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2 TRADERS WAY - BUILDING INSPECTION (4) -R tI� The Commonwealth of Massachusetts Department of Public Safety V� Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-o mil w (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 addre rs not available) I2 Traders Way Salem 01970 aj No.and Street City/Town Zip Code r Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used 8 If New Construction check here❑or check all that apply in the two rows below . Existing Building❑ Repair❑ Alteration L� Addition❑ Demolition 0 (Please fill out and submit Appendix 1) r Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? YesylP No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No� Brief Description of Proposed Work: INTERIOR BUILD OUT OF COMMERCIAL RETAIL SPACE.WORK TO INCLUDE NEW FIXTURES,FINISHES, NON-STRUCTURAL PARTITIONS,LIGHTING and PLUMBING FIXTURES. 1�Yd 'T�ml p.JT i 5 T' r-�81 Cj 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): MERCANTILE Proposed Use Group(s):MERCANTILE SECTION 4:BUILDING HEIGHT AND AREA - Existing Proposed 11 No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 1 Total Area(sq.ft.)and Total Height(ft.) �`t,l AtFz /6 a p SECTION 5:USE GROUP(Check as applicable) '.A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business 0 E: Educational ❑ F: Facto F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ElH-4❑ H-5❑ 1: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile R: Residential R-1❑ R-2❑ R-3❑ R-4❑ S: Storage S-l.❑ S-2❑ U: Utility❑ Special Use 0 and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA '0 Ill 0 IIA ❑ IIBN$W� IIIA 0 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: PUbhQZT Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ �Q as 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 0 or No� Yes❑ No ❑. SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Pr Edition of Code: Use Group(s):_�A Type of Construction: 7 Occupant Load per•Fleer: Does the building contain an Sprinkler System?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner JAGER MANAGEMENT INC 610 Old York Road, Ste 220 Jenkintown, PA. 19046 Name(Print) No.and Street City/Town. Zip Property Owner Contact Information: Scott Borsky or Alan Wod 215-_690.3220 Title Telephone No.(business) Telephone No. (cell) e-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 application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed sl2ace and/or not under Construction Control then check here O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Donald Rethman 937 312.8974 andy.mcloud@interbrand.com 10021 Name(Registrant) Telephone No. e-mail address Registration Number 7575 Paragon Road Dayton OH 45459 ARCHITECT Sheet Address City/'Town State , Zip Discipline Expiration Date 10.2 General Contractor TBA Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Telephone No. business Telephone No. cell e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVPI' 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 IJ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Building $15,000 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $5,000 appropriate municipal factor)=$ 3.Plumbing $5,000 - 4.Mechanical (HVAC) $5,000 Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $30,000 (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 tot of To know�dge and understanding. Please print and sign name -it Title Telephone No. D e �) I lAf. 1ula SH 1�M�/� 5r Street Address � City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date 13111�\WAIVI Burnham NaVonwide,Inc. Tasia Kallies 111 W.Washington Street Suite 450 >312.260.7090 r Chicago, I160602 I >312.407.791.5 �� v� tka/lies@turnhamnationwide.corn SIMPLY GETTING IT DONE. www.bu..nhamnationwidg.com .. Appendix 2 Construction Documents are required for structures 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 and 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* Mark"x"where a licable No. Item Submitted Incom lete Not Required 1 Architectural 2 Foundation - 3 Structural 4 'Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 S ecifications 12 Structural Peer Review 1.3 Structural Tests&inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investi ation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 'Other(Specify) iA *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority Having jurisdiction.Work started prior to approval may be subjected to triple the original permit fee. Registered Professional Contact Information �1 l 002� OoNAgQ ?C4� nA 3 '�- 1/?- 45�� c� Registration Number Name(Registrant) Telephone No. e-mail address fI, Et,q a, co , 7575 ePM4GartLD. 12 kr�Z>r4 / t" Street Address City/Town State "Lip Discipline Expiration Date �it>�rµG Ct�4ERn/aG •F7 3A 1?%7(- nJ Name(Registrant) Telephone No. e-mail address Registration Number Street Address - City/Town State Zip Discipline Expiration Date Name(Registrant). Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zi i CITY OF SALEM, XL-1SSACHusETTS BUILDING DEPARTMENT 120 WASHINGTON STREET,Yo FLOOR TEI_ (978) 745-9595 FAX(978) 740-9846 K1,IBERLEY DRISCOLL MAYOR THOMAs ST.PmRRE DIRECTOR OF PUBLIC PROPERTY/BUILDD4G CO\LMISSIONER CONSTRUCTION CONTROL DOCUMENT Project Title: -T" 9ho9'uE Date: 04 03 1 Z Project Location: z HERS 41dY S c o pe o f P roj e c t: INTgo-lo4- pLyr cks6,4 ey-,\sr .lca LP.66E-e-; i.JCL:pi.ly Fizri „1r,, Ftmn.�iq ?""Tin OAS pp_sr'g'�o-of-j6yJ-- 1Jg" In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code I. Mass,Registration Number (0O_11 being a registered professional Enginee;//lrchitect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,compu ;_uo.,a and specifications concerning: pq Entire Project [J Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [] Electrical j ] 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. Furthermore,I understand and AGREE 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 by 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 the building permit,and approval for the conformance to the design concept. 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. I shall submit periodically, in a form acceptable to the building official,a progress report together with pertinent comments. Upon completion of the work,I shall submit to the building official a final report %R satisfactory completion and readiness of the project for occupancy. Signature and Seat of registered professional: d�/ 'V" o� 10021 92`, yl DAY-(ON ' OHIO '1'EA�n10F M?S�P� Jager Management, Inc City of Salem Inspectional Services 120 Washington St., 3rd Floor Salem, MA 01970 RE: T-Mobile Highland & Traders 2 Traders Way Salem, MA 01970 To the City of Salem: This letter will serve as our authorization for Burnham Nationwide on behalf of T-Mobile to obtain permits for the interior alteration of the above referenced location. The letter will also serve as authorization to proceed with construction with our permission once all permits approvals have been received through the City of Salem. Please feel free to contact Jager Management, Inc. if you have any questions at 215-690- 3220. Sincerely, Scott Borsky Jager Management, Inc Senior Leasing Representative JAGER MANAGEMENT, INC. 610 Old York Road,Suite 220 Jenkintown, PA 19046 Telephone: 215-690-3220 Facsimile: 215-690-3236 April 11, 2012 VIA OVERNIGHT MAIL Design Forum Architects Inc. Donald J Rethman 7575 Paragon Road Dayton, Ohio 45459 Re: T-Mobile Highlander Plaza, Salem, MA Dear Mr.Rethman, Please find the enclosed plans for T-Mobile dated 3-30-12. Please be advised that Landlord approves these as complete plans, with the following stipulation: The square footage is 1600, not 1588 square feet. Premise is measured outside offront and back walls and center of side demising walls. Approving this plan is only for conformance with the design concept of project and compliance with the information given in the lease specification. It is not intended in any way to relieve either the tenant or the tenant's agent of their responsibility for coordination and compliance with all requirements of construction processes necessary to properly execute work, and approvals from all legal authorities having jurisdiction over this project. Should you have any questions please do not hesitate to contact me at the number listed above. Sincerely, I elanood Director of Operations ,r COMcheck Software Version 3.9.0 Interior Lighting and Power Compliance Certificate 90.1 (2007) Standard Section 1: Project Information Project Type:Addition Project Title:T-Mobile Highland Ave&Traders Way Construction Site: Owner/Agent: Designer/Contractor: 2 Traders Way T-Mobile Tim Raberding Salem,MA 01970 12920 SE 38th St Design Forum Engineering 4th Floor 7575 Paragon Rd. Bellevue,WA 98006 Dayton,OH 45459 937-439-4400 Section 2: Interior Lighting and Power Calculation A B C D Area Category Floor Area Allowed Allowed Watts (n2) watts 1 ff2 (B x C) SALES FLOOR(Retail:Sales Area) 927 1.7 1576 Allowance:Other retail highlighting/Fix. ID:T 465(a) 1 465(b) BACK OF HOUSE(Common Space Types:Office-Open Plan) 661 1.1 727 Supplemental Allowed Watts(c)= 326 Total Allowed Watts= 3094 (a)Area claimed must not exceed the illuminated area permitted for this allowance type. (b) Allowance is(B x C)or the actual wattage of the fixtures given in Section 2,whichever is less. (c) Supplemental watts must be associated with retail merchandise highlighting fixtures.Supplemental watts are not included calculation of lighting complaince percentage. (e) Additional controls/switching allowances are based on number of fixtures or wattage controlled,not floor area of allowance. Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp I Wattage Per Lamp I Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. !SALES FLOOR(Retall:Sales Area 927 sq.ft.) Track lighting 1:T:Wattage based on 87.0 feet of track 0 0 0 2610 Linear Fluorescent 2:24"T8 17W/Electronic 4 12 68 Exempt Exemption:Lighting Sales or Education BACK OF USE(Common Space Types Office-.Open_Plan 661-sq_ft.);,�g,r,�,", Linear Fluorescent 2 copy 1:F4:2X4 FLUORESCENTS/48"T8 32W/Electronic 2 7 64 448 Compact Fluorescent 1:EF-1:RR LIGHTING/Twin Tube 1 BW/Electronic 2 1 36 36 Total Proposed Watts= 3094 Section 4: Requirements Checklist Lighting Wattage: O 1. Total proposed watts must be less than or equal to total allowed watts. Allowed Watts Proposed Watts Complies 3094 3094 Passes using retail merchandise highlighting supplemental watts. (D 2. Exit signs 5 Watts or less per sign. Controls, Switching, and Wiring: Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 1 of 5 0 3. Independent manual or occupancy sensing controls for each space(remote switch with indicator allowed for safety or security). F% 4. Occupant sensing control in class rooms,conference/meeting rooms,and employee lunch and break rooms. Exceptions: , p Spaces with multi-scene control;shop classrooms,laboratory classrooms,and preschool through 12th grade classrooms. 5. Automatic shutoff control for lighting in>5000 sq.ft buildings by time-of-day device,occupant sensor,or other automatic control. Exceptions: 24 hour operation lighting;patient care areas;where auto shutoff would endanger safety or security. ri 6. Master switch at entry to hotel/motel guest room. 7. Separate control device for display/accent lighting,case lighting,task lighting,nonvisual lighting,lighting for sale,and demonstration lighting. ri 8. Tandem wired one-lamp and three-lamp ballasted luminaires(No single-lamp ballasts). Exceptions: p Electronic high-frequency ballasts. ❑ Luminaires not on same switch. O Recessed luminaires 10 ft.apart or surface/pendant not continuous. p Luminaires on emergency circuits. Voltage Drop: 9. Feeder conductors have been designed for a maximum voltage drop of 2 percent. Fi 10.Branch circuit conductors have been designed for a maximum voltage drop of 3 percent. Section 5: Compliance Statement Compliance Statement.