Loading...
1 DOVE AVENUE - BUILDING JACKET A` DOVE AVENUE 552-14 `#:4 . = 1527 COMMONWEALTH OF MASSACHUSETTS r:1ap: 24 CITY OF SALEM ;Lot: 0216 u, tegory: RENOVATIONS '_ . IPertxut# 552.14 BUILDING PERMIT :Project# JS-2014-001200 Est Cost. $26,800.00 !Fee Charged:�' $187.60 - r° a :Balance Due: 1$ 00 PERMISSION IS HEREBY GRANTED TO: iConst Class: _ Contractor: License: Expires: Use Group: v Parris&Associates Inc./Robert A. Parris Gen.Con tiaetoi/Code I G -40567 ,Lot Slze(sq. ft) 230868 Owner: SPAULDING HOSPITAL NORTH SHORE -7:-iun . ° i .k� t :. UrolO alned:', j" jApplicantk Parris&Associates Inc./Robert A.Parris r. inits st u t _ _SAT: 1 DOVE AVENUE [ o ),< Sale# _ �— ' SSG'ED ON.- 23-Jan-2014 AMENDED ON: EXPIRES ON: 23-Jul-2014 TO PERFORM THE FOLLOWING WORK: MINOR RENOVATIONS TO 2ND FL CONFERENCE ROOM INVOLVING SELECTIVE: DEMOLITION. (SEE DRAWINGS FOR DETAILS) POST THIS CARD SO IT IS VISIBLE FROM THE STREET _ Electric Gas Plumbing Builclin2 Underground: Underground: Undemoand: Excavation: Service: / Meter: Footings: Rough: /s/�(/j ,g/(7�/pJ�0�yp/ Rough: Rough: Foundation: Final: /t'� /�//4 UJ/�/[ Final: Final: linugh Frame: M •�J�d�]/t. Fireplace/Chimo11e1___-:���+++ O.P.W'. Fire Health ,2 Insulation: °4Uer: Oil: I,, ., Final: tliiuse4 Smoke: i .� Treaso": Water: Alarm: Assessor Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLA N OF ANY OF ITS RULES AND REGULATIONS. _ Signature: Fee Type: Receipt No: DateI-aid: Check,No: Amount: BUILDING REC-2014-001209 23-.fan-14 1629 $187.60 IMPORTANT:OWNER OR CONTRACTOR MUST ' ARRANGE FOR PERIODIC INSPECTIONS DURING GcnTMSOO 2014 Des Lauriers Municipal Sohrtions,Inc. CONSTRUCTION.SEE CURRENT BUILDING CODE CHAPTER 1 FOR LIST OF REQUIRED INSPECTIONS. ` CALL 978-619-5641 TO SCHEDULE AN INSPECTION Jendry, Edward L. From: Jendry, Edward L. Sent: Friday, July 01, 2016 11:38 AM To: 'Thomas St. Pierre' Cc: Bisegna, Shelly C. Subject: Existing Spaulding stairwell handrails and guardrails Tom: As per our last telephone conversation I have reviewed all of the applicable code provisions in the International Existing Building Code, (IEBC) - 2009 edition with Massachusetts amendments that pertain to the issue of the existing Spaulding stairwell handrails and guardrails that are not scheduled to be renovated. A brief synopsis of my code review of this issue is as follows: 1. In terms of the 3 different code evaluation methods allowed by this code I believe that Chapter 8 Alterations— level 3 is the appropriate one to use in this case for the proposed Spaulding renovations . The Prescriptive Compliance Method in Chapter 3 as well as the Performance Compliance Method in Chapter 13 do not work well with a project with the proposed extensive renovations with a 1-2 use. 2. Chapter 8 Alterations- Level 3 is for renovation projects that involve over 50%of the aggregate building area. This applies to the proposed Spaulding renovations. 3. When Chapter 8 Alterations - Level 3 is used it also requires compliance with Chapter 6 Alterations—Level 1 and Chapter 7 Alterations—Level 2. 4. The key language in this case is in Chapter 7. Specifically paragraph 705.9 Handrails. This paragraph reads as follows: "705.9 Handrails. The requirements of Sections 705.9.1 and 705.9.2 shall apply to handrails from the work area floor to, and including, the level of discharge. 705.9.1 Minimum requirement. Every required exit stairway that is part of the means of egress for any work area and that has three or more risers and is not provided with at least one handrail , or in which the existing handrails are judged to be in danger of collapsing, shall be provided with handrails for the full length of the run of steps on at least one side. All exit stairways with a required egress width of more than 66 inches shall have handrails on both sides. 705.9.2 Design. Handrails required in accordance with Section 705.9.1 shall be designed and installed in accordance with the provisions of the International Building Code." 5. The key word in the first sentence of paragraph 705.9.1 is "not". Basically, since the Spaulding stairs do have handrails and since they are not in any danger of collapsing 1 then no further work to replace the existing handrails is required under the code and the existing handrails can remain because the existing stairwells are scheduled to remain. 6. The same language in paragraph 705.10.1 for Guards has the same key word of"Not'. Therefore, my analysis of the stairway guardrail issue is the same as the handrail issue, that being that the existing stairwell guardrails can remain as is and do not have to be replaced to conform to the current IBC building code with Massachusetts amendments. In conclusion my interpretation of the (IEBC—2009) code is that I feel that the existing handrails and guardrails can remain in the existing stairwells and do not have to be replaced. After you have had time to review this issue please let me know if you concur with my analysis. Regards, Ed 2 Commonwealth of Massachusetts City of Sale 120 Washington St, 3rd Floor Salem, MAO 1970 (978) 745-9595 x5641 # CERTIFICATE OF OCCUPANCY Per mit,Number: B-2014-0573 Map/Lot#:' 240216O.s < <{-;. Date: 3/4/2014 THIS DOCUMENT NOT VALID UNLESS SIGNED BY�THE BUILDING OFFICIAL CERTIFICATE OF OCCUPANCY I This certificate of occupancy is issued to- �'��W�144 u•5 LrwLLl.5for the work authorized under permit # 8- 2014-0573 for RENOVATIONS at 1 DOVE AVENUE. This work has been inspected and found to be substantially compliant with the Massachusetts State Building Code. This certificate has been issued and approved for occupancy. The Use Group, in accordance with the provisions of the 780 CMR, 8th Edition Massachusetts State Building Code is: The Type of Construction as defined in the Massachusetts State Building Code is: 1 ` / k Design Occupant Load : 0 Comment: MINo�, C�ErtOVATtoNS TO 2 LOOrZ /A �� .. 3/4/2014 Building Official Date: NOTE: A new Certificate of Occupancy is required for each change in the use, or after alterations of the property described. A new Certificate voids any Certificate of a prior date. Certificate No: Budding Permit No.: 873-10 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the OTHER located at Dwelling Type I DOVE AVENUE in the CITY OF SALEM - -- - -- - - Address Town/City Name i IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY Fire Pump Enclosure I This pemvt is granted in confomrity with the Statutes and ordinances relating thereto, and expires . unless Boone ended or revoked. Expiration Date Issued On: Fri Jul 1, 2011 ' 14 P0- T T. 19.l7b i k ilr7CTJ2, GeoTMSG2011 Des Lauriers Municipal Solutions,Inc. ---- — -- --- - — -------- ---- ---- --- ._.-.- _...-.....- DOVE AVENUE 873-110 cis a �527 _ CJM"VION.VE ' TH OFMASSACHUSETTS • _. map its a' "l CITY OF SALEM , Blocker r� '' "i Lot: r�10216 (Category: RFPAIR/RFPtACE - 873 10 ; ,_ , . BUILDING PI+._1gMIT S��ect# JS 201_0-0012°0 ,,P { EskCost:, $35,500.00' ' Fee Charged: _ $390.80 x' *}#. 1 1831 nee Due v $.00-1 f PF,-Pill SSION IS'IiF,RE3Y GDRANTETO: ^ Cow trnclor: License: Expires Use Group r.- %a� ,,.;.'' '' ` Parris Sc Associates Inc:Robert A.Parris LotStze(sq ft) ?308 IT IZnnmg1 - ;Owner SHAUGIBNLC, --KAPLANI?1;1, nI3cGS?' Linin Ga ined:- a ',Applien/FL: Parris k A gelates Inc!!obcttA.l_rris .� r ms`s UmrsLost: , „i T: t DOVEAVFNLIE ' "'Svia) OiV: 02-Juts-2010 f:ljEldl.T 1 Oil' ��.. E:�T "ES ON: 02-Nov-2010 '0 i':.'RFOR/VI THE F,OLL01 lA'f-t' I[ PRA: �— NEW FIRS PUMP SFA"CION PEiZ PLANS jbli POST TIIIS�CARD SO IT IS VISIBLE FROM TELE S'T'REET T---- -�-- -- Gas Plumbiij" �IludcrrounU: Unilcr;;racnU: ,,. OuJugronud: Fsr:n a:inn: Sen ice: / ate r: - lF,xd;.„s: V^ Rm: .: f�/ i2 �,�f�n I ou-h: • (Rough; t ,Filo / /Q ii;:al: i:ai: Itu�I,I fratnuQ�, & 0. 20, `.1{1 Firr,U.yo,Ch.nmcy: Health r - 1,rsn: Meter: Fi � nal q House 0 1 f I: O'aier. .Olsu:u+� ii(_�t,�f ASsessn!_ lV [� final: �so%cr: oen a l�pprpA,iwr K{Q TEllS PERMIT P./TAY IT' iTEV0KE_Il Lit'i-:T. CITY OF AT.:.i�$ UPON VIOL. ' 01 F ANY OF IT RULES AND REGTJT.A'1'TGNS. S. tee Typc:._ R, opt N'I <r Da 'I yt ChcckNo: AnounF • UTA DING �.. REV201 f: 4, — 32Il10 .pWnpletian o1 work, p y� 873.61 g5641 `' s4— �:ir f:2nl%11L:sil'0I, i u ars Municipal SoLaions,Inc. t �w a ; e^• } i - 5 _ Certificate No: Building Permit No.: 880-10 I Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certifythat the OTHER located at Dwelling Type 1 DOVE dd eAs ENUE_... _ .. -- in the Cro Y Oy SALEM A E I IS HEREBY GRANTED A PERMANENT CERTIFICATE OF I OCCUPANCY Construct Garden Walls and Ramp I This permit is granted in conformity with the Statutes and ordinances relating thereto, and expires --_.-_ -_ unless sooneAK- r revoked. Expiration Date - Issued On: Fri Jul 1, 20lI -.. .l t --- GeoTMS02011 Des Lauriers Municipal Solutions,Inc. l ' 'T.7.:e'ae 1 DOVE AVENUE o 880-10 Des# X527 r4 nr`,' COMMONWEALTH OF MASSACHUSETTS x.. Map g24 �Block * k „ < QTS OF SALEM Lot: d- Y 0216 .i = r Category REPAIR 1tEPLACE x, �Pernnt# T 880-10 _ BUILDING PERMIT to�ect P # r JS-201 0-0 01221, ,�' r �yn s 'Est Cost i yea $44 600.00W�7?x*I- spy 6 �;�V Fee Charged �,s $4.95.00 ala we Due. : " $00" I lw �. PF_'RMISSIOAIS trFP.E-Bl,Gk24NTED TO: Const Class Con tractor: y Lice rse: Expires "r f Use Group j1', Ac` is Parris&A_ sson ,aecs Inc./ Ro�,_r4;a Parns Gen Contractor/Code IG-40567 IotSize(sq.fft) 230868 ;( I_ � Olvner.: SHAUGHT.F.SS,.Y-KAPLANREHAB HOSP iZonmg a.' ' a. r -g,. jUnits Gained .; v ',-� , ,,Applicant "Parris 2 Associates Inc./Robert A.Parris Units Lost ' �0-a ",``���, , " , AT: 1 DOVt As'$NUE • !Dig Saf_#_,,. . ISS[JED ON: 02!Jun-2010 AMENDFD ON: 'i ' ' EXFIRES ON: 02-Nov-2010 TO PERFORM THE FOLLOWING WORK: ' � f CONSTRUCT INSPIRATIONAL GARDEN AND RAMP PER DRA7'INGS jbh «; 'POST THIS CARD SO IT IS VISIBLE FROM THE STREET_ Electric Gas' ` - Plumbing Building "�.. -- Underground: Undergrcu id: Underground: Excavation: Servic.:. Meter: Fo'ru;;.: Rough: ��1�d1io Rough: =t, Rough: IFmwdalion: Fi:aI:/1-77/vI/o/ Final: Final: (Rongh Frame: --- :ircp'41ce/Cl imncp: D.P.W. //t Fire — Health r` \e Insulation: Meter: - Oil: House# Smoker / _—_-- Treasury: Water: Alarm: Assessor ` t Sewer. Sprinklers: Final: THIS PEWITIT MAY BEREVOKED 13Y THE CITx( O'F SALEM UPON VIOLA TI011i'C Fn1NY OF TTS RULES AND REGULATIONS. Signature: IfFee Type: Receipt No: Ua[e aid: Check No: Amouiiira BUILDING �I EC-2UU10;,�ri: 0.--° 'f=;cn-10 _._. e -_ $495.00 woexW • An k� won WmPiet'0() Ol -work, P1111"s Go . 8786(8-5641 3 3 � P GcoTMS®201.0-Des Lauriers Municipal Su:otiuns,Inc. , .x Sol S 7b . 1H n 4py4f 4 s Yr Certificate No: 398-09 Building Permit No.: 398-09 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the HOSPITAL located at Dwelling Type I DOVE AVENUE in the CITY OF SALEM Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY 2rd FLOOR DIALYSIS SHAUGHNESSY This permit is granted in conformity with the Statutes and ordinances relating thereto,and expires unless sooner suspended or revoked. Expiration Date I Issued On: Mon Apr 13, 2009 ...... GeoTMS82009 Des Landers Municipal Solutions,Inc. ----- ------ -------- ------ ------ - ---- k I DOVE AVENUE 398-09 GIs#: — I1527— COMMONWEALTH OF MASSACHUSETTS Map: i24 Block: I _ -- CITY OF SALEM Lot: 0216 Category: IREPAIR/REPLACE ;Permit## --- 398-83 09 -----_- BUILDING PERMIT Project# JS-2009-000652 :Est. Cost: 1$47,900.00 Fee Charged: $551.70 Balance Due: PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Expires Use Group: _ _ K.D. NADEAU CONSTRUCTION LLC/ CONSTRUCTIOSUPERVISOR-81901 ;Lot Size(sq. ft.): 230868 `Zoning: (Owner: SHAUGHNESSY-KAPLAN REHAB HOSP Units Gained: --Applicant: K.D. NADEAU CONSTRUCTION LLC/DANIEL NADEAU U to s Lost: SAT: 1 DOVE AVENUE Dig Safe#:— -— -- - — --J ISSUED ON. 14-Nov-2008 AMENDED ON: 11-Feb-2009 EXPIRES ON. 11-Jul-2009 TO PERFORM THE FOLLOWING WORK. ALTERATIONS TO PROVIDE MEDICAL AIR OUTLETS jhb ADDITIONAL WORK TO SHAUGHNESSY 2ND. FLOOR REMODELING ROOM TO A NEW DIALYSIS SUITE(AMENDED TODAY CHECK RECEIVED IN THE AMOUNT OF $335.00#3147 ADDITIONAL PROJECT COST$30,000.00 jhb POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Buildine Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough:////(O/� / Rough: Rough:�V f 41 �i 4,y)*7 Foundation: ('.��.�\ Final: ! Q��/ Final: Final: 6?- 4t� ' ,� /fa� Rough Frame:X 't�f t&1•6• ` D.P.W. Fire Health Fireplace/Chimney: Meter: Oil: Insulation: ,/l, �'� Final: /I'w`ii House# Smoke: — Water: Alarm: Assessor Treasury: Sewer: Sprinklers: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEMU ON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. / ., sig 1j .. Fee Tvpe: Receipt No: Date Paid: Check No: Amount: 14-Noe-08 3109 5551.70 An insp@Qilan +: L'i5O.l'!.,I!"^fj . 74645.,6 EXt W GenT:\IS©2009 Des Lauriers municipal Solutions. Inc. I DOVE AVENUE 552-14 GIS #: 1527 COMMONWEALTH OF MASSACHUSETTS Map 24 Block: CITY OF SALEM Lot: 0216 (Category: RENOVATIONS Pe t# 552-14 BUILDING PERMIT Project# JS-2014-001200 Est. Cost: $26,800.00 Fee Charged: $300.00 (Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Expires: Use Group: 'IRA Parris&Associates Inc./Robert A.Parris Gen.Contractor/Code 1G-40567 Lot Size(sq. ft.): 230868 �' ' ' Owner: SPAULDING HOSPITAL NORTH SHORE Zoning: Units Gained: Applicant: Parris&Associates Inc./Robert A. Parris Units Lost: _JAT: 1 DOVE AVENUE Dig Safe#. Iii; ISSUED ON. 23-Jan-2014 AMENDED ON: EXPIRES ON: 23-Jul-2014 "TO PERFORM THE FOLLOWING WORK: MINOR RENOVATIONS TO 2ND FL CONFERENCE ROOM INVOLVING SELECTIVE DEMOLITION. (SEE DRAWINGS POR DETAILS) POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: Underground: Excavation: Service: Meter: Footings: Rough: Rough: Rough: Foundation: Final: Final: Final: Rough Frame: Fireplace/Chimney: D.P.W. Fire Health Insulation: Meter: Oil: Final Llouse# Smoke: Treasury: Alarm: Assessor Se\v'ei Sprinklers: Final: }„ THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION OF ANY OF ITS =RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: BUILDING REC-2014-001244 27-Jan-14 1603 $112.40 BUILDING REC-2014-001209 23-Jan-14 1629 $187.60 �GcoTMSa 2014 Des Lauriers Municipal Solutions,Inc. Certificate No: 200-09 Building Permit No.: 200-09 Commonwealth of Massachusetts City of Salem Building Electrical Mechanical Permits This is to Certify that the HOSPITAL located at Dwelling Type 1 DOVE AVENUE in the CITY OF SALEM - - - - --------------- - - ----------------------------.. Address Town/City Name IS HEREBY GRANTED A PERMANENT CERTIFICATE OF OCCUPANCY OCCUPANCY PERMIT FOR CHANGES MADE TO ROOMS. This permit is granted in confortnity with the Statutes and ordinances relating thereto, and expires unless sooner suspended or revoked. Expiration Date VA Issued On: Tue Oct 14,2008 �' - ------------ --------------- GeoTMS®2008 Des Lauriers Municipal Solutions,Inc. ---- ------ -------- --------------------------------------------------------- C # '-1-DOVE AVENUE 200-09 GIs1527 Map:: 24 COMMONWEALTH OF MASSACHUSETTS Block: CITY OF SALEM Lot: 0216 Category: REPAIR/REPLACE Permit# . 200-09. ,r �,.. .r: BUILDING PERMIT Project# JS-2009-000279 Est. Cost: $75,000.00 =F Fee Charged: $830.00 Balance Due: $.00 PERMISSION IS HEREBY GRANTED TO: Const.Class _ ___ ' Contractor: License: Expires Use Group: . NADEAU DRYWALL CO., INC. STATE-81901 Lot Size(sq. ft.): 230868 Owner: SHAUGHNESSY-KAPLAN REHAB HOSP Zoning: _ Units Gained: J.Applicant: NADEAU DRYWALL CO., INC. Units Lost: AT: I DOVE AVENUE Dig Safe#: r,l ISSUED ON. 04-Sep-2008 AMENDED ON. EXPIRES ON: 04-Feb-2009 TO PERFORM THE FOLLOWING WORK: CONVERTING A FAMILY ROOM TO A PATIENT ROOM&CONVERTING A PATIENTS ROOM TO FUTURE EXIT CORRIDOR AND FAMILY ROOM jhb POST THIS CARD SO IT IS VISIBLE FROM THE STREET Electric Gas Plumbing Building Underground: Underground: ._ Underground: Excavation: Service: /q1 Meter: f Footings: Rough:yl�Q�Q�(tOn Rough: Rough: c//.l�)l±9 Foundation: Final: Q]/�O[[[��DU Final: Final: 6r40rl �m/a Rough Frame:�� ` O ' 'I Fireplace/Chimney: D.P.W. Fire Health MInsulation: Meter: Oil: House# Smoke: Final: Water: Alarm: Assessor Treasury: Sewer: Sprinklers: Final: - THIS PERMIT MAY BE REVOKED BY THE CITY OF SALEM UPON VIOLATION O ANY OF ITS RULES AND REGULATIONS. Signature: Fee Type: Receipt No: Date Paid: Check No: Amount: �• 04-Sep-08 1817 $830.00 An insriection is Upon Completion of work, pf"00 745-9595 EXL 385 GeoTMS®2008 Des Landers Municipal Solutions,Inc. Y, FIELD:COPY - l'- CITY OF.SALEM BUILDING ', SALEM.MASSACHUSETTS 019701. PERMIT . _ .. •.DATE Au%77ust_ 3., _ 19 )4 'PERMIT NO. y19Fn-C,7a APPLICANT HmDlre Wilders '-ADDRESS"p-n. Rnv I411 Poahnrfv Ma FR. Id41 _ �_ _ �, _ •�_ _ .._-_. (NO.] ISTRE[11_ - -- ICONTA•S-LICENSE 1.. Rnon$hnl NUMBER OF � PERMIT TO :'QItPrAt itTnc (_I STORY _ - DWELLING UNITS ".ITrPE.OF.IMPROYEMENTI NO. ._ .. - IPPOPOSED USEL_, ING AT (LOCATION) I nnt/P Aup 4To rri 1 _ -_ DISTa CT INO.1 ISTREET) BETWEEN AND'- ._ _ (CROSd STRE[TI _ - r— - .ICROf S':ST R[QT) - - - _ _ LOT SUBDIVISION LOT - 'BLOCK SIZE BUILDING IS TO BE FT. WIDE Re FT. LONG BY FT.SIN HEIGHT'dhD'SNALL CONFORM IN-CONSTRUCTION TO TYPE USE GROUP - BASEMENT WALLS OR FOUNDOT ION (TV.PEI REMARKS; Install Dartetion for rehab center, 2nd floorShauahnessv, w AREA OR. ' PERMIT VOLUME. -ESTIMATED COST S29,428 FEE S IaS•0o - -� ICUBK-SQUARE FEETI OWNER Shauehnessv.Hosnital. ' ADDRESS I Dove Ave. . Salem. Nass. Lon R_ TrAmh I aw A << >� THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Massachusetts 01970 Tel.978 741-1200 June 14, 1999 Arthur White-Engineer P.O. Box 211 Wakefield, MA 01880 Re: NSMC/Shaughnessy-Kaplan Hospital Fire Suppression Project Dove Avenue Salem, MA 01970 Our Project#: 9707-117 Dear Mr. White, Thank-you for your 06-01-99 Construction Control report. I wish to respond to your recommendations. 99-4: This was an oversight on the part of the drawing preparer. This area will be sprinkled in conjunction with this final phase of the project. It is our intent to fully sprinkler the entire SKRH facility. 99-5: What is the purpose for this recommendation? 99-6: We will verify that the sub-contractor installs these caps (plugs) at each outlet valve location throughout the building. I will also take the prerogative and forward a copy of this letter and your Construction Control report to both the City Of Salem Inspector Of Buildings Department and Fire Prevention Bureau for their edification. PARTNERS. HealthCare System Member Founded by Massachusetts General Hospital and Brigham and Women's Hospital Thank-you for your time in this matter. Sincerely, Fch � ter Project Manager NSMC Facilities Department cc: Ken Thompson James Larkin, Larkin Sprinkler Co., Inc. John Pelletier Project File encl.: 06-01-99 SKRH Fire Suppression Project Construction Control report ARTHUR WHITE - engineer P. O . BOX 211 WAKEFIELD, MASSACHUSETTS 01880 TEL . 781Sxict . 245 - 37 S 2 Mr. Rich Kanter Project Manager NSMC Facilities Department 81 Highland Avenue Salem, MA 01970 Re: Shaughnessy-Kaplan Rehabilitation Hospital Salem, MA Fire Suppression Project Project No. 9707-117 This is to certify that on June 1, 1999, I made a Construction Control inspection of the captioned project in the company of James Larkin of J.D. Larkin Sprinkler Co. , Inc. Following is the result of this inspection. Retrofit piping and sprinkler heads have been installed on the lst and 2nd. floors (except see Recommendation 99-4 below) and are in accordance with construction plans as approved by this engineer December 8, 1998. Piping for the previously noted 5th and 4th floors has now been correctly tied into the existing risers as shown on the plan. Piper were tying in the 3rd floor system with completion of this floor expected on June 1. The 1st and 2nd floor systems, are expected to be in full service by June 10. During my walk-through I made note that the sprinkler heads installed in patients' rooms are of a listed Quick-Response type. The previously noted feed main to existing and some new heads on the 2nd floor near the Cardiac Rehab area has not yet. been completed. Previously noted recommendations have not yet been completed. RECOMMENDATIONS: 99-4. Extend sprinkler protection to any unsprinklered areas (not shown on original plans) 1st floor, west side, executive office area. Approx. 20 heads required. 99-5. Provide pressure reducing valves on 2k" hose connections, all floors. 99-6. Plug all 1k" hose outlet valves, all floors, to prevent possible water damage from unauthorized use. N.B. : Small hose has been removed. I plan a further inspection upon the completion of all work (including electri al c nne 1tions to the new alarm system) and final testing. Arthur White, Jr. P.RTHUR CyG cc: Larkin Sprinkler Co. , Inc. v15 ,r WHITE, JR. John Pelletier, Project Manager, NSCH.'1" A `^ JISTE �.=5»PoAL EM0 << >> THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Massachusetts 01970 t Tel.978 741-1200 April 23, 1999 Kevin Goggin City Of Salem Inspector Of Buildings Dept. One Salem Green Salem, MA 01970 Re: Shaughnessy-Kaplan Rehabilitation Hospital Salem, MA 01970 Fire Alarm Project Our Project No. : 9707-114 Dear Kevin, Thank-you for taking the time today on the telephone to discuss the issues concerning the SKRH fire suppression and annunciation system retrofits. As I mentioned we are approaching the conclusion of the projects and I was continuing the open dialog we've maintained throughout these projects. The primary intent of my call was to make you aware that I had not received written approval regarding the fact that the Hospital will not reinstall the existing patient room automatic door closer devices nor patient room smoke detectors as we previously discussed, provided collaborating substantiation for, and as verbally approved by you in January of this year. You noted that written documentation was not necessary and that ultimately final testing and City approval would make my request a moot issue. You addressed the following conditions that were to be met that qualified your agreement with our understanding of this issue. We are doing this as a result of the relief that is afforded us by (a.)the facility being protected by a full coverage fire suppression system (b.) that utilizes quick response sprinkler heads in all patient rooms, (c.)that the patient room doors positively latch, (d.) all other (non-patient room) existing automatic door closer devices will be tied into the new system, and (e.) that the sprinkler system retrofit complies with pertinent seismic installation criteria as in regards to the Massachusetts State Building Code (6th edition). I also addressed your question of whether we took pictures documenting the condition of penetrations through existing smoke and fire walls. Although we did not take pictures, the installations of both systems met stringent smoke and fire stopping requirements. All work above the ceilings was monitored by a representative of this Department. Acoustical ceiling tiles removed for P� 77�� ^ T^ RS. HealthCare System Member Founded by Massachusetts General Hospital and Brigham and Women's Hospital access to the ceiling could not be replaced without prior inspection. In addition field surveys by both engineers of record and our recent preparations for and actual inspections and recertifications by both JCAHO and CARF substantiate the heed paid to this issue. I appreciate and welcome your attention to detail. Sincerely, #1chKanter Project Manager/NSMC Facilities Department cc: K. Thompson J. Keys J. Pelletier D. Canham (RWS) J. Larkin(Larkin Sprinkler) J. McDonnell (Baystate Elect.) F. Preczewski (F.I. Salem Fire Dept.) A. White, Jr. (A. W. Engr.) \`tJ 1` W Y a THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Massachusetts 01970 Tel.978 741-1200 April 23, 1999 m -mac Kevin Goggin City Of Salem Inspector Of Buildings Dept. One Salem Greenam kn e*.) Salem, MA 01970 Re: Shaughnessy-Kaplan Rehabilitation Hospital v' Q ~ Salem,MA 01970 Fire Alarm Project Our Project No. : 9707-114 Dear Kevin, Thank-you for taking the time today on the telephone to discuss the issues concerning the SKRH fire suppression and annunciation system retrofits. As I mentioned we are approaching the conclusion of the projects and I was continuing the open dialog we've maintained throughout these projects. The primary intent of my call was to make you aware that I had not received written approval regarding the fact that the Hospital will not reinstall the existing patient room automatic door closer devices nor patient room smoke detectors as we previously discussed, provided collaborating substantiation for, and as verbally approved by you in January of this year. You noted that written documentation was not necessary and that ultimately final testing and City approval would make my request a moot issue. You addressed the following conditions that were to be met that qualified your agreement with our understanding of this issue. We are doing this as a result of the relief that is afforded us by (a.)the facility being protected by a full coverage fire suppression system(b.)that utilizes quick response sprinkler heads in all patient rooms, (c.) that the patient room doors positively latch, (d.) all other (non-patient room) existing automatic door closer devices will be tied into the new system, and (e.) that the sprinkler system retrofit complies with pertinent seismic installation criteria as in regards to the Massachusetts State Building Code (6tn edition). I also addressed your question of whether we took pictures documenting the condition of penetrations through existing smoke and fire walls. Although we did not take pictures, the installations of both systems met stringent smoke and fire stopping requirements. All work above the ceilings was monitored by a representative of this Department. Acoustical ceiling tiles removed for PARTN777 EI& HealthCare System Member Founded by Massachusetts General Hospital and Brigham and Women's Hospital access to the ceiling could not be replaced without prior inspection. In addition field surveys by both engineers of record and our recent preparations for and actual inspections and recertifrcations by both JCAHO and CARF substantiate the heed paid to this issue. I appreciate and welcome your attention to detail. Sincerely, 4ztO--_ Ifich Kanter Project Manager/NSMC Facilities Department cc: K. Thompson J. Keys J. Pelletier D. Canham (RWS) J. Larkin(Larkin Sprinkler) J. McDonnell (Baystate Elect.) F. Preczewski ( F.I. Salem Fire Dept.) A. White, Jr. (A. W. Engr.) TRANSMITTAL Salem 81 Highland Avenue t LETTER Salem,Massachusetts 01970 Hospital Telephone(508) 741-1200 AIA DOCUMENT 0810 PRO)ECr: Fire Alarm Detection & Annunciation ARCHITECTS 9707-114 (name, address) and Fire Suppression Systems Installation PRO)ECrNO: 9707-117 Shaughnessy-Kaplan Hospital Dove Ave. , Salem, MA 01970 DATE: 01-04-99 TO: r City of Salem 1 If enclosures are not as noted, please Inspector of Buildings inform us immediately. If checked below, please: ATTN: L Kevin Goggin J (X ) Acknowledge receipt of enclosures. ( ) Return enclosures to us. WE TRANSMIT: (X) herewith ( ) under separate cover via (X) in accordance with your request FOR YOUR: ( ) approval ( ) distribution to parties (X ) information ( ) review & comment (X ) record (X) use ( ) THE FOLLOWING: ( ) Drawings ( ) Shop Drawing Prints ( ) Samples ( ) Specifications ( ) Shop Drawing Reproducibles ( ) Product Literature ( ).Change-Order a ). Correspondence COPIES DATE REV.NO. DESCRIPTION ACTION CODE 1 11-19-98 1 Fire Protection Construction Documents Narrative E.1 Fire Sprinkler and Fire Alarm System Retrofits (9 pages) 1 11-30-98 -- Drawing #FA-2, "Proposed SKRH E.2 Fire Alarm Annunciator Location" ACTION A. Action indicated on Item transmitted D. For signature and forwarding as noted below under REMARKS CODE B. No action required E. See REMARKS below C. For signature and return to this offict REMARKS E.1 for your record as requested E.2 for your information COPIES TO: (with enclosures) Kenneth Thompson Jon Keys John Pelletier Rich Parent Project file David Canham 0 AIA DOCUMENT G810 • TRANSMITTAL LETTER • APRIL 1970 EDITION IA° COPYRIGHT ® 1970 ONE PAGE THE AMERICAN INSTITUTE OF ARCHITECTS,1705 MASSACHUSETTS AVENUE,N.W.,WASHINGTON,D.C.20036 �� , �/" /a �s �� asp� Shaughnessy - Kaplan Page 1 of 9 + Shaughnessy - Kaplan Hospital Salem, Massachusetts Fire Protection Construction Documents Narrative Fire Sprinkler & Fire Alarm System Retrofits November 19,1998 The Following is provided to the Salem Fire Department and the Inspectional Services Department in order to satisfy the requirements of 780 CMR, the Massachusetts State Building Code, 6"' Edition, sections 903.1.1 (la), (lb) and (lc). 