23-25 WARD ST - BUILDING INSPECTION (2) The Commonwealth of Massachusetts
Department of Public Safety ZI 3 'Z-.g
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: jDate Applied: Building Official: -
SECTION 1:LOCATION(Please indicate Block A and Lot it for locations for which a street address is not available)
23-25 Ward Street Salem,MA 01970
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2 PROPOSED WORK
Edition of MA State Code used_ If New Construction check here or check all that apply in the two rows below
Existing Building YES lRepair YES jAlteration YES lAddition NO Demolition (Please fill out and submit Appendix 1)NONE
Change of Use NO lChangeofoccupancy NO Other Specify:
Are building plans and/or construction documents being supplied as pan of[his permit application? Yes
Is an Independent Structural Engincenng Peer Review required? No
Brief Description of Proposed Work: Work includes Selective Scope and upgrades to various kitchen cabinets and countertops, new appliances in various units,upgrades
to flooring in various bathroom and kitchens,upgrades to various plumbing fixtures in bathrooms,new roofing membrane on all buildings,window replacement,
masonry restoration,upgrades to life safety(Fire Alarm),installation of various new light fixtures,repairs and upgrades to various exterior balconies.
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if a Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34)
Existing Use Group(s): RESIDENTIAL(R-2) Proposed Use Group(s):RESIDENTIAL(R-2)
SECTION 4:BUILDING HEIGHT AND AREA
Existing Pro osed elf
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 4 1 1442 SF No Changes to storlcor Ar
Total Area(sq.ft.)and Total Height(ft.) 5768 SF 1 37'+/- 1 No Change to total area or h ' hb
SECTION 5:USE GROUP Check as applicable) "" p -
A:Assembly A-1 A-2 Nightclub A-3 A-4 A-5 B: Business E:Educational t*1
F: Factory F-1 F2 H: High Hazard H-1 H-2 H-3 H-4 H-5 r<
1: Institutional 1-1I-2 I-3 I-4 M: Mercantile R: Residential R-2 Sa
S:Storage S-1 5-2 1 u Utility ISpecial Use and please describe below: ;0
Special Use: _
SECTION 6:CONSTRUCTION TYPE Check as a Bcable - ••
IA IB IIA IIB IBA IIIB IV VA VB co in
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply:Public Flood Zone Information: Sewage Disposal: Trench Permit. Debris Removal:
Outside Flood Zone Municipal Trench permit pi lied by Licensed Disposal Site
sitework contractor
Railroad righbof-way: Hazards to Au Navigation: MA Historic Commission Review Process:
Not Applicable Is Structure within airport approach area? Is their review completed?
No Not Required
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code:8th Edition 780 CMR Use Group(s): R-2 Type of Construction:III B Occupant Load per Floor: 7
Does the building contain a Sprinkler System?:NO Special Stipulations:NO
SECTION 9. PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner SALEM POINT II LIMITED PARTNERSHIP
No.and Street 102 Lafayette Street City/Town Salem,MA Zip 01970
Property Owner Contact Information: North Shore Community Development Coalition Contact:Mickey Northcutt,CEO
Telephone No.(business) (978)745-8071 e-mail address mickey®northshorecdc.org
If applicable,the property owner hereby authorizes NEI General Contracting
Street Address 27 Patella Park Drive City/Town Randolph,MA 02368
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION S0:CONSTRUCTIONCONTROL(Please fill out Appendix 2)
(If building is less than 35,000 ca.ft.of enclosed space and/or not under Construction Control Oren check here and skip Section 10.1)
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Cliff Boehmer,Davis Square Architects - Registration Number 10697
Telephone No.617-764-3700 e-mail address cboehmer®davissquarearchitects.com Discipline Architectural
Street Address 240A Elm Street City/Town Somerville State MA Zip 02144 Expiration Date OW14
10.2 General Contractor
Company Name NEI General Contracting
Name of Person Responsible for Construction Douglas Grant Barnum,Superintendent License No.and Type CS-069714
Street Address 27 Pacella Park Drive City/Town Randolph State MA Zip 02368
781-885-3792 781-6644811 gbmnum®neigc.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
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor and Total Construction Cost(from Item 6)-
Materials) $11 per$1,000 of Construction Cost for each building as per the attached breakdown
1.Building $305,116.57 305,116.57/1000=$3,356.29
2.Electrical $ BY OTHERS Enclose check payable to City of Salem
3.Plumbing $ BY OTHERS (contact municipality)and write check number here 26339
4.Mechanical(HVAC) $ BY OTHERS
5.Mechanical(Other) $ BY OTHERS
6.Total Cost $305,11657
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.
Name:Alyson B.Therrien,Project Manager NEI General Contracting Tele No. 781-885-3792(office);617-640-7453(cell)
Street Address 27 Pacella Park Drive Randolph,MA 02368
Signature " I " -IE? 2 e(IX(.� Date: 6/10/14
' / Municipal Inspector to fill out this section upon application approval:
Name Date
S
Initial Construction Control Document
To be submitted with the building permit application by a
d Registered Design Professional
for work per the 8u'edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Salem Point Apartments Date:05/02/14
Property Address: 17-19, 23-25,41-43, 45-49, and 52 Ward Street,20-22, 38, and 46 Peabody Street,
57-59, 64, and 64 %Harbor Street, Salem Ma
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Renovations to existing residential buildings.
