5 PARADISE RD - BUILDING INSPECTION 1
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CITY OF_SALEM
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Permit to:
BUIUM PERMIT APPUCATION FOR:
(Circle whichever apply) Roof. Remof, Install Siding, Construct Deck. Shed, Pool,
Repair/Replace. Other A�J-Mi e)R 2s_10.]A I ; On;
PLEASE FILL OUT LEGIBLY i COMPLETELY TO AVOID DELAYS IN PROCE8SM
TO THE INSPECTOR OF BUILDINGS: '
The u applies fora it to build aocorcL to the
rtderogned �Y R� P� ig. following
specifksitions:
Ownees Name ILMA- .T UC eI Bo /1&1 6,20 o
Address 3 Phone
Architect's Name O RL + ASSnc.
Address d Phone a(Jar Sf su', r-c olimfi"�4 11A (m ) 331 -8'P/
Mechanics Name At!At LJ /PRaS Co vs ,
Address A Phone Q Rruhd;GR PRk k0JIJAA offl 1 01- 100
What Is sr p mpoa it NOW U AAJ k 61 AM A
mdww of buldle0? M■r" mm n,for how mmy fsmMiss?
we hul"Cmdo m to low? �!£S AsOulos? NC
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SIGNED THE PENALTY'
(SOg)Say 3535
DESCRIPTION OF WORK TO BE DONE OF PERJURY
S-Jckink REAIotmr;ou of ExisJ �ti3 8-4,✓k LQCAr-;0J P'ar
NORrir SAOU 6AA Rs 4£2 G1nJS7-fW0r1Dd 4/9".)s
MAIL PERMIT T0: C/lAkwi- SmaRw1. - NW U200,n_ S PIZ()S t f St
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APPLICATION FOR
PEFWW TO
LOCATION
PERMIT Gr. D
APPROV f D
LZ`'
)NWiECTOR OF BUILDINGS
MECHANICAL CONSTRUCTION CONTROL
In accordance with 780 CMR, Section 116.0 of the Massachusetts State
Building Code, I, Curtis G. Rand , being a Registered Professional Engineer certify
that I or my designee shall perform the necessary professional services and be present on
the construction site to determine that the work is proceeding 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, 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 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.
At the completion of construction, I shall submit to the Building Official a
report as to the satisfactory completion and compliance with the plans, specifications and
Rules and Regulations of the Massachusetts State Building Code for the intended Use
and Occupancy.
Or4f;
c� CURTIS
RAND ".,
Date: 1 2 4- - O 4- No,21344
Signature & Seal
Project Title: North Shore Bank
Project Location: 5 Paradise Road, Salem, MA
Nature of Project: Modification and additions to the existing Mechanical
systems in accordance with the 6th Edition of the MA State
Building Code.
CONSTRUCTION CONTROL AFFIDAVIT
(SECTION 116.0 OF MASSACHUSETTS STATE BUILDING CODE)
(PRIOR TO ISSUANCE OF PERMIT)
ON THIS 8TH DAY OF DECEMBER,2004,BEFORE ME,QUALIFIED FOR THE
COMMONWEALTH OF MASSACHUSETTS,PERSONALLY APPEARED DONALD R.LONERGAN
WHO,BEING DULY SWORN,DEPOSES AND SAYS THAT HE HAS SUPERVIED THE PREPARATION
OF ALL THE DESIGN PLANS OF NORTH SHORE BANK—6 PARADISE RD SALEM,
MASSACHUSETTS AND THAT HE WILL SUPERVISE AND/OR CHECK ALL THE WORKING
DRAWINGS AND SHOP DETAILS FOR CONSTRUCTION;AND WILL MAKE SITE OBSERVATIONS
AT INTERVALS APPROPRIATE TO EACH 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
APPROVED PLANS,AND THAT SUCH PLANS CONFORM TO THE CODES OF THE
COMMONWEALTH OF MASSACHUSETTS,AND WILL REVIEW AND APPROVE THE QUALITY
CONTROL PROCEDURES FOR ALL CODE-REQUIRED CONTROLLED MATERIALS.
BEFORE SUCH BUILDING OR STRUCTURE IS PERMITTED TO BE USED OR OCCUPIED,
THE LICENSED PROFESSIONAL ENGINEER AND/OR REGISTERED ARCHITECT WHO PREPARED
AND FILED THE ORIGINAL PLANS AND WHO OBSERVED THE ERECTION OF THE BUILDING
SHALL FILE AN AFFIDAVIT STATING UNDER OATH THAT THE PROVISIONS OF THE CODES
HAVE BEEN FULLY COMPLIED WITH AND THAT THE BUILDING MEETS ALL THE
REQUIREMENTS OF LAW FOR THE PROPOSED USE AND OCCUPANCY.ALSO,AGREES TO
SUBMIT REPORTS,AT INTERVALS APPROPRIATE TO EACH STAGE OF CONSTRUCTION,
RELATIVE TO THE MATERIALS,PROCEDURES AND FURTHER TESTS THAT MAY BE REQUIRED
IN CONNECTION WITH THIS JOB.
- y
Original afore ea Date
SUBSCRIBED AND SWORN TO BEFORE ME THIS 8TH DAY OF DECEMBER,2004.
