0072 FLINT STREET, HALSTEAD SALEM STAT. BLDG 1i
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: I Building Official:
t SECTION 1:LOCATION(Please indicate Block#and Lot#for locations i a street a e t available)
72 Flint Street Salem MA 01970 (Map#26 Lot#0091 Halstead Salem Station -Building 1
t \j No.and Street City/Town Zip Code Name of Building(if applicable)
t SECTION 2:PROPOSED WORK
Edition of MA State Code used_At If New Construction check here®or check all that apply in the two rows below
Existing Building Repair Alteration Addition Demolition (Please fill out and submit Appendix 1)
Change of Use Change of Occupancy 1 Other Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 00 No
Is an Independent Structural Engineering Peer Review required? Yes No M
Brief Description of Proposed Work: -Foundation to 1st elevated slab construction of 80-unit apartment building(BLDG 1).
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.) 1 story
Total Area(sq.ft.)and Total Height(ft.)20,935 OSF 11 FT
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 A-2 Nightclub A-3 A-4 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 1-1 I-2 I-3 I-4 M: Mercantile R: Residential R-10 R-2 R-3 R-4
S: Storage S-1 S-221 U: Utility Special Use and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA IB X IIA IIB IIIA IIIB IV 1 VA VB
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Trench Permit: Debris Ren oval: ;
Water Supply: Flood Zone Information:Sewage Disposal:
Licensed Dis al Site MPublicMCheckifoutsideFloodZone Indicate municipal W
A trench will not be I
required O or trench or specify:
Private or indentify Zone:A_ or on site system permit is enclosed
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable IN Is Structure within airport apprgach area? Is their review completed?
or Consent to Build enclosed Yes or No® Yes No IN
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: 9th Use Group(s): S-2 Type of Construction: Occupant Load per Floor:1 05 Persons
Does the building contain an Sprinkler System?: YeS Special Stipulations: None
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property OwnerDSFSalemFlintLLC950Winter St., Suite 4300 Waltham MA 02451
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Thomas W. Mazza, Managing Member- 781-250-2940 - tmazza@dsfadvisors.com
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
N.A. -------------------------------------------------
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)
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
Daniel M. Skolski 978 965 3470 clskolski@cImsdesign.com 20038
tuN 6 Center, Suite 3 c°ne N°
Beverly
e-maiOress
01915 P ctifecT
Numb t8/31/2019
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Fulcrum Associates
Company Name
Tom Ploude C5-083441 (Unrestricted )
Name of Person Responsible for Construction License No. and Type if A plicable
5 Tech Circle Amherst,I H 03031
Street Address City/Town State Zip
603/673.3200 603)_732 - 6845 tploude@fulcrum-nh.com
Telephone No.(business)Telephone No. celle-mail address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAMIT .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 ISI No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item
Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ 1,052,101.00
1.Building 1,052,101.00
Building Permit Fee=Total Construction Cost x$11 (Insert here
2.Electrical appropriate municipal factor)=$ 11,573.11
3.Plumbing
4.Mechanical (HVAC) Note:Minimum fee=$ contact municipality)
5.Mechanical Other
Enclose check payable to
6.Total Cost 1,052,101.00 contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering name bel ereby attest under the pains and penalties of perjury that all of the information contained in this
applicatio e d
TIV
cora to the best of my knowledge and understanding.