I Clifford J. Boehmer MA Registration Number: 10697 Expiration date: 08/14 , am a registered design professional, and
I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
X Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2: Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'.
pEDq
Enter in the space to the right a"wet"or
electronic signature and seal: Qo EBB
697 s;
s IDLE. �0 ►
so MA �W ►
Phone number: 617-764-3700 Email: cboehmer@davissquarearchitects.com
1
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
W To be submitted with the building permit application by a
Registered Design Professional
€ for work per the 8`s edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: Salem Point Apartments Date: May 2.2014
Property Address: Salem MA
Project: Check(x) one or both as applicable: [ ]New construction [x] Existing Construction
Project description: Renovations to existing residential buildings
I Mark F. Rattenburv, MA Registration Number: 42757 Expiration date: June 30, 2014, am a registered design
professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly
supervised the preparation of all design plans,computations and specifications concerning':
[ ]Entire Project [ ] Architectural [ ] Structural [ ]Mechanical
[ ]Fire Protection [x] Electrical [ ] Other:
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I (or my designee) shall perform the necessary professional services in accordance with the
Professional Standard of Care,and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents. Such review shall not diminish or
relieve the Contractor of its submittal and other responsibilities.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code. The Contractor shall be responsible for performing the work in accordance
with the contract documents and shall be exclusively responsible for its construction means, methods, sequences
and procedures,and for construction safety.
4. The performance of the services shall not require any special testing or inspections unless specifically stated in the
Code.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'.
p1 OF fy
Enter in the space to the right a"wet"or opj ASSy
electronic signature and seal:
MARK F. Ntr
g RATTENSURY
OO NO.42757
ELECTRICAL N
Phone number: 6-4144 A A
Email: mrattenbury@ury@wbaengineers.com '0�ao FCtsTER�o
�' FIDAA E. BARBAR
NOTARY PUBLIC
colsroxwentntoFsErts
_. . rM comet Expires Oct z�,zan
Building Official Use Only
Building Official Name: Permit No.: Date:
JA13084 Salem PointVSfidavitsVnitial Constr Ctrl Elec 5-2-14.doe
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8u'edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: Salem Point Apartments Date: May 2,2014
Property Address: Salem,MA
Project: Check(x) one or both as applicable: [ ]New construction [x] Existing Construction
Project description: Renovations to existing residential buildings
I Zbigniew M. Woznya MA Registration Number: 34029 Expiration date: June 30, 2014, am a registered design
professional, and hereby certify, to the best of my knowledge, information and belief, that I have prepared or directly
supervised the preparation of all design plans,computations and specifications concerning':
[ ] Entire Project [ ] Architectural [ ] Structural [x]Mechanical
[ ]Fire Protection [ ] Electrical [x] Other: Plumbing
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I (or my designee) shall perform the necessary professional services in accordance with the
Professional Standard of Care, and be present on the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents. Such review shall not diminish or
relieve the Contractor of its submittal and other responsibilities.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code. The Contractor shall be responsible for performing the work in accordance
with the contract documents and shall be exclusively responsible for its construction means, methods, sequences
and procedures,and for construction safety.
4. The performance of the services shall not require any special testing or inspections unless specifically stated in the
Code.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
'CH OF Aq�
Enter in the space to the right a"wet"or �'� �'y
o ZBIGNIEW
electronic signature and seal: � M. G`^m
Cl) WOZNY H
MECHANICAL
No.94029 ka
ARPhone number: 781-826-4144 ICEmail: zwozny@wbaengineers.com
Building Official Use Only
Building Official Name: Permit No.: Date:
JAI3084 Salem PointWfridavitsVaidal Constr Ctrl M-P 5-2-14.doe
I
The Commonwealth of Massachusetts
Department oflndustrialAccidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
N8I110 (Business/Organization/Individual):
NEI General Contracting
Address:27 Pacella Park Drive
City/State/Zip: Randolph MA 02368 Phone #:781-885-3792
Are you an employer? Check the appropriate box: Type of project(required):
L❑ I am a employer with 4. ❑■ I am a general contractor and I
employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietoror partner- 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'
[No workers' comp. insurance comp. insurance.:
9. Building addition
required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'My applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:Twin City Fire Insurance
Policy#or Self-ins. Lic. #:02WEQT9365 Expiration Date:3/5/2015
Job Site Address: Ward, Peabody, and Harbor Streets City/State/Zip:Salem, MA
Attach 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 MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/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 of the DIA for insurance coverage verification.
I do hereby cer ify under the ins nd penalties ofperjury that the information provided above is true and correct.
Si afore: te:
6/10/14
Phone#: 781- 853792
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6. Other
Contact Person: Phone#: