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0001 POWDER HOUSE LANE - BPA-14-237 � . ` � �v^7 - l � t3E�z-�,� �� �o • � The Commonwealth of Massachusetts , � Depaztment of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two- '1 1 ' (This Section For Official Use Only) Building Permit Number: Date Applied: Building Offic . SECT'ION 1:LOCATION(Please indicate Block#and Lot#for locaHons for which a eet addres ' a�lable) 1 Powderhouse Lane Salem,Massachusetts 01970 Bertram Field-Retaining Wall No.and Sh�eet City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK � � Edition of MA State Code used "�a If New Construcflon check here O or check all that apply in the two rows below Existing Building❑ Repair❑ Aheration ❑ Addition❑ Demolirion ❑ (Please fill out and submit Appendix 1) „-.-_---.-.�--- -6hange�of-�Use-� ❑ - -.ChangeofOccupancy O- --�� Other ��Specify:-RetainingWall - 2'"hei9ht—` -- ' ---' �� - . Are buIlding plans and/or construction documents being supplied as part of this pemut application? Yes ❑ No ❑ Is an Independent Siructural Engineering Peer Review required? Yes ❑- No ❑ B7ief DeSCCiPtion of Proposed Work:Consiruction of a retaining wall and repair to fve(5)existing Footings for the handiwpped ramp providing access to the ezisting home grandstand.The retaining wall is not more than 2'in height,antl is proposed to consist of modular concrete block as manufactured by Versa-Lok. The new concrela footings Por Ihe fve(5)support posls became nacesury when Me existing(ootings shifted during ezwvation and consWc[ion of Ihe proposetl wall immetliately aEjacent ���{ to ihe ezistlng footings.The existing HC ramp footings were approximately 8'diameter z 24'tlepih precast conaete footings.The new footings vrill be 12'x 72'x2B'pour wnuete, as shown on the atlached plans and detail provided by Huntress Associates,Inc.-Plan entitled"Bertram Field-Retaining Wall Detail sheets sk-1 of 1,tlated 9.4.13 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an E�cisting Building Investigafion and Evaluarion is enclosed(See 780 CMR 34) ❑ Existing Use Group(s):�� - Proposed Use Group(s):..i� SECTION 4:BUILDING HEIGHT AND AREA � Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.R) fl/e fl/e Total Area(sq.h.)and Total Height(ft.) Ne n/8 � � � SECTION 5:USE GROUP(Check as applicable) � A: Assembly A-1 ❑ A-2�❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educafional ❑ F: Facto F-1 ❑ F2❑ H: Hi Hazazd H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R-4❑ S: Storage Sl ❑ S-2❑ U:�UHlity❑ Special Use�and please describe below: Spxial Use:n/a - SECTION 6:CONSTRUC'I'ION T'YPE(Check as applicable) IA ❑ IBD IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA ❑ VB ❑ SEC'TION 7:SITE INFORMAT'ION(refer to 780 CMR 111.0 for details on each item) � Water Suppl : Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public� �Check if outside Flood Zone❑ Indicate municipal❑ A trench w' t be Licensed Disposal Site❑ Private❑ or indentify Zone:"�a or on site system❑ required or trench or specify:n/a permit is enclosed❑ Rail[oad right-of-way: Hazazds to Air NaVigation: MA Historic Comxnission 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 £3ition of Code: "�a Use Group(s): "�a Type of Construction: ^�a Occupant Load per Floor: nia � 'Does the building contain an Sprinkler System?: ^�a Special Stipulaflons: n/a /« HUNTRESS ASSOCIATES LANDSCAPE � ARCHITECT[JRE L4ND PLANNING ' � Christian C Huntress,RLA . s7 Tewksbury Street . Mdover MA o�Sio 97g.47o.888z 978.q7o.889o/u, � A" 4�. � ` . SECTION 9: PROPERTY OWNER AUTHORIZATION � � -�Name and Address of Property Owner � � City of Salem 120 Washington Street Salem, Massachusetts 01970 Name(Print) No.and Street City/Town � Zip Properiy Owner Contact Informarion: Tom Devine 978_619 _5685 tdevine@salem.com TiUe Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Huntress Associates, Inc. 17 Tewksbury Street Andover MA 01810 Name StreetAddress City/Town State Zip to act on the ro er owner's behalf,in all matters relarive to work authorized b this buildin ermit a licafion. - SECT'ION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buildin is less tlia��35,000 cu.ft.ot enclosed s ace and/or not under Constructlon Control then check here 0 and ski Section 101 101 Re 'stered Professional Res onsible for Construction Control - � Barbara J. Thissell P.E. �8i _501 _5503 bjt@barbarajthissell.com �j�j�l� �if�— Name(Registrant) Telephone No. � e-mail address Registration Number ' 352 Nahantan Streel Norvrootl MA' O2OBZ pro[Engineer / Street Address City/Town State Zip Discipline Expira on Date 10.2 General Confractor - � � David W. White & Son Company Name . David W. White n/a Name of Person Responsible for Construction . License No. and Type if Applicable 5 Johnson Road Bow NH 03304 Sfreet Address City/Town State Zip so3 zzs 8873 603_231 _4957 david@dwwsport.com Tele hone No. usiness Tele hone No. cell ' e-mail address � SEC'TION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'�Compensarion Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this applicatlon. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a si ed Affidavit submitted with this a lication? Yes❑ No O . �. - SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE - � Estimated Costs: (Labor � � Item and Materials) Total ConstrucHon Cost(from Item 6)_$2500 1.Building $2500 Building Permit Fee=Topl Construction Cost x ��a (Insert here 2.Electrical $ appropriate municipal factor)_$^ia 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum_fee=$n�a (contact municipality) 5.Mechanical Other $ Enclose check payable to n/a - City of salem 6.Total Cost $2500 (contacf municipality)and write check number here � � SECT'ION 13:SIGNATURE OF BUILDING PERMIT APPLICANT - By entering my name below,I eby attes der the pains and penalaes of perjury that all of the information contained in this applicaGon is true and accur the t 'y knowle e and understanding. . Christian C. Huntress President s�a 470 8882 9/4/13 Please print and sign name � Title Telephone No. Date Huntress Associates-17 Tewksbury Street Mdover � MA 01810 ' Street Address City/Town State Zip . Municipal Inspector to fill out this secHon upon applicafion approval: �. � Name Date � ` Appendix 1 �� For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety: ' Please fill in the information below and submit this appendix with the building permit , application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot# far locations for which a street address is not available) . n/a No. and Street City/Town Zip Name of Building (if applicable) For the above described property the following action was taken: Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) ' Appendix 2 Construction Documents are required for struciures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required for this. The applicant , shall fill out the checklist arid provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mazk"x'where a licable . mi d Incom lete Not Re uired No. . Item Sub tte 1 Architectural N/A 2 Foundadon � N/A 3 Structural � N�A 4 � Fire Su ression " NiA �5 Fire Alarm ma re uire re eaters N�A 6 HVAC N�A 7 � Electrical N�^ 8 Plumbin include local connections N/A 9 Gas Natural,Pro ane,Medical or other � ' NiA 10 Surve ed Site Plan Utilities,Wetland,etc. N�A 11 S ecificaHons � NiA 12 Structural Peer Review NiA -- 13 Structural Tests&Ins ections Pro am N/A 14 Fire Protecrion Narradve Re ort N�A 15 Existin Buildin Surve /Investi ation N�A 16 Ener Conservatian Re ort N�A 17 Architectural Access Review 521 CMR N�A 18 Workers Com ensation Insurance N�A 19 Hazardous Material Miti ation DocumentaHon N/A 20 Other S eC� XX-WaIlDetails � 21 Other S 2C� N�A 22 Other S ec' wA `Areas of Design or Construcrion for which plans are not complete at the time of application submittal must be identified herein.W ork so identified must not be commenced until this application has been amended and the proposed construcfion document amendment . has been approved by the authority having jurisdicrion.Work started prior to approval may be subjected to Mple the original permit � fee. Registered Professional Contact Information Barbara J. Thissell �si 501 _5503 bjt@barbarajthissell.com MA 35614 Name(Registrant) Telephone No. e-mail address Registralion Number Prof.Engineer 6/30/2014 352 Nahatan Street Norwood MA 02062 Street Address City/Town State Zip Discipline Expiration Date Christian C. Huntress 978 47� 8882 chris@huntressassociates.com MA 1178 � Name(Registrant) Telephone No. e-mai7 address Regisiration Number land.Architect 1/31/2014 17 Tewksbury Street Andover MA 01810 Street Address � Ci /Town State Zi Discipline Expirafion Date Name(Registrant) Telephone No. . e-mail address Regislra6on Number - Street Address Ci /Town State Zi Discipline Expiration Date . � The Commnnwea[th of Massachusetts , Depurtment of Industria[Accidentc 0,8`'ue ojlnvestigations 1 Congress Street,Suite 100 Boston,MA 02I14-2017 r www mass.gov/dia Workers' Compensation Insurance�davit: Builders/Contractors/Electricians/Plnmbers Applicant Information Please Print Leeiblv Name �s�s����o�r,���z+ann�a���au�>: David W. White and Son, �f1C. Address:5 Johnson Road City/State/Zip:BOW� NH 03304 Phone#:603 226-8873 Are you an employer?Check the appropriate box: Type of project(required): 1.❑� 1 am a employer with 30 4. ❑ 1 am a general contractor and 1 6. ❑� New construc[ion employees(full and/or part-time).• have hired the sub-contractors 2.� I am a sole proprietor or parmer- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. � Demolition working for me in any capacity. employees and have workers' 9 � guilding addirion [No workers' comp. insurance comp. insurance.= �q���d� 5. � We are a corporation and iu . 10.0 Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. (No workers' comp. right of exemption per MGL l2.❑ Roof repairs insurance required.] t c. I52, §I(4),and we have no employees. [No workers' �3.❑ Other comp. insutance requiredJ •My applicanf tNa[checks box It i mas[also fill out[he section below showing their workers'canprnsa[ion policy infotmation. r Homeowners who submit ihis affidavit indicating ihey are doing all work end tlien hire oulside conVactors must submit a�rew a�davit indicating such. �Conuacars that check lhis box must anaciced an additional shcet showing the name of the subtantrectors and s[ate whetha or not those entities have employees. If the sub-cantraclors have employees,they must prmide their workers'comp.policy number. 1 am an employe�that is providing workers'compensation insurance jor My emplayees. Below is ihe po[icy and job site tnjormatioa Insurance Company Name:Acadia lnsurance Company Policy#or Self-ins. Lic. #:wCA507779610 Exp'vation Date: ��11�3 tob s�te ndaress: Powder House Lane City/State/Zip:Salem, MA 01970 Attach a copy of t6e workers' compensation policy declaration page(showing the policy number and eapiration date). Failure ro secure coverage as required under Section 25A of MGL c.752 can lead to the imposition of criminal penalties of a fine up to$1,500.00 a�d/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 ofthe DIA for insurance coverage verification. I do kereby �fy unde�r pa� d penalties ojperjury tkaJ the informallon provided above is bue and cnrrect Sienature:o_���D11Yd-tL"���' V � Date.9/4/13 � Phone#: 603 226-887 �cial use only. Do not write in this area,to be completed by city ar town o,(/'uia/. City or Town: PermiULicense# Issuiog Authority(circle ooe): 1.Board of Heaith 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing InspeMor 6.Other � Cootact Person: Phone#: - � Information and Instructions ' Massachusetts General Laws chapter 152 requires all employers [o provide workers' compensation for[heir employees. Pursuant ro this statute,an emp[oyee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An emp[oye�is defined as"an individual, partnershiq association, corporation or other legal entiry,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 aparhments and who resides therein, or the occupant of the dweiling 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 employmen[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 coromonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Addirionally,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 aceeptable evidence of compliance with the insurance requirements of[his chapter have been presented[o 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 Paztnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensa[ion insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Departrnent of Industrial Accidents for confirmation of iosurance 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, oot the Departrnent of Industrial Accidencs. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Departrnent at the number listed below. Self-insured companies should enter their self-insurance license number on[he appropriate line. City or Towo O�cisls 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 pertniUlicense number which will be used as a reference number. In addition,an applicant that must submit multiple pertniUlicense applicatio�s in any given year,need only submit one affidavit indicating cucrent policy information (if necessary)and under"Job Site Address"the applicant should wri[e"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 fu[ure pertnits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or pertnit not relazed to any business or commercial venture (i.e.a dog license or permit to burn leaves etc J said person is NOT required to comptete this affidavit. The Office of Investigazions would like to thank you in advance for yo�u cooperation and should you have any questions, please do not hesitate to give us a call. The Deparanent's address,telephone and fa�c number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of InvestigaHons 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext 7406 or 1-877-MASSAFE Fax #617-727-7749 Revised 7-2013 www.mass.gov/dia _ '����� CERTIFICATE OF LIABILITY INSURANCE 9iai2oi�' ' THIS CERTIPICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO FUGHTS UPON THE CERTIFlCATE HOLOER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CER'f1FICATE OF INSURANCE DOES NOT CONSTTUTE A CONTRACT BETNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTAi1VE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the eertlHcate holder is an ADDI710NAL INSURED, the poliey(ies)must be erMorsed. If SUBROGATON IS WAIVED,subject to the terms and eondiHons of Me poliey,certain polieies may require an endorsemeM.. A sfatement on this certlfieate does rwt wMer rights to fhe eertificate holder in Ifeu of such endorsement(s). PROOUCER ' �NTA Ai1t10ii0 F(OM81C2]�k Tt� ROWLEY AGENCY INC. P�NE . (603)224-2562 F'� .