780 CMR, Section 903.1.1 (La) NARRATIVE DESCRIBING THE BASIS (METHODOLOGY) OF DESIGN FOR THE PROTECTION OF THE OCCUPANCY AND HAZARDS FOR COMPLIANCE WITH 780 CMR AND APPLICABLE NFPA STANDARDS SECTION 1 - Building Description The building is an existing 1-2 building meeting the requirements of 780 CMR 409. The building presently has a sprinkler system in some of the hallways, mechanical and patient care areas. There are two standpipes in the building connected to municipal water and supplemented by an existing fire pump. There are no existing sprinklers in the patient rooms. The existing fire alarm system provides detection at the smoke doors and in the patient yT " ----- _ w _ – -- — — — — rooms. liere are_automatic door closer devices on the patient room do� The existing fire alarm is a voice type system and aging to the point that repair parts are no longer readily available. There is an existing paging system, which gets used to supplement the fire alarm system. SECTION 2 - Applicable Laws Regulations and Standards The fire sprinkler and fire alarm systems that will be installed in the Hospital will be designed and installed in accordance with 780 CMR and applicable NFPA Standards. In particular: 780 CMR Chapter 9, NFPA 13 & 72. Chapter 34 of 780 CMR, the Massachusetts State Building Code, will also apply to this retrofit. No"Federal Regulations or specialized Codes will apply to the Hospital and no change in Use Group will occur. Shaughnessy - Kaplan Page 2 of 9 SECTION 3 - Design Responsibility for Fire Protection Systems (Robert W."Sullivan, 7ncorpora'�ted has beenretained by the Hospital as'the Responsible Professional in Charge of the fire sprinkler and fire alarm system retrofit projects:As the " Responsible Professional in Charge, Robert W. Sullivan, Incorporated(the Engineer) has fully designed fire alarm system that will be installed in the Hospital. The installing contractor has designed the fire sprinkler system but Robert W. Sullivan will be providing construction supervision for both aspects of the project. Fire Protection Construction Documents prepared for both systems are as required by CMR 780 and applicable NFPA Standards. The fire sprinkler and fire alarm systems that will be installed will be integrated with other existing building systems to the maximum extent practical. Robert W. Sullivan, Incorporated has specified all materials and equipment that will be a part of the fire alarm system and will review shop drawings, calculations, material data sheets, test reports and all other items required by the project Specifications to be submitted to the Engineer for review. Robert W. Sullivan, Incorporated will also conduct periodic construction administration site visits during the installation of these systems to monitor compliance with the approved Fire Protection Construction Documents and project Specifications. At the completion of the project,Robert W. Sullivan, Incorporated will issue documentation certifying that the systems installed comply with the approved Fire Protection Construction Documents. SECTION 4 - Fire Protection Systems to be Installed Fire Sprinkler System: The Hospital is currently equipped with a fire pump taking suction from the City of Salem distribution main. The fire pump supplies two (2) existing 6" standpipes located in each of the main egress stairs of the Building. The existing fire pump and standpipe systems will be used to supply the new fire sprinkler systems to be installed in the building. The new sprinkler systems on each floor will be "cross connected" to provide two sources of supply for each floor of the building. With the exception of the main transformer vault the partial existing fire sprinkler system will be upgraded to provide complete protection. The new fire sprinkler systems that will be installed in the Hospital will meet the requirements of NFPA 13 (1996) as required by 780 CMR, section 906.2.1. The fire sprinkler systems have been hydraulically calculated in accordance with NFPA 13 requirements for a Light Hazard Occupancy (.1011500) with a 100 gpm hose allowance in Office areas and for Ordinary Hazard (Group II) Occupancy (.20/1500) with a 250 gpm hose allowance in all Mechanical and Storage areas. Shaughnessy - Kaplan Page 3 of 9 All fire sprinkler systems installed as a part of this retrofit project will be supervised as required by CMR 780, section 923. Drawings for the fire sprinkler system show the piping layouts for the systems as well as hydraulic reference points and the remote areas selected for calculation. Hydraulic calculations have been performed in accordance with NFPA 13 (1996), Chapter 6. The drawings and calculations provided satisfy the requirements of 780 CMR, section 903.1.2. The fire sprinkler systems that will protect the Hospital are to be connected to an upgraded fire alarm system. As noted throughout this document, the existing fire alarm system at the Hospital will be upgraded to facilitate the new fire sprinkler systems as well as resolve existing fire alarm system concerns. At this time, the existing fire alarm system in the Hospital notifies the Salem Fire Department via a municipal transmitter in accordance with 780 CMR and NFPA 72 (1996), the National Fire Alarm Code. When the retrofit of the fire alarm system is completed, the upgraded fire alarm system will be arranged to function in the same manner as well as send supervisory signals to an in house constantly attended location. Fire Alarm System: The Hospital is currently equipped with a fire alarm system compliant with Codes in force when the Building was erected. The new system will be installed and tested prior to deactivating any portion of the old system. Once the new system has been tested the old system's notification functions will be replaced by the new system. 1,The-existing_old_panel.----- cwillremain•active-and-continue.to.monitor.th_e-patient-room,smoke•detectors.—,The zone outputs from the patient room smoke detectors on the old panel will activate temporary zones on the new system�7As the-floor's priiaklered-tlie patient room smoke`detector-zones wily Gbe,.elunmated_and..the-devices-removed3 When all the floors are fully sprinklered the old panel and any remaining equipment will be removed. The new fire alarm system that will be installed in the Hospital will meet the requirements of NFPA 72 (1996) as required by 780 CMR, section 917 �The_fife_aliii syst&—m will:beD �, full-y-addressable-,-zoned per-floor and-supervised-as required by CMR-780_,`-78 Fire alarm system alarm, trouble and supervisory signals from all intelligent reporting devices will be encoded on NFPA Style 4 (Class b) Signaling Line Circuits (SLC) with short circuit protection for each floor. Initiation Device Circuits (IDC) will be wired Class B (NFPA Style B) as part of an addressable device connected by the SLC Circuit. Notification Shaughnessy - Kaplan Page 4 of 9 Appliance Circuits (NAC) will be wired Class B (NFPA Style Y). Digitized electronic signals will employ check digits or multiple polling. A single ground fault or open circuit on the system Signaling Line Circuit will not cause system malfunction, loss of operating power or the ability to report an alarm for any area larger than a single floor. Alarm signals arriving at the main FACP will not be lost following a primary power failure (or outage)until the alarm signal is processed and recorded. NAC speaker circuits shall be arranged such that there is a minimum of two speaker circuits per floor of the building. Audio amplifiers and tone generating equipment will be electrically supervised for normal and abnormal conditions. NAC speaker circuits and control equipment will be arranged such that loss of any one (1) speaker circuit will not cause the loss of any other speaker circuit in the system. Drawings for the fire alarm system show the device layouts for the systems as designed. The drawings provided satisfy the requirements of 780 CMR, section 903.1.2. SECTION 5 - Features Used in the Design Methodology Building occupant notification and evacuation procedures will be such that when a fire alarm condition is detected and reported by one of the system initiating devices all fire alarm system output programs will be activated by the particular point in alarm and the associated system outputs will activated. The fire alarm system is designed, and will be installed, to operate a private mode system with a manual selective evacuation system. Existing smoke exhaust units will be controllable from the main fire panel in the lobby. The new fire alarm system will provide all the programrning, detectors and relay_outputs for elevator are notpart ll the p ons7The upgrades that are required for the existing elevator_equipmen� �- - The project should not require any impairment of the existing systems for any extended periods of time. During the times when systems must be off lime for any duration the Salem Fire Department will be given advance notification. In accordance with 780 CMR, 527 CMR and the Massachusetts General Laws (MGLs), once the fire sprinkler and fire alarm systems are completed, tested and accepted by the Hospital, they will be tested and maintained as required by those documents. In general, the testing and maintenance requirements of NFPA 72, the National Fire Alarm Code, and NFPA 25, the Standard for Inspection, Testing and Maintenance of Water Based Fire Suppression Systems, will apply. Documentation as required by all applicable Codes will be the responsibility of the Hospital after initial testing and acceptance has been completed. Shaughnessy - Kaplan Page 5 of 9 SECTION 6 - Special Consideration and Description The fire alarm system is intended to be a private mode system designed to operate in a similar fashion to the other buildings in the complex. 780 CMR. Section 903.1.1 LI& NARRATIVE DESCRIBING THE SEQUENCE OF OPERATION FOR FIRE PROTECTION A. Fire Sprinkler System The Hospital will be protected throughout with automatic fire sprinkler systems. The occurrence of fire or any another source of heat generated in a sufficient amount to fuse heat sensitive elements at individual fire sprinklers or a break at any point within the fire sprinkler system or any other situation that would create a water flow within the fire sprinkler piping system equal to the water flow from one fire sprinkler will cause the system water flow switch to activate. When electrical contacts within the system water flow switch activate, an alarm signal is sent to the existing Fire Alarm Control Panel. This will cause the Fire Alarm Control Panel to acknowledge an alarm condition and the Fire Alarm system will respond accordingly. A drop in system pressure to predetermined levels will activate the fire pump. The sprinkler system will be supervised per NFPA 72 sprinkler supervisory service requirements. All valves will be supplied with tamper switches and all pressure conditions affecting the operation of the sprinkler will be supervised. The signals from the supervisory portion of the system will annunciate-at all system annunciators (each level by nursing station) as well as the complex operator's station. B. Fire Alarm System: The Hospital will be equipped with a fire detection/fire warning system as required by the Code for this Use Group in a fully sprinklered structure. All fire detection devices and associated equipment shall be Underwriter's Laboratories (UL) listed as a minimum. Design and installation criteria shall be in accordance with NFPA 72, Shaughnessy - Kaplan Page 6 of 9 the National Fire Alarm Code. The fire alarm system will be a Class B, 24 volt do system. Detectors will be analog type and removable to facilitate periodic testing and maintenance. Manual pull stations shall be provided with test/reset key and operated by cover pulling which will activate the device. Batteries for emergency back-up power within the fire alarm panel will be rated to provide 60 hours of back-up power. The activation of any manual pull station, automatic smoke detector, automatic heat detector, water flow switch will result in following system alarm responses: 1. The location of the incident will be identified in English at the annunciators provided on each floor. 2. The alarm will be transmitted the to Salem Fire Department via the municipal transmitter. 3. The system will provide an alert tone throughout the building and close all automatic doors. 4. The voice module will provide a recorded message throughout the building detailing the floor of incident for the responding staff. The message will be he same as in the rest of the facility (code red X floor with X being the floor of incident). 5. The staff will investigate and direct the fire department to the cause of the alarm. 6. Upon approval of the fire department the system will be reset. 7. In the event of a condition requiring the evacuation or relocation of patients the fire department may use the microphone in the lobby to give specific instructions to individual floors. The fire department may also choose to manually activate an evacuation signal for the entire building or any individual floor or set of floors. The evacuation signal will include a temporal code to the area as well as activating visual evacuation signals in the area to be evacuated. In compliance with ADA guidelines and to avoid confusion, at no time will strobe light be activated in any area not being evacuated. 8. During the evacuation of a specific area the speakers in all other areas would continue to sound the original code red signal. Designated supervisory devices will activate supervisory signals. Supervisory signals will be visually and audibly indicated at the FACP. The sequence of operation at the FACP for SUPERVISORY conditions will be as follows: 1. Illuminate a yellow system supervisory LED visual indicator. 2. Pulse an audible buzzer at the FACP that will sound until the panel silence Shaughnessy - Kaplan Page 7 of 9 push button is pressed. 3. Display specific information as described above under sequence of operation at the main FIRE ALARM CONTROL PANEL. The complex phone operator will also be notified of a supervisory condition. 4. Print specific information as described above under sequence of operation at the main FIRE ALARM CONTROL PANEL (FACP). 780 CMR, Section 903.1.1 (l cl NARRATIVE DESCRIBING THE TESTING CRITERIA TO BE USED FOR FINAL SYSTEM ACCEPTANCE SECTION 1 - Testing Criteria The project Specifications contain requirements whereby the Installing Contractor's must establish a testing schedule with the Hospital as each project develops. Once a testing procedure has been established, it will be reviewed by the Hospital and the Engineer to assure that all requirements of applicable Codes have been met. Installing Contractor's are also required to notify the Engineering as well as the Salem Fire Department prior to any testing that must be witnessed by the City. After testing is completed, Installing Contractor's must submit testing documentation to the Engineer for review. Testing criteria for each system shall be as follows: Fire Sprinkler Systems: Final system acceptance requirements for the fire sprinkler system will be as required by applicable sections of Chapter 8 of NFPA #13 (1996). The building fire sprinkler systems will be hydrostatically tested in accordance with NFPA #13. All valve supervisory switches and water flow indicators on the fire sprinkler system will be tested for proper operation and integration into the building fire alarm system as required by NFPA #72. The proper operation of water flow devices on the fire sprinkler systems will be tested by flowing water at the inspector's test stations. Valve supervisory switches will be tested by actual operation of the valves. ' Shaughnessy - Kaplan Page 8 of 9 The Hospital will maintain the fire sprinkler system within the building in accordance with NFPA #25, Standard for the Inspection, testing and Maintenance of Water Based Fire Protection Systems. B. Fire Alarm System: Acceptance requirements for the fire alarm shall be as required by Chapter 7 of NFPA#72 (1996). Test methods will be as required by the applicable sections of Table 7.2.2 contained in NFPA #72. Prior to testing, the installing Contractor must prepare and submit documentation to the Engineer as required by Section 1-7 of NFPA #72. Testing of the building fire alarm system shall be conducted by the installing Contractor's job foreman in the presence of. a representative of the Hospital, a representative of the City of Salem Fire Department and the engineer. Fire alarm devices shall be operated to ensure proper operation and correct annunciation at the main Fire Alarm Control Panel. All representatives will be notified by the installing Contractor in advance of any fire system testing. Individual initiating circuits and appliance circuits shall be opened in at least two locations per zone to check for proper function of supervisory circuitry. All testing of the fire alarm system shall be in accordance with NFPA #72. SECTION 2 - Equipment & Tools No special tools and/or equipment are anticipated to be required for testing the fire sprinkler and fire alarm systems. Standard tools and equipment required for testing, adjustment and system programming requirements will be provided by the Installing Contractors. The Engineer will assure that the sequence of operation as outlined in this narrative is a part of the information distributed to the Installing Contractors prior to testing and acceptance of the fire sprinkler and fire alarm systems. Manufacturer's instructions will be available for all ancillary devices and representatives from the manufacturers of the Fire Alarm Control Panel will be required to be present during initial system testing. Their presence will be required in order to assure that their systems are functioning as listed individually and together with the building fire alarm system as a completely integrated system. When dates and times for testing have been established, occupants of the Hospital will be informed in writing by means of written notification announcements. SECTION 3 - Approval Requirements m Shaughnessy - Kaplan Page 9 of 9 Code Officials will be provided with documents as outlined by CMR 780,`Section 903.4 and as required to satisfy their operational code compliance needs. The project Specification requires the Installing Contractors to prepare and submit to the Engineer an "Operations & Maintenance Manual' for each of the systems. The specifications for the Manuals also require that a listing of the names, addresses and telephone numbers of Installing Contractors and Manufactures be provided to the Hospital for emergency use. ' s-B va• a ❑ o NEW ANNUNCIATOR PANEL I ON LOBBY 51DE OF WALL I S (FACES LOBBY) 1 PATIENT REGIS. WALL ELEVA -�� w a ENTRY VESTIBULE i = LOBBY F— o �LEV��jTORS I I w C ' Z X]L NEW FIRE ALARM ANNUNCIATOR PANEL. CL O EXIST. FIRE ALARM PNL. 1� Z I{/ TO BE REMOVED O Z B o a A v e _..e.� a z z _.. �._. FURR EXIST. WALL 4S 518' 14L. STUDS FIRE ALARM SYSTEM EGbJIP. LEGEND 18' D.C. a 1 LTR. FF[ p 1/2' TYPE 'X' YR. Q4 FIRE ALARM MAIN PANEL Q2 AUXILLARY CAB. FOR CONTROL MODULES a myyky I 81*W Am Sin MA OR a Q3 DIGITAL MESSAGE GENERATOR 97LV412625B0 In 97E74462 Q PATIENT REGISTRATION 4 BATTERY CABINET PARTIAL PLAN SKKH LOBBY � ''�" U 4 1 NOTE: PRELIM. LAYOUT OF EQUIPMENT 1. ' a NUMBERED 2,8,&4.FINAL LAYOUT TO BE SCALE: 1/8'=P-0• A^ Z o COFIRMED WITH OWNER,ELECT. SUB- CONTRACTOR AND EQUIP. MFG. (SUPPLIER) Project No. 9707-11 ARTHUR WHITE o (Sngineer P. O . BOX 211 WAKEFIELD, MASSACHUSETTS 01880 T E L .781—)fficJJt&x- 2 4 5 - 3.7 9 2 March 22, 1999 Rich Kanter Project M ager NSMC Fa lities Department 81 Hi land Avenue Sale , MA 01970 Re: Shaughnessy-Kaplan Rehabilation Hospital Salem, MA Fire Suppression Project Project No. 9707-117 This is to certify that on March 19, 1999, I made a Construction Control Inspection of the captioned project. Following is the result of this in- spection: Retrofit piping and sprinkler heads have been installed on the 5th, 4th, and 3rd floors of this building and are in accordance with construction plans as approved by this engineer December 8, 1998. The piping has not yet been tied into the various existing risers as shown on the plans. The tie-ins will involve installation of new sectional control valves, vane- type sectional water flow detectors, inspector's test pipes and test water discharge drains in the stairwells involved. Construction is proceeding on the 2nd floor with pipers installing sprink- ler heads and piping in various common areas. This 2nd floor system is as 3rd to 5th inclusive, i.e. , in compliance with the design plan, but not yet connected to the main risers. Work has not commenced on the 1st floor. As agreed with the Salem Fire Department, no sprinklers are to be install- ed in any fully tiled shower rooms. This is not considered a serious defect and is acceptable. The feed main to existing sprinklers and some new heads on the. 2nd floor near the Cardiac Rehab area is to be re-routed from that shown on the plans resulting in a more direct feed. This new feed arrangement is fully accept- able, and the change will be shown on the as-built plans when prepared. RECOMMENDATIONS: 99-1. Fullyclose up to full wall thickness any openings about sprinkler piping where penetrating fire cut-off walls or floors using...masonry or other non-combustible filler. (To do. ) . 99-2. Provide sprinklers under duct work 4ft. or wider, Mechanical Rooms, 4th and 3rd floors. One additional head needed in each area. Ci/4 Shaughnessy-Kaplan Rehabilation Hospital Salem, MA Fire Suppression Project Project No. 9707-117 Pg. 2 99-3. Remove combustible storage (plastic bags in corrugated card- containers) from Mechanical Room, 3rd floor. This is inapprop- riate storage for this critical area. I plan a further inspection upon the completion of work on the 1st and 2nd floors, and another to verify the tie-in arrangements and final test- ing. H Or MgSr 2� JJ 9C F AR{IHUR ys of WHI E,, JR. ti GISTEP����� FS S/ ENS\ Arthur White, Jr. AW/w cc: Larkin Sprinkler John Pelletier Project Manager, NSCH ��,.,►�� THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Massachusetts 01970 Tel.978 741-1200 ` March 29, 1999 Kevin Goggin City of Salem Building Department One Salem Green Salem, Massachusetts 01970 Re: Shaughnessy Kaplan Rehab Hospital Install Sprinkler System Facilities Project#: 9707-117 Dear Kevin: Please find attached for your information a letter dated March 22, 1999, from the engineer Arthur White concerning the installation of sprinklers at the above-referenced location. If you have any questions or concerns, please contact me at 978-741-1215 x 2592. Sincerely, John Pelletier Project Manager cc: Jon Keys, Plant Operations t Kenneth Thompson, Facilities Project File: 9707-117 1 IP:CMW 9707-117.ENG � PARTNERS. HealthCam System Member Founded by Massachusetts General Hospital and Brigham and Women's Hospital THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Massachusetts 01970 - Tel.978 741-1200 Kevin Goggin City Of Salem Inspector Of Buildings Dept. One Salem Green Salem, MA 01970 Fax#: 978.744.5918 Re: Shaughnessy-Kaplan Rehabilitation Hospital Salem, MA 01970 Fire Alarm Project Our Project No. : 9707-114 Dear Kevin, Pursuant to our telephone conversation Friday (in which you concurred that the MA Blg. Code 6th ed. does not require patient room automatic door closure), subsequent conversations with our consultants and our understanding of this issue, we are planning not to reconnect the existing automatic door closers presently in operation at all patient rooms at the SKRH facility. We also plan to phase out these closers mainly due to upkeep and restocking issues. Please note that all other non- patient room door closers and those mandated by applicable codes and guidelines will be maintained and tied into the new fire alarm system. We are doing this as a result of the relief that is afforded us by the facility being protected by a full coverage fire suppression system and that the doors positively latch as in regards to the Massachusetts State Building Code (6th edition) and our interpretation of NFPA 101, and both DPH and JCAHO guidelines. Thank you for your time in this matter. Si el ch Kanter Project Manager/NSMC Facilities Department cc: K. Thompson;J. Pelletier;D. Canham(RWS);J. McDonnell (Baystate Elect.);A. White, Jr.;File 7��+t�11' � PARTNERS. HealthCare System Member Founded by Massachusetts General Hospital and Brigham and Women's Hospital t ij February 11, 1999 Robert W.Sullivan, Inc. City Of Salem Consulting Engineers Suite Building Department ne 302, union when Boston,Massachusetts 02109 -8227 One Salem Green t)f 623 (FFax)523-8076016 Salem, Massachusetts 01970 A. Eugene Sullivan P.E. Anthony T DiStelano P.E. BahigA. Kaldas P.E. Attn: Mr. Kevin Goggin Eugene B. Kingman Inspector of Buildings Steven P Quieto Mark J. Sullivan Re: Fire Alarm & Fire Sprinkler System Retrofits Paul D. Sullivan P.E. Shaughnessy - Kaplan Rehabilitation Hospital (SKRH) Salem, Massachusetts RWS File #4407 Dear Mr. Goggin; Attached please find a copy of a partially completed Construction Control affidavit that was submitted to Richard Kanter at the North Shore Medical Center. The affidavit indicates that I would be responsible for construction control with regard to the installation of both the fire sprinkler and fire alarm systems at the Shaughnessy - Kaplan Rehabilitation Hospital (SKRH) in Salem, Massachusetts. This correspondence is to inform you that the North Shore Medical Center has decided that the engineer who has sealed and signed the fire sprinkler system shop drawings should act as the engineer of record for that system and provide the required construction control operations. Therefore, we ask that you place this correspondence on file where required to indicate to all that Robert W. Sullivan, Incorporated and/or my self, Edwin A. Kotak, Jr. PE#38500, bear any responsibility in matters concerning the fire sprinkler system that will be installed at the Shaughnessy - Kaplan Rehabilitation Hospital (SKRH) in Salem, Massachusetts. If you have any questions, comments or require any additional information, please corlvct oln" office. nrn Very truly yours, nn CO ROBERT W. SULLIVAN, INC. ` oZA v 3 M Cn EDWIN A. KOTAK,'JR'.; PE- Senior ESenior Fire Protection Engineer cc: Mr. Richard Kanter-NSMC (SKRH) .. P:Iprojects144071021199 city ofsalem ltr.npal - - James D.Albanese, PE Kenneth S. Charest Robert V. DeBonis Pedro Gonzalez Edwin A. Kotak, Jr., P.E. Michael J. McGillicuddy �4 CONSTRUCTIONCONTROL PROJECT NUMBER: 9707-114/9707-117 h ` Shaughnessey-Kaplan Rehabilafion Hospital:@ NSMC.;Installations of ua s PROJECT TITLE: • s sion System's � ' ' -PROJECT LOCATION- 1 Dove Avenue, Salem, MA;: 01970 NAME OF BUILDING: Shaughnessey-Kaplan Rehabilitation Hospital NATURE OF PROJECT: Installation of Fire Alarm,& Fire Sptliikler Systems IN ACCORDANCE WITH SECTION 127.0 OF THE MASSACHUSETTS STATE BUILDING CODE I Edwin A. Kotak, Jr. Registration; No. 38500 BEING A REGISTERED PROFESSIONAL ENGINEER/ARCHITECT HEREBY CERTIFY THAT 1 HAVE. PREPARED..OR,DIRECTLY SUPERVISED THE PREPARATION OF :ALL 'DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS CONCERNING: ENTIRE PROJECT , ARCHITECTURAL STRUCTURAL FIRE'PROTECTION---r­ ELECTRICAL MECHANICAL OTHER (speci'fy). *` ire Alarm FOR THE.:ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE; SUCH;PLANS, COMPUTATIONS_IIND SPECIFICATIONS MEET THE APPLICABLE PROVISIONS OF .THE MASSACHUSETTS STATE. BUILDING"CODE,: ALL ACCEPTABLE ENGINEERING PRACTICES AND APPLICABLE LAWS 'AND ORDINANCES FOR THE PROPOSED USE AND' OCCUPANCY. . I FURTHER. CERTIFY THAT I SHALL PERFORM THE. NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE. GONSTRUCT.ION 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 127.2.2: 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 controlled materials. 3. Special architectural or engineeri.ng .professional '.inspection of critical construction components requiring .controlled materials or construction specified in the accepted engineering practice standards' listed in Appendix B. PURSUANT TO:SECTION127.2.3, I SHALL SUBMIT PER'FDDICALLY,,A PROGRESS.REPORT TOGETHER IdITH PERTINENT. COMMENTS TO THE BUILDING INSPM'OR. UPON COMPLETION OF THE WORK, I SHALL SUBMIT A"` .INAL° 0 A T E ATIFACTORY COMPLETION AND READINESS OF THE PROJECT FOR 0 UPANC . Sign 'ure SUBSCRIBED AND SWORN BEFORE ME THIS DAY.'OF' , 19_ - %S3T111I7M_' dSOH N371S 20'ET 26, 70 AON THE NORTH SHORE MEDICAL CENTER Salem Hospital 81 Highland Avenue Salem,Mnssachusetts 01970 Tel.978 74M20n 20n Kevin Goggin City Of Salem Inspector Of Buildings Dept, One Salem Green Salem, MA 01970 Fax#: 978.744.5918 Re: Shaughnessy-Kaplan Rehabilitation Hospital Salem,MA 01970 Fire Alarm/Sprinkler Retrofit Projects Our Project Nos. : 9707-114 and 9707-117(respectively) VIA FACSIMILE Dear Kevin. Please be advised that Mr. Arthur White,Jr. shall be providing construction control services for the Fire Suppression Project in lieu of Robert W. Sullivan,Inc. Mr. White is the engineer of record for the fire suppression construction documents. RWS is the engineer ofrecord, and therefore will continue to provide construction control services for the Fire Alarm Project. I have made available to Mr. White the narrative,provided by RWS which was required by the City and outlines the method of operation and interface of both the new fire alarm system and the retrofit to the fire suppression system. A construction control affidavit will be completed by Mr. White and filed with the city. If you have any questions or concerns regarding this or any other matter pursuant to these two projects please do not hesitate in contacting me. Sincerely, ich Kanter Project Manager NSMC Facilities Department PARTNERS 1VERS IlealthCareSysi mMember roundcd kv Masmel,usnes General fla.pilaf and thlgharn aM womrn:v{iaap i'l T'd /S3I1IlI3UJ dSOH W3-1US aZ:T S 66, SO Had Cc: K.E. Thompson J. Pelletier A. White, Jr. J. Larkin E. Kotak(RSW) Project File Z'd /S3I1I-1I3Hd dSOH W3-1US OZ:TT 66, SO H33 i Facsimile Transmission THE NORTH SHORE MEDICAL CENTER FACILITIES DEPARTMENT 81 Highland Avenue Salem, Massachusetts 01970 Please deliver the following pages as soon as possible. Thank you. Date:--OZ- 0 Time: am/pm Total Pages (including cover): 2 TO: Mr. FROM: Company: C s Telephone #: (978) 741-1215 Ext i Telephone M 4NA Fax #; (978) 741-4872 Fax #: I v -5 RE: qLl& 4q;i M f Message: l' 61 /lL�- 424' _ 6*&44� rV (A 661Utdtnc If you did not receive all pages, please call (978) 741-1215 Ext. 2590. Receipt confirmation requested. If checked,kindly fax this Cover Page to(97a) 741-4872 to indicate your receipt of all pages. T'd /S3I1I-1I3Cd dSOH W3-1US 00:4T 66, TO Had r January 29, 1099 Robertw Sullivan, Inc. Consulting Enyiret Kevin GOggin Swire JC2, Union Wfad^, o Salem Building lnspe t-tot's Office BO,iOn,hussacrn spas ,o (d 17)523.0227 1 Salem Green (rp;525.809E Salem, MA. 01973 A, Eupene Sufi van P.E. gnrnony L 040tala00 P.E. Bang a. Kardas PE. 8ltaughrtewy . lCaplx»}poapital Eugene S. idngman Borth Shore Medical Canter Steven P ouieto a gigWoind Avenue Marx„I Sullivan Salem, MA 01970 Paul 0, sudiw PE. Dear Mr. Goggin: It is out understanding that once the building is fully sprinklered the door holders win no longer be required per 780 CMR section 409.3.1. 406.3,A Corridor Doorw Corridor doors, oilier than those in a wall required to be rated by 780 CMR 302.T.T or for the enclosure of a vertical openifl!7 or an exit, shall not have a required fireres-istancL raring and shnlf not be requiped to be equiyped tuith self-closing or automatic-dosi�de�ces, but shall moke and latching. Roller e an luta! eS are not.permirted.harrier to limit the nAll other doors-shall ll be nform to 780 CMR 716.0 e We believe the patient room doors to fall into this code section. The reference to 302.1.1 would apply to doors to carcata such as locker rooms or mechanical spaccl. There is adequate spare brtween the top of the door and the ceiling to provide all effective barrier for smoke spread. The existing latches meet the stated requirements. After reviewing tlhc upcoming maintenance budget thc hospital has decided to remove the existing automat-ic door closer devices along with the patient room smoke detectors. This work will be done as part of the fire alarm retrofit project. This work will not be done until the areas am fully Sprinklered in order to maintain compliance with the building code at all times, If you have any questions regarding Ibis work please call me. Thank you. Sincerely, ;11dC�CanhakDl, CET —' cc. Ed Kotak • I2WS Richard Kanter - North Shore Medical Center Z'd /S3I1I-1I3UJ dSOH W3-1US 60i4T 66 'e. 933 BDiLDHIG DEPT. ilLNE SEP 1b 9 28 AM 495 5 Pickering Wharf Salem,Massachusetts 01970(508)744-3467 - RECEIVEO September 201, y�FSSQLEF„P,Q$$. City of Salem Building Department 1 Salem Green Salem, MA 01970 Attention: Mr. Leo Tremblay Re: Shaugnessy Kaplan Hospital Roof Garden Dear Mr. Tremblay: As of my visit on the morning of September 19, 1995, corrective work on the roof garden was nearing completion. With the exception of the planting bed depth at the extreme west, all work appeared to be in general conformance with the sketch we had submitted, dated September 5, 1995. . The westernmost planting bed has 711 to 811 of soil as opposed to the 411 which we had required, and the hospital will direct the contractor to install styrofoam voids in the soil to conform as closely as possible to the requirements of our re-analysis. We have assumed an average blanket snow load of 45 psf, due to the relative roughness that the roof garden creates, and we have considered the assumptions listed in our letter to Larry Healy dated September 5, 1995. We also understand that the rooftop pool will be drained and kept drained in the winter. With the current substantial completion of this work and the abo,e considerations, we are satisfied that the above project meets the general structural requirements of the Massachusetts State Building Code and proper engineering practice, and can safely be opened for use. Cordially, MILNE ASSOCIATES, INC. o M. Wathne, P.E. CC: Larry Healy An Equal Opportunity/AtTirmative Action Employer 1. r�oNluy- �Otr, CERTIFICATE9/19/94 ED 5 ! DATE CITY OF SALEM ` s SALEM. MASSACHUSETTS 01970 BUILDING PERMIT - �a4� CERTIFICATE OF OCCUPANCY DATE - - 19 yd' PERMIT NO. APPLICANT -- ADDRESS IND.) (STREET)` ICONTR'S LICENSEI PERMIT TO (_I STORY NUMBER. OF ' DWELLLNG UNITS ITIPE OF IMPROVEMENTI NO. IPROPOSEO USE) AT ILOCOTION! I ' 'L+-'d`-'�x' P ZONING - DISTRICT INC.) (STREET) BETWEEN AND (CROSS SigEEil ICg055 STREET) LOT SUiiOIV IS IDN LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE P. FT. LONG BY FT. IN HEIGHT AND SHALL•CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ITYPEI .REMARKS: .ill:' :a1- Dc!i L_ - for JCPUdi) CcaCCLI _r�ir�Pi:� 'Ja:i^_[:i:1cU.f,ii:1:?651iy y yT �.fy AREA OR DRMI df1FE1 C1REl � rj� VOLUME 6 '�R�EEES.ISYAAF�FF�O6NECF �MRIIMn�F �1�1_fI 'M'4aaPEFFEYYE.WIII nnEEEW...... WI NNEEWWFFO C :BIC SQUIRE PEETI NS OWNERoe,rloi"rlo�-nsrnv�-nvvlsemvvlbvlbcFloe:nvvlve�le�rlsrPlsc'Eln ..L!.•.:: HO'- S1=S L TO BE POSTED ON PREMISES ADDRESS L:OvC F.F; u1i'::.r - SEEIREVERSE S1DEiFORICONDITIONS OF CERTIFICATE DEPARTMENTAL APPROVAL FOR CERTIFICATE of OCCUPANCY and COMPLIANCE To be filled in by each division indicated hereon upon completion of its final inspection. BUILDINGS Permit No. 326-94 - Approved by John J. Jennings Dale 9/19/94 Remarks i i PLUMBING Permit No. i Approved by Dennis Ross 9/16/94 Date Remarks ELECTRICAL Permit No. i I Approved by Al Falkowski Date 9/15/94 Remarks i i OTHER Fire Permit No. Approved by_ Norman LaPointe Date Remarks OTHER Permit No. Approved by Date Remarks BUILDING PERMIT JOB. WEATHER CARO DATE 19 PERMIT NO. APPLICANT ADDRESS ' IND.) (STREET) (CONTR'S LICENSE) NUMBER OF PERMIT TO1_1 STORY DWELLING UNITS (TYPE OF IMPROVEMENT) NO. )PROPOSED USE) AT (LOCATION) DINING DISTRICT (NO.) ISi REETI BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ITYPEI REMARKS: AREA OR Cali fa,- ermit to DOWN PERMIT c VOLUME ESTIMATED COST FEE S :CUBIC%SQUARE FEET) OWNER BUILDING DEPT, ADDRESS I " ... x ,c ....� 1 . BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY 04 SIDEWALK OR ANY P4RT THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION, STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF TEQRAPPROVED PLANS NEE CALL MUST BE RETAINED ON JOB AND THIS ERE APPLICABLE SEPARATE INSPECTIONS RUIRED FORWHCARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ALL CONSTRUCTION WORK: ELECTRICAL. PLUMBING AND I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEADO TO LATH 3. FINAL FINAL INSPECTION HAS BEEN MADE. L INSPPINECTION BEFOREE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS In LUMBING 1 P TION APPROVALS ELECTRICAL INSPECTION APPROVALS BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT.IN ECTING APPROVALS 1 1 � ✓ I{{ ll 1 /J OTHER CITY ENGINEER 2 D WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS WORN IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGEDFOR BY TELEPHONE STAGES OF CONSTRUCTION. PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. DIMENSIONS Numcecefof stones a. M. DEMOLITION OF STRUCTURES: Nu "d. Total omsquare cafeet of Hoot area Has Approval from Historical Commission been received all floors.oases a f floorexter dnensms .................................................... ....... _._ for any structure over fifty(50)years? Yes_ No_ a. total lano area.sq.M.-............-...................................... Dig Safe Number 4UMBER OF OFF-STREET PARKING SPACES PeSt Control: il. Encloseo ...._....._ ......................... HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? :z. outdoors........................................................................... Yes No IESIDENnAL BUILDINGS ONLY Water: ;3. Endosed ............................_..................._..._._........._. Electric: Gas: Full..........._............................ Sewer: i4. Number of bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Part's--------------- BEFORE A PERMIT CAN BE ISSUED. COMPLETE THE FOLLOWING: Historic District? Yes_ No—Z (If yes,please enclose documentation from Hist Com.) Conservation Area? Yes_ No (If yes,please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yeses No_ Is property located in the S.R.A.district? Yes_ No Comply with Zoning? Yeses/ No_ (/if no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ Nov (If yes,submit documentation/if no. submit E W If new construction, has the proper Routing Slip been enclosed? Yes_ No /(/f� Is Architectural Access Board approval required? Yes_ No (If yes,submit documentation) Massachusetts State Contractor License# 0 S/0.7 77 Salem License # /q 31 Home Improvement Contractor # /0 zf '? 2 7 Homeowners Exempt form If applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT If an extension is necessary, please submit ,NSTRUCTION IS TO BE COMPLETED BY: in writing to the Inspector of Buildings. IDENTIFICATION - To be completed by all applicants Name - `/ Miming address-Numcer,street,cry.and state ZIP c000e/� Tel.No. 'r OrI)Atlrt �S 1 GF Q . 0 Y GM ` 13v rev actor I Builder's y� License No. :ect or ,eer hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application s his a ed agent and we agree to conform to all applicable laws of this jurisdiction. azure a Address Applicafion date NN�d1 ST— o "1.$— City of Salem Ward 3 3 APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT•Applicant to complete all items in sections:1, ll, 111, IV. and IX- I. AT(LOCATION) / v �} Ile DIISTRICCT Re, LOCATION NO1 smEE t OF BETWEEN AND BUILDING .CROSS STREET CROW STREETI LOT SUBDIVISION LOT BLOCK SIZE 11. TYPE AND COST OF BUILDING •All applicants complete Parts A -D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE t ❑ New building Residential Nonresidential 2 Addition fit residential.enter number of new 12 is ❑ Amusement.recreetion al ❑ ❑ One family nousmg units added,it any,in pan 0, 131 t 9 C] Cnaoh,other religious 13 13Twoor more lamely-Enter number 3 'AITA Alteration(See 2 above, of units 20 ❑ Industrei 21 ❑ Parking garage 4 ❑ Reoau replacement 14 ❑ EnterTransnu hotel. units or dormitory. 22 ❑ San"station.repair garage Enter number of iritis ..............._...... 5 ❑ Wrecking(If mutldamdy resCenlial enter number _ 23 � Hospital.(nsinutional of units in budding in Part D. 13) 1° -::none - 24 ❑ Office.bank,professional 6 ❑ Moving imccationl 16 F11 Caroon 25 ❑ Public utility i ❑ Founoatan only 26 ❑ School,library,other educational 17 11 Other-specify 26 ❑ Stores.mercantile B.OWNERSHIP 26 ❑ Tanks.towers 8 2) Private(individual,corporation.nonprofit 29 ❑ Other-Specifymstautlon.etc.) 9 ❑ Public(Federal.State.or local government C.COST (Oma cents, Nonresidential-Descnbe m detail Proposed use of buildings.e.g..loop processing pent, machine shop,laundry building at hospdal,elementary school,secondary school.College, parochial school,parking garage for department store.rental office budding,of bukm 10. Cost of imorovement ...................... 8 �. Z. at mdustnal plan.If use of existing building is being changed,enter OrOpO$W uss. ID be installed but nol mcludeo n the above cost y 2 /� pa b. Plumbing................._._.............---.................... fOrr�B 7. Heating.air condaiomnq _....... �"7d� C. Other(elevator,etc.) ............................. _. pL"o 11. TOTAL COST OF IMPROVEMENT III. SELECTED CHARACTERISTICS OF BUILDING • For new dulldings and additions, complete Parts E - L.demolition, complete only Parts J& M. all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF�S£WAGE DISPOSAL 1. TYPE OF MECHANICAL 30 ❑ Masonry twall hearing, 35 ❑ Gas 40 ,L-,LJ-,"PPuubllc or private company Will there be central air condmcnmg? 31 Wood frame 36 ❑ Oil ,1 Cl Pnvate(septic tank.etc.l 32 ❑ Structural steel 37 Electncay, 44 9151-yes 45 ❑ No H. TYPE 0 WATER SUPPLY 33 Reinlonced concrete 38 ❑ Coal rL/�l Will thenre by an elevator? ;4 ®c Other-Specify Kc 39 ❑ Other-Soemty 42 Public or Private company 46 rrpl!y� 47 ❑ No d 4-t/� 43 ❑ Povatelwell.asternl l DO NOT WRITE BELOW THIS LINE I. VALIDATION Building i/� �jA FOR DEPARTMENT USE ONLY Permit number P /Y Building Use Group j Permit issued i Fire Grading Building ((7J G fl Permit Fee r'/js Live Loading Occupancy Load Certificate of Occupancy S Approved by: Drain Tile S Plan Review Fee $ rrrLE � NOTES AND Data- (For department use) (� Roy o is PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: COMMONWEALTH OF MASSACHUSETTS `0 DEPAR—.m1NI' OF JNDUSTRIALACCIDENTS ' 600 WASHINGTON STRE>=I' ;amen.: zanooer BOSTON, MASSACHUSETTS 02111 ss,one• WORKFRSS' COMPENSATION INSURANCE AFFIDAVIT ,N0 4S7ANc Y ( icenseuvermineel with a principal place of business/residence at: 9s' (City/sumlZip) do hereby certify, under the pains and penalries of perjury, that: ( J I am an employer providing the following workers' compensation coverage for my employees working on this job. Insurance Company Policy Number bQ 1 am a sole proprietor and have no one working for me. [ ) 1 am a sole proprietor, general contactor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation insurance policies: p LQ_(/: fYt7�o�� isd/ a �70o$, l/IXR FM Ai're y r fele F-S r t Ztr t�r a H Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number Name of Contractor Insurance Company/Policy Number [) I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowoen who employ perwas to do maintenance.constmetico or repair work on a dwelling of not more than three unitsin which the homeowner aiw resides or an the grouada appurtenant thereto ire not geaenl{y considered to be empiovers wader the Workers' Cosnotmatson Act(GL C. 152.sect. 1(5)), appiscatson by a homeowner for a license or permit may evidence the legal sums of an employer under the Workers' Compensation Act. i understand that a copy of this statement will be forwarded to the Deoanment of Industrial Accidents' Office of insurance for coverage �cnficanon and that faiiure m secure coverage as reotared under Scction 25A of MGL 152 can iced to the imposition of criminal penalties consisting of a fine of up to 51500.00 andlor impruonment of up to one yew and civil penalties in the form of a Sloss Work Order and a Fine of 5100.00 a day against me. Sic is 2. '5day of J AZIZY �' 19 �..f r Licenscei Permiaee Licensor/Permitror „tebamiwi 5. Dultajua `ar."'°r 10,"0' KeRalo rsntaltml �� Area.. �,llmlaootier.... 02102 mamma loll G3arta J. Dlaeao ---- amr M E M 0 R A N 0 U 14 O: AM Builutae Ocaaruaentsrauta 8urwtaa tnsnenars FROM: Chorea J. Duma.Admmatrstor - DATE Oaooer 11. 17RR SU8JECT. MGL cia. 154. Added n.v3ttd. S9 or the nen mr 19” The aawe•mmtwam statute r=utm cnaz w:ara restoune tram the uco atuton. rcaowuRMI.feY1lllls -r utter altectum no a nuname or structure ne utsoosea of to a ormsenw ncenses slaw a d" aauty as ucfuu= by tAGL 6111. S IJCA anu gnat nuttume pertm s or uCCMSa are M umrmR.YS IOC .,( one taQaty at Wilma the Saul &ICBM Is In ne uLSllntea. THIS REOUIRENiefrMOE3 N1 .i,PPLY TO NEW CONSTRUG:ON. In arae in slmmlfy the 111000111 aao fit nrttvttte unrfgummr. we are atlarame a t33OW t/r a InR'�Ri� ,;=Cttaer rep mucr ana use as it is stn=inC C=DlctCa farm will be agf,"6 to Inc Vida OW4W 610M pcMu s or utas» or reptoau=a an "sur teteernCmL !n ase at mantC=L Carlen Cf=L tnututr=L ur matn•amt nntume tonstruawn. Inc mmra®tRW Rat to ;he aumester sun=ntracter at me it= nt the ouousna permtt aepoatten. in sura cases.1111321111111Rtht of as ^(ndavtt an oe uses. 'he Cammete taw is rnnatnea to the Nnvemncr issue ul CODEWOR0 wmcn wild be tntllad M rrtm in i SCM two wee= ;r vne snaula have any uuattan. r.tcase tct to know. UD1Ym AFFIDAVIT As a result of the provisions of MGL c 40. 554. I actnowledae that as a condition of Building Permit Number all debris recultme from the construction activity governed by this Buildine ?emit shall be aisoosea of in a oroperiv licensed solid waste aisposal facility. as defined by MOL c 111. S 150A I cunfv that I will notify the Building Official by (iW o months m—mumi of the location of the solid waste disposal faahry where the debris resulting from the said construction actfviry shall be dtsoosed of. and 1 shall submit the appropriate form for attaehmeet to the Building PermlL D Signature of Permit Appb= (Print or type the followin¢ informationi Name of Permit App;—=t- Firm Name. tf anv C?y5 Ino Address In accordance with the prowsions of MGL c 40. S 54. a condition of Building Permit Number a that the debris resultine from this work shall be disposed of in a properly ljceasea solid waste disposal favi iry as damned by MGL c 111. S 150A. The debris will be disposed of in: (Loauon of Fachty) Signature of Permit l5k.ppacant � L e No City of Salem Ward 32 d li 4ctmn v� APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:/, ll, ///, IV,and IX. 1. AT(LOCATION) SKRH%Salem Hosp: 8 a v 1970 ZONING LOCATION OF BETWEEN - --� O •"` " 4- AND BUILDING (w STREET) (CROSSLOTET) SUBDIVISION LOT—BLOCK SIZE II. TYPE AND COST OF BUILDING -All applicants complete Parts A-D A, TYPEOFIMPROyEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential T 0'Addition(if residential,enter number of new 12 ❑ One family 76 ❑ Amusement,recreational housing units added,it any.in pall A 13) 19 ❑ Chmch,other religious 73 ❑ Two or more family•Enter number 3 Alleraliort(See 2 above) of units _ 20 ❑ Industrial 21 E] Parking garage 4❑ Repair replacement 74 ❑ Transient hotel,motel,or dormitory: 22 Service statimrepair garage Enter number of unify._.._....-� 5❑ Wracking Of mulfitamityresidenfiA enter number 23 E] Hospital,institutional of units in building in Pan A 13) 15 ❑ Garage 24 ❑ Office,bank professional 6 ❑ Moving relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 26 C] School,library,other educational 17 ❑ Other-Specdy 27 ❑ Stores,mercantile B.OWNERSHIP 26 ❑ Tanks,taxers an Private(individual,corporation,nonprofit 29 ❑ Other-Specify _ eatitutim etc.) 9 ❑ Public(Federal,Slate,or local government C.COST - (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant, machine shop,laundry building at hospital,elementary school,secondary school,college, 9 1800 00 parochial school,parking garage for department store,rental office building,office building 70. Coll of improvement --_�_.�.---- 3 at industrial plant.If use of existing building is being changed,enter proposed use. To be installed but not included - in the above cost Shaughnessy-Kaplan Rehab HOC ,;n'ial nnvA a Electrical b. Plumbing__,.__ _______ Ave. location. Permit required for fence cHeating,air conditioning___.�-_____ installation at the above named location d..Offer(elevator,etc.) - 11.TOTAL COST OF IMPROVEMENT a 9 800.00 at the Outdoor Rehab. Therapy Garden. III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions,complete Parts E-L;demolition, complete only Parts J 8 M, all others skip to IV E PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HFEXnNG FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30 ® Masonry(wall bearirp) 35 W Gas 40 Public or private company Will there be central air 31 ❑ Wood frame. 36 04 41 ❑ Private(septic tank etc.) conditioning? 32'❑-Structural sleet. 37 ❑ Electricity 44 n Yea 45 ❑ No 33 ❑ Reinforced concrete 38 ❑ Coal H. TYPE OF WATER SUPPLY Will(here by an elevaloR 34 ❑ Other-specify 39 ❑ Other-Specify 42 ® Public orprivate company 46 ❑ Yes 47 ® No 43 0 Private(well,cislem) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: ' 49. Numbers stories_ - % 49. Tolal��abaudonDoor� Has Approval from Historical Commission been received ;mensions for any structure over fifty(50)years? Yes_ No_ 7. 50.Taal lana area,sq.fl._N[A Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED? 52. outdoors __.__...N/A — Yes No L RESIDENTIAL BUILDINGS ONLY Water. 57. Enclosed Electric: Gas: Fal N/A Sewer. - 54. Number of bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Pa^'a— BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ No-L (It yes,please enclose documentation from Hist Com.) Conservation Area? Yes_ No-.2L. (If yes, please enclose Order of Conditions) Has Fre Prevention approved and stamped plans or applications? Yes---L No Is properly located in the S.R.A.district? Yes_ No- Comply with Zoning? Yes--L No_ (if no,enclose Board of Appeal decision) Is lot grandfathered? Yes_N,LA No_ (If yes,submit documentation(f no,submit Board of Appeal decision) If new construction,has the proper Routing Slip been enclosed? Yes-IL No_ Is Architectural Access Board approval required? Yes_ No--L- (If yes,submit documentation) Massachusetts State Contractor License# 015544 Salem License# 947 Home Improvement Contractor# N/A Homeowners Exempt form(if applicable) Yes_ No_ CONSTRUCTION TO BE COMMENCED WITHIN SIX(6)MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: If an extension is necessary,please submit in writing to the Inspector of Buildings. V. iDENTiFICATION • To be completed by all applicants Name Mailing address•Number,street city,and slafe LP Code Tel.No. 1. Ome or. lessee 2. Ken Thompson 81 Highland Avenue 01970 41-1215 Contractor BulldWs Salem, MA 01970 LicarsseNo. X2593 a Architect or Erginex thereby t the proposed work is authoriz the owner of record and that I have been authorized by the owner to make This application s rz a ent and we agree to conform to al livable laws of this jurisdiction. ig r ddress Application date 81 Highland Avenue, Salem, MA 01970 DO NOT WRITE BELOW THIS LINE ' ,p VI.,VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building Use Group Permit issued t9— Fire Grading Building Permit Fee $ Live Loading Certificate of Occupancy $ Occupancy Load Approved by Drain Tile $ Plan Review Fee $ TITLE NOTES AND Data•(For department use) 2 � z PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by. Completed by. VI ZONING PLAN EXAMINERS NOTES r DISTRICT 1 USE FRONTYARD SIDE YARD SIDE YARD REAR YARD NOTES bIT E On PLOT PI:414 For Applicant Use Please see attached drawings. LL O N ; 1 r� -- - IY Fel w� . --- - _ APPROVD) Subjcxt to approval by any et cr X �I� auJi ti-ity having jurisdiction. CI;.`i of SALEM, PdA`�S FIT�' .REVEIFTit?�? LAPP VED`•eJ__Y FCR iC-tidTG;Crd'�!i'r:OF TWE AND L 'TI'' : C'F Fi4E PROTECT:'N CE"Li4 8. ALL PISS Pi OT� `.i0i1 D":iCES .E 4,.j2 CT TO A .. . . - dD:.�.a-'vCr;O:J TO cO?r;:LF."i-COxSPL6 ANC:, J• _- r i �'NO. J, City of Salem Ward APPLICATION FOR PERMIT TO BUILD ADDITION, MAKE ALTERATIONS OR NEW CONSTRUCTION IMPORTANT-Applicant to complete all items in sections:1, ll, /it, IV,and IX. I. AT(LOCATION) D®ve, 4V DISTRICT ZONING LOCATION ('104 (STREET) OF BETWEEN AND BUILDING )CROSS STREET) (CROSS STREETI LOT SUBDIVISION LOT BLOCK SIZE IL TYPE AND COST OF BUILDING -All applicants complete Parts A-D A. TYPE OF IMPROVEMENT D. PROPOSED USE-FOR"DEMOLITION"USE MOST RECENT USE 1 ❑ New building Residential Nonresidential 2 ❑ Addition(if residential,enter number of new 12 Q One family 18 ❑ Amusement,recreational (rousing units added,if any,in part D,13) 19 ❑ Chruch,other religious 13 Q Tvro or more family-Enter number 3 Alteration(See 2 above) of units......................._........................ ... 20 ❑ Industrial 4 ❑ Repair replacement 14 Q Transient hotel,motel,or dormitory- 21 ❑ Parking garage Enter number of units ........................... 22 Q Service station,repair garage 5 Q Whacking(it multifamily residential,enter number ❑ 23Hospital,instltutiorual of units in building in Part D,13) 15 Garage 24 Q Office,bank Professional 6 ❑ Moving(relocation) 16 ❑ Carport 25 ❑ Public utility 7 ❑ Foundation only 17 C] Other-Specify 26 ❑ School,library,other educational 27 ❑ Stores,mercantile B.OWNERSHIP 28 Q Tanks,towers 8 Private(individual,corporation,nonprofit institution,etc.) rag C] Other-Specify 9 ❑ Public(Federal.State,or local government C.COST (Omit cents) Nonresidential-Describe in detail proposed use of buildings,e.g.,food processing plant machine shop,laundry building at hospital,elementary school,secondary school,college, parochial school,parking garage for department store,rental office building,office building 10. Cost of improvement ............ ..0........._`'............... $ G ny g 9 changed,enter proposed use. / D-'0--to at industrial plant.If use of existing building s Dein To be installed but not included in the above cost 8romade FXfSy��%ty A 4 . Rncl ce-1 a. Electrical........................................................................... -,L r r b. Plumbing.........._........................................_........_.......... YI i n.7C7`h Zy (y''gi l,/� Ifr e/4. c. Heating,air conditioning............................................. 1..700 — J rp j d. Other(elevator.etc.)..�/��'.!._?_K� .rS.............. 11. TOTAL COST OF IMPROVEMENT $ 44 Joe -! III. SELECTED CHARACTERISTICS OF BUILDING -For new buildings and additions, complete Parts E-L;demolition, complete only Parts J& M, all others skip to IV E. PRINCIPAL TYPE OF FRAME F. PRINCIPAL TYPE OF HEATING FUEL G. TYPE OF SEWAGE DISPOSAL 1. TYPE OF MECHANICAL 30 Q Masonry(wall bearing) 35 Q Gas 40 Public or private company Will there be central air 31 Q Wood frame 36 Q Oil 41 ❑ Private(Septic tank,etc.) conditioning? 32 Q Structural Steel 37 ® Electricity 44 ® Yes 45 Q No 33 ❑ Reinforced concrete 38 Q Goal H. TYPE OF WATER SUPPLY Will there by an elevator? 34 ® Other-Specify Adi& 39 Q Other-Specify 42 Public or private company r 46 E] Yes 47 M No Frwme PRr 1'l fir errs 43 ❑ Private(well,cistern) J.DIMENSIONS M. DEMOLITION OF STRUCTURES: as. Number of stories ............................................................ 69. Total square feet exterior area, all floors.based on Has Approval from Historical Commission been received n ezledor '3�Ct( dimensions ..................................................................... for any structure over fifty(50)years? Yes_ No_ 101 ,14 50. Total land area,so.tL................................................... Dig Safe Number K.NUMBER OF OFF-STREET PARKING SPACES Pest Control: 51. Enclosed ........................................................................ 52. Outdoors..............-..................................................._..._.. HAVE THE FOLLOWING UTILITIES BEEN DISCONNECTED?Yes No L RESIDENTIAL BUILDINGS ONLY Water: 53. Enclosed.........................................................._........... Electric: Gas: 54. Number of Full........................................ Sewer: bathrooms DOCUMENTATION FOR THE ABOVE MUST BE ATTACHED Partial------------------ I BEFORE A PERMIT CAN BE ISSUED. IV. COMPLETE THE FOLLOWING: Historic District? Yes_ Nom (If yes,please enclose documentation from Hist. Com.) Conservation Area? Yes_ No (If yes, please enclose Order of Conditions) Has Fire Prevention approved and stamped plans or applications? Yes—X No_ Is property located in the S.R.A.district? Yes_ NOP Comply with Zoning? Yes No_ (If no,enclose Board of Appeal decision) Is lot grandfathered? Yes_ Nol� (If yes,submit documentationlf no,submit Board of Appeal decision) If new construction, has the proper Routing Slip been enclosed? Yes_ No_0 Is Architectural Access Board approval required? Yes_ No-.K (If yes,submit documentation) Massachusetts State Contractor License# O 4-10'? 7 Salem License# �y � Home Improvement Contractor# !1 2. 7 74 Homeowners Exempt form(if applicable) Yes_ No CONSTRUCTION TO BE COMMENCED WITHIN SIX (6) MONTHS OF ISSUANCE OF BUILDING PERMIT CONSTRUCTION IS TO BE COMPLETED BY: 6 If an extension is necessary, please submit in writing to the Inspector of Buildings. V. IDENTIFICATION - To be completed by all applicants Name Mailing address-Number,street,city,and state ZIP Code Tel.No. 1. Owner or WkYt?e- oho t0Ave- OIQOG Y.3; !z Lessee z. EAPI`T- 3vAJeA-5 1,0, a 3o90,5- Pe"odYMR, vMo Contractor Builder's License No. 3. Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized a ent and we agree to conform to all applicable laws of this jurisdiction. Signature of applicant Address Application date DO NOT WRITE BELOW THIS LINE VI. VALIDATION Building �✓� FOR DEPARTMENT USE ONLY Permit number Building Use Gmap Permit issued 194Y Fire Grading Building J Permit Fee $ /�4/ Live Loading Certificate of Occupancy $ Approved b occupancy Load Drain Tile $ Plan Review Fee $ itt NOTES AND Data • (For department use) PERMIT TO BE MAILED TO: DATE MAILED: Construction to be started by: Completed by: Q THE NORTH SHORE r MEDICAL CENTER .�� Salem Hospital November 2, 1994 Mr. Leo Tremblay City of Salem Building Department One Salem Green Salem, MA 01970 SUBJECT: Fence Installation at Shaughnessy-Kaplan Rehabilitation_Hospjtal Permit Number 477-94 Dear Leo, Please be advised that we have completed the installation with respect to the above mentioned permit and have applied the flame retardant as shown on the attached literature. If you would like to come up and observe the installation, please feel free to do so at anytime. If you have any questions, please feel free to contact me. Thank you for your cooperation in this matter. Sincerely, ,,� j Jam--✓ - �/ Ken Thompson Construction Manager KT:kfc cc: Norman LaPointe Larry Healey.. _^ , 81 Highland Avenue Salem, Massachusetts 01970 . Telephone 508. 741. 1200 5085359775 WALLS OF DECOR 606 F01 NOV 01 '94 14:09 AACtlIt'bU'IUPM.UUAI e.W .Y..CaC t..'LIWJ.V. INDUSTRIAL COATINGS Tel. (508)5355100 �- MAINTENANCE SUPPLIES Pax(508)5359775 - COAT)NGS,.INC. w.o.o.INDUSTRIAL SUPPLY 515 L4wOt Street.Peabody,Massachusetts 01960 Produdt aefarmation On: FL)1DtE CONTROL NO. 10 CLASS "H" 0) CLEAR TIRE RaTARAANT PENETRATING WOOD TREATMENT proNgt Description; Flans Control No. 10 fire retardant penetrating wood treatment was developed to meat the requirements for a clear fire retardant treatment for EXTERIOR use, on previously unfinished cedar shakes and shingles. It is wry effective in reducing the fire hazard of cedar and other edge grain woods. Tlaaw Control .No. 10 contains no water soluble salter therefore, its fire retarding properties are lastirg. Properly treated wood, when subjected to fire, will char. Application: Apply two coats by brush, spray or by dipping. Dipping is the most effective method of treatswnt for shaken and shingles, as all surfaces are treated. Allow 24 to 49 hours drying time between coats. (see CAUTION) . When applying the treatment by dippinq; allow Sufficient time for penetration of the material. risme Control No. 10 should be applied WMOUT thinning or dilution. Covasages. 130 $4.2t./U.B. gallon (3.7 m 2/1.1 , applied in two Coats at a rate of 300 sq.ft./U.S. gallon 17.4 m2/L) , per coat. NOTE: The surface area of hand split and rough textured materials is CREATAR than the apparent aware footage of the area, reduce spreading rate to Compensate for greater surface arca. Clean : US* Xylol, Toluene or Aromatic 100 for cleaning equipment. N ING- AdOwAte ventilation must be provided during and after application, until the coating has dried. Avoid breathing vapors or spray mist. CAUTION; The liquid coating Contains volatile (!laminable) solvents. Due care must be exercised during and after application until coating is dry. ltaintananoe. All exterior wood treatments and coatings are subject to deterioration when exposed to weather. In order to insure maximum continued protection, exposed Surfaces should be retreated every three to tour years. Exposure to Strong sunlight will cause the wood to darken due to the nature of the fire retardant ingredients. This darkening in no way affects or impairs the fire retardant qualities of the Crtlatmei;t. Post-It'"brand fax transmittal memo 7671 1 0 of pages . MANUFrICtU To 4/ /IE,14 FIM /!J& 0 CHEMICALS Ce. ALCM 7p co. (!:.)J, O • i7 Dept. F89 5085359775 WALLS OF DECOR 606 P02 NOV 01 194 14: 10 Paacka44n9+ Standard packaging, 1 gallon, S gallon, and 5s gallon containers. ST 0 (eyaail scale) A cedar Shingle approximatelY one foot square was divided in hall. One section was Created with two coats of ?lame Control NO. 10, at A coverage rate of 300 Sq.ft./gallon, per coat. Panels were allowed to dry 72 hours, before fire testing. The panels were placed at a 45° angle for an incline fire test. A Fisher high temperature gas burner, having a flame temperature of 1800r, was placed two inches from the panel surface, and the time of flame exposure measured. The flame was removed at 15 and 30 second intervals, and the time in seconds for the panel surface to self extinguish was recorded. RE8VLT6 No. 10 Treated Shingle ?lame Exposure Time to Belf Extinguieh Control tSecando�_ (Seconds) yhcoated Shingles 15 -------------------------------- 1 -----------------------------r 4 30 -------------------------------- 2 -------------------------- continuous 60 -------------------------------- 3 burning 90 ................................ y 120 ------------------------------- 15 ----------------------------------------------------------------------------------- rire Tests, (Foil Scale) Flame Spread Rating. Class "8" M . when applied to No. i grade, RED CEDAR SHIINGILES and tested in accordance with ASTM E-84, the treatment, obtained the following fire hazard classification. FIRS HAZARD CLASSIFICATION (when applied to Cedar 3hingles) system Details Flame Smoke Fuel Spread Developed Contributed Sealer - None Type No. 10 applied in two coats at 300 sq.ft./DS 35 $90 to gallon par coat 17.4 m2/L) Topcoat — Nene --r-----W.I..-- --------------------- ----------- ------------r (a) Class "8^ lire retardant rating per NFPA 703, section 2-2.1.3 As we Cannot anticipate all conditions under which this Information and our products, or the products of other manufacturers in combination with our products, may be used, no $adept is responsibility for results obtained by the application of this Information or trio safety and suitability of our products, either eland or in combination with other products. Usero Ore advised W MAN* their own tests to determine the safety and Suitability of each such product or product combination for their own 014rpdaea. We sell the products without warranty or guarantas, and buy$rs and users assume all esponaibiiity and liability for lata or damage arising from the handling and usd of our products, whether used alone or in combination with other products. .. .� ,;i''�".f.,t "i'J� Y'�.�. 7r� �""`�'%Y�'�-'y'1.,�..�„"cw"'^'T'�1r"�.�r�•yz•s �+ - �, C a CITY OF$AUM. BUILDING APPLICANT COPY SALEM. MASSACHUSFTT-S,0119,70, PERMIT �� vAp1o�T�oM - 11 94 477--94 Rgl mr N0 A7Rl ICAMT keri Tfio4am All Ave _ ADDRESS, �, ,ICOMii•{ .I�i q RE�M.T to. bti3id`fence i I sTOgr hoepitrl. wumsto Oof vwlrs,_ RIEIII f q( 0� W/ROv{Mtwi w0,' INO►O{(O V{(1 - AT It O:wt,OAit ;`;. _ D67e t EpuwG. . .. �.. .. . .. ,. ..� S iwo.l I IETwEEr.r ' Aw0 1{Ao{f f»ttil S000ry If10M - lDt.. RLOCN_,,��SIZE: - O4A101N0-IS.YO SE Ft. it 110E Or_T TT,.l4NQ DT FT, IM ME IGMT ANO SMALL,CONFQRM IN.COMSTR.gvi" . TQ 7YRt USE 6ROUR OASEMENt tvAtl¢'WI fOUMOATION, " €on r Iden. REMARRSiA. till. - � An mcneccor, -,3 745-9585 Ext.385 iO4u►[ r s 9800. FrEEREMrt 50. awMtR +hanghu&asy laplan Rehab Hospital Aao.cas 78 ne. ; em, JOHN JENMGS f ( ` ItiSUCTOR' OF BUILDINGS i f I �. A P'D' 17 7r_7- r;T (7r uf TO K Kin wr: I f I h_PPROVED ' `SJ autbeet to approval by any other -wwzcrity having juris&ciion. — - -----' -- :Ii ` r„SALEM, MAS!elf4 -T� — ?LSSA. RG Sv'LELY RI0cNTIFlCAT!O':OF YE A, LOCAT :! OF FIRE PROTECTION DEVV'_`u. .. ALL FIRE PROTE'STIGN nEVICES ARE 0J2:c P TO A FMALT $TAN.!)V;3F=^,TIO N,FORCOMPLT-T-'-COMPLI• �1 im _70 & v `�-`-•�' .f't� .:�iaaa�ts a`'.v��:� .�e�aeariowe ad.: , \lichaai :i. Dukaiu� Covetttar Vfa. C2ff Liiiii.ow .L2; — •lLaaaw t'.Vs iCmnta rstits„�t „�.�... ..l�..aoin+.�ii. o�J►oB chain= tem Quries J. Dineao AdtUMMratar MEMORANDUM 'ro. AH Buildlne Ocpartmentsr;Autc Budding insoeaors FROM: C3utts J. Dinezzo. AdWMcItrator DATE Ckaoncr J 1. Ivan SMECT. MCI. cJn. %SI. Added 1tv r5R/. N9 ar the ACM of 19117 i The anavo•mentioncu statute requires Inst ucum resuttine tram Inc uciaouuon. rcnoyauaL reesbiblatton sir ntner atteauon of a nutidine ar %Iruaure ac utsposcu of in 2 properry nccrsea soitd •1+2111 dixptlot iacwty as ucGncu ov MGL 6111. S150 ;roil 11129 auttutne permns or tirrasa are so intnota.91lat 023M ,I( Inc tatanty at wnren Inc situ Licans is III ne aisrimcu. THIS REOUIREMENT-1306 NOT \PPLY TO NEW CONSTRUC1ION. In urger in simunfv the pro= and to proYue untformity. we arc atiacnint a tmov of a Sam Witte Von un etcher reprouum aau use=it u sin¢the compictcu form vnu be attacacn to tuc ouiae tu"ot bmldi" permits or ticca - or reptaaucc it an Your icttcrnc=L. In case of Monto=L nommen L tnuttstrt2t.ur multt•unc9 nausmx construcllon.the contralaor anlr not kWW she uumgater sunwiltraclor at Inc time at the building permit appuation. In sura mi:36 9Aeatta01111C p! of an A(fidaint an tie uses. The comtete law Is cnnnmea in Inc Nnoremner issue of CODEWORO wnicn wtii he matlyd to Well In the next two wee= If you snouia have anv uuattnn. picaae tet us know. CUDAM • 1 AFFTDA ViT As a result of the provisions of MGL c 40. 554. I acknowledge that as a condition of Building Permit Number all debris resulting from the construction activiry governed by this Building Permit shall be disposer of in a properly licensed solid waste disposal facility. as defined by MGL c 111. S 150A. 1 certifv that I will notify the Building Official by 3— t ^01 y (levo months maximum) of the location of the solid waste disposal facility where the debris resulting from the said construction activity shall be disposed of. and I shall submit the appropriate form for attachment to the Building Permit. 20-J7,'-1 C, Date Signature of Permit Applicant (Print or type the following information) W O. 0 In CSS CSD CO P h �� Name of Permu Applicant Firm Name. if any Add[ess In accordance with the provisions of MGL c 40. S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a property licensed solid waste disposal facility as defined by MGL c 111. S 150A The debris will be disposed of in: L At d /a lc/ (LA)cation of Facility) I 'Sig re of Permit App cant -2(' ._ q(-1 Date COMMONWEALTH OF MASSACHUSETTS `c'r DErAR;MENI' OF INDUSTRIAl-ACCIDF.NTS 600 WASHINGTON STREET �anove: BOSTON, MASSACHUSETTS 02111 ;aures ^�sSiOne WORKERS' COMPENSATION INSURANCE AFFIDAVIT LAJAQl. (l ice n sear oermt sseu with a principal place of business/residence at: 359 A P n� Lej S- (City/Sate/Zip) do hcrcbv ccrtiry, under the pains and penalties of perjury, that: ] I am an empiover providing the following workers' compensation coverage for my employees working on this sob. Insurance Company Policy Number 441- 1 am a sole proprietor and have no one working for me. [ ] I am a sole proprietor, general contactor or homeowner (circle one) and have hired the contactors listed below who have the following workers' compensation insurance policies: t - Z ilar Il/ - r C��l� S Name or Contactor insurance Company/Policy Number Name or Contactor Insurance Companv/Policv Number Name or Contactor Insurance Company/Policy Number [] I am a homeowner performing all the work myself. NOTE: Please be aware that while homeowners who emoicy persons to do maintenance.construcuoo or repair worst on a the ground+a dwelling of not more than three units in which the bomcowner Liao resides or on appurtenant thereto are not generally considered to be emoiovers under the Workers' Compensation Aa(GL C 152.sect. 1(5)), appiicatton by s bomeowoer for a license or permit may evraencc the legal status of an employer under she Workers Compensation Act i understand that a copy of this statement will be forwarded to tnc i7coartment of industrial Accidents' Ofrice or insurance for eoveme �enfieacton and that faiiurc to secure coverage u reautred under Section 25A of MGL 152 can icad to the imposition of eriminai penalties consisune of a fine of up to 51500.00 andior imprisonment or up to one year and tarsi penaiva in the form of a Stop Work Order and a ;ine of S 100.00 a day against me. Siened this day of 19 tcensee Pcrmiaee licertsoriPermtrror S Building Dept ✓ _ A�ZCIIITECT"$" wNER'- ❑ IN/EX DESIGN GROUP ,Inc. FIELD REPORT ARCHITECT ❑ V CONSULTAN96 Richardson Road T ❑ . AIA DOCUMENT 0711 FIELD ❑ MeJ rose, MA 0.2176 .(,6,ZZ) ' 665:'1223 Newmedicine Dept. PROJECT: Renovations 2nd Floor/S.K.R.H. • -N _._ f� FIELD REPORT NO: 2 Cne Dove Avenue i -- CONTRACT: Salem Hospital/Salem,MaARCHITECT'S PROJECT NO: 9227 DATE 1/4/94' TIME 11:45 WEATHERNA TEMP. RANGE N� EST.% OF COMPLETION 50$ CONFORMANCE WITH SCHEDULE(+, —) WORK IN PROGRESS PRESENT AT SITE 1Superv. Jackson Const. 2 plulibenj OBSERVATIONS 1. Demolition work_ccnpe+ 2. Metal stud partitions ccmpleted, wallboard started. 3. Plumbing work 50% complet6d. 4. Electrical work started. • NOTE: Ccmpletion of work is anticipated within four weeks. ITEMS TO VERIFY INFORMATION OR ACTION REQUIRED ATTACHMENTS REPORT BY: Joseph G. De MarcO,AIA Poject Architect AIA DOCUMENT 6711 • r r THE AMERICAN INSTITUTE OF ARCHITECTS,FIELD1735 NEW YORKREPORT - OCTOAVE.,INW,972 EWgSHIT1OIIIGAIA TON® m 1� 2 0006 page / of / pages D E S I G N G R O U P I N C 0 R P 0 R A T E 0 ARCHITECTS P L ANNE RS CONSULTANTS January 12, 1994 MEMBER AMERICAN INSTITUTE OF ARCHITECTS 96 RICHARDSON ROAD MELROSE, MA 02176 Mr . Leo Tremblay, Building Inspector 611 -665- 7223 City of Salem Public Property Department One Salem Green Salem, MA 01970 Regarding: Renovations to Neurology Dept . Ground Floor/NSCH Building Phase 1 & 2 The North Shore Medical Center Salem Hospital 81 Highland Avenue Salem, MA Gentlemen: Pursuant to Article l,. _Section .127 . 0 Construction Control of the State of Massachusetts Building Code, I hereby submit this letter as final review and approval, to the best of my knowledge, of all quality control procedures for all code required materials and installations performed at the above location. If you have any questions, please do not hesitate to call . Very truly yours, I Josp G. DeMarco, AIA Pre ' ent Mas Reg. #3852 cc : .:Frank. Neville-;� ;Projec,t. Manager Y J . BRANCH OFFICE: P. O. BOX 1492 ROGERS ROAD YORK BEACH, ME 03910 207 -363- 7381 r ' FIELD COPY CITY OF SALEM BUILDING SALEM. MASSACHUSETTS 01970 PERMIT a4(� Dec. 23, 92 597-92 Neil Jacksm DATE 19 cr]-Y/ PERMIT NO. 1004 APPLICANT ADDRESS "'``--'"`'"`'"'�.���j — T�r�pCEr� T/�r�7INO.1 ISiR[C TI I[ONTA•$ LICENSE) PA MTION �PITAIA NUMBER OF PERMIT TJ (_I STORY DWELLING UNITS I1II�E/ry' I,MpA�O v�EINC NIIl�}�E*�gry�yN�OI�.�ryy (pAOpO$(D U$[1 AT (LOCATION) D= AVE. (�[]ifVE'LD9;S6 ZONING DISTA ICT_ I NO.1 ISTRE CTI BETWEE'• _ AND (CROS. STREET) (CROSS STREET) LOT SUBOIU)S ION LOT BLOCK SIZE BUILDING IS TO BE FT. w-DE R. FT. LONG By FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TTPCI REMARKS: Interior partitions pEE2D sy 745- AREA OR a 1j� S 80,000.00 PERMIT 485.00 VOLUME ETIMver EO C-Oa FEE �CUAIC SO SQUARE TELn OI Salem Eiospital OWNER $-�g ..��., -awe:�Fl ,e leo E. Tz�esnblay ADDRESS INSPECTOR OF BUILDINGS FIELD COPY Q ~ 1' CITY OF SALEM BUILDING !0 SALEM, MASSACHUSETTS 01970 PERMIT ,A V.LID.TION DATE Nov. 19, 19 92 PERMIT NO, 545-92 APPLICANT Neil Jackson ADDRESS Melroae.MA. 1004 INO.1 (STREET, ICONIR'5 NfEN3(I PERM-T TO DFMM,TTTON 1_) STORY 140SPTTAT, NUMBER OF 47'Pt O• IURAOv[uC NTI MO. �f IPROR03[o USCI DWELLING UNITS AT ILOCAT IONI D(M AVFJE WART 5 ZONING DISTRICT R-1 1«0.l 1ST+[[TI BETwEEN t AND ICROSa STREET) ICNOSS STREET, LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS.TO BE FT. WIDE By FT. LONG BY FT, IN HEIGHT AND SMALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION ITIREI REMARKS: IN=OR DEMOLITIONOF PARTITIONS AND ACC OUSTICAL CEILING AS PER PLANS CALL FOR INSPECTION 745-9595 AREA OR PERMIT p VOLUME ESTIMATED COST $ 1.0000.00 FEE S ].5.00 �c•a sou, .+E OWNER Salem Hospital A^o�E�sdi HigFiland Ave., Salem.MA Leo E. Tremblay INSPECTOR OF BUILDINGS D E S I G N G R O U P I N C O R P 0 R A T E D ARCHITECTS P L ANNE RS CONSULTANTS February 16, 1993 MEMBER AMERICAN INSTITUTE OF ARCHITECTS 96 RICHARDSON ROAD MELROSE. MA 02176 - - Mr. Leo Tremblay, Building Inspector 611 665 7223 City of Salem Public Property Department One Salem Green Salem, MA 01970 Regarding: New Rehab Medicine Dept. (Phase 1) 2nd floor/SKR Hospital One Dove Avenue Salem, MA Gentlemen: Pursuant to Article 1, Section 127 .0 Construction Control of the State of Massachusetts.-,Building-Code, I hereby submit this letter as final review and approval, to the best of my knowledge, of all quality control procedures for all code required materials and installations performed at the above location. If you have any questions, please do not hesitate to call . Very truly yours, 9&000011� J eph G. DeMarco, AIA esident Mass . Reg. #3852 CC : Frank Neville Facilities Design. Department BRANCH OFFICE: P.O. BOX 1492 ROGERS ROAD YORK BEACH, ME 03910 207 - 363- 7381 r . CONL y �Otr, CERTIFICATE ISSUED'' ! DATE August 22, 1994 CITY OF SALEM SALEM, MASSACHUSETTS 01970 BUILDING. PERMIT;" 4� CERTIFICATE OF•OCCIfPANCY DATE- IB �' . .� . PERMIT NO:-185-94.. APPLICANT : l':.DlrE: EUJ_LL"1.ET:: ADDRE`ss :.).Q.Lo.; �095 '•Paabodv, ;'ass. 1431 1 -: (NO.) ISTRECT) (COTXA•S LIEEMSEI PERMIT TO - Alterations � a '1 •,�, \ NUMBER OF ( t' (�) STORY I Wt-�__-- 7T4$•pt DWELLING UNITS (TYPE or IMPROVEMENT) NO. ; (PROPOSED D9 ) AT (LOCATION)- (711P TIn7Qn Aug- i�ar� ? ZONING DISTRICT. At• I t (N0:) _ - f. - (STREET) BETWEE d--_ - AND" $CROSS- STREET) - _ (CROSS .STREET) _LO.T SUBDIVISION LOT. BLOCK .SIZE BUIUDING IS 70.8E FT,'WtDE.'P.• FT. LONG BY 'Fr: IN HEIGHT AND SMALL-CONFORM•314•CONSTRUCTION i TO TYPE USE.GROUP BASEMENT WALLS OR FOUNDATION t( ' Ir r'BJIOVP•^2%inti=A' "%Arnim L ITI • l '•n .t • ! L 17�A:'.•Gill `j r REMAR KS: (�' Q$-'�I � t t l� ') •rt .. - � ><I` it � �Syyp/�I- ii Ap�ii� ' , I ,�I:' •• ry K AREA OR �1RNIEIR71f11 � N VOLUME 999AA,LA MM 9MM, 99EEMMYY A C?BIC•SDULR E,IE ETI OWNER rel}:ilCin'.racGP� ('-OSTtF P'AI srgoi-no�lo�wor'norver„be.'rlblfloCTloeerl of.7lse.�ISflasn,slTo - - .TO BE ROSTER ON'PREMISES ` 4DDRE SS 7ti@. I�'�Y_-' A`fl'• :3_?Qi: '_'IP•:8 'SWRBVERSE'S10E1 FOR'CONDITIONS OF CERTIFECALE ,..._--DEPARTMENTAL+ApPROV L FOR CERTIFICATE � o(_OCCU ApCY an�COMPLIANCE" S I + a filled inb each division indicated hereon i l ��( co pletipn of its final inspection. j NGS sI PehInit No. 185-9�i i i�ppioved by John:j. ennin�s � Date 7/20/94 i Remarks I I PLUMBING Permit No. � JohnILideIC , i 7/27/94 Approved by. Date I Remarks + i ELECTRICAL Permit No. Approved by Pauli Tittle Y� + Date 7/22/94 Remarks is OTHER Fire. Permit No. I Approved by Norman Lapointe' Date 7/22/94o ; Remarks I OTHER f Permit No. Approved by Date Remarks ' BUILDING PERMIT, JOB WEATHER :CARD/. : DATE -Hey 2- 19 94 PERMIT NO. APPLICANT ?caatrr. BailQers ADDRESS P•:.''•DO:. -(195 Pe4hoQT. mans . 1431 (NO.) (STREET) (CONTR'!•LIC[K![ •" 1 PERMIT TO Ai:aCat iOOM (_) STORY appkUi,4 L -f.1- `J OF NUMBBERING UNITS(TYPE Or IMPROVEMEXTI NO. �. (PROIO![d•USE)" E� 1 KING AT (LOCATIONI Q';C Does AiW• AT11 DISTRICT (X0.1 (l TREET) q BETWEEN AND ,{Tjr (CROSS STREET) (CROSS STREET) , LOT } SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUC IONS r' TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION I REMARKS: �J`P.I':O�%n B:IBC A:1¢. 9:a:1i♦�C)� ( :nr, and 1219 L:?Il iity 'iii .•Ii �iFi(`l andh?,,l' rfo OD•) Call for Permit to Occupy .A AEA OR VOLUME ESTIMATED COST $ � ' �.�,b FEEMIT S S17• coelc souARE r[en OWNER •Jt!?tl lia:IC:$:i IJY �OlB�CHa ,.ii!r deia ADDRESS t'I:N UaVP. Ave. •, : T a 3c=u BUAMUNd.DE PT C Ci•1 h 1 EN �.'��;•, . . BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET. ALLEY 04 SIDEWALK OR ANY PIRT THEREOF. EITHER TEMPORARILY OR- ► PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY. NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST EIESAP— PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE-OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THEtCONOITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. �•a7y i�:;-A MINIMUM OF THREE CALL AppRO /ED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PFRMI TS ARE REQUIRED POR- ALL CONSTRUCTION WORK) ELECTRICAL, PLUMDIN6�,. ANDS^, 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE'""OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS, 1. PRIOR TO COVERING STRUCTURAL QU1RED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERSIRE AOY TO LATH). FINAL INSPECTION HAS BEEN MADE. !. FINAL INSPECTION BEFORE • OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET" - -W BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS to e1 -. BOARD OF HEALTH =� v GAS INSPECTION APPROVALS FIRE VERT.INSP ING APPROVALS OTHER CITY ENGINEER 2 Z �. Y r WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD I INSPECTOR HAS APPROVED THE VARIOUS WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. OR WRITTEN NOTIFICATION. PERMIT IS ISSUED AS NOTED ABOVE. COMA�NWEALTH OF MASSACHUSETTS DEP�A F PUBLIC HEALTH Division of Health Care Standards and Regulation Hospita'1s and Ambulatory Care Facilities Program UNN 9 30 AH _HOSPITA(UTQa- LY FIRE INSPECTIONAL REPORT S. In accordance with the requirements of General'Laws,Chapter 1,48,Section 4, the Marshal or the head of a fire department, to whom he may delegate authority shall make an inspection every three months of institutions licensed by and under the supervision of the Department'of Public Health, and shall make a' report of such inspection to the Department of Public Health on forms provided by the Department of Public Health,. In accordance with the statutory mandale, the Dr Robert Shaughnessy Chronic Disease/Rehabilitation Hospital Name of Hospital* Dove Ave Salem Mass 01970 Address of Hospital was inspected on 06-15-82 Date of Inspection by Raymond T Dansreau Name of Inspector REPORT OF INSPECTION x Conditions satisfactory at time of inspection. APPROVED ' DISAPPROVED Date _ ' f f Signature' and Title L Please Return This Report To: Date Carolyn Zavarine, M.D. Division of Health Care , *ONE COPY SHOULD BE Standards and Regulation SENT TO HOSPITAL Public Health Department Room 940, 80 Boylston St. ., Boston, Mass. 02116 AO r j � Cljl. • LDI1�r; �CE'r .. •• �?r?�r�1ii{�r.�.:T'•'I nv�t1's�;cal:'�;=�!-�•.� • DEPAIiTtSE\f Or FCI .3 C. I:�;hL,: b' iG ';lQCcr, Ci�S • ...I31,�.,4La,ii C2 ii.Eli,i'l; i:4i�1L,"I"T� B1 CITY pFEC£IVLc • )WPITAL ^I!ART:T. V 3'I5u SAIl!HiAT _..� _. _ . . in accordcnce with th!1 ro-,vir4•'.^.onts of GaLigral 4-.W.-4, Ciirptlar :. , Faction 4, tho 2,:ar2hal of tho hoad oY n firJ Ci o'Q3Y.'i:;:.V'oi�, to l71,G81 l:e nay d3IoCste Uutti,c.l ty shrr71 a!ike an in30o--tiaa eve:.-.-y tlox t3 =(;nt ?3 of ir.Istltutions liccutled by r.nd und.or tha of Tho tzent of rublic 11calth, anti shall lzsho a rnport ns; r._!ch. in;pvc;,ian to tbo j'?:j°art lent G:,' 1`ublic Kto}-th all fcr:.1s provided, the Depur-xe_,p `oYb�iC• Ileatth. Ia Cccoroance with tho statutory r:andsto,. tbe T)-& Rn nrt Chnn BS�ie T yly�+ l i Dove Ave.Salem_Mass 01970 ----- ---- -- - • was iasp.acted on 10_07 -82 (Third Quarter Inspection) by Raymond T Dansreau I • ,I��Artt: ,i.1, l t �'.Y Ii...��Z.? afjL, Conditions satisfactory at time of inspection, Y P Oil .41 mim {' �- 1 Oot. r ?; 1982 Fire Chief � ''+,� k�;' '`s�I.l i , ,.::' ,'I}�,',•. ,{ '�,' 'r e. - I Sitgns uzo snd,' Titio Building Inspector Dept. ISalem Health Oct. 7, 1982 Health . - - 31 EMGs.• Dept. Of• Q Public Health Iate ` F F!'lz ase Return Th is Repor t To X0:2 CO^t sE:J[,LLi 3p Si�TP ^o ' 6 �. r: 1:C. UITAL : .Carolyn „Zav Grine, tv:•D . Divtsia n of Med ical Care "' �;,EF?ublic Health Depa rtment Poo1 9-40, 60 Boylsto n St. , Mass. 02116 ''' Form #38 (SFPB) CCV1P.)Y1fT+.1LTM 117 WIS.IACNT-I '.tT3 DEPAVIdNT OF PCr.L1C 1 fiAL'IH 2MVI3I014 OF KEDICAL C.41LS BURLAU OF KtE Li_i3 FACILITIM 1103PITAL CTARTIMLY PIPE 11"MMONAL 1;F`VIRT In accordance with the roquirwnu6ts of General L,ow&, Chapter 148, Laction 4, the Mrrshal or the head of n firs dopartzont, to xvhom he may doleOate authority aholl make an inspoctiou evt�ry thsea months of institutions liceunod by and under tha aupervision of the Jnrart- • merit of Public Health, and shall cjal;o a roport of Finch inspection to tbo Hal:art7ant of Public 1y.vo?.th oil forms. provided LNy the Depurtxent of Rtblic I1coalth. In occordeece with the statutory randato, the Dr Robert Shaughnessey Hospital Dove Ave Salem Mass 01970 Addrora oY IiospttaY was iaspoctod an 9-07 '83 - rtat3 0= Ita. �_�cl.oau by-- mnnd-Z—Danarea-u ___ G of Ing. ctoz • R=10aT OF IV3.P (r1 . anl,.ov11D !� Conditions satisfactory at time of inspection, . DI&Alar'x.'LOYL�D We signature and Titio y -2 Late Ple ase Retu rn Th is Repor t To: *ONE COPi' SVi)ULI] DE 39!IT TO Carolyn 7_avarine, M.D. VC,3PITAL Division of Med ical Care Public Health Department Room 940, 80 Boylston St. , Boston, Mass. 02116 I C^MUt�ti It r`,I.TH o� btu+.s.�•tC?(�J°E'I'1'3 DEPPARTtdNT OF i'Z�'P'Li('. KhALU !)IrI3ZG;t CF KEDICAL CORS EURrXJ CF PIT_,1L71! FACILITIr.3 P03PITAL CTART^lVe FIRE V'SPE�_i IR`IAL Dr?0TtT In accordance with thn roquiromonts of Goueral 1Ews, Chapter 14S, ; .action 4, tho A:nrshal or the head of n firs dopart.7.ont, to whom he Pay dalecate autNarf.ty eu*11 aske' an inspoctiou ewary threw months ,o? inatitutiors 2icenaad by end under tha aupesrvi.sion o3 tho Da?;art- Lent of Mblic 11a31t11, and shall rake a report of such inspection to Vie ^4.,artnent o:" rublic N_evo!.th on forma. provided by the Depertxent of Pablic Mi alth. In eccordeace with the statutory tandato, the Dr. Robert Shaughnessy Rehabilitation Hospital J.GA .OT t.Js,�1.tsZ� . Dove Ave. Salem, Mass. 01970 r.G�irc:;a et i:os�ttAY r.•as in!1pacted on January 24., 1984 by— Capt. David J. 'Goggin r=131E.-I or All conditions found satisfactory at time of inspection. % Jan. 24, 1984 Dnte ._PutA. e Chief 31Z:101!to wad .lo cc: Building Inspector Jan, 24, 1984 Salem Health Dept. Mass. Dept. Of Public Health Late �cjepant Pie ase Retu rn Th is Repor t To•• no;Z Co^r 3V-orjLD DVI SRi,T TO Carolyn 7_avarine, N'v.D. UCSPI TAL Division of Med ical Care Public Health Department Roon1 940, 80 Boylston St. , Boston, Mass. 02116 - Form #38 (SFPB) ILNE � 0- September September 5, 1995 5 Pickering Wharf Salem,Massachusetts 01970(508)744-3467 North Shore Medical Center 81 Highland Avenue Salem, MA 01970 Attention: Mr. Larry Healy Re: Shaughnessey Roof Garden Salem, MA. Dear Larry: As of our meeting this morning and based on our �insp�gionvof as-built construction conditions, Fal-Stone CLLand§cape hl'anagement will be modifying the Roof Garden atop Qthe Z-aw moot of aug essey er our recommendations. -f w Torg " record, I would like to summarize the required modiY"tcabgons and the reasons for them. C� w Of U_ f o REASONS FOR REDUCTION L%s you~ are aware, a significant lateral soil load was placed upon this building shortly after completion of its original construction. As this soil load was apparently not planned for in the original design of the building, the resulting bending moments, in some of the beams and columns, were found to have diminished their load carrying capabilities so that the original roof garden design loads given on the structural drawings are no longer entirely valid. This condition was summarized in our report of January 14, 1992 . The facility has, fortunately, exhibited no obvious signs of structural distress to date, and the condition can be assumed to have stabilized, notwithstanding any significant external loads. The loads of the roof garden, when added to the predicted live loads constructed, exceeded the safe capacities of some of the supporting members, and some of the already questionable members. We had recommended that the garden remain closed until the capacities of the members were re-evaluated and the loads reduced accordingly. Due to the nature of demolishing new construction, we have "sharpened our pencils" and revisited the assumptions made in our earlier report. . We have subsequently made the follow ing .two .liberalizing assumptions, with which we are comfortable: An Equal Opportunity/Affirmative Anion Employer l 1 . As the structure was originally constructed using 4, 000 psi concrete, it is typical to perform subsequent structural analyses based upon 4, 000 psi concrete. As the structure appears to be in good condition, and also due to the fact that concrete continues to cure well after the 28-day age at which j the strength is verified by test, we believe that it j is reasonable and safe to assume that the concrete has reached 5000 psi strength by this time. 2 . Five of the columns, to which soil loads are being added are, by our calculations, grossly overloaded in bending, even in consideration of 5, 000 psi concrete. Two of the columns are governed more by tension in the reinforcement than by compression in the concrete. The reduced soil loads added to these, represent total increases in compression of 3 percent or less, and a have negligible effect on bending. we feel that this is an acceptable condition. The other three columns are governed by bending compression in bearing atop the footings. we have considered the 5, 000 psi concrete; a rectangular \ rather than triangular bearing stress distribution as is used in beam design, and up to a 20 percent mome'nt redistribution, due to partial fixity of the undoweled supports. With these more liberal, vet reasonable assumptions, we can accept the 4 percent or less load increases due to the reduced added soil loads. Loads are to be reduced as necessary in the areas which affect these columns, and where necessary to not overload the supporting joist and beam system. REDUCTION METHODS Soil loads will be reduced, where necessary, from a typical 133 psf in three ways: 1. Styrofoam voids are to be added to fill the lower 12" of the average 16" depth over at least fifty percent of the plan areas where designated. The voids are to be placed directly against the underlying drainage composite, resulting in a continuously dry condition on their bottom surface. i i i With the resulting elimination of hydrostatic uplift beneath the voids, they should not be buoyant, as long as the drainage composite is clear and working. The voids should reduce the average soil load to 80 psf. 3 . The depth of the soil is to be reduced to 4" where designated. This will reduce the soil load on the roof to 33 psf. 3 . One of the planting beds will be eliminated in its entirety. To compensate for the loss in planting bed area, we have allowed a relocation of some of the evicted plantings to a new 6 foot by 16" high bed which can be created along the north parapet, between the existing bed and the high portion of the building. The light, easel type moveable planters may be located anywhere. The pavers which had been planned will be minimized. The desired affect can be achieved by lightweight materials such as wood, rubber, or plastic, mounted directly on the deck. Paving will be used where indicated, in the manner shown on our original drawings. Total average depth over the hydroduct shall not exceed 2-1/211 . Please refer to the layout sketch, SKS-1, attached. RESOLUTION At the request of the Building Inspector, I will inspect the completed roof garden modifications. At that time, assuming the above modifications have been made properly, we will notify you and the Building Department, in writing, that the garden may be opened. Cordially, MILNE ASSOCIATES, INC. i John Wathne, P.E. Structural Engineer cc: Leo Tremblay I . . . ---- - - . . . . ; . I . :� : o".. : i . . : I . a � . . . . a : : . . : s � ; : z . -, z ; ; : : . . � i ; . a . i . ; ; a z i : z ; I : z . . . . i ,I, J i . � ; ; : ; . : . . : . : i : a . : . . . i . i . . . . . � . ; i a ; . . i . a ............... .. .1...................I..............:..........................i............. ............;.................�.......�.............. .....................................i.......�......:..........................r.............. ....................................... I.......................... ............;...... -.........I.... . . . � : . ..............a........6..!-� .... ........ A. ............. ................................�............ ...�.........-...................................... ................�..................... .....�..... ............i ............ ............ ......................... . .........?..........- F . a . . . - ..... ............r--""' " . . . : . . . !....... , . . . . ' : . . . . : . . . : a a . . . . a : . . . . a . : . . . : . . ! . ; . . : i . . .............4............i....-..... ...........�......................... ............. : . . . ..............-....................................-.......................... ....................................... .........................4.........�.... .......I..... ........................................ ....................................................... .............i . . . ; ; ; . .. . . ..................................-I .............t.....�.......?............. .............. ........i............;- ...... ................... I . i . . . . . . ........................- ......... I............. ...................�........ i......... .. .... ............�..................................................F............. ........�..................I.............. .......I.................?............. .........................I.......... : : : : : : ; .**'*''- '- . "- '- ..................................f..........�. ...........r.............i............ ........................... ........................... .............F.............1.......--. .......................... . . . . ; . i i : a . a ;. ' . . : ! : 1 . . P . I i . : . . . . i 1 . ; : .......�.. .......-.;.....�....... .......�... .............: ................................I.................i............ow : : : od.......... ........................ .. -.1.............r............................-.......... -...I.....1............................ . . . : I .--...-I . ; t--- I 11-. ............. ..................I.........................-.-..... ............. . .......... .............................I................................... : . � : . . . . . ......�.........�......... . i . . : � ...........: : I ...�......... ............ -..........�.............;.......... .............. .........�-........... ............. ................�........ ...................... ......................................�..............:.............- ........................i.............;_ I.....:...........4............:............... ......... . .........I..............i........................ : . . . � . . .............i_..._...........-....._i.............:._...... . . . . a ..........-....................... ............. ........�...............;............. ............:.... ....;..... ..................�....................... ......-, .......... ..........�t........- : : ; i z : . . ..........1. s . . . . : ; � . . : � : z : ... : ; . . . . i it .; i i. . . . : . ! i z i ; : . i a . ... -.1-.....i............1..I...... .............1... : : i � . . . ::: . : . - . . j : . : . . . . . . -, .................. ........................:...........I t................................. ...I....�............... ...................................... .......I.....................�....I... ........................2.............4................... ......I..................�.........I.. ...............-...........11 ; . ! I .- . ! . i I....I.,............ .......... -.. ........d............a... .. ii . . : t : . . ! . . , . . , I . . i . . . � ; z . . . ; . . : . . . , a , ! ; - ; ..........................;.............i ............ .............. ................ ......................._i......... ... .....I...-.1.............. ..................................... ......................................I............!..........4...........f-.......... ....... A............. .----�.........i----- :.............i............. .............................. . . ....................... .i.. ......�...........i........... ....... . ......................;...........;.....�...... ...... ....t...........i........................�.............1..............i......... �.............!............................a......... ..........:-.....-. . . . . . . . ..;...................................... . I . : : . z .-..- 1....... . . ii : . . ?'- . . .. . . . . i : . ; � ; . . i . 2 : . z . : i i : . . : i . . a . . i ! i i ; : . : . i ; . . . . . . . . . . . . . . : i r : . ......... ......... .........4..........................:.............�....�......i...... "-. ..................... : ............It............ ............-........��............r............ . .. - --...-...........i.............. � .................�I...........r..'......... ..........................I .......... .........................4................................ ....................... - .. ....i t . :. : i . � a . . I : . .........:.............�............. _..........>..........._i......._ i ''1-'7 - .I : : z.......... ; ... . : ......... ..:.............................I.........�.... ' . . ... . .. 4 I .......I.........�'................J . ....�....-A..... .................� ................i........�.....i.............4.. i.............�........... ..............i.... . . . . r . .......,.I.............I., ............. ....�...... - . . : ; . . :' . .. . ! i I . . i . . 4 ; . . . . . - . . . . . . . . . . a I . . . . ; ...i............. .........................r : . : : . : ; ; ; � : ! . : : : . . : : . . : .1..........I............:..............._...._i.........I . . ... J.............1......�............ .........................I....I...............I..........................-I............�.............. .......... ....i--.-�---. .................. . : : . : . . . . . . . ........ ;' . .--..;........--......r............1.........�....................--.;........................... : . . z . --.-� . . . - = ?--1;-- - ; . ; I : ! : : ; . i ' 1 . : : . . . : . � ; i .. : . a . : . � . . I ; i - �.-: - ; ! i : . i j i � a ; . : : I ; : . i t ................I............................... .......... ........... ....... .............;.......... . . I....�............I...:.........-1.............i.......I.....I:... ..... : . b-) . a I i i ! ..........;..L 1.................!-. .....I . . . I . ! ............I.............. .............1............4.............4............. .........!- .................................................................:................. � . I �.... ...I a........... ; : a ; : ; r-- . i : : I i i i ! i j i ; . . i . I a -, : : s : i ! i ! i i ! . . . z I . i : . .. . i ; : . . � . � i. i ! i . : . . . I . i .. i z ; i ! j . z : 4: . . . . ! ! i i . i . : . . . . ' - -- ......................I...... .............�.............r........I....i..............:.......................... ........... ...�...................... .......... .............I.........Ii.. � : ;: I ; : ; . ; ............:---I........T ..........................:.........................:........................... ......I............ ' ..................�........................................�................. --�- ...-... ...... . . *..... ..........;.................................... ........ .... ....................A.........-........... ............. . : : . . ; : : 7 i ! i i z . . ; ; : z i 7 z . ; . . : . i : i z i i z ; z : : : : . . ; i � : i : . I : . ; ; ; � : : I ; I : i : T . . : . : . . � . . . . ; . - � i. ! . I . : . . . � : . I i . ; ; . . : z ! ! i - z � 10 � i r - - �... � ......;....I ...j............. ............-: i I : : t . . : I . ............T.............t..............-..................:................................I......i.........I....i..............:.............r......... .............;-..........i.........................!............ ... �... . .......� : . i ... . . . . : . z : � z ; . ; . --�- ....�......:.......... ................I ..... ... ....-....:1-.......I......................- . ......1.............1.............i..........4 - ........ ..t............ ........... ......... ....... .... I........................I.1..................- . i ; ; : : z : ; : : . : : i : : i i i I ' ; a ; . i : : " i . ; : . . . : : ; . . s . : : � . a . : . . ; : : a . . . . - I . . . � . . . . : . : . . I. ; &'PC 1 . / 11 . : . : '5�1'tj .. : . . . . � � : . . � : . . : : m . : . . . . .....7, 1 ............................r.......�................ ..........I..."........................--.....i-............i.... I.................7.....................................................I.............................�..................................t--..................I...;.............�....... .�............. : a . . ; . . ; . i . .-.-.... .........�............... .... : i : i ; . . . � i . . ; . . . : a . a : . ; . ; . ; : : ; � . . ; . : : : : . i 7 . . . � � . . ; ; . �i i . . a i I - : ; : /�!-0.o fZ- w; ; . ; i ; i j -, i � .- 1 : ' 4 . : i . . ............I............................ ............i.................. �........... .. ;�:...Ar....................... I...........................�..............i..... . . : z ....... ........................................... ..............1. ............ ..............................................................................-............ . ...... -......-!- .........................I. ... � ... ... a....� ...... . . a . . : : : . .:. ' ''* : : : ; . - i i . : i : a . . i i ! "- i : i I -- ' . I . . I ; . . ; . . . ... . : . ...........4............. : . : ; . 7 : . . .........................i.............44L.:....4 ..........:... ............/:... ...... �..... �- ............ . .......� ...�.......�... .. ...�..................�........;-.....- ................I. .........................t...........I............... . ; . ................................ ...............�.......... .....I...... ..............................I....:1..........................4.......................... ......... , , : a . , - i . I . . i . . . . . . i : . . t . . ; . : ...........;...... ...........1 I..........?.......... 19 ill I i � ...........I 4 1...... ... it../N.1. i........... ........:........... .1..........; . . . : . . . : ....... .............. ....... . ............. -... !, : .............:.............�... ....... ...z..........I.............. t -- ..............i.........................�.............! : I i . . .. . -� q . '-- �"- Z- * ; i : ! . ; � � i a i � . : i i ; ,, t ; . ; i i : i . . i . . : ; . i . � i i : . : i a ; . ! : . ; i o it : ; .: . '� i : ; i : . � t : : : i i i /. i . ; 1 i 1 i . i i . a z . . . i " ; ; : - � . ; ; . i . : ; ' ; . I ; : . a : , . ! i i i . I : : .. : ...........%............�..................................... .............�............. ....................................... .--.................4...........................1........................................... . ....: .... r, .. � I . .......... ...........�....... ,- ......I..............- .....