�d" design represented in this document is consistent with the building plans,specifications and other calculations subUt,� ith this ee �'k lication.The proposed lighting system has been designed to meet the 90.1 (2007)Standard requirements in COtvkrJY kV fs�i91n 0 a omply with the mandatory quire a in the Requirements Checklist. E aZA1GA1- d EG 1i9 i APR 9"� 2012 Name-Title -'s'�'p e Signature Date Section 5: PostTprisfr9 Compliance Statement �'rarra0 Record Drawings and Operating and Maintenance Manuals: 1. Construction documents with record drawings and operating and maintenance manuals provided to the owner. Lighting Designer or Contractor Name Signature Date Project Title:T-Mobile Highland Ave&Traders Way - Report date: 04/03/12 Data filename: M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 2 of 5 COMcheck Software Version 3.9.0 Mechanical Compliance Certificate 90.1 (2007) Standard Section 1: Project Information Project Type:Addition Project Title:T-Mobile Highland Ave&Traders Way Construction Site: Owner/Agent: Designer/Contractor: 2 Traders Way T-Mobile Tim Raberding Salem, MA 01970 12920 SE 38th St Design Forum Engineering 4th Floor 7575 Paragon Rd. Bellevue,WA 98006 Dayton,OH 45459 937-439-4400 Section 2: General Information Building Location(for weather data): Salem,Massachusetts Climate Zone: Sa Section 3: Mechanical Systems List Quantity System Type&Description 1 HVAC System 1 (Single Zone): Cooling: 1 each-Rooftop Package Unit,Capacity Unknown,Air-Cooled Condenser Section 4: Requirements Checklist Requirements Specific To: HVAC System 1 : ❑ 1. Equipment minimum efficiency: Rooftop Package Unit: 13.00 SEER ❑ 2. Hot gas bypass limited to 50%of total cooling capacity Fi 3. VAV fans with static pressure sensors are placed in a position such that the controller setpoint is no greater than one-third the total design fan static pressure.If placement results in the sensor being located downstream of major duct splits,multiple sensors are installed in each major branch. Exception(s): LJ Systems with DDC of individual zone boxes reporting to the central control panel and reset of static pressure setpoint based on the zone requiring the most pressure. Fl 4. Systems with DDC of individual zone boxes reporting to the central control panel has static pressure setpoint reset based on the zone requiring the most pressure. Generic Requirements: Must be met by all systems to which the requirement is applicable: 1. Hot water pipe insulation: 1 in.for pipes<=1.5 in.and 2 in.for pipes>1.5 in. Chilled water/refrigerant/brine pipe insulation: 1 in.for pipes<=1.5 in.and 1.5 in.for pipes>1.5 in. Steam pipe insulation: 1.5 in.for pipes<=1.5 in.and 3 in.for pipes >1.5 in. Excepfion(s): Piping within HVAC equipment. ❑ Fluid temperatures between 60 and 105°F. ❑ Fluid not heated or cooled. p Runouts<4 ft in length. I] Pipe unions in heating systems. 2. Load calculations per acceptable engineering standards and handbooks 3. Thermostatic controls have 5°F deadband Project Title:T-Mobile Highland Ave&Traders Way Report date:04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 3 of 5 Exception(s): ❑ Thermostats requiring manual changeover between heating and cooling ❑ Special occupancy or special applications where wide temperature ranges are not acceptable and are approved by the authority having jurisdiction. ' ❑ 4. Demand control ventilation(DCV)present for high design occupancy areas(>40 person/1000 ft2 in spaces>500 ft2)and served by systems with any one of 1)an air-side economizer,2)automatic modulating control of the outdoor air damper,or 3)a design outdoor airflow greater than 3000 cfm. Exception(s): ❑ Systems with heat recovery. ❑ Multiple-zone systems without DDC of individual zones communicating with a central control panel. ❑ Systems with a design outdoor airflow less than 1200 cfm. ❑ Spaces where the supply airflow rate minus any makeup or outgoing transfer air requirement is less than 1200 cfm. ❑ 5. Where separate thermostats are used for healing and cooling,acceptable measures are used to prevent simultaneous heating and cooling ❑ 6. Stair and elevator shaft vents are equipped with motorized dampers Exception(s): ❑ Ventilation systems serving unconditioned spaces. ❑ Gravity(non-motorized)dampers are acceptable in buildings less than three stories in height above grade. ❑ 7. Acceptable measures used to prevent simultaneous humidification and dehumidification Exception(s): ❑ Desiccant systems and systems for uses requiring specific humidity levels(approval required) ❑ 8. Automatic controls for freeze protection systems present ❑ 9. Duct,plenum,and piping insulation surfaces suitably protected from weather,moisture,or likely damage ❑ 10.Duct Sealing: a)Pressure sensitive tape used as the primary sealant is certified to comply with UL-181A or UL-181 B, b)longitudinal and transverse seams for ducts in unconditioned spaces, c)longitudinal and transverse seams and duct wall penetrations for ducts outside the building, d)transverse seams on buried ducts ❑ 11.Motorized,automatic shutoff dampers required on exhaust and outdoor air supply openings Exception(s): ❑ Gravity dampers acceptable in buildings<3 stories ❑ Gravity dampers acceptable in systems with outside or exhaust air flow rates less than 300 cfm where dampers are interlocked with fan ❑ 12.R-6 for supply air ducts located outside the building,in ventilated attics and in unvented attic above insulated ceiling R-1.9 for supply air ducts in unvented attic with roof insulation, R-3.5 for supply air ducts in unconditioned and underground spaces R-3.5 for return air ducts located outside the building,in ventilated attics and in unvented attic above insulated ceiling ❑ 13.Humidistat controls prevent reheating,recooling,and mixing of mechanically heated airwith mechanically cooled air Exception(s): ❑ Capability of first reducing supply air volume 50%or less of the design rate or minimum outdoor air ventilation,or per regulatory standard,whichever is larger,before combined heating/cooling occurs. ❑ Cooling capacity<80 kBtu/h and capability to unload cooling equipment. ❑ Cooling capacity<40 kBtu/h. ❑ Rigid humidity requirements. ❑ Site-recovered or site-solar energy sources or. ❑ Use of a desiccant systems. ❑ 14.Kitchen hoods>5,000 cfm provided with 50%makeup air that is uncooled and heated to no more than 60'F unless specifically exempted Exception(s): . ❑ Where hoods are used to exhaust ventilation air that would otherwise exfiltrate or be exhausted by other fan systems. ❑ Certified grease extractor hoods that require a face velocity no>60 fpm. ❑ 15.Buildings with fume hood systems having an exhaust rate>15,000 cfm has at least one of the following features: a)VAV hood exhaust and room supply systems capable of reducing exhaust and makeup air volume to 50%or less of design values. b)Direct makeup air supply equal to at least 75%of the exhaust rate,heated no warmer than 27 below room setpoint,cooled to no cooler than YF above room setpoint,no humidification added,and no simultaneous heating and cooling used for dehumidification control. c)Heat recovery systems to precondition makeup air from fume hood exhaust. ❑ 16.Exhaust air heat recovery included for systems 5,000 cfm or greater with more than 70%outside air fraction or specifically exempted. Exception(s): ❑ Laboratory fume hood systems with a total exhaust rate<=5000 cfm. Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 4 of 5 ❑ Systems serving spaces that are not cooled and heated to<60"F. ❑ Systems with more than 60%of the outdoor heating energy is provided from site-recovered or site solar energy. ❑ Systems exhausting toxic,Flammable,paint,or corrosive fumes or dust. ❑ Commercial kitchen hoods. _ ❑ Systems requiring dehumidification with cooling coil energy recovery in series with the cooling coil. ❑ Where the largest exhaust source is less than 75%of the design outdoor airflow. Section 5: Compliance Statement Compliance Statement: The proposed mechanical design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed mechanical systems have been designed to meet the 90.1 (2007) Standard requiremenem r ion 3.9.0 and to comply with the me story r q d ments in the Requirements Checklist. SSgC v\_ �� APB arrt2 Name-Title ""��,r .>);�_ o \�gRDING �a Signature Date Section 6n St on Compliance Statement s ❑ HVAC record dlawifigs°,b u9stallation and performance data for each equipment provided to the owner within 90 days after system acceptari0g,�"( � _......,,tea ❑ HVAC O&M documents�o�an mechanical equipment and system provided to the owner within 90 days after system acceptance. ❑ Written HVAC balancing report provided to the owner. The above post construction requirements have been completed. Principal Mechanical Designer-Name Signature Date Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename: MAT-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 5 of 5 COMcheck Software Version 3.9.0 Interior Lighting and Power Compliance Certificate 90.1 (2007) Standard Section 1: Project Information Project Type:Addition Project Title:T-Mobile Highland Ave&Traders Way Construction Site: Owner/Agent: Designer/Contractor: 2 Traders Way T-Mobile Tim Raberding Salem,MA 01970 12920 SE 38th St. Design Forum Engineering 4th Floor 7575 Paragon Rd. Bellevue,WA 98006 Dayton,OH 45459 937-439-4400 Section 2: Interior Lighting and Power Calculation A B C D Area Category Floor Area Allowed Allowed Watts (tt2) Watts/f:2 (B x C) SALES FLOOR(Retail:Sales Area) 927 1.7 1576 Allowance:Other retail highlighting/Fix. ID:T 465(a) 1 465(b) BACK OF HOUSE(Common Space Types:Offlce-Open Plan) 661 1.1 727 Supplemental Allowed Watts(c)= 326 Total Allowed Watts= 3094 (a)Area claimed must not exceed the illuminated area permitted for this allowance type. (b) Allowance is(B x C)or the actual wattage of the fixtures given in Section 2,whichever is less. (c) Supplemental watts must be associated with retail merchandise highlighting fixtures.Supplemental watts are not included calculation of lighting complaince percentage. (a) Additional controls/switching allowances are based on number of fixtures or wattage controlled,not floor area of allowance. Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp/Wattage Per Lamp I Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. SALES FLOOR(Retail.Sales Area 927 sq.ft.)- Track lighting 1:T:Wattage based on 87.0 feet of track 0-. 0 0 2610 Linear Fluorescent 2:24"T8 17W/Electronic 4 12 68 Exempt Exemption:Lighting Sales or Education BACK OF HOUSE_(Common Space Types�Office-Open Plan.661 Linear Fluorescent 2 copy 1 F4:2X4 FLUORESCENTS/48' T8 32W/Electronic 2 7 ... 64 448 Compact Fluorescent 1:EF-1:RR LIGHTING/Twin Tube 18W/Electronic 2 1 36 36 Total Proposed Watts= 3094 Section 4: Requirements Checklist Lighting Wattage: 1. Total proposed watts must be less than or equal to total allowed watts. - Allowed Watts Proposed Watts Complies 3094 3094 Passes using retail merchandise highlighting supplemental watts. 2. Exit signs 5 Watts or less per sign. Controls, Switching, and Wiring: Project Title:T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename:MAT-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 1 of 5 .53 3. Independent manual or occupancy sensing controls for each space(remote switch with indicator allowed for safety or security). 4. Occupant sensing control in class rooms,conference/meeting rooms,and employee lunch and break rooms. Exceptions: , ❑ Spaces with multi-scene control;.shop classrooms,laboratory classrooms,and preschool through 12th grade classrooms. 5. Automatic shutoff control for lighting in>5000 sq.ft buildings by time-of-day device,occupant sensor,or other automatic control. Exceptions: LJ 24 hour operation lighting;patient care areas;where auto shutoff would endanger safety or security. ❑ 6. Master switch at entry to hotel/motel guest room. 7. Separate control device for display/accent lighting,rase lighting,task lighting,nonvisual lighting,lighting for sale,and demonstration lighting. ❑ 8. Tandem wired one-lamp and three-lamp ballasted luminaires(No single-lamp ballasts). Exceptions: CJ Electronic high-frequency ballasts. Fi Luminaires not on same switch. FJ Recessed luminaires 10 ft.apart or surface/pendant not continuous. Luminaires on emergency circuits. Voltage Drop: 9. Feeder conductors have been designed for a maximum voltage drop of 2 percent. C] 10.Branch circuit conductors have been designed for a maximum voltage drop of 3 percent. Section 5: Compliance Statement Or r:fq Compliance State-gen't:��,T uy$�p Fi ing design represented in this document is consistent with the building plans,specifications and other calculationssuta d%tle,.,vVftJNlfiis f 'If application.The proposed lightin .system has been designed to meet the 90.1 (2007)Standard requirements in-COMcheF"eF5io�ip8.9. ��lo comply with the mandatory r quirem is n the Requirements Checklist. i _.p; '31CAL �o , 179 ."' APR 0 3 2012 Name-Title Signature Date eh'0,cF�-,L'-""i FN6 o�a Section 5: Po`W` 'I Ip ae�ctlon Compliance Statement Record Drawings and Operating and Maintenance Manuals: 1. Construction documents with record drawings and operating and maintenance manuals provided to the owner. Lighting Designer or Contractor Name Signature Date Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 2 of 5 COMcheck Software Version 3.9.0 Mechanical Compliance Certificate 90.1 (2007) Standard Section 1: Project Information Project Type:Addition Project Title:T-Mobile Highland Ave&Traders Way Construction Site: Owner/Agent: Designer/Contractor: 2 Traders Way T-Mobile Tim Raberding Salem,MA 01970 12920 SE 38th St Design Forum Engineering 4th Floor 7575 Paragon Rd. Bellevue,WA 98006 Dayton,OH 45459 937-439-4400 Section 2: General Information Building Location(for weather data): Salem,Massachusetts Climate Zone: Sa Section 3: Mechanical Systems List Quantity System Type&Description 1 HVAC System 1 (Single Zone) Cooling: 1 each-Rooftop Package Unit,Capacity Unknown,Air-Cooled Condenser Section 4: Requirements Checklist Requirements Specific To: HVAC System 1 : ❑ 1. Equipment minimum efficiency: Rooftop Package Unit: 13.00 SEER O 2. Hot gas bypass limited to 50%of total cooling capacity ❑ 3. VAV fans with static pressure sensors are placed in a position such that the controller setpoint is no greater than one-third the total design fan static pressure. If placement results in the sensor being located downstream of major duct splits,multiple sensors are installed in each major branch. Exception(s): Systems with DDC of individual zone boxes reporting to the central control panel and reset of static pressure setpoint based on the zone requiring the most pressure. 4. Systems with DDC of individual zone boxes reporting to the central control panel has static pressure setpoint reset based on the zone requiring the most pressure. Generic Requirements: Must be met by all systems to which the requirement is applicable: ❑ 1. Hot water pipe insulation: 1 in.for pipes<=1.5 in.and 2 in.for pipes>1.5 in. Chilled water/refrigerent/brine pipe insulation: 1 in.for pipes<=1.5 in.and 1.5 in.for pipes>1.5 in. Steam pipe insulation: 1.5 in.for pipes<=1.5 in.and 3 in.for pipes >1.5 in. Exception(s): Piping within HVAC equipment. p Fluid temperatures between 60 and 105°F. ❑ Fluid not heated or cooled. CJ Runouts<4 ft in length. ❑ Pipe unions in heating systems. ❑ 2. Load calculations per acceptable engineering standards and handbooks ❑ 3. Thermostatic controls have 5°F deadband Project Title:T-Mobile Highland Ave &Traders Way Report date: 04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 3 of 5 t Exception(s): ❑ Thermostats requiring manual changeover between heating and cooling ❑ Special occupancy or special applications where wide temperature ranges are not acceptable and are approved by the authority having jurisdiction. ' ❑ 4. Demand control ventilation(DCV)present for high design occupancy areas(>40 person/1000 ft2 in spaces>500 ft2)and served by systems with any one of 1)an air-side economizer,2)automatic modulating control of the outdoor air damper,or 3)a design outdoor airflow greater than 3000 cfm. Exception(s): ❑ Systems with heat recovery. ❑ Multiple-zone systems without DDC of individual zones communicating with a central control panel. ❑ Systems with a design outdoor airflow less than 1200 cfm. ❑ Spaces where the supply airflow rate minus any makeup or outgoing transfer air requirement is less than 1200 cfm. ❑ 5. Where separate thermostats are used for heating and cooling,acceptable measures are used to prevent simultaneous heating and cooling ❑ 6. Stair and elevator shaft vents are equipped with motorized dampers Exception(s): ❑ Ventilation systems serving unconditioned spaces. ❑ Gravity(non-motorized)dampers are acceptable in buildings less than three stories in height above grade. ❑ 7. Acceptable measures used to prevent simultaneous humidification and dehumidification Exception(s): ❑ Desiccant systems and systems for uses requiring specific humidity levels(approval required) ❑ 8. Automatic controls for freeze protection systems present ❑ 9. Duct,plenum,and piping insulation surfaces suitably protected from weather,moisture,or likely damage ❑ 10.Duct Sealing: a)Pressure sensitive tape used as the primary sealant is certified to comply with UL-181A or UL-181 B, b)longitudinal and transverse seams for ducts in unconditioned spaces, c)longitudinal and transverse seams and duct wall penetrations for ducts outside the building, d)transverse seams on buried ducts ❑ 11.Motorized,automatic shutoff dampers required on exhaust and outdoor air supply openings Exception(s): ❑ Gravity dampers acceptable in buildings<3 stories ❑ Gravity dampers acceptable in systems with outside or exhaust air flow rates less than 300 cfm where dampers are interlocked with fan ❑ 12.R-6 for supply air ducts located outside the building,in ventilated attics and in unvented attic above insulated ceiling R-1.9 for supply air ducts in unvented attic with roof insulation, R-3.5 for supply air ducts in unconditioned and underground spaces R-3.5 for return air ducts located outside the building,in ventilated attics and in unvented attic above insulated ceiling ❑ 13.Humidistat controls prevent reheating,recooling,and mixing of mechanically heated air with mechanically cooled air Exception(s): ❑ Capability of first reducing supply air volume 50%or less of the design rate or minimum outdoor air ventilation,or per regulatory standard,whichever is larger,before combined heating/cooling occurs. ❑ Cooling capacity<80 kBtu/h and capability to unload cooling equipment. ❑ Cooling capacity<40 kBtu/h. ❑ Rigid humidity requirements. ❑ Site-recovered or site-solar energy sources or. ❑ Use of a desiccant systems. ❑ 14.Kitchen hoods>5,000 cfm provided with 50%makeup air that is uncooled and heated to no more than 60°F unless specifically exempted Exception(s): ❑ Where hoods are used to exhaust ventilation air that would otherwise exfiltrate or be exhausted by other fan systems. (J Certified grease extractor hoods that require a face velocity no>60 fpm. ❑ 15.Buildings with fume hood systems having an exhaust rate>15,000 cfm has at least one of the following features: a)VAV hood exhaust and room supply systems capable of reducing exhaust and makeup air volume to 50%or less of design values. b)Direct makeup air supply equal to at least 75%of the exhaust rate,heated no warmer than 2°F below room setpoint,cooled to no cooler than 3°F above room setpoint,no humidification added,and no simultaneous heating and cooling used for dehumidification control. c)Heat recovery systems to precondition makeup air from fume hood exhaust. ❑ 16.Exhaust air heat recovery included for systems 5,000 cfm or greater with more than 70%outside air fraction or specifically exempted. Exception(s): ❑ Laboratory fume hood systems with a total exhaust rate<=5000 cfm. Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename: M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 4 of 5 ❑ Systems serving spaces that are not cooled and heated to<60°F. ❑ Systems with more than 60%of the outdoor heating energy is provided from site-recovered or site solar energy. ❑ Systems exhausting toxic,flammable,paint,or corrosive fumes or dust. ❑ Commercial kitchen hoods. ❑ Systems requiring dehumidification with cooling coil energy recovery in series with the cooling coil. I] Where the largest exhaust source is less than 75%of the design outdoor airflow. Section 5: Compliance Statement Ak Compliance Statement:��pTp,fFe? 'l chanical design represented in this document is consistent with the building plans,specifications and other calculations submftt yif� it application.The proposed mechanical systems have been designed to meet the 90.1 (2007) Standard require In a h 9.0 and to comply with t e mandat requirem � �l�ents in the Requirements Checklist. Name-Title Signatu a Date ma A ,�^r I�TE✓,`��4 Section 6: ,r'C: tion Compliance Statement D?wvs7v v a HVAC record drawings of the actual installation and performance data for each equipment provided to the owner within 90 days after system acceptance. ❑ HVAC O&M documents for all mechanical equipment and system provided to the owner within 90 days after system acceptance. ❑ Written HVAC balancing report provided to the owner. The above post construction requirements have been completed. i b 2�1� Principal Mechanical Designer-Name Signature Date Project Title: T-Mobile Highland Ave&Traders Way Report date: 04/03/12 Data filename:M:\T-MOBILE TPR 2011\5_Sites\Highland Ave&Traders Way-MA\05-CDs\_PME\HighlandComcheck.cck Page 5 of 5 To:'19787409846Q Page 1 of 1 2012-05-16 09:05:39 GMT-06:00 17604542385 From:Tasia Kallies FAX COVER SHEET TO '1 978 7409 846@ COMPANY FAX NUMBER 19787409846 FROM Tasia Kallies DATE 2012-05-16 09:00:01 GMT-06:00 RE T-Mobile-2 Traders Way COVER MESSAGE Hello Joyce- Please note that the General Contractor for T-Mobile project is Schimenti Construction 650 Danbury Road Ridgefield, CT. 06877 CONTACT:Jonathan Gombotz phone;203-044-9064 I will get you insurance and State license asap! Have a great day! Thank you! Tasia Kallies 9h Burnham Nationwide, Inc. <http://www.bumhamnationw!de.com/> 111 West Washington Street Suite 450 Chicago, IL 60602 > 312.260.7090 p > 312A07.7915f tkallies@bumhamnationwide.com<mailto:tkallies@burnhamnationwide.com> Facebook Us!<hffps:/AwAv.facebook.com/BumhamNafionwideiNC> I Tweet Us!<https://twifter.conl/#!/B urnhamChicago> WWW.E FAX.C 0M May. 24, 2012 9: 56AM No, 1811 P. 2 Page t of 1 Jonathan Gombotz From Tasia Kalli s [kalli c humhamnationwide noml Sent: Wednesday, May 16, 2012 11 31 AM To: Jonathan Gombotz Subject: T-Mobile-2 Traders Way; Plans approved for permit. Importance: High Follow Up Flag: Follow up Flag Status: Red Attachments: Salem workmanscomp affidavit.pdf;Salem debrisdispaffa.pdf Hi John, Building and Fire have approved plans for permit. Building Permit fee was paid at submittal (based on $30,000) Before Permit can be issued: Wda*ers Cocnp'lnsurance Affidavit(attached) Jti.v iitfficate,df>Liability(naming Ciy of Salem as cert holder) abris Disposal Form (attachedo Need this before you can go in to pickup permit. Electrician must pull his TRADE permit at 48 Layfette Street. Thank you! Tasia Kallies Burnham Nationwide, Inc. 111 West Washington Street •- Suite 450 Chicago, IL 60602 Ak— * 312.260.7090 p * 312.407.7915 f tkalliesPburnhamnationwide.com Facebook Us! Tweet Usl ;nv�m� May. 24. 2012 9:56AM No. 1811 P. 3 ' I I . :�rassachu.ctts- Dcp:u'tmcnt of Public S:d'cn Board aY Building R .Jervis an.and tit:uuhu'd� Construction Supervisor License license: Cs 93492 ROBERT G MCCIOUGAL 1639 WILSON ST 9ALIDWIN,NY 11510 Expiration: 5115/2013 Cennniglnn¢r Tr#! 14507 May. 24. 2012 9: 56AM No. 1811 P. 4 CITY OF S.UEN4 NIASSACHL'SETTS • BuMI ,NGDEPARTbEIEVT m T EL (978)745.9595 FAX(979)746-0846 KItiiBER1F-Y DRISCOU MAYOR Tko61As ST.Pmm DIRKTOiL OF PUBLIC P&0PE&TV/BL'IIDVG CON1361ISSIONFIL Workers' Compensation Insurance Affidavit: B4diders/Contractora/ElectricianslPlumbers Applicant Information Ple ose Print eMpilt ' dame IBusim'w%Draanixaripvindivtdaaq: �✓�t+m�!�( Wn 7r✓u Gr7a rl_ •(ylyf!�a y y Ll—� Address:�S City/State/Zip: �i� i lei Ct 66S -7 PhonoN; M9 ,-) — v2iy-• Qloo Are you an employer?Check the appropriate hQV Type or project(required): 1.❑ I um a employer with 4. Mot a general contractor and 1 6• []New constmedim employees(full andtor part-time)-* have hired the sub—contractors ,,-,,[ 2.❑I am a role proprietor or partner- listed on the attached sheer,I 7• Uj rtamodeling ship and have no employees These sub•contractots have S. L]Demolition working forme in any capacity. workers'comp.Insurance. 9• ❑Building addition [No workers comp.insurance 1 ❑ We are a corporation and its 10❑Electrical repairs or additions required.] officers have exercised thew 3.0 1 am a homeowner doing all work right of exemption per MGL I I Plumbing repairs or additions myself[No workers'comp, c. 152,§1(4),and we have no 12.0 Rnof repairs insurance required.)t employees,[No workers' 13.❑Other Comp.insurance requira i.] 'Any al0cal that chucks bac#I mwtdw fill out rho wa{m Wow showingtheir a,kca,' oe c&ti t,,policy ibmi,l mloa 'I htmeowmr who submit thin atfiehvn indicating stay sro dalaa as work and than him otenide eaneeaeeoer must submit a new alydavit Hdirari„a sash. lCommnota Am eh. kthis box musearfhedan additimad cMaeshawlna theavmeaa,e aubwyntraaeo,sm,dth.h wothan'remp.pvlisy infomulim. I am an employer that is providing workers'compensation insarancrjor my employeaa Below In the po!!ey and Job site lnjermarloa f� Insurance Company*lame 2 ✓� l��� P 't Policy H or SclFiro.Lie. Te 2.3 —,,,, /� Q2 q�/et Z 1 7—% v Plratian Dok: fP o2 v20 ' Job Site Addfos#: c2 rz dews vVQ Ci[y/StaWZip: 5a- Attach a Copy aI the workers'compemation poll declaration gaga(showing the policy number and ehpiratlon date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition ofcriminal penalties ofa fine up to S 1,500.0o and/or one•year imprisonment,as well an civil penalties in the form of a STOP WORK ORDER and a Eta of up to$230.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invcstigarions of the DIA For insurance coverage verification. [do hereby certify, nder t pales mid perraliles ajperjuty that rhr injannullon provided ab re is true and correct I ' ,_,Date: 5, . I V I I1L., ,....� PhonaN. ON)- a2 y5 — 9l� _ OJrcial use only. Do not write in this arm robe completed by city or Iowa official. City or Town: _ Permlt/l,icenge# Issuing Authority(circle one): L Baard of Health 2.Building Department 3.City/rown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other CautactPerson: _ Phone#: [ 1 . May. 24, 2012 9: 56AM N0. 1.811 P. 5 n ® I A6 Z CERTIFICATE OF LIABILITY INSURANCE 5�ieI2012" THIS CERTIFICATE 13 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 N i N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION 15 WAIVED,subject to the terms and Conditions of the polity,certain policies may require an endorsement- A statement on this certificate does not confer rights to the certificate holder in lieu of such endomemen s. PRODUCER CONTACT Kasten-Brown Insurance, LLC PRONE ' (203)336-6302 FAI I203)36B-1940 277 Fairfield Ave. , 3rd FloorADDRESS, PROOUCER Bridgeport CT 06604 INSUREIRM AFFORDING COVERAGE NAICe INSURED INSURERA:Travelers P6C CDmbTanv of 5674 SChimenti Construction Company, LLC INSURER s:TrELV01E a P&C COMPanY eP 25674 650 Danbury Road I RERc RLI Insurance Company 13056 13056 Ridgefield, CT 06677 INSURER D.Charter Oak Fire Insurance Co 5615 (914) 244-9100 DN RERE:Travelere Indemnit Co of w 25666 INE BERF: COVERAGES CERTWICATENUMBEM/29/11-12 Master Renewal 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 ISE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 15 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDU CED BY PAID CLAIMS, INSR TYPE OF INSURANCE AODI - LTR PO4CYNUMBER LIMITS GENERAL UABIUTY TC2J-CO-e205A27-7-1117WS HOCCURRENCE b 1,000i 000 Xt COMMERCIAL GENERAL LIABILITY EBEMISEG MA T .P=rO m b 300,000 'A CLAIMS-MADE ®OCCUR D EXPU aIM ereoR b $ 000 _ RSONAL S AO/INJURY F 1,000,000 NERAL AGGREGATE 5 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER'. PRODUCTS AGO b 2,000,600 POLICY X[ PRO LOG S AUYOMOBILF LIABILITY , VTJ-CAP-8205A30-B-11 06/29/201136/29/2012 COMBINED SINGLE LIMIT S 1 000 000 (Ea acd"MtI , , X ANY AUTO BODILY INJURY(P<r person) 7 ' B ALL OVMED AUTOS BOhILY INJURY(Per BCCI�II[) S ' SO11wuLEOAUTOS PROPERTY DAMAGE X HIRED AUTOS (Pereccidam) 6 X NON.O MED AUTOS i UMBRPILA LU1a X OCCUfl 0261311 09/29/201106/25/2012 EACH OCCURRENCE 5 10,DDD,DOD a• E%CESS LVAB CtAIMSWADE AGGREGATE S 10,000,000 DHDUCTII s C RETENTION S b D WORKERS COMPENSATION !r0-OB-9205A29-0-11 36/29/2011 06/29/2012 X WC TATU- 0 H- AND EMPLOYERS'UABILRY ANY PROPRIETORIPARTNEFJ % WTIVE YIN (NT, MA 6 NJ) EL:EACH ACCIDENT S 1.000.000 OFFICER'MSMS99 EXCUOEDi NIA twyir&tmry in NIn C2a-O6-e205A2e-9-11 O6/29/2011 6/29/2012 E.L.OISEASE-EA EMPLOYE S 11000,000 OESCRIP ON OF OPERATIONS bales+ TNS=R:E/OTHER STATES E.L.015EASE-POLICY LIMIT $ 1 000 000 B Contractors Leased/Rented T-660-222D4267-TIL-11 O6/29/201106/29/2012 $150,000 Per Item Limit/ Equipment (FIRST P8AA8 LIFE TNH, x Total-$250,000,$1,000 Ded OESCRIPBON OF OPERA TONS(LOCATIONS I VEHICLES IAeach ACORD 101,AWRlanal Remaaw Sehemlo,0 mgr:space H rmquimd) RE: Job #12030,' T-Mobile, 2 Trachea Way., Salem, He 01970. 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, Building Department 120 Washington Street, 3rd Flr AUTHORIZED REFRESeNTATIVE Salem, MA 10970 ../ Robert Resten/JPPC -�-- ACORD 26(20c9/09) - - (D1989-2009 ACORD CORPORATION. All rights reserved. INS025 p4o9o9) The ACORD name and logo are registered marks of ACORD ichimenti Construction Date: May 18, 2012 . i50 Danbury Road ti 2idgefield, CT 06877 914)244-91GO , lob#: 12-030 - - 'roject Name: T-Mobile, Store#2351 Submitted By: Marina Ekholm Hz:: )roject Address: 2 Traders Way, Salem MA Telephone: 914 244-9100 Ext 317 E-mail: mekholm(iDschimenti.com Subcontractors Name&Address State Certificate of Compliance Federal lD Contract Labor Material Misc. 'rofessional Fire Systems, Inc. n/a 06-1761570 3,600.00 1,900.00 1,700.00 200 Stonewall Blvd., Suite 2A, Wrentham MA loor Works, Inc. n/a 04-3229185 4,520.00 4,020.00 500.00 535 John Hancock Road, Taunton MA Vood Commercial Painting, Inc. n/a 04-2938722 2,250.00 1.735.00 515.00 258 Willa rdStreet 0uin cy MA :astern Services Electrical Contractors, LLC 26-1081034 18,105.00 14.000.00 1,200.00 2,905.00 40 Lowell Road, Lfn t 1, Salem NH :El Boston, LLC 04-3542295 18,000.00 18,000.00 15 Shire Drive, Norfolk MA n/a )ucharme Construction Management, LLC 20-5209378 11,660.00 11.660.00 18 Bloomingdale Drive, Nashua NH MD HVAC, Inc 45-2701283 8,000.00 8,000.00 25 Brown Ridge Road, Weare NH clue Hill Pluntbin 04-3086080 11,000.00 11,000.00 John Dietsh Blvd., Unit 8, North Attleboro MA n/a P Network, d/b/a Seco unty Source 20-2560380 2284.48 985.00 224.48 375.00 187 Ballardvale St, Suite A225, Wilmington MA n/a z Total 79,419.48 71,3Q0.00 4,839.48 3,280.00 May. 24. 