�so3�zza-eoi2 139 Loudon Road ' �� .akooralezyk@roxleyageacy.com - P.O. BOX SZZ INSURE S AFFOROINGCOVERAOE NqICtl Concord NH 03302-0511 � wsursenaAcadia lnsurance Com INSURED INSURER B: David W White S Son, Inc. , INSURERC: DPW Materials, LLC, Jareka Properties LLC. �NSURERD: � 5 Johnaon Road . iNsunene: BOOP NH 03304 INSURERF: � COVERAGES CERi1FICATE NUMBER: REVISION NUMBER: � ' THIS IS TO CERTIFV THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSl1RED NAMED ABOVE FOR THE POLICV PERIOD ' INDICATEO. NO7WITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANV CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAV PERTAIN, THE INSUR4NCE 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. �N� TYPE OF INBURANCE POIICY NUMBER �UCY EFF �p Y FXP u�� - GENERAL tlAB1UT' EACH OCCURRENCE $ 1�OOO�OOO X CAMMERCIAL GENERAL UABILITY . A MI e E ZSO�OOO � A CLnIMS-MADE �OCCUR pA50977H910 ' 2/31/2012 2/31/2013 MEDEXPAn meparson) E 5�000 X CGO001 PERSONAL 8 AOV INJURY S I�OOO�OOO GENERAL AGGREGATE S 2�OOO�000 GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPIOP ACaC. E 2�OOO�OOO . POLICY X PR�� X LOC E AUTOMOBILELIA�LITY EOMe�ent IN LEUMIT 1 OOO OOO A X qNYAUTO BODILVINJURY(Patperson) S ALLONRJE� SCHEOULED 0?779210 2/31/2012 2/31/2013 BODILYINJURY(Pwec�tleirt $ AUTO$ AUTQS � X HIftEDAUTOS X p�p-0gNMEO PpR80P�ERe DAtdAGE E b X UMBRELIA L1N8 X OCCUR EACH OCCURRENCE E 6�OOO�OOO j� EX�ESS W1B CWMS-MADE , pGGREGATE § 6�000�O00 DED X FETEMION ����9<-11 2/31/2012 2/31/2013 f j� WORKERSCOMPENSATpN ,A. � NH� I�R, CT X WCSTATU- OTl4 ANDEMPLOYERS'W81LRV ��N ANY PROPRIETOR/PARTNERIEXECUTIVE E.l EACH ACCIOENT E SOO OOO OFFICER/MEMBERE%CW�EM � N�A pAanartorylnNH) CA507779610 /I/2013 /1/2010 E.LDISEASE-EAEMPLOYE S $QQ QQQ ' Ii yes,Cesbibeumlet avid W Whit6 -� ExCl OESCFIPTIONOFOPERATIONSCeIav E.L.DISEASE-PMICYUMIT E SOO OOO A Legg93 & ROnted EquipIDOnt 8A507778910 2/31/2012 2/31/2013 Limitafinwre� $50�000 � � DeEuc4ble $1.Q0� DESCRIPTON OF OVEpATONS I LOCATON91 VEHICLES(Atlec�ACORO t01,AEEitlonel ROMerb SMepule,M mora epaw le npui�ul) Re: 0-60 Beruam Field Renovation, Salem t9�. The City of Salem, t�A ie iacluded as additional inaured, when required by mritten contract. CERTFICATE HOLDER CANCELLATION � SXOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7HE E%PIRATON DA7E THEREOF, NOTCE WILL BE �DELIVERED IN ACCORDANCE WITM THE POLICY PROVISIONS. The City o£ Salem MA 120 Washington Street Salem, MA OZ9�IO � NUTMORIZEDREpRESENTAINE - Cp�_ ..o-ee.__� ...oO.�.-��yl2 _ � Annette Roralezyk/A[�IIC � ACORD 25(2010/05) � � OO 7988-2010 ACORD CORPORA710N. AII righLa reserved. INS025��mM6�m Tho ACf1Rfl e�.rm and Innn aro ronicfnrod ma�lrn nF ACl1RI1 2 � � - I �- � � �� " _ 4 _ - l'i! \ �a_�,.'` ` � � _. � � �\ - > . 5� �— B E N C H M A R K �"oN N� �N�R�°�nN� Huntress Associates, Inc. SEE 1DEfAIL \ H YD R A N T Landscape Architecture&Land Planning � , , ,, T � i , �- VERSA-LOK � � � � , _ CAP STONES r 17 Tewksbury Street \ 6�.���8 � Fj 2 • � T� n N = � �. � 2 Andover,Massachusetts 01810 ' 7 � � � �' / • 4 ___ - 978 470 8882 FAX 978 470 8890 C', ' FJZ.rJ"rJ / � , \ \\ 1 \ y T a � � ��h/W I l O � O( �) i \ � ^ .. `.� �.4 . L . . •• . . ` 6 . ^` 4 .` {... 0. .. . � •a -V���� .. � 6 5. 40 G� �_ - - =� �- ," ,��•"_ -- .�1'j \ '�' . ,- � ' ` w ��.� '�t � . i "e ^s � � � � � ' � � � � �ss\ � � �. � U � �1 = U.�. � �� � �'�� i � i ��{ �.{ �� � �..� -�� w '-� �y � t � (-� J,-{ y� ( ���� �.� r � � , � �� ;�, ,, ,;. �� O � i � v . V i . . � � �,---�"L��hr ��� .-c�.-/��T�v'r�htJ-�-.��--�-''h. L �4'h .�-C.'�L``�`- , 1`J�-�-'�'J },� ';) t"V',�`�•,..�-�.•� �JS�`� i•I f I� �,`� t`�: .��� . � • � _ . ' r i_. ,,, .. ///��� fff � � � � �' :� `. -�S� . �� � � � � � � �����`: �� � � � � NN � W6�.75 BOW) 62.60 (BOW) �� '� ., .,a', ,<a��- _ ) �� �'; �;,��� � .�. I 17 .�. I 6" tEVELWG PAD FINISHED GRADE � ��' 6 4. 