��.... .........I.!.............:�............4�..........;............. ! ! . . i : � 1 ..... ' -...............i........... i.............4.................._.-. ....-.11. .-I I.1.1 ....-.- .....� ............ ........i............. ............I.-................................ �.............E . . : I m . z i i i i ! - ; . a � :........... : . ; . . . . : ! . . : : : i . � . � i; - . i i i 2 i : i ;, I . -: ! . : : . � 11 . i .% t . . . : s . . . . . ; A - t I : i � j lk�' ; � : : . : i . . � r : z : : � . : ! . i ...' I 2 i ! i : . ; . . . : ; i , . . . . i : ; ; . . . . . . ; : � a : r : . . . I : : z . ; : ; a . .. . ; : - i � : i : i z : � . . : i : . ; . : I ; : : . . - - ! i. . z . .....�.......�.............r.............. .....I---I................I........... ...........�.........�..........I.....i...........:: .......... ...........t........................I............. .....I......T ...................I.................. ........... ......... ............:...... .........;..... ........!................. -- �...1-1 --.. ........-.. t ..........�....I....I......i. .......... N ; s . : . ; 4 . 1........t�............... -... i-...�.....i......... , ............ . I:.........;.......................�......................... ......... :-.11........ .....................�......: ............. ............;..........................t-.............-.......;.......... . ; . . . : ; z . . . . 4 . ; � . . . . z ! ; z . .i ! I : : ! . : w � . -F 1 . . . � . i 4............7.......................... - ; : t ****t ; z . I i ; . . ; : : : : : : i I ..�. -F 3 i ; . .ri, ' ; ! ; . : .. : . . 4 : � . : . . . . : . . . : : ! � ; 1 I D . . - : . . - . ............. ................I......... .............a.............I.............i.............�...................... : . : ; - L t .. . i . ................. ...4 ............ ....................:........................... .............r.............. ....................... I.. ....k.... ..........I......... ..............�....... ............:.........I.................4.-.....'.. ....... ............... .......�.....i..-....... - ........ �...............I......;....................X� ............ .....I...........-...... .......... --.............................I .......I..." : . . .- . ....... .....................I . . . i . . . . ; : . . : .. . . r - ' . : z . i : . : . . ; . : ; : . I : / i : . i i -s : : : a ; : ; : ; ; : ; : . : - ; : . : ; ; . : i . 4 ! pe7 oz_ . a � ! I ! : i a . : . . : ; ; t : . : . i : . ; ; i . i . . .............i..............:.......................... .................. . � . ; . i . . ; . ...................I............:................................�...I., ............ .......... ......... -Z..........I .......-.-...................."...........�'............... .........:1........ ........... ......t.............-I* ; � ......... 11...............�.....I..........�....I.-I-.- i � . . w. " I ........ ... .......... : ; : r . . : ; a . : . i ; ; i : 4 . . . . : ! . : i ; ; . --l- -/�'- : * � ill ' : � . a . . . z ' z � : : . ; : . I � . i . . . ; i z : : : . - ; ; - ' . . . : : . - . i i . . : ! : ; . . ; . : . . . I .. i . 1- 1 ' .m.1 .......�.... I ........................4........... .............. ..................... ................�......................I.....11...... .............;...................I......i................... �.............:.............................�... �.............v......�... ...... -� ......................1- ................................... I . C71 . i : ; . . . I .......;. ...........�............................1........I.......1. ......................... .....I.......j...�......... . ; .. . : . . i * //%N, : ..............4............ .. .. ; ................................ ; I......... �..........i....... A. ..... .......... . . . : .. z : ; ; i . : . : . ; i . � : . : . : . . . � ; i - /- . . . . : i � . : � . . : i I I i I t z . . : : : . : 7 . , ,- a . ; . ... z . . : : : ; . : . . ,> ; i : a : : . : . . L'I , ' . i : I . a I I ; . z : : : : I ' . . i ! i, : : . . . ; . : - ! i . . . . . . . - - . : .................................................................. -............... .. : : I ............. .............. .....................�: �..........a - ! - - - - . . . . . . : . : . . � : . ............- I .1 . � : : : t . ..................i..............i ............. ..........�.............I I, .: .. I : : . : i ; : . . ; ; f : z : . . ; . : i . ; : : f . ; t . . I � : : : . . . i ; . . : t : : : * i : : : : . ; . 1 . ; ' i I .: : . . I , . � ; t . . : ............. . . - . i ! . : - i : t ;............................�......�..........................................�.............�............. ................................. . ........I... .......T...... ..... .........I...............t...............................................I.r.....�...................;.............t ...v t.....................-.:............I..............:.............:........... .............z...........�:....................................... - I... ..........!.............. i ........I.. . .............. - . . . . . . I . . . . L . . . . . . .. . ; : i . . r . i : . i : .; i ....: ;;; . ; . I . . ! . : I . : . ; : � ! . !! I i : � : : : ; ! . . : : : � i ; . . . . 4 ' : . : i . i : . . . . - . .; �- ! � 2 i : * ; : . ; i , . ........... ...................................I.. ............................................................. - - i............i. ......................i...I........................... 4 �......... ......;- � ! . . ...................... .......i....... . ........-..............i............1.... . . : i i : : ; : : . ! . ! � I t ; .....................!I..........i................ ...........1.........................�............ .......... I i...........�'............ .............L:�...... ............... ...... ...................�.... ..�.................... ......I...i ....�... ...... i ..........-1....................... ..... .......... ......... . . ; ; . -- --� ..........�.............i...... : ; . ! ! i i : : a . . . : i t i . . i z a : . . . : . . . . . . : F i i i i I . . . . A R40-0 . . . : i � . . : ; i : : . : ; : a ; i . i ! ;' . ; : : : i i i !- i ! i : a . . . . . .. i i i . .. . : z ; . . : z I ; ; i . ! : ; . i i - I a ; ; I ; �; � . ' ' . . * - ! i : . i � : . i i ; I . . I : ; . i . ; . : I.......i.............;.........:...!...............i.......... ............1....... :1................... ; i ' i �/ter . - .... I . ; i ; t . ; tk---I ............ ...........11......................I.. ............I...........................4..........................�.............:.............� ...::: ...........................: i ......I.....4 .. � .... . ... : ....... ..................r... ....... . ..........I......v......-... ..........................;........ :..........i..............I........ ......................... ... .... .......CIF-i.................................... ............� .............................................. .......:..............�.........4...................... �.......... . . ! . : i i . - ; : : I . . i . I . i , i i I . : z : : z i i . ; . ; i i . i ; ; : i i � i i . : . ? i i . ; ! ! � j . • f. i ! . i - : . : .......��.....................I.......:.................... ...!.............i ............ LyX ................................. ...f?............I............. ...... - . j a : a . : . . ...�....................................... . : . --4-- I 1 -...........i.............. .....�......v. ..t............. ....... .......................i..... ............ ................�............. ........ .... .i . - �..........: .. ........... . ............................................. ' I � i''-....V -.. -i......... . i....... . . : :.....�........... .........v..................I......... - -;- - .............. --.--. i i 1 . . . : a i . a . � i ! i .N : -I I ! : I i a 11516-� - . : . . . . a a : : i i . ; . - . i - - : i i a . a : . . � . . ; . . : i I I . . . i . . . I i 1 I f : . . a . - i i a i...... .........1.............i..//O r.,........i............L � : -�.� I/I// , : . I i . 4� i t i i - . : j I . � ! ; ............:................................I.....I............. �. i : r : : ; ...........;....... : .......... : -. .I i . ? ;.............T .i :.. - i . . ; -i............. i ..............1..............i ......i.......... ..... .� �.. .................... .../9 i\� . ....;... ........: . - .. .....I-A............: .........i.............. ...........:-....................i............ ............1........... .......... ....... ...-........ -...........�...........�. ................................. ........I.... .- .. �k\ .... . ........... . � :.............;............ ....................-.;............I I :.... . I. '�. . . I .lit . /i�� .......i' -.- ........:............: .......... - z : ; : : : : : : . i : 7 I ; z i ; '� /'/ " : :..... . : . i % ! i �: i i : : � z H i . t .. ; . i t . : ; : a : i i : i i 'd '%V'r" 1 : : : : . z i ; : : . z . I . i i. : . - . . i ,A :' 1:1 � .; i i : i : . . . . : ; j 'I- f I . i : : : --..--,..,-----.-" � .. . . I : ! ; . . - � . � . . . . - . .....I...- ... ..... . . � I . � - . I I --- . � . I . . . . - - .. . ... .......... ....................... ,; z : . i : z i i : z . : : z z i i . . i i i i : . ; : . : a : . i I i 1 i* i . i I ; . : i a . ; i I : ; . . i(& ..", i ; 2 a i ............. . i i ! . . i i i j i J a : ; . i i ! . . . . . ,; � . ; : i ; ...................................... . ................. .....................�..........i............�4....... ....... ... I . .........i i " . ............. .............: .........�............: ......... ............ ...................... -.4...................................... ...-.- . ; : I ; : . ; ' ....... ..... .... ....�'......... ,.! .. ........I--- c....... .....I.......... I...........i...........�............... ............I . ......... . . . ; . . � . , -I -- -..-..................�......... .............. . : ; . . : : . : i i i - '0*v ... . ! : . � ; : r i : i i . : . - i ; i 1 .• 'o : � : : � a ; ; . . . : ; . i . i 7) '�"- . ; : , ; . . ! ; : . . i i i i a - - . ; : : . : z a . N : : : . . ; -..Cr . ; . � : Ae -.....�.................. ..... ....�........a..............-.1..............-- i........................... ........... . . &.�1 P - -� . . : . . . : . , I I ...�! 4. ! ........................i................. : i i . � . ; . � . . . .............. .........................!...........:....... ............&............;. ...................... -........... ..........1. ...5 . . -......i........ ........................4 � : : ; . I �. . � --..............V............!........ ..... .....:......... . .......................... .... : : I . . i : � : : : . � I ,I i : � e 7 !I .'I - - I ! : ; : ; . � ' : i ! 2 i � . . � : . . ; i . : . . . I . . : ; i 10 I IK4 ' i ' . . : . : : 1 i : . : ! . ! ; I - - ; : . ; - : . .: : : , ! ; : i I z I........................; � . i ..................................... 1-1.........i............�...........I........ ...I.......... i ....... : . . ;: : '.. ;..... ........... � - ' �.- ' ............ ................... ..... ...........4.............. ...i- .1......... - �.................. .............4 - ' a �................... ................................. ........ ...... . .........................�.................... .......... ......�............... ..................................�.......................... I...... ..... . ........�................. ----.........�......................i............. ...... . . . . . : - : I.. . . i i a ! � z : !- ; . � ! ! ; : i 1, i : a ' i . z � . . - I : a ; I ; 2 ! ; . . i i j (5 D I t . � . I I. . : : ; t . . i i : ; i : : : ; ! �' . . . : : , ; ! . z : : i i 1' i : ; i : I . : . : - : -.... ............i.............s................ ............I.....1.. : . - - ' i : : I : 4............i a i i - - I - ............ . : ! ! i i . . i i . : : . - i : ' I I . - : . . . I.. -.1...li ....... ..............i.........................L i .....- ....k..........i.............4............:..............:.......................I.............. ...... ............. . .....................r........I.................?............t.....................................1................................... . ...........I.... . : ; I . ,....................................!................ ......................................:..... ............................i .......� ...... ............Z..........i............:�.........................I........ ...... .............. ; . i --.. ......... ........... -- ! i A z ; : � . . . . ! . . . . i . + . ! : I . t ; 4 . 406., . . . . . � . i i f ; ; z : I . i ; : . : , � . ; ; * i � : : : . ;' � : : ! i m z : ; . ! z . . ; : i : : z . . .............I.............:.............1..........................i............I..............!.......... . - � . .0 151, . Lle'111-7 : ,-IV 1-10-eeo9l - ....................t.................... 1- 1, I : : . - : z I : i N . ........:.I.:.............�.......................�.............J...........i...I......i........................4.............1..........................i................... - � ei I : : ; � ! i i i i i ; � - --- . - . z ; ; ; E i ; : : : : ; � ; i i i i i . i i i ! i i I i i i ! i i i i i : . i t i i F i i : : i i . ; : % - : . � � � : : ; i : � s � . : i : . ; . . i : . . : : . . : . i . . I i i i i i i ! i � i I i : : : i ! i i ! ! i : : : 2 ; : .. . ; : . ; i � ! . : ; : ; -..................... : ... 4-0 rt---.5.-t.......i.. i 1 i i i i ; i i . I........ .............i......... -4.... ..............� : I : i i ; i i :.............i... : i ! i i ! g . � . . ...........t.............. ..........1...............................!...............�. .....� - .........i.............. . i ; I � ! . . ; : . .I - . . +� .;I .. ----;............1�.......................... ......... .........i.......-.1................... ..--.. ...... ..........-!........... ... ........ - 4 ...............1.............� - .. . -. . : - -............;.... ... ...................... ........................ ................... . ....F.......... : i .........t............I............:.............i.................�.........;.............�.............. ..............: ............. .�....�.......... ... I... : ; ! ,i I :. i ; . i !* : i . : t ; : :............:;...........� ............4.....--!4.......:...... -.'�... : i i' i �- i i ! : i i i a ! i i i i ! i a a i : . : ; i : i . i : : : ; : : : : : . . i -r � .. ; : : ; . -1 : . � : s i ! ; I : i : ; i : : ; a : ; : : . r : :.:: -I .. . . i : . . : - f ; i . I � : i ! a s : ! : : i . : : . - : .� i r. � : . --.-.�4...� , ; '�', i ' - i t . ?-6 C/o s�C�� I 5� �-t).e.q..P-92- .1.2.1... l.---'�_--4 48�5, . i . /' ip 0�031 I"4x&4 . - + .........i............ ........................... ............ �- " , : i . -- I.........i.............. --r... -i......... �---..-I............1...................................I...-- i.. ......1- ...t.........i............................. .......... ... .......... ..........f.........�............�........................!............. i . . . � . i . . . : . . : : i i i ! E i ! i . i i i i ! i I i i i i i i ! 4 i - : � i i : : . : . : I : . . . . ; . . : '. . . i i : '( I ; : : i i - - � : ! : . : ; : . � . � � i : ., . ! i i f 7. i r71-4 (-..Ir6e�v.........�...e....el: � & ! 9 - C.... - .....' ��---.- -e-P410. 4...f.4-.1.1......... Joa. 14 � . ............r......................... ..................... ...........-t..........:-...... 4-------i..1, - ......i...... - - ............................ .. t,/��t r-.14 r.1...........46 ....... -�....C- '........... ...... . -...jz.................................... . ; . !...$�." .... ......!......... ........I....I............1 1 : : I . ; . . I i ; i i ! i i i i i . � i i i I., i i . ; . ; . : /�?a'ojlz.. ; i : . . . i . : ; � -e,94W : . . , ) B IV. S.- --"-e- -'5 rV--I ��IZ41 . s ; : � i : z ; . 1 ! i i . . � ; : : . : ��". .� ,. � . ; : t : Jo - : . . ... F � . 4E 14Z7 . I : ............:............. .....�....V";...'t............1........S;Lievior.........L.olvi...........1.......ooc.-.iA'o.'..-I.............I/.....0...?! �...j 0, I . e -1 : a i . I/ .....�.... ........................ . ; . -r......i.....C..." I �............ .-...........- --v ............. .... -..........................I............. , .;............�...........!.......... ........................ -...... 5 Pickering Wharf . ; ! i I i � : z I , : I ........ : ; ! : - ; : i j I ! z � i i i i i : : . . A SHEET NO. OF - I I i i . . i I i z ; ; j i : I; ; .L . I : I : ; : ! : : : i i s .. - .1 .L .. - : i ! I .: . ! f : i : j i ! ; . ; I : i A. : : .t i .v i i i I : t i a : i i . : 4 4 v : i ; � .i. z ... i i i I ; : : ; � : i : t .:. I .T f I : ; i zI : ! ii +Tii. .; . �.. i i iI i ! i I .z. .z. � .. i ; I : ; : : I 1 : .: T T I' A .:. - : : : . z ; : : ; : ; i ; ; : t ; : t : : : : : .t 4. -i ; : a i +T . I - : I : i : i i I i i : : i : : i . .. .i I a i . I ; I ; : : i . ; : : , : : I F : : : i 0 I ; I I i 4 I a : . ; : .; : i : ; : ; ; : � : I : ! : . : : : I : .: : : ; i r : ; : : : . I I I I I . : ; : t .; : : : : : 1 4 I : : : : : � f i ; : : .; a I .. ; : . q : i . . . i i ! ! i : i : ; ; . : I ::j:(�'e 5 - I I ; : ; ; : ; :�a ' i ; I i . ; ! s : ; . : : . . . - ! ; : ;�9117- I 0-P. ! : SALEM,MASS.01970 _.i..........._........._._:.._......._: ; - �..... i...........................T.. ... 0 ! .: : : : or ......11��.......-III, 1�"'!......i... --.07;?-�/ e-4 1 ,!on 5r-'c-i �:I./ . : : ; . ...11....i ......-e .'A;'C� ; - . - (508)744-3467 :............1......... . ✓.......... .....-I .............:..............�+ - ...I..........-;............ .............:.......... . ; I ...........4............... . ........................z...............,.o.l .........�...........4.........�I .Fzl+ ; .. . . ;- --? . a . ! : i 1 i 1 i i i ! i i i- : i i i � : 11 q- 5 - "�*5 ' . : : : : I : . i i i i . . . : .. : MI LN CALC*ULATEO BY g::���E- . . ; . : : : . i . : . ! ; i . i : . � . : : -7 '%el 5; ... k i ! i i i FAX(508)744-9938 . � -r......-1. ...........L;�............... P ' e4joo� � i i I. ............4.. . : ! ! 1 . ... ............�........................�' -----............. -2.v s;?- lRe 9. 1 qoko�?-.<'............6./. z I : - .......... .............i............. 1-.. ............. ........ .........4........ . I �� ...................-..............................:....................... .......�. : . !............ ....... ..............I.........................4........... . . ; � . . I : ; : : i i ! i i I . i i I i CHECKED BY DATE . i i ! : : i : : : i : i :_ i ; : : � 4 :e�'fnwo i e-- : ; i I ! i i : : ! i i . : .. . t ** . : ; i : : i i ; : : : : ! j ; : : I ; : ; I : .1- I : . : . - .: ; : : . i . -* . ' " -2�.� ; 5 -L i : z . I . -f- .............:.............I.....-.1..... ; i . i & I k � .....................1............................ . .,..+:P)Z ; I .......4.....T.....7;.;.! ..2e�?- -�....�i..C.:�.�I....-........-C>'*15 . . I : . ! + : a . ....I....-. ...........I...........!................. :1 -. ............:............i..........................i..... .............r.........- - .� . : : : : .. .......i..... : . .............. . : : i .......................................-T . z . i ....... ............. . . Z�! :5:- / : i t : : . . : . z j SCALE C� ; : . . : z . : : i ! z ; . : � i : : � . � ! z : . i : ! : . : ; : . . i i : � � : : : : ; ; ; . : : z : � F : i . . : ; ; : i i : : : - . : ; I z z I ; : : : : � i ; ; ; ; : 2 . . � I '; . . i . : . , . -i . I . . : t . 1 . . .. . .. 11 - . . : ; . . : I .. ! i . . - PROOM MI(PaW IVEDGP PRMV W I(P&W Ir EDGQJ�,tx-.GMM MM.01471.TOWU MNE MU FREE I-WO-V.�= . . - - - --- .---. SEP 20 '95 14:08 P.1i2 BUILDING DEPT. , 5 PICKERING WHARF q Q SALEM,MASSACHUSEftS�1�70 8 14 AM `95 MILNE FAX:(soft)508) x67 Ax: 744-993e RECEIVED CITY OF SALEM,MASS. c c7 NUMBER OF PAGES DATE ? �y—5/ TIME G' ( 5 ElA.M. u'PM. (InClUding Ccver Letter): NOTE:If you did not reoelve all of the pages or if you have a question,please call the verifying number(below). TO: FROM: CO.NAME � � � NAME ADORES3 SUBJECT GO E" ATTENTIONFAX NO. ' FAX NO. VERIFYING NO. FAX rransmissliffli REMARKS: 40 L L°© G r �o 7e40e-' SEP 20 195 14:09 P.2/2 QD�9PLDIR�G DEPT, MILNE SEP ZI 8 14 4M 095 S Pickering Wharf Salem,Massachusetts 01970(508)744-3487 RECEIVED September 20, 1995 CITY OF SALEM,MASS. City of Salem Building Department 1 Salem Green Salem, MA 01970 Attention: Mr. Leo Tremblay Re: Shaugnessy Kaplan Hospital Roof Garden Dear Mr. Tremblay: As of my visit on the morning of September 19, 1995, corrective work on the roof garden was nearing completion. With the exception of the plan-ing bed depth at the extreme west, all work appeared to be in general conformance with the sketch we had submitted, dated September 5, 1995. The westernmost planting bed has 711 to an of soil as opposed to the 411 which we had required, and the hospital will direct the contractor to install styrofoam voids in the soil to conform as closely as possible to the requirements of our re-analysis. We have assumed an average blanket snow load of 45 psf, due to the relative roughness that the roof garden creates, and we have considered the assumptions listed in our letter to Larry Healy dated September 5, 1995. We also understand that the rooftop pool will be drained and kept drained in the winter. With the current substantial completion of this work and the above considerations, we are satisfied that the above project meets the general structural requirements of the Massachusetts State Building code and proper engineering practice, and can safely be opened for use. Cordially, MILNE ASSOCIATES, INC. M. Wathne, P.E. cc: Larry Healy M Eywd 0ppatunity/Aff1 etire Actlun$mpinycr SEP-20-1995 14:24 FROM TO 1508744591833 P.01 ATTN: WATER SUPERINTENDENT/ METER SHOP M1, PERNIS�IZPT It's our 5th Birthday, we are celebrating by offering you a 5%discount on purchases of. (30 Day Special) SEP ZI 8 14 41,1 195 Water Meter Wire(1,000'Spool) Price Qty RECEIVED Order Qty. 3Cond 22AWG $49.95 1-12 CITY 3 Cond 19 AWG $90.00 1-12 OF SALEM,FfASS. 2 Cond 22 AWG $47.95 1-12 2 Cond 19 AWG $80.00 1-12 4 Cond 22 AWG, $58.45 1-12 Copper Seal Wire(1,000'Spooq $20.00 1 "SPECIAL" New CO2 Savair Freeze Kit $649.00 1 1/8, 1/2,3/4, 1, 1.5, 2"Collar Sizes (Does not include tank) Plumbers Kit $449.00 1 1/2, 3/4, 1"Collar Sizes (Does not include tank) ACT Lead Free Seal prevents meter $ .50 ea. 8"Wire Seal ) Minimum tampering (Environmentally $ .55 ea. 10"Wire Seal ) Order friendly, replaces lead seals) $ .60 ea. 12'Wire Seal ) 50 YESI I would like you to send me free samples of the ACT Seal. Quick Flushing Sand Trap Strainer 4",6", 8", 10", 12"Sizes $Call for price details I Would Like More Info. MUN-1 Utility Service Analyzer $799.00 ea. I Would Like More Info. for field testing residential water meters MUN-3 All Purpose Test Meter $4,499.00 ea. I Would Like More Info. for 2"to 8"Meters(Portable) Meter&Backflow Standon Pipe $Call for price details, I Would Like More Info. Supports for 2"to 24"Line Sizes priced per line size ;170" ilTo: Ship To: Total Cost: Less 5°h Authorized Signature: Purchase Order#: ACT Services,Inc.sells high quality products and discount pricing is available on volume orders. NOTE: Prices do not include UPS Ground shipping and handling charges Please fax this order form to* 1-617-762-6680 CALL TOLL-FREE 1-800-488.0978 I would like my utility to be removed from your distribution list:_YES NO Ercerrent.JorBackftom ACT SERVICES, INC. find Metcrinatatiation<t 916 Pleasant Street, Unit 3A Norwood, MA 02062 smrrorsorrrrrs ST METERthecm.,kf$ppo,lb," (Ort 6r rel t, �V Acrlcn n.ql L,rgewvtrv,"[Itn.fl b,Yeliq fM :IaOINDoeP rt1iM11Mw..ah..lnanll..:w...,.w�T�...:_.. TOTAL P.01 FILE/C. O. COPY CERTIFICATE OF OCCUPANCY CITY OF SALEM Issued it{� 13'/-9 1 � SALEM, MASSACHUSETTS 01970 CO of Salem 8WIding Dept DATE APRIL 11 19 95 PERMITNO. 134-1995 APPLICANT DAVID ESANCY / EMPIRE BUILDE ADDRESS PO BOX 3095 PEABODY MA (NO.) (STREET) (CONTR-S LICENSE) CITY STATE ZIP CODE TEL.NO. 506-532-5533 PERMITTO CONSTRUCT DECK. �) STORY HOSPITAL, INSTITUTIONA NUMDWEBEROFLING ITS 0 (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT(LOCATION) 0001 DOVc. AVENUE ZONING CT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION MAP 24 Lor 0c 16 BLOCK SIZE 5. 34' ACRES BUILDING IS TO BE FT.WIDE BY FT.LONG BY FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: BUILD 2 :_EVEL GA-EBO DECK, ON 3RI7 FLOOR ROOF DECK.. J. J. J. AREA OR PER(CUBIGSOUARE FEET) MVV MIT Q VOLUME ESTIMATED COST$ 20. 000 FEE $ 25. 00 OWNER SHAUGHNIESSY DR J ROBERT B ADDRESS KAPLAN CPR HEAL7H C N��TER BY j. J J. J � ��t; �.:TOB S �Z)RX:,�>�._�,,�;. 3 a"''4'"� �>�,-�.,•,-�,.ri mow'�.': �,r �,°"", ,,,;+, -Ew • iLD CITY OF SALEM NG .. 1 SALEM, MASSACHUSETTS 01970 r � a . P*15.RM IT�Miwf a 1:it<r j 15 14 APR I .Rt a, 6^ 1E3n4 o—�1�9e.95DATE F APPL zsDAVIA;,ESANCY / •EMPIRE BUIL_DEADDAEj�Fp ,EiQX :3095 P.EABODY MA " !K C;ry, .. a'.' '(ND•) CONTR'SU STATE ZIPCODE 'TEL NO: 508-532-5533 CONSTRLIC =i 5 -.T NUMBEROF PERMITTO (' ) STORY �5`��' - � !N!NB • a-'U 1 I ul\- DWELUNG UNITS ", (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT(LOCATION) 0001 D3%/--- YIVENLIG ' ZONING .:PP.) (STREET) DISTRICT BETWEEN - AND , (CROSS STREET) (CROSS STREET) LOT SUBDIVISION MAP 2L. LOT 0215 BLOCK SIZE 5. 0 ^r'RL'c-' BUILDING IS TO�BE FT.WIDE BY � FT.LONG BY •'r FT.IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION IN TO TYPE USE GROUP BA&'EMENT WALLS OR FOUNDATION (TYPE) . REMARKS: BUILD 2 LEVEL GAZEE'D DECK ON 3RD FLOOR ROOF DECK — AREA OR Call for P�ermit_to Ccupy . PERVOLUME ESTIMATED -Do, ��'u�' FEE �� �'•'� (CUBICISQUARE FEET) �- OWNER ``-.�.AULiri:JE:':= r' ;;% : • _: .- ADDRESS KAPLAIN DBUILDING DEPT. . TA U :=.a:. 1 'I '=`-'t`.t'il_i .BU - J. T THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY,ENCROACHMENTS ► ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION,STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. . MINIMUM OF THREE CALL INSPECTIONS APPROVED PLANS MUST BE RETAINED ON JOB AND THIS CARD KEPT WHERE APPLICABLE SEPARATE REQUIRED FOR ALL CONSTRUCTION WORK: POSTEDUNTIL FINAL INSPECTION HAS BEEN.MADE. WHERE A PERMITS ARE REQUIRED FOR 1.FOUNDATIONS OR FOOTINGS. ELECTRICAL,PLUMBING AND 2.PRIOR TO COVERING STRUCTURAL CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH BUILDING SHALL MECHANICAL INSTALLATIONS. ' MEMBERS(READY TO LATH). NOT BE OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 3.FINAL IN•-f ECTION BEFORE OCCUPANCY. , POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS (Vo-0 ys^ BOARD OF HEALTH GAS INSPECTION APPROVALS FIRE DEPT.INSPECTING APPROVALS 1 1 OTHER CITY ENGINEER 2 2 I WORK SHALL NOT PROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS INSPECTIONS INDICATED ON THIS CARD INSPECTOR HAS APPROVED THE VARIOUS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED CAN BE ARRANGED FOR BY TELEPHONE STAGES OF CONSTRUCTION. AS NOTED ABOVE. OR WRITTEN NOTIFICATION. �.-� � � ,_ / . - J . .. � J . L} . y9 CON'PIL\CCOR INFUItMATION � � Nume Address � r<ra ,.� Telephone (no�,� $3-9HS Construction Supervisor's Lic # �1 '`'i O � Home Improvement Contractor# ' ARCHITECT/ENGINEER INFORMA'fION /� . Nume a N�. �rt tamhi��1�2 c.� 5 inL • — Address Telephone Mass. ReQistration # PERMIT FEE CALCULATION � Residential est. cost x $7/$I,000 + $5.00 = Commercial est. cost x $1l/$1,000 + $5.00= � �f'�O.C� COMMENTS - . The unde�signed does hereby attest that all infonuation stated above is true to the Gest of my knowledge underthe penalties of perjury Signed '� ��oLlo-�— Date 8�d T S' i ---�` I � ; � ► , � ` `A � � � ... . f.� f �Y . . � T� . :J �.. i . ^ ���� • I�.i � � � ' � .,� ,.. t �� �� r � I � � 1 � ';� '�r� � �� C� . O •� �: � v � q� A ;' , : � '- � `'V . ' -'� � c � `� :; >_ � � �` ,. . L� . . - V �I� �i r.'��. 'I 't ' ' ll � �" �S�S � 3, o., ono�2 � � . � � ` � �:0.. � ( SiQ.. J V �2. P � � �,�. Ab�M V ;sua I � NufSe �G�' —� - N�,� vQ«�,��, �°� ' �'e-� ����, — A ' N¢,..,� t'4d r e,�I V�� r � �— ,> ; t,� 1 , � ti,,`�j , C� ' _____V_.�----- - -- --�— — -- —�--C� ' i ; i 3 � � �i � � � , _._�_.__.._.._�_--- ---v__.�__..__�_._...---E-� �--- � � C � � � � ,� � �, ___ __----- -._,_ � ._ _ �_.___ � __..____- --- -- I � ; � � , r ; ; , ____ � ____ ___ __ --- � --- - � -----+-- , � I� _�, � � ,�- , , .�._.____,_..._---�------ �- ��-_ � � �� � __ i 4 i �.�,- s j � T� � � .,,. ��T^ 9..._�a__'__—.�_�—'_ � 4 6 _.___ _ i _ � .. — -- _.�_____..._.____ . f ,� ! ����,�- �,i � �C�t�i�� f,t. C-°C' �'"}a�F 2 aC�?F"t%c' �ti a�t�..� +.. '���,, �� �d�'`l L��$ �"��f2.. C:...'� Ca t_ .... � ��?e";����-� . � — (�al Q �� �A� '��e'� � 4;C�°Pt� -*§^��a v J:c ta�.r� di'"°" .1 '�'�. e�j i�� L>rG 1 +. �a"'^ "'p,,.. �' . � ,_. � �.�._`�._._��._���� ...�_e.�__4..,�r�.:o ___..�._ '� � � � _____• � ... _ __ _ _ .. .. _ _ � �:._ � �` __.. ____� --- � ---'----�--�____ _ _ - - _- --� � � , . . i . . . . ,I .. L . . . _ r ' ' �I� y �� . ��� , . . . I � �, . - . . } ' . . . . . . � . . . . . . ' ' . . , . ' , . ' , . . . . � . . . . � � i , . . . f � � , � � � - I � . . � ' � . � , . � . . 4��� . .. .. .. I . ' . . . � " � I ►g� U w�� , i j �tew t��t,oJ1wc�� �nll� l� , — yy'yt'I�+�n . f... l,� �;s�+�B�tTK� Gl�t�l;-} ' -- I! , 1..�a ----- , . , _ � ... ' - _ , � - .P�Xis�,� ��$1n�" UtnQav+clL. ;:M � , .�•w co;l v►M`f �;1 cM,i-I- ' • � '�y, .. �` - I V r., ��fi� � i , RP,�`6Ue. �'� ���'�' . ' - - — � � , - -- . ; , � -� ---'-¢��a(.� S �N I�. �r�, , . I �ev�- L�i) �� � _ _ ---- --- to rew av�:,(ec.1�� (�l.o�,d�� ���.j.. � R � � �,c�, ,,- n - � � � GivLUr�" �D'v+C11�� ��+�2Pr�L. TSp-- -- - � — ----. �.__ _. �nv�.P� � ►�af.V p �, 5 f�/�A 5�rin �A� ,r �-e»-�11Z �y� 1��114e. GA� ��( p �� _ �N U . a�X� �-�1�' P , 1l.G1- --t-- '�ZW COvv� •� . WYr co,, dlN i R� k �li � Gv) T�•y � � �"' Yk�''`�' '' � . . , � _ ' ' � n ;° ; . Wi�� ---- -. .. Nu+Se- �4 ���� 1 � O. � 59 •.?� . ,p.. ._ .. �( �� �i G� �BU�) LiW'D� ^- �� . � �M.�U Z X2 -� Y� �� "�X'''y�"Q . , '� . , -- ,, '� n �.�.M..�.W[, i k .� 1 gU - �' )•�°ro ? ' ��- � ___ ,N._ . + c,e;ll � . i'D wY�t�.i 2x�s�� "rea- _. -:- -_ - -___. .. .._____ . . �-!'.�D� i t ' �t T• --. .... - , , i`d _ 'Pcf".�,v�` �i vv� T , R� C� � �c �afs �'S �.0 ��-�� „�- �h„ao_ � � , �-� P�)v :_ � � 5�+c_ C-� " . �� � Pewfc2 �.� �� .. �¢QD'�Q� a ��i �� I�d�►.t�l,�-- . I��C �v,►�,!(1caG l�ra� � ' S i�el�are`�'�-r''�'nnkQo�t" �,�'�e�. �� . , �'�'��r� �-` , � � ; � ' T`'Q "�p P F ; -1'0 li� yo�`'� �p,�.6v.2 — - --- ��� �,,� lv) rwrk, C�t(� cb.v�sS ��P�� �� -� R,�, , � t ' ( �• � �;�� - � � ,. . I�e�.e�t,vf�.� SP , I ! , p �� � � --------- - 5 •wk2v�t ,:�i�4`� �� �"�eac ' , ' �xs-��y Ic� dvnf' e,ye �!'�e, d�eaY 'f� �e,,,d� � � 1` ;: � �` ��wi� o ;: �-,Y , � �P � +"; � i ; ;� i L $ t , �•! I�� , • _ _ .. ....___ --- ._-. . _ _._.__. . __ _. __. . . . -- - - -. .._ I : �---- _ _._ ._ ..__..__._ _ - --- _..-- ...._.... ._._..__ _. _._.__ .._ _ . _ _.._ _ _ _ . _ _. _. _. _ . __. .__._,....------------------___ ..._..._---------- - � _..__.__._ . . _ _ � . - -- -- . , � � � �, , , - � f�-e� � ( �cltiu,s-F o►v-vf �. �—� � a , I , _ � ��►"�G{,�. -_I �-- NeW �ii- hi�nr+ � �5� �il,p� (;�I,�.}yc.�'P�w- I ; I : _ _ . _._ _ _- --. -- - ---- - - - - . . .. _ : � , _�t¢�,r;�� _ cPl�►;, . _ _ ►��,�,(_—, _'P[�w► ; ---� �ive; -�O�'� �I�, __ — - 'C,. ,�;�,;� �,,�.T I ;, _ u . � . _ � �' w ; ~ _ _l�Gfl1�Pi+-%s���-.�=0`� � .-G�GA1ei: l4 ��-_:J�On. __. ._ _ _ _ . . � -- -,��� - .,.�I,,� . _ _ � a � � � � �� � -- . � - - ��,� .. y�. - .� .o _ __ _: _ , :� � _ ; - �- _ _ � � � -- -- - _ __ _. _ _ _ . ' � � �o4�or.��+�-�'X� w�"�"' r,rew 'alvwHwuw� dac,t, ,s���^�'`� �� }� i ; ., . '"" "�,� �� I i . ��p�hPi�' �AN+�7DYY1 �� ' C�y�rv� itIVWNn�wF�n ��fit�.G�2�dV'`� I G.° ,�OdC�jV1 ,, , i '. bv�� " n df�ti.¢, WAII ' IJI.W �� � ""'a¢.`A �G bp�, � �0"G�G�P�� � olb�� GI85¢� � IoU�' � ���J� +, ' T`PM'tTVQ, �W - r-, OVY,'. A Unn.iYWWi h��{• ' U . a�� I� � , . C�utN+ � �or �►��e , � , � R�e- �y�d� a�da. �° ' .n , • ,eor-�P,,,t„L wr.,dcw ub!I R�br'.. a 5�Ci6�' e�-11^�ox w trx�tu wA!I ���Ju I � ,..v��.a�, w� ry�d, � 't y� .�-�,'ti;s�" '{'�� I2� ' � wi�ew wct�� . '4v Y�^" _ I , ti. . , . . . �, __ -- -._ . _ . Yhryw, - - -- .,. ! - - - . , QQNN�� `�;�' '� GJl{�jiY�+� `}'0 �.r.:.r i _ . - , �I wtivdawvAldYr.e mloa� _ . �vUI� W� -— ===- •— , = I ►JewAluw.+ . - • ,Fi . _� iH � S�II �b,� � co�)'uin+�b- � '!Mi✓� 4NeA' - - -- --- __ . . . � ' ^ i:, #, „ ,y � �,� ��;�� � ( ,� 5 f�^�;► ��+c� � � , 1 �, � � � , � � v�T. , , , r � � . . f� E . • 1 ;' ` .'�'��1C� ; � � � I��-�. •fM.c. hc• ce;ll`� '�.�.1 c�,t;,Q- i '"�'� ; � �p,�y�¢, q(•-- i1�'` �y+t�`' I j 'h'G�. � P�lir�, 0� , �J � _ __ � �,��;,:s • � � � • . �� � ��I �' ` ';�-�.I,��rau� W,►�� �I-° �cew�u � " 'New Covri� _1�1�.0 �cvl�a,v�' I,�suv�e,.e.. _ . _ �-� ,�+ � __� o�-� ) p� � I � � � � ��� k. ,°�. ' �� �"'�.wa �r2 -�'Yp,� {�2w•trv.e .ax. ;. �,J�,�, r � , '� /i�c�,�., % �� ov�'V�kC�•4o�c, li �a .'%�� ►�re �� �cu�ada. i �orebv��" _ , / �M►,� Ro�w, � � � �, c� �'\.,/ )/�... � , Rsw.eva• tnu+� G\nU ��� �.� : T� � � (u p�����,�� _-_/� I �� , �G -- • � � Tv,� _ , . �(iVi(,ehC'Y��l AkfQ� ��' � ��•�`%" -` ,�� C� C�""��'�- '�' "�`�'��� �r(' W/D�c� � �1�/1G CEz��c� �,i � �._�_ � _'__-�.. j r�.�.) � o�-t�-�ts L i � w� r.e,�-� , '. , ----t � ' � � �,U,a.wa�IS `� .r- -_=3;' �`•'� � r i�au�ev� �'''pt°''c °"1��.` , I G�ow�dc� �� ��U�t� '� . , __ � � � C��� �• : ^ � ; cevaclu;c �+'� o � �:Rcµo-t��loo� t i�i �mwg.r,.2 ►a.wse-�s►ll cldu'cw ' rn� �c'�w+o�.. ..` �. b,;�'7, � �'J�o' , i, •,,.� : 9Q �- , � � L.,�� s�`"� ! i � C�,-�,� � ' � ' � ,, Gt�+�' � ( pupn,kmd I;�/1�� i � "'.. \\` I I o� �' �,�, I ""^M ' i ' ' ' .. - - 1 1 �"� � C� � 1. .� { 4-�x• d� 4��o�ca�.e. �f+�4� .va'm," ', '��"� �" .. _ � • Q'piY,� PR, ` � S �('t'� � . i "' ��o,p�C ` I LX• W'�w5 „ ',' - _—._ - I . . 1� d..N:�� � i ' ,. , . � �- ---- .._ i'G`♦ �i �` � ^ _ � _ ...,. _ . �, ' • , . ,�ryi I Av�1"f'Oy' , � . � , � ,. ; _ _ _ __ . -- � --- _ -...__ --------- ._.._ . . _ ' . ' r. � . . . . . . , '^ . ._._ . . .____. .. _ . . _ . . . . _ _ . ' � . �ti� WIFJc� YW6^W�� 0���4M� . � i . . � �� � " � . . /(� I _. . .. _i . __. .. . . . . . _' ,'.. ' '' M �F �t� l/ -JR" ` a Y i + ` Rgw,sv� a��vl�a, oF-� " Ra�wr+ Y�+�ut�� �,M�r w/wall -Cc�w�d�,c� i ''� ., '' �; ,.� 'L�,A=----#''Ir��c. Gow:d.o�C 't'�z h�t.,�d�;l ,k wah � > .`` ` , . �� 2,�d. �''la�c Covr�da�C 'yrx� �'-tmsc Cavv�da� �` '`', .�,. ��� ...' � � .;�:i �r,� b�� ', . �.• r, : s. ;; . � " '� , , . . k ,,` , I _. _����G I'_ ' . . ,. :,. .�X�s-}i� �� .,,�1-,'-�o�ns �la�.+� �,..I . pe�l�� f'►�,� p�;,-- C ��_---- -- . . _ -- � � . ', : ; hco�,le I D rxDl : � � � _p" _ _ _ _Sc�►l� •- 4�� � 1 d _ pu.- - `r�� , `f' � ;I ; u � � y4 - � /.��� � _ , y , „ : .; �� _ � �� �,� T .r� , �:;` �r `,� , '� •.: , • t L v . �� �r���by •> , ' � .� � � _ ,� _ � . . � � � k....l"Gt;:�._ �/ t r �-�-�7 �}'� }� -�7 ' : . � ''i . . � . _.__. l^\\\w`' 7��n 1I�I, _ �fJ���y ��-��yl�' �����(�j • }�'y�n\ ".' ,. f� ,. :'� ' ...� ' ' �. � . . `� . �_.� _���_. .__.+�i�-�-��.�-�+i +�___......1i .i-+I"I" ��������� �I . . • ' — - _'—_ _'__._... .___ ___.'_— ..___ . i . _... . .__. .. . � . . . �__I v� ?i .___ . .. . ... .. .. .. � . . ' ' � . . . . . . . . - - - � L�.... ._..... . __. . . --Ct,�. p _ . __ u,,I I . �' -: � - w�,�—��s��nQos�. s�� `�r1••e.. ... _ _ _ ._ _ __ __ _ ��� vn . 'I ���� �� � l�J �� ��� -�.t�,..A �� _ � j� iY�¢�.- hi�G. -�y�L A 40 �j¢�Q. Uv�.i�}• i5 �a SA.�-r. � . _ I�II_. .�_ __��_ _ _ _ _ �I C��.I�� �.�I� -�. �. _ � -���, � � I� �p f� � �G!ldVY� iS On�t,� 'J-� �Sl.�T . ` � � �.�I.aI�I�I � �.���C�I�I�T�I����' � . . � . ' , .i , ����� , I a /�� !�S ARCHI'IBCfS IlVG. '; , �, J � . _ --- -- ._ .-- . . _ _ _ ------ - ____ .__ --- ___ __ _--- - - -- _ __ . _ _ _ __— _ _ 1 � ; _ __-----_ __ ----- ------- - -- _ — __ --- � _ _ _-- -- :� __ - ---. _ _� _ � __ __ _ - --- _ ___ . � Crry ( )I, S�Iii pul3l 'ic DEPARTMENT M V,I IR CU\C \LI11Pt,luN m.KI .I fit 11 11,111.9-11 F-APPLICATION FOR PLAN EXAMINATION AND BUILDING PERMIT ALL BUILDINGS EXCEPT ONE AND 2 FAMILY-DWEILLINGS IMPORTANT: :%pplicamifs must complete all items on this pagV SITEINFORMATION Location Name Building_ Property Address ) Ili e-. Located in: Conservation Area Y/N Historic district APPLICATION DATE OL::t, Use Groups (check one) Group Homes R3 114 Residential (3 or more Units) R2 Type of improvement Residential (hotel/moi III (check one) Assembly (Theaters) Al New Building Assembly restaurants & clubs) A2r—A2nc Addition Assembly (churches) A I _ Alteration Business B Repair/Replacement= Educational E Demolition Factory (moderate hazard) F1 — Move/Relocate Factory(low hazard) F2— Foundation Only High Hazard It Accessory Building Institutional (residential care) 11 — Institutional (incapacitated) 12 Institutional (restrained) 13 Mercantile M Storage SI _Moderate Vlazai d Storage S2 Loo I lazaid OWNERSHIP INFORMATION(Please type or Print Clearly) OWNER Name Or-Y" �i Hqdtray Cen-Iii Address f'%) Telephone !3-7 Signature DE'SCRIP'TION OF %%ORK'1'0 BE IIERF(i -*- HAP(coi AIM— , P mt-T 1.:S IT'Al,% 'ED CONSTRUCTION COST 0(). UD `I CONTRACTOR INFORNIA"I-ION . Name Address A Csro�an R��� Telephone tuba- sig- s to 3 Construction Supervisor's Lic # $1 CIO Home Improvement Contractor# :\RCHITEC IVENGINEER INFORh1ATION Name Address Telephone Mass. Registration # PERMIT FEE CALCULA,rION Estimated Cost x $11/$1,000 + $5.00=!!S__ 5.00=!SS 1• _q 0 CONih1EN'rs ::The undersigned applicant does hereby attest that all information stated above is true to the best of my knoivledge ,under the penaltie�o� ury Signed I� �Owner APPRO en t� DATE APPROVED: b �' a k.�• QaAA-a L.( Cco Skru ck;on 111-f . i O �:urnit\n and ,(% s-�atl «Aka+s Ca) �r) each 0-F ao C-conS .Tt¢ inko 111L) (iir Mair) On a"c1 -('1ooE• . 7�j,n t �/y " 511K113 l�ne,JfiU eaCV) ex;S{tn� rnkd,ca1 u;n 2one_ \I lve- 1QoX on -ktilyd (porrS On each Zorxe_ . cknd inSIall �wO a:r- -�-rgh5dute (-s \Ze. 4ted k' nVo e)r4js�;n� rn2ci:ca\ Ctkar,M -�Ane,I )XM yd V0.ccuum Out\eAS ((3) 1 n 24 c>n cl+ vacc-ki.,rr vukAe-ks -"ro be. Aced in'ro +s rub room �• L7' n���n anc� (a�� r aF'�-.er' worti C.�iw.nb�1 s do rte. JQX The Commonwealth of Massachusetts k Board of Building Regulations and Standards Tom �i7 Massachusetts State Building Code, 780 CMR, T"edition Building Dept Building Permit Application To Construct, Repair, Renovate Or Demolish a 1 W IOne- or Tyco-Family Dwelling This Section For Official Use Only Building Permit Number, - Date Applied J it 5-00 Signature: O Building Commissioner/InsrKtor of Buildings Date SECTION 1:SITE INFORMATION �1.`1^Property Address: C,1 1.2 Assessors Map& Parcel Numbers 1..1a'u �^JG QW trm a �L ✓vm f lfn I.l a Is this an accepted street?yes_ no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq R) Frontage(B) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.O.I,C.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: _ Outside Flood Zone? Municipal ❑ On site disposal system 13Public❑ Private 13 Checkifyes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Ownert of Record: Sa1¢vvL llos �4I � (_2n CJrm�L V enti e— Name(Print) GA.ddress forCS^ery—ice: p q q 1 �'�lOS / Y Signature telephone SECTION 3: DESCRIPTION OF PROPOSED WORKS(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ❑ Alteration(s) 19 Addition ❑ Demolition ❑ Accessory Bldg. ❑ 1 Number of Units_ Other ❑ Specify: Brief Description of Proposed Work': JAJlAC-Vjons,% SECTION 4: ESTIMATED CONSTRUCTION COSTS Estimated Costs: Official Use Only Item Labor and Materials 1. Building $ I. Building Permit Fee: S Indicate how fee is determined: ❑Standard City/Town Application Fee 2. Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3. Plumbing $ 2. Odmt f ccs: $ 4 Mechanical (HVAC) $ List: 5. Mechanical (Fire $ Total All Fees: $ Su ression Check No. Check Amount: Cash Amount: 6.Total Project Cost: $3v OD 0 ❑Paid in Full 0 Outstanding Balance Due: SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(CSL) License Number Expiration Date Ngmc of CSL-Helder List CSL Type(see below) Address Type I Description U Unrestricted(up to 35,000 Cu. Ft.) Signature R Restricted 1&2 FamilyDwelling M Mason Onl RC Residential Roofin Coverin Telephone WS Residential Window and Siding SF Residential Solid Fuel Burning Appliance Installation D Residential Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Registration Number Address Expiration Date Signature Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152.4 25C(6)) Workers Compensation Insurance affidavit 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. Signed Affidavit Attached? Yes .......... ❑ No........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1, as Owner of the subject property hereby authorize to act on my behalf,in all matters relative to work authorized by this building permit application. _ I Signature of Owner Date SECTION 71b: OWNER' OR AUTHORIZED AGENT DECLARATION 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. t Name" o1�lt ignatu a of Owner or Authorized Agent Date Signed under the pains and penalties of peru NOTES: 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(HIC)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 i I O.R6 and I 10.115, respectively. 2. When substantial work is planned,provide the information below: Total floors area(Sq. Ft.) (including 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 dumber of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage" may be substituted for"Total Project Cost" � � �� � i� �� - . � ��f5� � � �C�� - - - _ _ � � � � . r Pwv.er�+ � 't� �,..��e� — w � MIUIOdodMMol1 YM-���' M N�rM 1oo�n0 b MOMMII/r111Alrt YM.�•�� :� . ���A��� PM111��C � Q1,�Iwn `� a� �� P� w■� ����� ��y.���� �w�r�`�-� vs w w�oca�wn PIiAfE l�L.�IR I�Y 1►OOYMi1iLY TO AVO�ON.A TO TFIE INBP�TOR OF BIALDW36. Th� � �'� �� br a P� 10 build �°°01dYp w tlw 1oYdwi�q �� c 4 Oia�s wnw . � C � `'� hn i o__� 'A��- _— l�r 5s1�_k �� � — Ad�w�i PMa�r Aldl�t'� Nrll� \e r h, a ec �ddr..s a Plion. . G�; C�,-�h�, � S��p,��k — �Ll�z� � �s -�sia — � � � 1 AddlrM i Pho�M '� Sr a sGd� � n ��\��.�. _ �. z � S�kl- �5`� — v�M/�In.prOon ol a�0Y�1 h , . � 1 o n IAIMIrI q O��la1 �' -� ���M��.�hOM 1�/tl����'�"� 11�Mlldni o0d01�l011w4 i�ia oor $�.�aM��� N A w�yl�n�� n�5 �`� c� � � �.-` X �. ,_ aowr uwo����n �� o�cwarww o�wowcro�coNe o k, ,� ;-e -� o� c�d;n S"l�d; cQ , '(�d��n � \ n., I�AII P9M�IT � • �' ��- �0 ���� Gd � � �, .�� �°�.�S C,�P� ,�f.� r,���- � ,. ;t ',; The Commonwealth of Massachusetts P� � .� 1� �� � Department of Public Safety �P ��� .,_�,./ \le.s.uhu.vtl.til,itr tluddinti Code 1:�30 C\1R)ti���rnth Edit�.in City of Salem Buiidin Permit A lication for an Buildin other than a 1-or 2-Fami D •i (Thi,4atiun Fur Vfficial U..runlv) I�udding Permit Numbrr: Datr Apf�lied: Bwlding In.pectur. SECTION I: LOCATION IPlease indiote Block N and Lot N for locations for which a street address i ot available3 1 Dove,P+anrt �jc�ew� OI°�7o Xo..ind titcrel Cin� /Tu�vn ZiF�Cudr Name of Building(if applicablr) SECTION 2: PROPOSED WORK If Nrw Cun,trudiun check hrrr O ur chrck.�ll th.0 apply in thr twu ruws brluw Esi.ting BuiWing❑ Rrpair� Alteratiun ❑ Addition Drmulition ❑ (Plevr fili uut and,ubmit Apprndix 1) Change�f Usr ❑ Changr vf Occupanty ❑ Othrr ❑ Sprcify: Are building pl.ins and/ur curutructiun documrnte bring supplied as part uf this prrmit application? Yea f3� Nu O I,an Independrnt StrucWrnl Enginrrring Peer Revirw requircd? ( /� Yrs ❑ No C�' BriefDe�crivti��nufPrup�>.ed Wurk: Fiie (�nuSt s.,Z.�io�,. ine��d�ti F�^!e►+s«�,� '�eb ow 92e�g� wo��e-� _���I vs��5 z.�l' ra�' .rg,�e«.'� / 6+h t�ec� ' -� � F�t4AL Ze n o�a �c.e/ e� d2 i �♦ I �pu+d. I.w lkzl 4trn d���+,1��� ISEC('ION 3:COMPLETE (S SECTION IF EXI57TNG BUILDINC�DEACOING RENOVATION,ADDI770N,OR I CHANGE IN USE OR OCCUPANCY 'Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) O � Existing Use Group(s): Proposed Use Group(s): P Exi�ting Hazard Index 780 CMR 34: Proposed Hazacd Index 780 CMR 34: SECCION 4:BU/LDING HEIGHT AND AAEA Existing Proposed No.of Fluors/Stories(include basement levels)&Area Per Floor(sq. ft.j �(L. tt� /1 �/�,Q Total Area(sq. ft.)and Tutal Height(ft.) �� �-� �j� N/'� SECfION 5:USE GROUP ICheck ae a lieablel A: Aseembiy A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-0❑ A-5❑ B: Bueineas ❑ E: Educatianal � F: Pacto F-1 ❑ F2❑ H: Hi h Hazard H-l � H-2❑ H-3 O H-4❑ H-5❑ I L• Inetitutional I-1 ❑ I-2 ❑ I-J C�" I-�t❑ M: Mercantile❑ R: Residential R-t❑ R-2❑ R-3❑ R-J❑ �� S: Stonge SI ❑ S-2 � U: Utility O Speciil Use 0 and plra�e deuribr brluw: Sprcial U,e: SECCION 6:CONSTRUCfION IYPE ICheck as a licible) IA ❑ IB O IfA ❑ IIB ❑ IffA ❑ IfIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE MFORMATfON Irefer to 780 C�IR 111A(or details on euh item) LVaterSupply: Flood Zone Information: Sewage Disposal: Trmch Permit: Debris Removal: Public� C hcck �i��uL.idr 1=1u,�,1 Lnnv C3� India�tr mumaF,.il L�l :1 lrrnch will nut be Liirmrd Ui.pu.il5itr rcyuirrdOurtrench ur.F...�cil'c:�__^ I I'nratv❑ ur mdenUlc Zpnt': _ nr nn.�te.v.irm ❑ F.ermrt i.endu.rd O I Raiiroad righbof-way: Hazards to Air Navigation: �I:� f Inh.n. t-..mnn,.�."�If��v��,� Pn•„�..: � \„t .\f�F�h:.dd�•EY I.�truinn�c��nhm ,urF,��rt eJF prn.�eh.�rra' I. lhcir n•�ie�c r��mF�lctrd' � d � ��r(�nn.rnlwHud�li'nd��.cd ❑ 1r.� ur.\uNJ 1'r.❑ \u � SEC�ION 8:CON�iE.VT OF CERTIFICAfE OF UCCCPANCY : I'.Idn�n��i ('��.Ic _.__ l�.vl;n�uF.i.c ��F•c��tll�n.tniiu.�n: �lcaipantLn.nlF.vrFlu.�r ____. � Ih���. lh�•btnhlinq:nnlam.�ntiF.nnl.li�r}�.Icm': ?F�cci��l?liF•ul.tUun.' I - SECTION 9: PROPERTY OWNER AUTHORIZATION I Name and Address of Property Owner feat:(( Ftctnxts _ Pov4- Av tt4_ hew 14 01,170 Name (Print) No. and Street C itv/Town Zip Prr.�p-erty Che nee Contact Information: per' 2L-t�l�i eS :/feL(v, -- -- F'CG�OAQ 2AS P*T Title Telephone No. (business) Telephone No. (cell) a -mad address Ifpap�pli�cab,Cle, t property owner herebv authorizes F1S�Ut- N • ftm;5 Sr-- Y0277,p r� 'L � st7t •o F"^ LA o_7 Name Strcet Address Cih•/Town State Zip to act on the property oov ner's behalf, in all matters retain to work authorized by this building permrt application. SECTION 10: CONSTRUCTION CONTROL (Please fill out Appendix 2) 1 10.1 Reitistered Professional Responsible for Construction Control I Ed Tv"Jr 113 - fai Name�it',c- a�t t is T�IrF�une Ifo. c L.,.Q e-mail add 7 O& ,C Street Address City/Town State Zip 10.2 General Contractor '4106 - Registration Number Sgi Ara. N/A Discipline Expiration Date 1 •i-Cr�`J 9' FtS�lcclrhCJ Ine f Name of Penon,Respn: ible for Construction License No. and Type if A licable qW Tur.talt `-r�-. � Aas7-r— Street Address City/Town State Zip -l3D-0l4-0- SG8 -zw - oliii-' -_ �Pur-�sQPurisi tic.c�t Telephone No. (business) Telephone No. (cell) e-mail address A Workers' Compensation Insurance Affidavit tram 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 }' suance of the building permit. Is a signed Affidavit submitted with this a lication7 Yes fd No O SECTION 12: CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs: (Labor 3SS V0 and Materials) Total Construction Cost (from Item b) _ $T 1. Building S 11610M Building Permit Fee = Total Construction Cost x _ (Insert here 2. Electrical S &OCID appropriate municipal factor) = S 3. Plumbing $ IOC1C� 4. Mechanical (HVAC) $ g5bo Note: Minimum fee =$ (contact municipality) 5, Mechanical (Other) $ Enclose check payable to b. Total Cult is 'jW j c, (contact munici alit ) 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 +the be, f m , knowledge and understanding. �o1De�-a �rSt;S -.elon� SS ZTt7. ozb,57 47/ SOW I'lea.e print and ,ign nae Title Telephone Xo Oate 'itrvet .Wdre,> C itc;'T m11 @a ') Xf Z A I Municipal Inspector to fill out this section upon application approval: CITY OF SaZL.F"NI, INLkSSACHUSETTS • BUILDING DEnRTJIENT 130 WASHINGTON STREET, Yo FLOOR " TEL. (978) 745-9595 FA.e (978) 730-9846 KI\IBERLSY DRISCOLL iKAYOR THOMAS ST.PtERRs DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%LNIISSIONER �C�I"O�NSTRU TION CONTROL D UMENTy Project'ritle: F84bA. flom� lobate: Project Location: Scope of Project•. In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code: 1 _BALI ;S&AdN I _ Mass. Registration Number 4 W being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Entire Project (J Architectural [ ] Structural [ ] Mechanical [ J 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. 1 shall submit periodically, in a form acceptable comments. Upon completion of the work, I sha satisfactory completion and readiness of the proj Signature and Se o istered professional: report together with pertinent final report as to the May 18, 2010 City of Salem Building Department 120 Washington Street Third Floor Salem, Massachusetts 01970 Attention: Thomas St. Pierre, Building Inspector Re: Chapter 34 Compliance Alternatives for the Fire Pump Addition Shaughnessy Kaplan Rehabilitation Hospital Salem, Massachusetts Dear Tom: The purpose of this letter is to request relief from building code requirements using compliance alternatives as per the provisions of Chapter 34 of the seventh edition of the Massachusetts Building Code. There are two separate issues that compliance alternatives are being suggested. These issues are as follows: 1. Room Height: (Paragraph 1208.2 of the seventh edition of CMR 780). 2. Separate Diesel Fuel Supply Tank: (N.F.P.A. 20, Paragraph 11.4.2.3 reference document to the seventh edition of CMR 780). In terms of the first issue which is a room height issue, the Massachusetts Building Code requires a minimum ceiling height of 7'-0" as per (Paragraph 1208.2 Minimum Ceiling Heights). This paragraph reads as follows: "1208.2 Minimum Ceiling Heights. Occupied spaces, habitable spaces and corridors shall have a ceiling height of not less than seven feet six inches (2286 min.). Bathrooms, toilet rooms, kitchens, storage rooms and laundry rooms shall be permitted to have a ceiling height of not less than seven feet (2134 min.)." The proposed construction converts an unused area under an existing stair to a new mechanical room that will be used in conjunction with the installation of the new fire pump. This new mechanical space will be separated from the existing stair tower by a new horizontal and vertical 2 hour fire drywall enclosure. This proposal was discussed last fall with your assistant in a meeting at Shaughnessy Kaplan Rehabilitation Hospital. At that meeting the proposal was received well by your assistant. When the bottom of the existing stair landing is covered by the new drywall 2 hour fire separation the resulting ceiling height will now be around 6'-8" in height, not the 7'-0" height required by the building code. HEALTHCARE ARCHITECTS INC. 64 GOTHIC STREET NORTHAMPTON, MASSACHUSETTS 01060 1.417.585.1512 r • Page 2 May 18, 2010 The compliance alternatives that are being proposed for this building code requirement are as follows: 1. The mechanical space will only be used for the mechanical piping and equipment associated with the installation of the new fire pump. 2. A new sprinkler head connected to the Hospital's fire protection system. 3. A new smoke detector connected to the Hospital's fire alarm system. In terms of the second issue, which is a separate fuel source requirement, the Massachusetts Building Code, Seventh Edition lists N.F.P.A. 20 as a reference document in an appendix to the building code. hi N.F.P.A. 20, Paragraph 11.4.2.3 a standard for a separate fuel tank reads as follows: "N.F.P.A. 20, Paragraph 11.4.2.3: The fuel supply tank and fuel shall be reserved exclusively for the fire pump diesel engine." The proposed new Patterson diesel fire pump is being supplied with an independent 25 gallon day fuel tank with a rupture basin and alarms. This day tank system will then be tied into the Hospital's main diesel buried supply tank that currently furnishes diesel fuel to the Hospital's emergency generator. The compliance alternatives that are being proposed for this reference standard to the Massachusetts Building Code are as follows: A separate independent 25 gallon day tank is being furnished with the new Patterson Engine Driven Fire pump which has a capacity of 1000 GPM at 100 PSI. 2. A local alarm for the diesel fuel supply. 