X Thomas W. Mazza Managing Member 781 250 5940 X
Please print and si me Title Telephone No.Date
950 Winter St. Suite 4300 Waltham MA 02421
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:I
Name Date
Appendix 2
Construction Documents are required for structures that must comply with 780 CMR 107.The
checklist below is a compilation of the documents that may be required for this.The applicant
shall fill out the checklist and provide the contact information of the registered professionals
responsible for the documents. This appendix is to be submitted with the building permit
application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural X
2 Foundation X
3 Structural X
4 1 Fire Suppression X
5 Fire Alarm(may require repeaters) X
6 HVAC X
7 Electrical X
8 Plumbing include local connections X
9 Gas(Natural,Propane,Medical or other X
10 Surveyed Site Plan(Utilities,Wetland,etc. X
11 Specifications X
12 Structural Peer Review x
13 Structural Tests&Inspections Program x
14 Fire Protection Narrative Report x
15 Existing Building Survey/Investigation x
16 1 Energy Conservation Report X
17 Architectural Access Review 521 CMR x
18 Workers Compensation Insurance x
19 Hazardous Material Mitigation Documentation x
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
Areas of Design or Construction for which plan are not complete at the time of application submittal must be identified herein.Work
so identified must not be commenced until this application has been amended and the proposed construction document amendment
has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit
fee.
Registered Professional Contact Information
Daniel M.Skolski 978 965 3470 dskolski@dmsdesign.com 20038
Registration Number
Name(Registrant) Telephone No. e-mail address
Architect 08/31/2019
100 Cummings Center,Suite 339c Beverly MA 01915
Street Address City/Town State Zip
Discipline Expiration Date
Rimantis M.Veitas 781 535 5816 rimasOveitas.com
34028
Registration Number
Name(Registrant) Telephone No. e-mail address
Structural Engineer 06/30/2020
69 Granite Street,Suite 101 Braintree MA 02184
Street Address Ci /Town State Zip
Discipline Expiration Date
George Dubin 617 376 8877 dubinengrs@verizon.net
29370
Registration Number
Name(Registrant) Telephone No. e-mail address
Sanitary Eng 06/30/2020
40 Willard Street,Suite 302 Quincy MA 02169
Street Address Ci /Town State Zi
Discipline Expiration Date
James P Stroke
20068
cal Eng
06/30/2020
40 Willard Street,Suite 302 Quincy MA 02169
CITY OF SiU. N131 iNL-kSSACHUSETTS
BL'II.DING DEP#R1I1CvT
130 WASHINGTON STREET,3a0 FLOOR
TM (978) 745-9595
FAX(978)740-9846
KI1tBFM—EY DRISCOLL
i1riAYOR THOMAS ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUIIDLNG COS511 SIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leaibll
Name(Busitx-ss.Organization/individual):
Fulcrum Associates Inc
Address: 5 Tech Circle
City/State/Zip: Amherst, NH 03031 Phone M:
603/673-3200 EXT 214
Are you an employer?Check the appropriate box: Type of project(required):
1. 1 am a employer with
X 4. 1 am a general contractor and 1 6. El New construction
employees(full and/or part-time)." have hired the sub-contractors
2. 1 am a sole proprietor or partner- listed on the attached sheet.
7. Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. workers'comp.insurance. 9, C]Building addition
No workers'comp.insurance 5. We are a corporation and its
required.] officers have exercised their 10.El Electrical repairs or additions
3. 1 am a homeowner doing all work right of exemption per MGL 1 I.Plumbing repairs or additions
myself.[No workers'comp. C. 152,¢1(4),and we have no 12.0 Roof repairs
insurance required.]t employees.[No workers'
comp.insurance required.]
13.[:]Other
Any applicarq that checks box MI must also fill out the section below showing their workaa'compensation policy information.
f I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contrnuors must submit a new affidavit indicating such.
C.xnractors thou cheek this lox must anxhod an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I um an employer that is providing workers'compensation insurance for my employees. Below Is the policy and jab site
information.
Acadia Insurance Company
Insurance Company Name:
Policy#or Self-itis.Lic.M
WCA5173208-14
Expiration Date: 11/1/2019
Job Sire Address: Assessors Map 26 Lot 91,95&97
City/Statc/Zip:
Salem, Ma
Attach a copy of the workers'compensation policy declaration page(showing the policy number and explradon date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of it STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains acrd penalties of perjury that the information provided above Is true and correct+
Sign•iture•
57
Dote: 2/11/2019
Phone#• 603/673-3200 EXT 214
OJJlcial use only. Do not write in this area,to be completed by city or town ojjic&L
City or Town:Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other ._.
Contact Person:Phone M
FU LCASS-01 KPETTIT
ACRO
CERTIFICATE OF LIABILITY INSURANCE FD
10/24/
DDl1(
10/24/20188
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on
this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
PRODUCER CONTACT Kathy M.Pettit
Davis&Towle Morrill&Everett,Inc. PHONE FAX
115 Airport RoadINC,No,Ext:(603)715-9739 lac,No:(603)225-7935
Concord,NH 03301 E-MAIL .kpettit@davistowle.com
INSURERS AFFORDING COVERAGE NAIC 0
INSURERA:Acadia Insurance Company 31325
INSURED INSURER B:
Fulcrum Associates,Inc. INSURER C:
5 Tech Circle
INSURER D
Amherst,NH 03031
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
TYPE OF INSURANCE ADDL SUBR
INSD WDPOLICY NUMBER POLICY EFF POLICY EXPLTRLIMITS
A X COMMERCIAL GENERAL LIABILITY 1,000,000EACHOCCURRENCE
CLAIMS-MADE OCCUR CPA5173204-14 11/01/2018 11/01/2019 DAMAGE TO RENTED 300,000PREMISESEaoccurrence
MED EXP(Any oneperson) $
10,000
PERSONAL&ADV INJURY 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000,060
POLICY FX JECOT X LOC PRODUCTS-COMP/OP AGG 21000,000
OTHER:
A AUTOMOBILE LIABILITY COMBINEeD SINGLE LIMIT 1,000,000
X ANY AUTO CAA5173205-14 11/01/2018 11/01/2019 BODILY INJURY Per person)
OWNED SCHEDULED
AUTOS ONLY AUTOS BODILY INJURY
ent
Per accident $
X HIRED X NON-AWNED PROPERTY AMAGE
AUTOS ONLY AUTOS ONLY Per acddI
A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 101000,000
EXCESS LIAB CLAIMS-MADE CUA5173207-14 11/01/2018 11/01/2019 AGGREGATE 10,000,000
DED I X J RETENTION$ 0
A WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY
X i SATUTE ER
ANY PROPRIETOR/PARTNER/EXECUTIVE
Y/N CAS173208-14 11/01/2018 11/01/2019
E.L.EACH ACCIDENT 1,000,000
FFICER/MEMg EXCLUDED?N N/A
IAandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
It
S
describe under 1,000,000DESCRIPTIONOFOPERATIONSbelowE.L.DISEASE-POLICY LIMIT
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space Is required)
Workers Compensation: 3A States-NH,MA,ME,VT,CT.
For Informational Purposes Only.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
For Informational Purposes Only
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
tP y ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25(2016/03) 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of theUT*Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Halstead Salem Station- Building#1 Date: February 13,2019
Property Address: 72 Flint Street,Salem, MA
Project: Check(x) one or both as applicable: X New construction Existing Construction
Project description: New construction of a mixed-use project. All residential units will be rentals,not
condominiums. Building #1 will have 80 apartments with wood frame construction over one story of at-grade
podium parking.
I, Daniel M. Skolski, MA Registration Number: 20038 Expiration date: 8-31-19, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concenungi:
X Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.) together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a 'Final Constru
A
Document'.
Enter in the space to the right a"wet" or
c
F
electronic signature and seal:
Phone number:978-965-3470 Email: dskolski@dmsdesign.com s
Building Official Use Only Fqt tHOFM
Building Official Name:Permit No.:Date:
Note 1.Indicate with an'x' project design plans,computations and specifications that you prepared or directl} supervised. If'other'is
chosen,provide a description.