9 0 ` �n VERSA-LDK ` �� � �, �. � �; ,-,�. — . a., v,,, Y f � � ���.. .. ., i� ---_ � � , < < STANDARD UNITS . _ � _ _ . _ - +, ����r����� �� � �� � �i`-- _- i � � 6 4. 6 \� �' _ � -_ � . �v� � A M F� D 0 64.60 (TOW) aa�s No& ELEVATION DETAI L � ��,r"��,, �sa� ,�o ; - � �. ��1-.�i0 (TO . ) � � �,.t� '�`�'�''�„'-=�___�`"���''� �� 4. 59 64. 47 � il�., g ST MODULAR BLOGK RETAININ6 WALL NOTE: Gf�� j�0 \ • FOR EASE OF INSTALLATION, USE VERSA-LOK � STAi�fi NEW 4' GHAIN LINK E1��lG� RAMP DOWN STANDARD UNITS FOR THE BASE COURSE. �� • INSTALL WALL BLOCK IN CONFORMANCE WITH 6 ' l --�"""� MANUFACTURER'S STANDARD DEfAILS AND • v � RECOMMENDATIONS. 16 �� � 64. 78 64. 79 na ~ i �iv — F � F � — ,� MODULAR BLOCK RETAININIG WALL - SPOT GRADING PLAN 2 MODULAR BLOCK RETAINING WALL - ELEVATION DETAIL SGALE: I" = 10' SGALE: NTS I Pro�ect: ! NOTE: BERTRAM FIELD RAMP SHALL BE SIUPPORTED FOR 28 DAYS PRIOR TO LOAD TRANSFER TO) NEW CONCRETE FOOTINGS. CAP UNIT ADHERES WELD NEW Ya"X7"X10" SEARING PtATE TO BASE OF STEEL SUPPORT POST. CAP UNIT ADHERES TO TOP UNIT SET IN PLACE WITH 6" ANCHOR BOLL TO TOP UNIT W/VERSA-LOK REVIEW IN FIELD WITH P.E. PRIOR TO INSTALLATION. W/VERSA-LOK CONCRETE ADHESIVE NEW FOOTING TO BEAR WEIGHT OF RAMP. CONCREfE ADHESIVE - TOW VERSA-LOK MOSAIC 64.60 uy, f S� N�'� Salem, Massachusetts VERSA—LOK MOSAIC Ny� CONCRETE UNITS� � DRAINAGE AGGREGATE o ' FACING UNITS � J CONCRETE UNITS , (3/4" CRUSHED STONE) � � ` ° ° FACING UNITS �2" THICK MIN. a �� - 2 —�� ,< -� I �—� � � � I �—� ��- DRA�NAGE AGGREGATE '' =` ` � Drawin Title: 2 —� ,:�_i.,�:' (�'a� CRUSHED STONE) 12"Xt 2"X3'-6" SQ. CONCRETE " ' - ' - -I I I—I I I � � I I—I I g -. . -. -: :. �- : - . - � ... ..... .... . � ., —I _ .: °, � FOOTING FOR EXISTING HC RAMP. � —t I I-� IXISTING SfRUC7URE 3�-6� r Re�aining Wall � �' " � \ WITH TWO (2) #4 REBAR EMBEDDED. I I.;�I I I=I�1=I I I \� \ ' '\�\�\\` VERSA—LOK STANDARD � r� r-� �y � CONCREfE TO BE 4000 PSI, �'q" STONE � � �—' VERSA—LOK STANDARD —I � - =`=="" \�\�/ UNIT (BASE COURSE) .a , WITH 585 CEMENT FACTOR. oruiruce accaEcn� UNIT (BASE COURSE) �.-� " � ``-'�� (Yi CRUSHED STONE) I ( I—I I GRANULAR LEVELING � � � , a , FlLTER FABRIC Construction Detaits UNDISTURBED ' �—����—� �- PAD 6" MIN. — � % ��_�- SOIL GRANULAR LEVELING UNDISTURBED SOIL � '�'' �� GRANULAR LEVELING • AT ABUtMENT, ALTERNAiE NLL UNIT WITH HALF PAD E�� M{N. UNIT EVERY OTHER COURSE PAD 6" MIN. • START AT FlXED POIMS AND WORK IN70 MIDDLE ' PART OF WALL • DO NOT ATfACN VERSA—LOK UNITS TO OTHER TYPICAL SECTION—�UNREINFORCED RETAINfNG WALL TYPiCAL SECTION —HC R�AMP FOOTING DETAIL S��°"'R� ` - WALL ABUTMENT DETAIL - - - - MOSAIC MOSAIC �� SCALE: NONE SCALE: NONE SCALE_ NONE �µ OF � �� NOTE: INSTALL WALL IN CONF-ORMANCE WITH MANUFACTURER'S STANDARD DETAILS AND RECOMMEDNATIONS, AS NOTED. , � � 4' �p� ! �tfJtt E�G� 3 RETAINING WALL DETAILS .; SGALE= NT5 Revision Date 5cale: as noted Drawing No. Date: �i.3.13 � s � � Job: 00-10'7 File: PR-mp Drawn: GGk of Ghecked: -- � — --- � �---- _ — -.._ _. _ ------�-- R _ --- � �- __�. _ _ . _ . _I _ .,. The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-FamilyDwelling g (This Section For Official Use Only) _ Building Permit Number: Date Applied: Building Official SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street:address is not available) �R' .No.and Street City/Town Zip Coale Name of Building(if applicable) SECTION 2 PROPOSED WORK. Edition of MA State Code used If New Construction check here O or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition (Please fill out:md 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 ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: �1 I 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❑ 1 