3. A monitored alarm for the diesel fuel supply at the Hospital's switchboard. If you have any questions or want to discuss the proposed Chapter 34 compliance alternatives for this project, I would be happy to meet with you and discuss these proposals. Sincerely INC. Ce: Ron Freeman, Shaughnessy Kaplan Rehabilitation Hospital ,►'y The Commonwealth of Massachusetts l' I Department of Public Safety ,/. O/ w,.! \lasachu.a•ns timate Budding Code(780 C\1R)Srernth Edition �p City of Salem 1' Building Permit Application for any Building other than a I- or 2-Family Dwellin Del (This 4ectiun For Official Use Only) Budding Permit Number Dale Applied: Building Inspector: SECTION 1: LOCATION (Please indicate Block M and Lot is for locations for which a street address is nva able) IA2% tW4WE. 4der.1 0l'1 0 No.and Street City /Town Lip Code Name of Building(if� SECTION 2:PROPOSED WORK If New Constroctiun check here O or check all that apply in the two rows below - Existing Building❑ Repair❑ 1 Alteration Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes EK No ❑ Is an Independent Structural Engineering Peer Reviewresired? / Yes C1 No 0� Brief Description of Proposed Work: (m04ni l-f..• ef' air �yWi/ . ` 6-4a iae�ty�i r.t t!:rw Y 6/ �.( �ir1e s lvs(� �e 5 zs. 56-- P errclo 4r....mws �ro.1td J h, /ltt�fKde Anel.-/re S SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Evaluation is enclosed(See 780 CMR 3402.0) ❑ Existing Use Group(s): Proposed Use Group(s): P Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: _ SECTION 4: BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) crR &TR- $TR- (yrg Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as app licable) A: Assembly A-1 ❑ A-2r ❑ A-2nc❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑ ii 1: Institutional I-1 ❑ 1-2 ❑ 1-3 61,1-4 ❑ M: Mercantile O R: Residential R-1❑ R-2 ❑ R-3❑ R-4❑ IS: Storage S-1 O S-2 ❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IAO 111 IIA ❑ IIB ❑ IIIA ❑ [IIB ❑ IVO VA V8 SECTION 7:SITE INFORMATION (refer to 780 CMR 111.0 for details on each item) {Vater Suppl Flaod Lone Information: Sewage Disposal: Trench Permit: Debris Removal: Public C Check ii uubide Ploo,i Lnnr C� Indicate municipal A trench wwi�ill not be Ucemed Uinpos.tl Site d «alwred C.'('r trench ur.peri lc: I'n vale❑ ur umden Ulu 7_unr:_ or nn ate>%Hem ❑ ),remit ra en lo.ed ❑ _ I Railroad right-of-way: Hazards to Air Navigation: \I:\ hh�U art, < ,•nm.....,•n IL,e,+ I'n•„ \m Apphcal+le(ir I.Structure t,nhin auF„rtt appnoch orva' t'I, thwr rca ietc i,nnplctcd' •.r l nrt.rn! lei 14ui1.1 a'ni u.cd ❑ }c.❑ ur Xo 29 1'c•. ❑ \o CY SECTION 8:CONTENT OF CERTIFICA rE OF OCCUPANCY a I.ditwn '-1 l'�alr l-v l�r��upi.r. _ rtpc,rt C tin.truawn: Occupant Lead per l lu,'r I) •v. the luildnp•rntaio.at tipnnklcr Sa.tem': �pcei,tltiupmdalium' - SECTION 9: PROPERTY OWNER AUTHORIZATION N, r,ulP1 Add n<.+'of l'rupurle Utrner 6. S l�►w aVe4q, ! /fl o►°r7c Name(Print) No.andtitreet City/Town Lip I'ruperh/ C)wn[er� tact Information: �'y Arte-6s� U` 7L4 ( �PS <Tne�wa Gl.:sfr .e. Title Telephone No. (business) Telephone No. (cell) r-mad address If a +plicablr, thfe�pmpert�,nrnrr hereby authorize* _ A . {tlri5 •/. ZlLrfl TV.DtFG.iF !(iig&Al- LA 6-0 '471 Name Street Address Citv/Town State Zip to act on the prt,pert%owner's behalf, m ell matters relative to work authorized by this building permit a p plication. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) (It buildin•is Its.than 35,000 cu. ft.of endoxd s ntcv and/or not under Construction Control then check here O and skip Section 10.1) 10,1 Re istered Professional Responsible for Construction Control Ed le-4dm Nf3- ;ft- I57z yloS Name(Registmrlt) Tele hone No. e-mailaddress Registration Number W G,ff,A, V. fix olct6o pi--itrr6. NIX Street Address City/Town 'State Zip Discipline Expiration Date 10.2 General Contractor f7zcrls # Alf s Ing Cu r,�tgagy rrr}r} Name of Perwn Reslxmsible for Construction l� ��/� License No. and Type if A licable NEO TM�,Lr �bv1N r-JoN Oaj?S Street Address City/Town State Zip �-$Q- 6�is lrri�l _'L30 - lX•Sf �2tri5C�risiV•t.eeNN 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 M' No 13 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6) =$ 1. Building $ Building Permit Fee=Total Construction Cost x_(Insert here 2. Electrical $ appropriate municipal factor)_$ 3. Plumbing $ N00 4. Mechanical (H VAC) $ Note: Minimum fee=S.6M(contact municipality) 5. Mechanical (Other) $ a Enclose check payable tble to �,n 6.Total Cost $ Hc� boo (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below, 1 herebv attest under the pains and penalties of perjury that,dl of the information con toned in this application is trueue dnd accurat wledgeand understanding. "A. - mo , __f e51•4n k Ao- _ 236. OZS3 0 I'lea.e pant and sign n.0Title Ttdcphone\'n. 0,11e_ tiPot e k- 5 hov+k &J � �( oZa7.� Street .Wdres C1fc; T,mii . Lite ip Municipal Inspectorto fill out this section upon application approval: O \amr I),t to i CITY OF SM.&M. NUiSSACHUSETTS • BUIL.DING DEPARTNlEN1T 120 WASHINGTON STREET, 3" FLOOR TEL. (978) 745-9595 FAX(978) 740-9846 KL,iBFRLSY DRISCOLL �YOR THobtAS ST.PIERRH DIRECTOR OF PUBLIC PROPERTY/BUILDD4G CONMUSSIONER CONSTRUCTION CONTROL DOCUMENT Project"title: 1 [Dw Cly J Date: NO" tat %a 10 Project Location: 6k t3 AMA yt�t�/ � Scope of Project: _-_- _�DifYEPiY1ML. \O�r�....0 • Y In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code I Mass.Registration Number being a registered professional Engineer Architect herebyCKRTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Entire Project ( j Architectural [ J Structural [ ] Mechanical [ J Fire Protection [ ] Electrical [ ] 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 1 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 rogress report together with pertinent comments. Upon completion of the work, I shall submit t €r6i 1 a final report as to the satisfactory completion and readiness of the project for o u D c> Si nature and Seal of registered professional: ¢ \ao•ert q� ` ' � � I � �GO � Gl� cx�OSJ`6 �SSJS �a�� �� �l' ����':. r.�.... "� ' q � =� ' The Commonwealth of Massachusetts � M1� Department of Public��e�� 22 ,/9, � �� � �� � D�(assachusettr State Building Code(7S0 CMR) —�. Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Secfion For Offici�l Use Onty) l{'� BuildingPermitNumber: DateApplied: �7 201C BuildingOfficial: '.7' SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) , '' 1. �ove Ave Sa, .en,t , MA o i q 70 1 No.and Street City/Town Zip Code Name of Building(if applit�ble) I� SECTION 2:PROPOSED WORK '°"� Edition of btA State Code used_ If New Construction check here 0 or check all that apply in the two rows belo�v Existing Building❑ Repair❑ Alteration ❑ Addition� DemoliHon ❑ (Please fill out and submit Appendis 1) I Change of Use G Ciiange of Occupancy ❑ Cfl1er f9�Spetify: ' � Are building plans and/or construction documents being supplied as part of this permit applicaHon? Yes No ❑ Is an Independent Structural Engineerin Peer 2eview required? Yes ❑ No ❑ BriefDescriptionofPropasedWorky��3�'bl.� $'fI`UC.'�b�.Sf'�nwl�jj ��PLC,'ffT��7_�$-- cpsSoc�•t�-r�� w,'?2� �o�s�r.c.�.� eF a arew�-�p��p��F�ewrE- ��t��� SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDIT[ON,OR CHANGE IN USE OR OCCUPANCY� ' � � Check here if an Existing Building Investigation and Evaluation is enclosed(See 7S0 CMR 34) ❑ Existulg Use GrouF(s): Proposed Use Group(s): SECT[ON 4:BUILDING HEIGHT AND AREA Exisfing Proposed No. of Floors/Stories(include basement]evels)&Are2 Per Floor(sq.ft.) - Total Area(sq. ft.)and Total Height(ft.) SECTION 5: USE GROUP(Check as applicable) � A: Assembly A-1 ❑ A-Z❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑ F: Factor F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-�1❑ H-5❑ i I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-1❑ - R-2❑ R-3❑ R=k❑ S: Storage S-1 ❑ . S-2❑ U: Utility❑ Special Use�and please descriUe Uelow: Special Use: SECT'ION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ❑ IIA ❑ IIB ❑ tIIA ❑ IIIB ❑ IV ❑ VA ❑ VB ❑ SECTION 7:SITE INF021vIATION(refer to 780 CMR i11A Eo�details on each item) Water Suppl/y Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public G7' Check if outside Flood Zone❑ Indicate municipal � trench w' not be Licensed Disposal Site❑ required or trench or specify: C ka1'� Private❑ or indenfify Zone: or on site system❑ pennit is enclosed❑ G��Q �'j—L!.('�.�C/� Rall[o1d dght-Of-wdy: Haza[ds to AlL Navigation: \�IA Ffititoric Conunission Review Prot�_.�: � Not Applicable� Is Strutture within airport approach area? [s their review completed? or Consent to Build enclosed❑ Yes O or No❑ Yes ❑ No ❑ SECTION 3:CONTENT OF CERTIFICATE OF OCCUPANCY � Ldition of Code: Use Group(s): Type of Construction: Occapant Load per Floor: Uoes the building contain an Sprinkfer System?: Speciaf Sfipulations: �1� , `LS� ��1f�1LLs�D � '1`�lA'LLLN� �SF. I' I __ _____. __ _ _�_..--, -- -- , � � � SECTION 9: PROPERTY OWNER AUTHORIZATION N.ime and Address of Property Owner � � uan'�ska�e.,�rl�^eaLc�e.,��er (�t ff�kL�l`(-ve So,�.eN, . -b�.ia o ► To Name(Print) - �� �- No.and Street City/Town � Zip Property Owner Contact Infonnation: 5i�61v ti3cse��rA. 9�-�- rzvp - - 5k��se�,Jc�@Par-txs¢rs_ e Titl� Telephone No. (business) Telephone No. (cell) e-mail address � ff applicable, the property owner hereby authorizes , iva l s��xn'�'i.�5, �0 2�a coNUAerco°a L s�• �___�k o Z d Name Street Address City/Town State Zip to act on the ro ert owner's behalf,in all matters relaHve to work auNiorized b this buildin ermit a IicaHon. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If build'ui is less th.m 35,000 cu.ft of enclosed s ace and/or not mider Conskuctlon Control then check here O and ski Section 10.1 � 10.1 Re 'stered Professional Res onsible for Constcuction Control � � Name(Registrant) Telephone No. e-mail address Registration Nwnber Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor ����I-o�l.— 'e��nJC. .. . I Company Name YJ�lLi'.4„�C'.�kz�,r.lsk: cS o�o g 23 - �.�.Nreg�►-)ctea! I N.ime of Person Pesponsible for Construction License No. �nd Type if Applicable '7R t-Fc'�11,�.N fl l4ve �:cl d o�S'c, Sa,��eo� �v►,r� O 19�'D Street Address City/Town State Zip '��- '�Y! 12u� k SJSB (�'Z-S�f' Z�� G (��u z�.asfcJCa wa./bfi bre'ldle•s. coM 'I'ele�hone No. business Tele�hone No. cell) e-mail address SECTION 11: 4��ilRl:ISR�'CO�iPf:C'�S:\'CION IVSL9���CC AI�PIDAVIT M.G.L.c.152.§ 25C 6 r\ 4Vorkers'Compensation Insurance Affidavit from the tiIA Deparhnent of Industrial Accidents must be completed and , submifted with this application. Failure to provide this a(fidavit will result in the denial of the issuance of[he building permit. I, ls a si ned Affid�vit submit[ed with tlus a lication? Yes❑ No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor I�,� and b�laterials) Total Construction Cost(from Item 6)_$ �O�S '�•\ 1. 6uilding $ A, ��/ �000 Build'uig Pennit Fee=Total Construction Cost s_(Insert here 2. Hlectricai $ appropriate municipal factor)_$���� "�. 3. Plumbing $ fi -k. Ncch�nical (HVAC) $ No[e: Minimumfee=$ (caltactmunicipality) 5. ��fechanical Other) $ �'• � �- SQ�,eN� Jl�� '' Enclose check payable to ,d � � G.Tutaf Cost $ ,SM (contac[municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT 6��entering my name Uelow,I hereUy�ttest under dte pains and penalties of pequry that all of UZe informatiom m�tained in tlus � application is Liue and accu � e to the best of my knowledge and understanding. _�.�..�-` SeN�ar J�',.a�eaj'N.fas,e.�� - 6t':-5'E�I.ZS0,6 !r l?1/fo Plense print an ' p n�m� • �,Title Telepl�ne N� Dale 33 ���..e(�- .�l' � U-� I�IA� /ql Street ,4ddress , CitV/Tow /� State Zip '�C.� �eruZ641s / Mimicipal Inspecror to fill out this section upon application approval: � t�' / �l "���� � Name D�te r�� _ � �/���odv 1 VERIFY THE AUTHENTICITY OF THIS MULTI TONE SECURITY DOCUMENT CHECK BACKGROUND AREA CHANGES COLOR GRADUALLY FROM TOP TO BOTTOM' It i1v If n i✓�rSnN'+�.\Y' �` �yL�l_:tee � '�'IE /i ...'Ir� ia� Fir d Iezwrao,s I I - !ao-mss r �s�h,INS, 3i 'a I. !�[!"g, I ,nj�il 1 v r.. f1 r/al Il1A ppIjy'1i I' "�. I '%i r' I'Yo!E ��d1 'C=4f a�� 3i^.11i�..,^.�4 F,��i,L�j�i' � .n�{ .:i��'�.k wf.�j�, •�,;;,k�L s ., "��„;,,.`.o-�'`ih I � - II T Yh7 .<" Im_ .,•I a _ a fti - ! 'h :<pAYi Seventy-bneThogsaod<F,veHundred:andJrMP 1DoNats r TO?HE CITY OFSALEM ORDER OF BUILDING DEPT SAEMSHINGTNGTON ST MA ' ' - - MIMGRIII➢4GM.�NRE •. VgGIF NGI CISXm NTININ9]O4K 0000 5 S88 5 5 SO 1:0 L i 20 1 5 391: 0000800 569 7811• Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8d' edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project, Phase 1 - Generator Date: November 8, 2016 Property Address: North Shore Medical Center, 81 Highland Avenue, Salem, Massachusetts 01970 Project: Check one or both as applicable: 0 New Construction Q Existing Construction Project Description: Renovation of the existing emergency power hospital infrastructure. Two (2) new emergency generators will replace the hospital's two(2)emergency generators on Davenport 3. I, Adam C. McCarthy. P.E., MA Registration Number: 40730, Expiration Date: 06/30/2018, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concemingl: Architectural Q Structural Mechanical Fire Protection Electrical Other: Describe 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'. tH OF Enter in the space to the right a"wet"or electronic signature and seal: MCC v No.10730 y 9F Q Phone Number: (617) 737-0040 Email: McCarthy@,McSal.com 9o�F& NALE1401, 14018.011—NSMC—Salem,MA—Generator Framing Support—Initial Construction Control Affidavit 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 To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase 2 Davenport Chiller Date: 11/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x) one or both as applicable:_ New construction X Existing Construction Project description:Renovation of the hospitals chiller system to provide additional chiller to serve the hospital campus. I,John W.Nelson,MA Registration Number: 39839 Expiration date: 06/30/2018, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural _X 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: I. 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 commei4s,i$a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a `Final Construction Control a �c g� JO W tiN Enter in the space to the right a"wet"or NE m electronic signature and seal: CH CAL .-3839 9F6/STER�'� �Q .� FFSS/ONALEN�'\�� Phone number: (508)647-9200 Email:jnelson@engsolutions.com ,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 To be submitted with the building permit application by a Registered Design Professional for work per the 8'edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase 2 -Chillers Date:]1/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x)one or both as applicable: _ New construction X Existing Construction Project description: Renovation of the hospital's chiller system to provide additional chiller to serve the hospital campus I,John T.Sacharewitz,MA Registration Number: 50246 Expiration date: 06/30/2018,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection X 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, 1 shall submit to the building official a`Final Construction Control Document'. Enter in the space to the right a"wet"or V(H OF Mgss electronic signature and seal: yv'� 9p o? JOHN T. tiN SACHARE WITZ O ELECTRICAL No.50246 q90 9FU'ISTEQ`��a`4�Q Phone number: (508)647-9200 SSS/ONALENG Email:jsacharewitz@engsolutions.com 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 To be submitted with the building permit application by a a Registered Design Professional for work per the 81h edition of the v 'y Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase 2 Davenport Chiller Date: 11/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x) one or both as applicable: _ New construction X Existing Construction Project description: Renovation of the hospital's chiller system to provide additional chiller to serve the hospital campus.. I, Stephen A. Coduri,MA Registration Number: 49910 Expiration date: 06/30/2018, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': _Architectural ,Structural _ Mechanical Fire Protection _Electrical _X_ Other: Plumbing 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'. Enter in the space to the right a"wet"or Will OFgy - electronic signature and seal: �r l:,µ ,9 FF .4v30o Phone number: (508)647-9200 �s�"/OfpALNr'` Email: scoduri@engsolutions.com 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 To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the e'a Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase 2 Davenport Chiller Project Date:l 1/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: Renovation of the hospital's chiller system to provide additional chiller to serve the hospital campus I,Stephen A. Coduri,MA Registration Number: 49910 Expiration date: 06/30/2018,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': _Architectural Structural _ Mechanical X 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'. Enter in the space to the right a"wet"or Z8 OF MAss4 electronic signature and seal: STEP -NA. N r C BI Wil ' NIC e 9 0 90,c �G/S'r EPS ; Phone number: (508)647-9200 SSS/ONAL Email: scoduri@engsolutions.com 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 1 l 2013 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8" edition of the 'y Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Phase 1—Emergency Generator Date:11/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x) one or both as applicable:_ New construction X Existing Construction Project description: Renovation of the existing emergency power hospital infrastructure.Two(2)new emergency generators will replace the hospital's two (2)emergency generators on Davenport 3. I,John W.Nelson,MA Registration Number:39839 Expiration date: 06/30/2018,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural _X_ 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 Doc PsSN OF MA\SS4. Enter in the space to the right a"wet"or electronic signature and seal: JO N M CH N L N c.3 39 p Q- 10 IO Phone number: 508 647-9200 Email:juelson@engsolutions.com Building Official Use Only Building Official Name: Permit No.: Date: Note I. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, provide a description. Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase I-Generator Date: 11/08/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x)one or both as applicable: _ New construction X Existing Construction Project description: Renovation of the existing emergency power hospital infrastructure.Two(2)new emergency generators will replace the hospital's(2)emergency generators on Davenport 3. 1,John T.Sacharewitz,MA Registration Number: 50246 Expiration date: 06/30/2018,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection X 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'. Enter in the space to the right a"wet"or ASN OF&i electronic signature and seal: yv� 9p ate' JOHN T. yGm SACHAREWIR ELECTRICAL 7 No.50246 q'� Is Phone Phone number:(508)647-9200 �SIONALEN Email:jsacharewitz@engsolutions.com 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. n Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: NSMC Campus Consolidation Infrastructure Project Phase I-Generator Date: 11/10/2016 Property Address: 81 Highland Avenue Salem,MA 01970 Project: Check(x)one or both as applicable: _ New construction X Existing Construction Project description:Renovation of the existing emergency power hospital infrastructure.Two(2)new emergency generators will replace the hospital's(2)emergency generators on Davenport 3. 1,Scott I Patrowicz,MA Registration Number:33656 Expiration date: 06/30/2018,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning`: _Architectural Structural Mechanical Fire Protection Electrical X Other:Civil 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,l 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 b i Icial a' Construction Control Document'. Enter in the space to the right a"wet"or �!PY OF Mgskp electronic signature and seal: o`' SCOTT IAN PATROWICZ o CIVIL No.33656 X09 FC/STEQ'� Q Phone number: (978)836-6400 oFs/ONALEN��� Email: scott.patrowicz@ verizon.net 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. S52 - l � b'z� �� 1 �?� The Commonwealth of Massachusetts ® Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-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 s reet addr s is not available) One Dove Ave Salem Ma 01970 Spaulding Hospital North Shore No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used 8th If New Construction check here❑or check all that apply in the two rows below Existing Building X Repair❑ Alteration X Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes X No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No X Brief Description of Proposed Work:Minor renovation to second floor conference center involves selective demolition, new partitions,doors&frames,minor ceiling work,new carpeting and vinyl base painting minor electrical one new sink relocate sprinkler heads per attached plan prepared by Caldarola Design Associates dated 1/7/2014 SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑ Existing Use Group(s): Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) - Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Facto F-1 ❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ I: Institutional I-1 ❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R4❑ S: Storage S-1❑ S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IAO IB ❑ IIA ❑ IIB 13 IIIA ❑ IIIB ❑ 1 IV 1 VA VB [3 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 X Check if outside Flood Zone❑ Indicate municipal X A trench will not be Licensed Disposal Site❑ Private❑ or indentify Zone: . or on site system❑ required X or trench or specify Waste permit is enclosed❑ Management 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❑ or No❑ Yes❑ No X SECTION&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?: Special Stipulations: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Spaulding Hospital North Shore Ronald Freeman One Dove Avenue Salem,Mass 01970 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Director of Facilities 978-490-6518 rfreeman2Q12artners.org Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes Robert A.Parris Tr.Parris&Associates Inc.480 Turnpike St. So.Easton, Ma 02375 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 O and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Caldarola Design Associates 603432-8404 joec@caldarola.com 7728 Name(Registrant) Telephone No. e-mail address Registration Number 4 Birch St. Derry NH 03038 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Parris&Associates,Inc. Company Name Robert A.Parris Jr. 040567 CS Name of Person Responsible for Construction License No. and Type if Applicable 480 Turnpike St. So.Easton MA 02375 Street Address City/Town State Zip 508-230-0255 508-400-5951 rparris@parrisinc.com Telephone No.(business) Telephone No. cell e-mail address 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 X No 17 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE - Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 26,800.00 1.Building $ 22,000.00 Building Permit Fee=Total Construction Cost x26.8 2.Electrical $ 2,000.00 (Insert here appropriate municipal factor)=175002 3.Plumbing $ 1,600.00 4.Mechanical (HVAC) $ 1,200.00 Note:Minimum fee=$187.60(contact municipality) 5.Mechanical Other $ Enclose check payable to City of Salem (contact municipality) and 6.Total Cost $ 26,800.00 write check number here - SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby ttest under the pains and penalties of perjury that all of the information contained in this application is true an ccur�te to the est of my knowledge and understanding. Robert A Parris r. President 508-400-5951 1/16/1 Please print and sign name Title Telephone No. Date 480 Turnpike St. So.Easton Ma 02375 Street Address City/Town StA Zip Municipal Inspector to fill out this section upon application approval: Narnev bate EJALDAROLA DESIGN A S S O C I A T E S , P C Architecture o Interior Design ARCHITECTURAL AFFIDAVIT Project Number: ?fOl� Date: 1* Project Title: Project Location: p gr (; Alve. Name of Building: Scope of Project: ill pm g1gjdd4 -MZ01 61a;W I, Joseph V. Caldarola, MA Registration No. 7728 being a registered professional architect have prepared or directly supervised the preparation of the architectural design plans, computations and specifications for the above named project and that, to the best of my knowledge, belief and understanding such plans, computations and specifications meet the applicable provisions of the 8`h Edition of the Massachusetts State Building Code. I shall perform the necessary professional services and be present on the construction site as needed to determine that the work is proceeding in accordance with the documents approved for the building permit and shall be responsible for the following: 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 Chapter 17. 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 and this code. Upon completion of the work, I shall submit a final report as to the satisfactory completion and readiness of the project for occupancy. Signed by "" Date: Architect's stamp: 4aED ARS, F Na 7Tl8 ;tt LONDONDERRY, NN ae qUh OF OPPI 0 4 Birch Street, Derry, NH 03038 (603) 432-8404 (Fox)432-2706