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0023 R MAY ST -BPA 14-1454 SPLAINE PARK S 2-3 K M Si 25 - 00so , o The Commonwealth of Massachusetts UlfDepartment of Public Safety 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) 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) Splaine Park-May Street Salem 01970 No.and Street - City/Town Zip Code Name of Building(if applicable) SECTION 2 PROPOSED WORK Edition of MA State Code used 2009 IBC If New Construction check here 13 or check all that apply in the two rows below Existing Building❑ Repair❑ 1 Alteration ❑ Addition❑ TDemolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other M Specify: Outdoor Pavillion Are building plans and/or construction documents being supplied as part of this permit application? Yes 13 No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No 12 Brief Description of Proposed work: Installation of a open-air pavillion consisting of concrete columns and a wood- framed cedar and slate roof. 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.) 512 sf 12 ft SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5 IN I B: Business ❑ E: Educational ❑ R Facto F-1 ❑ F2❑ H: Hi Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) WOOD ROOF IA O IB ❑ IIA ❑ IIB ❑ IIIA O IIIB 13 1 IV ❑ VA O VB O 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. Public 13 Check if outside Flood Zone fd Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: or on site system❑ required®or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation MA Historic Commission Review Process: Not Applicable 29 Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No 13 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?: No Special Stipulations: G/� t✓ t_ C_o t_ f3Lj J1lMt � Gt '1 5-352 -+IIoCA(. lt1 HIV A,,." 2t CAPS 7 � Z+rD '3'�µAlt.- J'I�fatz2�rs ��QUt 2IG .Lor'�'t `""1 IL p t.) Ct I O SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner City of Salem 93 Washington Street Salem 01970 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Tom Devine 978 _619 - 5682 _ tdevine@salem.com Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Quirk Construction 1 Martel Way Georgetown MA 01833 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 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 PQ and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Quirk Construction Corporation Company Name Michael Alden CS-072769 Name of Person Responsible for Construction License No. and Type if Applicable 1 Martel Way Georgetown MA 01833 Street Address City/Town State Zip 978 352 4666 mike@quirkcorp.com 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 IN No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ 20,000 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ N/A appropriate municipal factor)=$ 3.Plumbing $ N/A 4.Mechanical (HVAC) $ N/A Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ N/A Enclose check payable to 6.Total Cost $ 2,Q Q 00 (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 application is true and accurate to the best of my knowledge and understanding. �/Z_10 S/{rn�S Ltl9✓L/� Pr,. e � Ono ceT 97G'- 3SZ S�IoG(o Please print and sign name Title Telephone No. Date exlxL cddsG ,-c47QYw //I xlre 6r,91'� &edn EGVLvr. /� nrf�� Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: J (iw✓ / , Name Date A� CERTIFICATE OF LIABILITY INSURANCE D TE(M DNYYY) 14 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 Brownson Insurance Agency,Inc. coxrncT Maureen Pollman 139 Albion St. NE . (781)245-2292 FAx PHO ,(781)245-3826 P.O.Box 349 Eb1AIL mo@brownsoninsurance.cam Wakefield MA 01880 INSUREFUSH AFFORDING COVERAGE NAICN INSURER A,Harleysville Worcester Insurance Co. 26182 INSURED INSURER B,Nationwide Mutual Insurance Co. 25382 Quirk Construction Corporation INSURER 1 Martel Way I INSURERD. Georgetown MA 01833- INSURER 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. NOTWITHSTANOING 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. HER TYPE OF INSURANCE ADD L SUBR POUCYEFF POLICYEXPLTR WAR. XL IMMIDDrrYYyl LIMITS GENERAL LIABILITY SPP00000016753Q 02/06/2014 02/06/2015 EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS-MADE T OCCUR MED EXP(Any one Person S 15,000 PERSONAL S ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGO $ 2,000,000 POLICY X PRO- LOC $ B AUTOMOBILE LIABILITY BA 00000099864H 03/10/2014 03/10/2015 COMBINED SINGLE LIMIT 1,000,000 ANYAUTO BODILY INJURY(Per person) S