H: Ili h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ L• Institutional I-1 ❑ [-2❑ [-3❑ 1-4 ElM: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ S-2❑ .e' •U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ❑ IIA ❑ IIB ❑ 11[e\ ❑ IIIB ❑ 1V ❑ 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: PP Y Public❑ Check if outside Flood Zone❑ hulicate municipal❑ �\trench will not be Licensed Disposal Site Cl Private❑ or indentify Zone: or on site system❑ required ❑or trench or specify: permit is enclosed❑ Railroad right-of-way: hazards to Air Navigation: \IA I I t,n,.Gtnun gsi t 1'ccic I r �•,,<s: 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 F_dilion of Code: Use Group(s): Type of Construction: Occupant Load per Floor: Dues the building contain an Sprinkler System?: Special Stipulations: t r � SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owpc r/ ^ NNo,and Street City/Town Zip ' Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) a-mail address If applicable, the property owner hereby authorizes Name Street Address City/Town State Zip to act on the property owner's behalf, in all matters relative to work authorized by this building permit a2plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If build ing is less than 35,000 cu.ft.of enclosed s :Ice and or not under Construction Control then check here O and skiP Section 10.1 10.1 Re istered Profe ional Responsible for Construction Control (I?• ''trap ) Telepht ie No. e-nail addr Regis tion Number Nil � f�i, 2 Street Address C ty/Town State Zip Discipline Expiration Date 10.2 General Contractor Company Name Na me of Person Responsible for Co nstruction License No. and Type if Appl Nanc P icable_:7:::Street Address City/Town State Zip Telephone No. business Telephone No. cell a-mail address SECTION Si:WORKERS'COhIN-NSn 11ON INSURANCH M O?AVI I 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 hr the denial of the issuance of the building permit. rs a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item ant Materials) Totil Construction Cost(from Item 6)_$ 1. Building $ Building Permit Fee-Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)=$ 3. Plumbing '6 Note: M u ininun fee=$ (contact municipality) d. Mechanical (HVAC) $ I 5. Mechanical (Other) Enclose check payable to I 6.Total Cost S (contact municipality)and write check number here ! SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attMstdhe pains and penalties f perjury that all of the information co tallied in this ap lication is trueand accurate to the beow edge an t rderst nding. Please print and sign name Title Telep lie I ri. Date Street Address City/Town Saute _ p Municipal Inspector to fill out this section upon application approval: / ✓ Name Da c CITY OF SM EM, j/'LA SSACHUSETTS BUILDING DEPARTMENT } 120 WASHINGTON STREET,3"'FLOOR .4 TEL. (978)745-9595 F.Aa(978) 740-9846 KIJBERLEY DRISCOLL THonfAS ST.PtFm MAYOR DIRECTOR OF PUBLIC PROPERTY/H(:IIDLNG COSL\IISSIONEA Workers' Compensation insurance Affidavit. Builders/Contractors/Electricians/Plumbers Alsnl(cant Information Please Print LeaibIV Namc(nusiixs&Organizaa1tiorvindividual): Address: Z—; City/State/Zip: Phone#: C�cJ3 �U`13 Are y an employer?Check the appropriate box: "type of project(required): 1. 1 am a employer with- 25 4. 0 I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached.sheet t 7. ❑fjmmodeling ship and have no employees These subcontractors have g. 6—Q✓Demolition working for me in any capacity. workers'comp:insurance. 9, 0 Building addition (No worker'comp.insurance 5. 0 We area corporation and its required.) officers have exercised their 10.0 Electrical repairs or additions 3.0.1 am a homeowner doing all work right of exemption per MGL I L[]Plumbing repairs or additions myself.[No workers'camp. c. 152,41(4),and we have no 12.0 Roof repairs insurance required.]t employees.[No workers' comp:insurance requirod.j. . 13.0 Other ;Any applkanl than chmits box Nl mart also fill out the aectim below showing their waken'compensation policy information. I I,mteuwnue who submit this affidavit indiwing they am doing all work and then him outside conumacts most submit a new aMdavit indicating such. :Cantmctors that check this box most attachtd an addidonol sheet showing the name of the sub+comncton and their workan'ramp.put ley information. l am an employer that fs prov/ding workers'corrtpetrsadon hrsarance for my empluyeex Below is ate pollcy and Job silo information. insurance Company?lame: Policy#or Self-ins.Lic. #: Expiration DateL ` 31, ��q3 ' Job Site Address: POW�V.- L� City/State/Zip " d^ M ,%ttacb 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'YIGL c. 152 can lead to the imposition of criminal penalties of a tine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of it STOP WORK ORDER and a tiae of up to S250.00 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. Ida leerrb rljy under t pu s an pe tattles of perjury that the information provided above is true and correct. S Data: P > �I- Z?,+- " 73 nJficial use only. Do not write in this aree,to be completed by city or rows ofJhlai City or Town: Permit/Llccnse# Issuing Authority(circle one): 1. Board of licalth 2. Building Dapartmunt 3.Cilyfrown Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other.. Confect Person:-___ Phone#: r- ;. CITY OFSALEM, J.A-u : CHUSETTS yF; 1201'11.isuWGT0V3TRgar 3"FLOOR y :J0 I'M (973) 741.9595 'CIS CO ERE SY ORISC0LL FL'((979) 740-934.1 �� L�YOR (IlO1L19$T.PIEAftB 1X2HCTOR OF PULIC PRGPEATy/9t:M0C4(3 C0dUtlSS,O.NER Construction Debris Disposal Affidavit (required fur all dcmolitian and rartuv;ttion work) fn accordanca with the sixth edition of the State Building Code, 730 CibtR section Mris, and the provisions of tMOL a 40, S Sd; ©wilding permit y this wur!<shall be at the dcbda resultin is issued With the condition that from I I t, S 1 SOA. disposed of in a properly licensed waste disposal facility as defined by tL(GL c 1'hc debris will be trusportcd by: W 1� -eta i aL (n�mc u1'haulw) The dQbris will bo disposed of in (naman(t�cdity) �- 1 ,y —� I``ts ufta:i61�)— I•tlldlfi(C (Pei I'll t.ipplic.uu Jew ;b s r Division of Professional Licensure: License Search Page 1 of 1 The Official Website of the Office of Consumer Affairs and Business Regulation(OCABR) Division of Professional Licensure Mass.Gov Mass.Gov Home Stale Agencies A-Z Topics I Home>Division of Professional Licensure> ONLINE SERVICES Check a License Check A Professional License Locate a Licensed Professional By the Division of Professional Licensure Online Address Change - Contact the Agency k LICENSEE More... Name:CHRISTIAN C. HUNTRESS REFERENCES& ANDOVER,MA RELATEDINFO NEW SEARCH 1 Disclaimer Regarding - - _-_ - - -- -_,-_------_ —__ _ - - Website License Searches Licensing Board: LANDSCAPE ARCHITECTS Enforcement Process Glossary License Type: LANDSCAPE ARCHITECTS Glossary of License Status License Number: 1178 j Codes Status: CURRENT More... Expiration Date: 1/31/2014 Issue Date: 10/28/1998 Exam Date: 6/1/1998 I School: I I I This web site displays disciplinary actions dating back to 1993. This license has had no disciplinary actions taken during this time. i The page above has been generated by the Division of Professional Licensure web server on Tuesday, July 09,2013 at 1:14:04 PM. 2007-2011 Commonwealth of Massachusetts Site Policies Contact Us bttp:Hlicense.reg.state.ma.us/public/PubLicenseQ.asp?board code=LA&type class=_&lie... 7/9/2013