IADV INJURY S 1,000,000 GENERAL AGGREGATE f 2,000,000 GEN.AGGREGATE LIMR APPLIES PER POL PRODUCTS-COMP/OP AGO S 2,000,000 ICY X PRO- LOD S AUTOMOOR2 LlASLRY WEO?INGLE UMff ANY AUTO BODLYNAJRY(Wr )ALL OWNED i EDULED AUTOS AUTOS SODILYWAJRY(Paeo:NenO S HIRED AUTOS NON-OWNED PROP TY DAMAGE S S X UMBRELLA LW X OCCUR EACH OCCURRENCE S 51000,000 A um"MLW CIAIMSHAADE 60006246E /27/3016 /27/2017 AGGREGATE f 5,000,000 RETENTION S R f WORKERS COMPENSATION WC STATLL OT14 AND EYPLOYSRr UJNIM Y/N ANY PROPRA TOR/PARTNERrEXECUTIYE EL EACH ACGDEM S OFFICERMEMBER EXCLUDED? NIA Buymn, ' I El DISEASE-EA EMPLOYE f DrWMPTION OFOPERATIONS balm E.L.DISEASE-POLICY LIMIT S � �.�mo®,i C:.::i iONa. - .-'�•v� _ __:.. SCOPE 1S.AGtl1^:.-:::... +uSUUMMW..Bme.Y�__z le..«n...n � ... CERTIFICATE HOLDER . CANCELLATION 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 J S Scholnick/MYB ACORD 25(2010/OS) 01988.2010 ACORD CORPORATION. All rights reserved. INSR2S nmlre�m TL.ArnDn w.rw..oA L...n.r.sMN...d.waw.M Arnon OP ID:LK ,d►`o�zv° CERTIFICATE OF LIABILITY INSURANCE pars 10/06/20 6 o/osnols THIS CERTIFICATE 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(ies) 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 endorsements. PRODUCER CONTACT DeSanctis Insurance Agcy,Inc. P ME, FAX 100 Unicorn Park Drive INC.No Est: ac No: Woburn,MA Of 801 Ea"aL ADDRESS: CUSTOMER I .CAPON-2 INSURE INS)AFFORDING COVERAGE NAIL" INSURED Caponigro Construction Co.,lnc INSURER A:Plymouth Rock Assurance Group 14737 159 Burrill Street INSURER s:Associated Employers 11104 Swampscott,MA 01907 WSURER G: INSURER D: WSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. JJ TYPE OF INSURANCE AlSUBI POLICY EFF POLICY UP INSR POLICY NUMBER MM1DDfYYYY1 MMIDDIYYYY LIMITS GENERAL UABIUrY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY ED PREMISES -R9ffT nonce $ CLAIMS-MADE ❑OCCUR MED UP(Any one person) $ PERSONAL B ADV INJURY $ GENERA-AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PR0. LOC $ AUTOMOBILE LUU$ILRY COMBINED SINGLE LIMIT S 1,000,000 (Ea acdtlent) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS A X SCHEDULED AUTOS PRC00001003551 06/0612016 06106/2017 PROPERTILY Y DAMAGE(Per acciaenp $ PROPERTIDENTI $ X HIRES AUTOS (PER ACCIDENT) X NON-OWNEDAUrOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION s X WCSTATU- OTH- AND EMPLOYERS'LIABILITYLIM B ANY PROPRIETCRIPARTNERIEXEGUTNE YIN NIA CC50050138902016A 09/2312016 09/2312017 EL EACH ACCIDENT $ 1,000,08 OFFICERIMEMBER EXCLUDED' (Mandatory In NH) (MA) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Hyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(AKecN ACORD 101,Additional Remarks Schedule,if more space Is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION TOWHOMI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To whom it may concern ACCORDANCE WITH THE POLICY PROVISIONS. AUTNORQED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD Initial Construction Control Document toTo be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Commonwealth Labs Renovation Date: November 01,2016 Property Address: 39 Norman Street, 2nd Floor, Salem,MA 01970 Project: Check(x)one or both as applicable: [ ]New construction [x] Existing Construction Project description: Modify existing Commonwealth Labs space as described in drawings. I, Ryan Conner, MA Registration Number: 10729, Expiration date: August 31,2017, 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': [ ] Entire Project [x] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other: for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care, and be present on the construction site on a regular and periodic basis to: 1. Review, 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. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 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 if the work is being performed in a manner consistent with the approved construction documents and this code. The Contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or All, electronic signature and seal: Q�eO\ G ��Ep a Pb,f0728 B081ON Phone number: 617-241-8300 AtA Email: ryan@conner-design.com 4 A<r1i OF kfP$�P Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen,provide a description. l