ALL OWNED I X SCHEDULED BODILY INJURY(Per amdent) $ AUTOS AUTOS X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS E A X UMBRELLA UAS X OCCUR CMB00000016752Q 02/06/2014 02/06/2015 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 X RETENTION$ 0 PERS/ADV.INJ AGG $ 5,000,000 WORKERS COMPENSATION WC STATU- OTH- ANDEMPLOYERS'LIABILITY YIN M ANY PROPRIETORRARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,describe under ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATION 51 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mom apace Is required) 8/14/14.Project: Splaine Park Renovation.Per written contract or agreement with the Named Insured,the City of Salem is named Additional Insured as regards General Liability.Umbrella Liability follows form. CERTIFICATE HOLDER CANCELLATION AI 095086 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cityof Salem THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 93 Washington Street Salem MA 01970- AUTHORIZED REPRESENTATIVE Fax:( ) - @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD A`f�® CERTIFICATE OF LIABILITY INSURANCE 8/14/22014) 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(les) 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 endorsement(s). PRODUCER CONTACT Select NAME: Eastern Insurance Group LLC PHONE . (800)333-7234 GFAX A/UCC No: 233 West Central St E-MAIL INSURE S AFFORDING COVERAGE NAIL p Natick MA 01760 INSURERA:Selective Ins Co of Southeast 39926 INSURED INSURER B QUIRK CONSTRUCTION CORP INSURER C: 1 MARTEL WAY INSURER0: INSURER E GEORGETOWN MA 01833-2224 INSURER F: COVERAGES CERTIFICATE NUMBER:WC Only: City of Salem 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. ILTR TYPE OF INSURANCE ADDLSUum POLICY EFF POLICY EXP POLICY NUMBER MM/DD/YYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY RENTEDDAMAGE TO PREMISES(Ea occurrence) $ CLAIMS-MADE ❑OCCUR MED EXP(Anyone person) $ PERSONAL$ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO LOC $ FAi BILEUABIDTY COMBINED SINGLE LIMITEa accidentAUTOBODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Par accident) $ OSAUTOS IRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LJAS OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION X WC STATU- DTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOWPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) WC 7956567 /11/2014 /11/2015 E.L.DISEASE-EA EMPLOYE $ 11000,000 Hyes,dasrnba untler /11/2013 /11/2014 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more apace Is required) Project: Splaine Park Renovation The City of Salem is an Additional Insured with regards to General Liability where required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Salem ACCORDANCE WITH THE POLICY PROVISIONS. 93 Washington Street Salem, MA 01970 AUTHORIZED REPRESENTATIVE John Koegel/PKG —r-�— ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS02519nims6 ni The Annon neme and Innn nro renio/erod mane of Anion 0 Of Massachusetts 'The Construction Testing People' -Pagel 5 Richardson Lane,Stoneham,MA 02180 781-438-7755(Voice)781-438.6216(Fax) Compressive Strength Report- Concrete Report Date 04-04-2014 Report No. 1 Distribution Copy Job Number 12449 Project Quirk Construction Quality Control Contractor Quirk Construction Concrete Co. J.G. MacLellan ALL FIELD TESTS DONE ACCORDING TO ASTM: C-172 C-31 C-143 C-1064 C-231 ALL COMPRESSIVE STRENGTH TESTS DONE ACCORDING TO ASTM: C-39 CLASS CONCRETE: 4000# 3/4" 1 No. Of Sets: 1 CUBIC YARDS: 6 SET 1 LOCATION: S laine Park - Salem; Pavillion Total '" .unk RVVtIbs1cu 6 1/4 Lab -Size .Area a l- Date Date ..,, Age ,r Load �� Load. `Fracture;, . 96 No`' Pnd .Isq.in:) . Condition' Cast _' Teated IDays .(Ibs,) (psi.) ..,.Type.,;_ F 67 B417 4 x 8 12.56 Good 04/04/2014 04/11/2014 7 39,000 3,110 2 253 B418 4 x 8 12.56 Good 04/04/2014 04/18/2014 14 48,500 3,860 2 1611562 9419 4 x 8 12.56 Good 04/04/2014 05/02/2014 28 73,000 5,810 1 Time11:00 B420 9 x 8 12.56 Good 09/09/2014 OS/02/2014 28 72,000 5,730 2 /cu ft B921 9 x 8 12.56 Good 09/09/2019 OS/02/2014 28 70,000 5,570 1 Air Content(%) 5.2 GENERAL REMARKS: liispedor' r, ;Premlum_. Travel ,'al a Name '1 c Tlme 1 Hours- No Sohn Barton Imi. nay 1 Hr(s) REVIEWED BY: Robert S. Granada FRACTURE TYPES X X T R i Typal Type 2 Type 3 Type 4 Type5 Type 6 Reasonably well-formed Wall-formed cone on Columner vertical Diagonal fracture Side fractures at top Similar to Type cones on both ends, one end,vertical