(Notary Public)
i CDL Driver's License
09-12-62 09-12-04 M 5'07- C 027580360
Date of Birth Expires Sex Height Class Number
P 09-27-99
Restrict Endorse Issued
`m
MACLEOD
SCOT7 A �
:7 BEiEAN WAY
S WEYMOUTH, MA _
02190-1866 - >'
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6/�/
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 031658
Birthdate: 09/12/1962
Expires: 09/12/2005 Tr. no: 3367
Restricted: 00
SCOTTA MACLEOD
W BEREAN WAY
S WEYMOUTH, MA 02190 Administrator
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I ant a sok proprietor and haw so one working fir an In any caoadq.
1 am a so'k propdomor, nvs homeowner (drde one) fey/ have bind die
contractors listed bth w who•hwe the following workus' compenssdon poldw
Congracgw Inwranie Companylpo Number
Contractor Insurance Company/Po lumbar
Consact� inswance Compaay/Polley Number
0 1 am a homeowner perforating all the work myself.
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Signed this . � /�
(0 _dap of I ,�srsM bs.g
' iccrucellcrmitcet tint Departrwe
n4iinf Eosre
Seiectmens Office
=ealch Depmrmer,c
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FROM :MacLeod Bros FAX NO. :17818783990 Dec. 02 2004 12:37PM P1
... ... ClignW: 1 _�..�_---.._MACLEBR01 -- ._....—..-.
AC CERTIFICATE OF LIABILITY INSURANCE 11130104
11TS 301 RMD,YYYY)
USI InER THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION
USI Ins,Services of MA,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
12 Gill Street,Suite 5500 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR
P.O,BOX 4043 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Woburn.MA 01888.4043
WBURap - INSURERS AFFORDING COVERAGE NAIC N
MacLeod Brothers,Inc. WsuneR A Fimman'0 Insurance Co.of Washing
83 Reservoir Park Drive I`NXIRER B: Acadia Insurance - - '—
Rockland,MA 02370 INSUrtcR r.
INSUHEq p:
COVERAGES -INSURER
THY REQUIED Or INOURANOn CONDITION
Or HAVH tltEN IaSVFD TU THE INBURCD NAMED ABOVE FOR THE PODGY PERIOD IN...... EU.NOTWITHSTANDING
ANY REOUIRP..MENT,TEHM OR CONDITION OR ANY CONTRA(:T OR OTHER DOCUMENT WITH RESPECT TO W HIIA1 THIS ERI INDICCA LE MAY HE ISSUED OR
MAY PERTAIN,THE ATE LIMITS SHOAFFOWN
BY THE POLICIES DESYRIOED HEREIN IB SUa•ICCT TO ALL THE TERMS,CXCLU$IONS AND CONDITIONS OF$UCH
POLICIES.AGGREGATE LIMITS SHOWn MAY NAVE BEEN REDUCED BY PAID CLAMS.
L TYPE OR INSURANCE PPo LTCYMFFEATEwYV16-nnrlcy E -
POUCY NUMOF.R —•• —. .._
A cENERALUMBLITY CPAOOB105713
08/01/04 09/01/OS
X CO LAcn Oh�URAI'NGY, r7,000,000
MMEHOIAI GCNF.Rm I,IABILRV D�Tn R[NTfU
CLAIMS MADC oOrCUR 310ECOP,IM�. a500,000
MrDEMw,�nrn,r Mw t10000 _
PEN!5nNAL E AUY INJURY_ $1000000
GGNL AOOREGATE LIMIT APPLIES PE{L UF.NEML M10REGATE E2A000,OOO
roucr rR0- rgouUM.CUMPAIPAGG $2,000,000 --
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A AVTOMOMu LIAaIL1T1' MAA010109111 08l01I04 08101105 "'-
Al COMI SINGLE UMIT
ALL OWNED AUTO, _ reR PLvdem) s1,000,000
SrJIEDULEUAU10s ROOILY INJURY
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NUN-OWNCO AIITON AODILY INJURY
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GARAGE LIAe1LRY (Vm9CArlwn) 1_
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CUA008105912 08/01/04 OBl01/05 GACNnOCURRENf!F 110,000.000
DYGDR FIClA1MSMARE ACCRCGA I _ $1000�yO00 -
DEDUCTIBLE fi
X RETENTION $0 ._-._..-_.s... -...
A WORKERS COMPENEAnoN"0 WCA008108013 WC S -
EMPLOYeRa•LURuITY 08/01104 08101105 on
D ANY PROrRETOkRARTNER?EXEUtJTNE
FPICEAMIEMEER GMAUOEOY L.e CncH grrmEgr s1000000 D,n.dMIM.,Mm EL.UIS�ASE-CA EMPI OYEE E1000 OOO
SPEC rROVISIt7NNNHUN ,_ FI_DIELA.y!-PJLIDYLIMA 41,DODr90B
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS AObEb 9y ENDOgaEYEM 14PECIAL PROVIaIONS -
Re:Oper8tious Usual to a Builder,
Project:North Shore Bank,Salem,MA.
CERTIFICATE HOLDER CANCELLATION
S"OULb My OF THE ABOVE DESCRIBED POLICIES eE CANCELLRR RPFME THE EXPIRATIoN
City Of Salem
GATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO All In DAYS WRITTEN
One Salem Green NOTICE TO THE CERTIFICATE IIOLDERNAMED TO THE LEFT,BUT FAILURE TO 00 30 SHALL Salem.MA 01970 ILIINOOBLICATIONOFLWRUWOF ANY,KWIC 11PM 1EWEUACR,ITS AGENTS 01
AEFReuR*ATWES.
ALIT QMI REPRESENTATIVE -
ACORD 28(2001100)1 of 2 AS102079111il 05 ,..,_
AX$CD w ACORO CORPORATION t➢HR