96 SWAMPSCOTT RD - BUILDING INSPECTION (12) k
g Si�E fiLfg4NG APPROVED BY T44E
JdSF'ECIGA.PWRTOA.PEMITMWC GRANTED
CITY OF SALEM
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No. ��� Dale
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BUILDING PERMIT APPLICATION FOR:
Permit to:
(Circle whichever apply) Roof, Reroof, Install Siding, Construct Deck, Shed, Pool,
Repair/Replace, Other: t wfnmr- 'f-pizZITlnt S
PLEASE FILL OUT LEGIBLY&COMPLETELY TO AVOID DELAYS N PROCESSING
TO THE INSPECTOR OF BUILDINGS.
The undersigned hereby applies for a permit to build according to the following
specifications:
Owner's Name of6
Address & Phone � � (jig I 1 Z03c5
Architect's Name (U lkym ��5
Address & Phone E° �C �._ (761 1 6-11 - -76322
Mechanics Name
Address & Phone (
whn W ttw p mPm a buft ? �T ZLF T TD T I 1 Fly iL�18�1-
mem"of Wl*V?�Mf5g-�_, dwe0q,for how many lami m?=—
WN hm&w=won to law? A08006?
t a*mmw coat 33" o' b 6=cuy ucmm r N °` sWe
7,
J! tio.. Iaptv....nt X Lie. I C '`S91 Signa ure o Applicant
Cx D y -o 1 -o% SIGNED UNDER THE PENALTY
OF PERJURY
DESCRIPTION OF WORK TO BE DONE
MAIL PERMIT TO:
No.
APPLICATION FOR
PERLUT TO
rloee-
LOCATION
PERMIT GRANTED
APPROVpD
�OtPgOTOR OF BU Ff S
lr
• ' STRUCTURAL ENGINEER'S CONSTRUCTION PHASE AFFADAVIT
PROJECT NUMBER:
PROJECT TITLE: 96 Swampscott Road,Units 7,8,9,and 10
PROJECT LOCATION: 96 Swampscott Road,Swampscott,MA
NAME OF BUILDING: 96 Swampscott Road
SCOPE OF PROJECT: Unit Fire Separation Partitions
In accordance with Section 116.0 of the Massachusetts State Building Code Sixth Edition,
I, Edward Moll Mass.Registration No.33718 being a registered professional engineer hereby certify that I,or a
duly registered staff person,have prepared or directly supervised the preparation of all design plans,computations _
and specifications concerning:
ENTIRE PROJECT ARCHITECTURAL X STRUCTURAL
MECHANICAL —FIRE PROTECTION _ELECTRICAL
OTHER(specify)
for the above named project,and to the best of my Imowledge,such plans,computations and specifications meet the
provisions of the Massachusetts State Building Code applicable to the mechanical,electrical and fire protection
systems design,acceptable engineering practices and laws applicable to the engineering design for the proposed
project.
I further certify that I,or my authorized staff,shall perform the necessary engineering professional services and be
present at the construction site on a periodic basis to determine that,generally,the work is proceeding in accordance
with the engineering documents approved for the building permit and shall be responsible for the following as
specified in Section 116.2:
1. Review of engineering shop drawings,samples and other submittals of the contractor as required by the
engineering construction contract documents submitted for the building permit,including critical
construction components requiring controlled materials specified in the accepted engineering practice
standards.
Pursuant to Section 116.2,my authorized staff shall submit periodically,a progress report together with pertinent
comments to the building official. Upon completion of the work,a final report shall be submitted as to the
satisfactory completion and readiness of the engineering portions oj4heqkroject for occupancy(excepting any items
not endangering such occupancy and listing pertinent deviations fro pproved buildin emut documents).
aa`c9' Signatu
Ear
HARAAENIAX3 T Name—e��cin� M OI.L Date
t_Y ^"� roe,II y 2Sj Z
TO,r. 'PfG (I " Engineer's Registmti umber
FSSkllB�l Ee��
SEAL
CONSTRUCTION CONTROL AFFIDAVIT
Project Number. Date:
Project Title: • �JSlAN� � I. G G
Project Location: 9fe 1 -f� i{`EE6A, NAA
Name of Building:
Scope of Project: NEE2W9-71"-ClD('l -Tl�lft�`'J
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I
mww �j- yutt&5 MASS. REGISTRATION NO. 339(o BEING A REGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:-
civil Architectural Y Structural Mechanical
Electrical Fire Protection Other(specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH
PLANS, COMPUTATIONS, AND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF THE
MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERING PRACTICES AND
ALL APPLICABLE LAWS FOR THE PROPOSED PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES
AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS 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 of shop drawings, samples and other submittals of the contractor as required by the construction
contract documents as submitted for building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix I.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A P c PORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING NSP TO ION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TO TISF ION
AND READINESS OF THE PROJECT FOR OCCUPANCY. M
Signature m� r
fA OF MP''t+
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY�_� 2004
My commission Expires:
Notary Public