2012 9: 56NM No, 1811 P, 1 '' CERTIFICATE OF LIABILITY INSURANCE s/1a/aQ12 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 REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder IS an ADDITIONAL INSURED,the polley(les)must be endorsed. If SUBROGATIDN IS WANED,subject to the terms and condltlons of the policy,certaln 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 NAME Beaten-Drown Insurance, LLC PHONE Be, (203)336-6302 FAX Na:IRU])366-1960 277 Fairfield Ave., 3rd Floor MAIL ADDRESS: PRODUCER Bridgeport CT 06604 INSURE 5 AFFORDING COVERAGE MAICR INSURED N OITERaTravelers PeC Comvanv of 25674 Schimenti Construction Company, LLC INSURERe:Travelera P6:C Company of 25674 650 Danbury Road msURERC;RLI Insuranca Company 13056 Ridgefield, CT 06877 INSUReaD:Charter Oak Fire Insurance Co 25615 (914) 244-9100 INSURERE:TraV'elerEl zndemnit Cc of 25666 NSURERF: COVERAGES CERTIFICATE NUMBERA/29/11-12 master Renewal 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. TYPE OFINSURANCE POLICYEPF POLICYE INSR WVD POLICY NUMBER MIDD M D LIMITS GENERAL LIABILITY C29-CO-B30$A27-7-11 06/29/201106/39/2012 EACH OCCURRENCE S 11000,000 X COMMERCIAL GENERAL LIABIUTY 17TE �ccu�cflco) $ 300,000 A CWMS-MADE ®OOLUR MM UP Anyone anon 5,000 PERSONAL&ADV INJURY $ 11000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLES PER: PRODUCTS AGO 5 21000,000 POLICY X PRO- L. S AUTO MOBILE LIABILITY TS-CAP-0205A30-8-11 061291201106/29/2012 COM21NED$INGLE LIMIT S 1,000,000 JX ANY AUTO (Ea awlden0BODILY INJURY(Pereerzon) $ ALL OWNED AUTOSBODILY INJURY(Peraccidem) $ SCHEDULEDAUTOS (PeramPROPE ent) GE HIRED AUTOS (PerecaWanO $ NON-OWNED AUTOS $ E UMBRELLA LIAR X OCCUR L0261311 06/29/2011 O6/29/2012 EACH OCCURRENCE 10,000,0Q0 x CX0¢$S LIAR CLAIMS-MADE AGGREGATE S 10,000.000 DEDUCTIBLE $ C RETENTION 9 $ D WORKERS COMPENSATION RO-OB-0205A29-0-11 06/29/2011 06/29/2012 WC TA OTM AND EMPLOYERS'LIABILITY YIN r XPR ANY PROPRIETOWPARTNEREXECUTIVE fNY, NA G Nil OFFICEAIMEMBE NIA E.L EACH ACCACCIDENT $ 11000,000 R E%CLVDED? (Mandatary In NH) TC2H-09-11205A28-9.11 06/29/201106/29/2012 E.L DISEASE-EA EMPLOY $ 1,000,000 Ifyye6 d 5miceunev DESCPROM OF OPERATIONS belay, RSORER,E/OTHER STATES E.L.DISEASE-POLICY LIMIT $ 11000,000 B Contractors Leased/Rented IT•660-222D4267-T"-11 06129/201106/29/2012 $150,000 9er Item Limit/ Equipment (FIRST REHAB LIFE INS, ax TOta1=S2S0,000,$1,000 Dad DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remante Schedule,If Mom e0ece le mQullod) REr T010 #12030, T-Mobile, 2 Traders Way, Salem, NA 01970, 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. Building Department 120 Washington Street, 3rd Flr AUTHORIZED REPRESENTATIVE Salem, MA 10970 Robert Rasten/,TFF � 1 Gam---— ACORD 25(2009109) ®1988-2009 ACORD CORPORATION. All rights reserved. INS025(20C90e) The ACORD name and logo are registered marks of ACORD May. 24, 2012 9: 57AM No. 181.1 P. 9 CITY OF SALEM. Uxssm-iusETTS BUKDLNG DEPARLMENT 120 WASH,IPIGTON STREET,3w Ft.00x TEL (978)745-9595 FAx(978) 740-9846 1tl.-agERLEY DRISCOU MAYOR THoNus ST.PrEaae DIRECTOR OF PUBLIC PROPERTYIBLIID,NG CONWISSI02IER Construction Debris Disposal Affidavit (required for all demolition and renovation work) In accordance with the sixth edition of the State Building Code,780 CMR section 111.5 Debris, and the provisions of MGL c 40,S 54; Building Permit# �I III is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c 111, S I50A. The debris will be transported by; D\/".j- xc W sr£ Sysrc.av S rn C_ (name of hauler) The debris will be disposed of in : ul�, .mod ylLn (name of facility) 7 /L S-Ta—i >er, (Zb)e"x, 7 104, (address of facility) s' shoe of permit plicant a CC Z- date Jenri>s0'.d�u: J The Commonwealth of Massachusetts ' I I Board`of Building Regulations and Standards CITY Massachusetts State Building Code,780 CMR,7a'edition OF SALEM Revised January Building Permit Application To Construct,Repair,Renovate Or Demolish a 1, 2008 One-or Two-Family�Dwelling BtfiltlinglenhittNufnber. r P) d. , $ignature Bmldtlig anhisstoperl(aapCctoi4 u - y _ 1 SE t �5 t Qglµ �.�$.Tl4 . ss 2N^ 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers Lla Is this an accepted street?yes_ no Map Number Parcel Number 1.3,Zoning Information: 1.4 Pra.serty Dimensions: Zoning Distriet, Proposed Use 'Lot AArea(sq ft) - Frontage(11) w - 1.5'Building Setbacks(ft) Front Yard - Side 1 xds Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Informatieji: 1.8 Sewage Disposal System: Public❑ Private O Zone: Outside Flood Zone? Municipal 0 On site disposal system ❑ Check if yes[ " 2.1 Owue fp f Record: ! ` f/i•SG/1 . /� /�olooy/lO Name(Print) Address for Service: Signature Telephone 9ECICOI!r3 DEI RIPITF? IYIEQSLp �1Y(Check-all.fhataP.PIY) -. - New Construction q 1,existing Building O Owner-Occupied ❑ Repairs(s) ❑ 1 Altemtio(s) ❑ Addition ❑ Demolition 13 I Accessory Bldg. ❑ Number of Units Other 17 Specify: Brief Description of Proposed.Work': v I 9 f ° r SECTION 4:ESTIMA1kp GOlYS;1RU1 TION;,COSTS Item Voyo , Estimated.Costs 0lfieia4aUse only ( Labor and Materials 1:Building $ / 1'? In H19 PennttFee $- In ucYate how fee is detemnined: t3 St2:idard City/,Tgwn Ap)Sltcatton Fee 2.Electrical �� Q FotA1l offer Cgs43, tem 6)is mulhPher x 3.Plumbing., 5 :r I 4.Mechanical�(HV31 •) $ t6t a t, 5.Mechanical (F.' $ Suppression) ofal A'll�ees' lrecic�To Check Amount Cash Amount: 6.Total Prolect?!t�st: �/ �/ p Batd in,Pu11_� ,0 0utstanding,Balance Due: 1 5.1 Licensed Construction Supervisor(CSL) M i , ' L \ �� License Number Expiration Date' r \1 Name of CSL-Holder List CSL Type(see below) (/ Address R l - ~ U Unrestricted in,to 35,000 Cu.Ft. R Restricted 1&2 Fnmilv Dwelling Signature M Maso Only ( R Covering C Residential Roofin Cov e M �J 7i ' ntial Window and Sidin Telephone F Reside SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Re istere I H el provement Contract� IC) �D { �_ `. Registration Number HIC CoCm-nan�jName orC Reg tt(trtt nt ne —7 / Address n �— f - G Expiration Date Sign to ` / Telephone SECTIHE 1S2.§ 25C(6)) Workers Comion. Failure to provide this affidavit al of the Issuance of the building permit. Signed Affidavit Attached? Yes ... No ❑ 5,ECTION 7a.(S�vddER ACITHORIA!�QN BE( 1111) 7s WHL N OWI!FER'S,AGENT.OR CQNTRACTORAFF S OR B3TI>TT1VCf PERM)i, .' 1 as Owner of the subject properly hereby th to act on my behalf,in all matters an orize relative to work authorized by this buildin permit application. (� 0 — SI lure of Owner Date . SEC'FI(3•Nr7Yt,O�S'TJERt,.�It`�, 4 - . 1)3kCX�1VT D�CLARA'FYON, ' ' as Owner or Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Print Name I-- LA l � �, Signature of Owner or Authorize/ d Agent Date - Si ned under the atns and enalttes of r'u ,,: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(IIIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations 110.R6 and 110.R5,respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq.Ft.) (incYuding garage,finished basement/attics,decks or porch) Gross living area(Sq.Ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"maybe substituted for"Total Project Cost"