cracks cracking through with no cracking or bottom(occur but end of less than f In. running through caps, both ends,no through ends;tap commonly with cylinder Is 125 mm)of cracking no well-defined cone well-formed cone& with hammer to unbonded caps) pointed throught caps on other end distinguish from Type 1 Our reports are available in PDF form via eauail. Please email us at reports@utsofmass.com for more information. Of Massachusetts 'The Construction Testing People' 0 Page 2 6 Richardson Lane,Stoneham,MA 02180 781-438-7765(Voice)781-438-6216(Fax) Compressive Strength Report -Concrete Report Date 04-04-2014 Report No. 1 Distribution Copy Job Number 12449 Project Quirk Construction Quality Control Contractor Quirk Construction Concrete Co. J.G. MacLellan cc: Quirk Construction Corporation David D. Quirk Quirk Construction Corporation Mark Masella, PM Quirk Construction Corporation Jamie Warren r Of Massachusetts 'The Construction Testing People' Page 3 5 Richardson Lane,Stoneham,MA 02180 781-438-7755(Voice)781.438-6216(Fax) Compressive Strength Report- Concrete Report Date 04-04-2014 Report No. 1 Distribution Copy Job Number 12449 Project Quirk Construction Quality Control Contractor Quirk Construction Concrete Co. J.G. MacLellan FIELD SUMMARY REPORT -Total Pour: Pavillion Method of Placement: ❑Pump ®Chute Discharge ❑ Bucket ❑Other Other: Method of Concrete Consolidation: ®Vibrator ❑ Other Other: Cylinder Fabrication Location: ® Truck Discharge Chute ❑ End of Pump Hose Cylinder Storage: Curing Box Thermal Blanket Hay/Straw Ld Trailer LJ Field ❑ Other Placement Protection: ❑Thermal Blankets ❑ Heat ❑ None ® Other Slump Specification(in.) 6 (+/-) 1 Number of slumps out of specification reported to If rejected Approved by Remarks: 'UTS of Massachusetts, Inc. Page a 5 Richardson Lane,Stoneham,MA 02180 781.438.7755(Voice)781-438-6216(Fax) Report Date 04-04-2014 Report No. 1 Job Number 12449 Project Quirk Construction Quality Control Attachment Of Massachusetts Inc. 'The Construction Testing PeopW` Page; ' o 1 DAILY REPORT OF CONCRETE POUR PROJECT NAM E:Simyje T20y1�- 'w�•ki PROJECT/NO.: DATE:_6L —Ot�-Jnl�i. _AIR TEMP.:_A "r TOTALYARDS: Lp LOCATION OF POUR: �/�)llllbrJ Load 81 Slump Botching Botching Time In Yards Concrete % of Ticket;* No. of Truck tr Inches In Out Minutes Temp. Air of Z �� 100 s25 &J I I INSPECTOR: REMARKS: h ' Z 5 Rirhar'ienn 1 vno Cfnnnhvm Maeeorl.neeMe noinn 17R11 d:2R-779q Cer 17Ril 4AR-621q r,all? 9 1 ..tyA• C 4!". r , r i ,,Fs�'i. Y,. I I a 5, 9 � TJ� S, , ,f i~• `r\ f P51 h wtv \ � RV, ` ' x T[ a �� tt . g�' **'*"�"-�1tq,�y'4'H��.':".._�r"{P"ti"S.,"'°" •gip �t - '� 'cam. ` f �M s p _ r N k yy ~° Y r § r ' a t , y t x r 1 � r -' ` h- +E.. its .• I lit ar M 1 t'� t -:'N':' }„ART R �•� i ♦ ':gin'! „r ',.�,,�F i a 3� �F M � ��a� Mal 74, Ir RSA .(`t,i t.-r `• �a `�F�Lq .�l-i �.tl `s''. S It 3�ye: 'f' 1}+yq 16 7ii! (, �,`; Is- IN r ?t �` � 4Y � `� �i # � r •< �1`a 4 �@ 1 H _ '�`J � .• '£(?r!` Y9 ���• FYI � kar'. �I ,.., l�P. `Ifi �`Y �,.,»'�� _'•. I ��0 � t t ��wt w•r a� ��. •!Y ti�.y`r SZ� ,b r�y M fill %s I t a � V 'Sys t `w•' ro(—jy,si 4 � „ .yy. Y.. 1 «ae�T— ., 4 ��y y S Wv � Y M � i �':�„1l {. �/ K•!an 'y�A ,j .1.1r�' a �y. e,.,@ w y g. •' a .' rE,w • �`'t'N ° Vas °t` 9 ; io _ �z ZVI vv Is 1 sr a Y •�• vy ' n *w ��� 2 '� a RVyyJ Y +♦�' It � Ya •��.'a �u j 1R 11 0 C� olk CONSTRUCTION CORP. Thomas J. St. Pierre Inspectoral Services Director City of Salem 120 Washington Street 3`d Floor Salem, MA 01970 RE: SplainePark—May Street—Outdoor Pavillion Dear Mr.St. Pierre, Please find our building permit application for the above referenced project. As you are aware construction of the pavilion is complete and we have been instructed to file for a building permit after the fact. I apologize in advance for the mix-up. As you may be aware the project was put on hold for almost 2 years and the building permit application requirement was missed during the restart of the project. Enclosed you will find the required application,detailed photographs documenting the various stages of construction and concrete strength test reports by UTS for the foundation system. It is our understanding that as a municipal project the application is fee exempt. If you have any questions or need additional information please feel free to contact me directly at (978) 430-5325. Respectfully, James Warren Project Manager Attachments: Building Permit application Cc(via email): Tom Devine, Naomi Cottrell