Version 01 01 2018
i
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for zvork per the ninth edition of the
SV
Y
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Halstead Salem Station-Building#1 Date: February 13,2019PropertyAddress: 72 Flint Street,Salem, MA
Project: Check(x) one or both as applicable: X New construction Existing Construction
Project description: New construction of a mixed-use project. All residential units will be rentals,not
condominiums. Building#1 will have 80 apartments with wood frame construction over one story of at-grade
podium parking.
I, George Dubin, MA Registration Number: 29370 Expiration date: 06/30/2020, 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 1.7,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
electronic signature and seal:
GD Consulting Engineers,Inc
40 Willard Street,Quincy,Ma 02169
Phone number:671-376-8877 Email:dubinengrs@verizon.net o r
p Q. S 70 1.F
Building Official Use Only
Building Official Name:Permit No.:Date:
SSiaNAL cyv
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
Initial Construction Control Document
FTo be submitted with the building permit application by a
ii s+
lyd Registered Design Professional
u for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Halstead Salem Station-Building#1 Date: February 13,2019
Property Address: 72 Flint Street,Salem,MA
Project: Check(x) one or both as applicable:X New construction Existing Construction
Project description: New construction of a mixed-use project.All residential units will be rentals,not
condominiums. Building#1 will have 80 apartments with wood frame construction over one story of at-grade
podium parking.
I, Rimantas M. Veitas, MA Registration Number: 34028 Expiration date: 06/30/2020, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
Architectural X Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a'Final Constructi ntrol Document'.
Enter in the space to the right a"wet" or A of A(
electronic signature and seal:
2
P
RPAANTAS
s'
0
VEITAS Gm
STRUCTURAL
Phone number:781-843-2863 Email:rimas@veitas.com
37028
p 'WIST a
Building Official Use Only s
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 01 01 2018
Initial Construction Control Document
To be submitted v,:fth the building permit application I a
I application )v
Registered Design Professiorial
fo I 71101*-pet,the ninth edition of the
17ssiichnsettsStt-ite B11,jitli,q, Code, 780 CAM, Section 107
Project Title: Halstead Salem Station- Building#1 Date: I ebrutjry 13 20i9PropertyAddress: 72 Flint Street., Salem, INLA
I
Project: Check(x) one or both as applicable: X New construction Existing Construct-ion
Project description: JNe%N, construction of a n1jxed-u-se project. All residential u, its will t e r--jtjjls
condorniniums. Buil&n, g,l k.,1 t
11 I , , not
leave arar mems wiOn wood fran-ie COnStFUCtiOn over one story of zit-grade,
P0diLLM P&I-kin
I, James P. Stroke, .1JA Registration Nui-nber: 20068 Expiretion date: 0630 1'2020, ain a registered design
PI'OfessiOollll, and f have prepared or ciLroctly supervised the pr epal-atic'n cif gall design VIaflS, COML)LItat'10115 andspecificationsconcc-rninc,-
Architectural Structural Mechanical
Fire Protection X Electrical X Other: Fire Alarm
for the above named project and that to the best of myZD ' i'IfOTMtIdMl, F11(i hehof such phms,
mncoputatios and spc-cjficalltlos meet ffie. applicable provisioni; of the i1vIassaChUSettS,5tdte F)1,1iJd-'ng CO3,JC,,, (7,S
CMR), and accepted engineering practices for the PJ-0f)()SCjJ PT(Iject. I lulders'and and agree that I "or 111v
designee} shall perform the necessary prclressionalservices aril be present on the constr on sits on a regular
and periodic basis to:
L Review, for conformance to this ccs,Ee and the d0kgll COT-Wept, shop drativirlgS, sa-tlJpIeS and other
submittals by the contractor in accordance with the requir-2rnents of the constructioi) documents,
Perform the duties for registered des ig!n professionals in /80 C N-1 R Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction 1(,)bccun)e generally familiar with the
progress and quality of the-,vork and todeh-.,rmi ie if the work is t)e.jjjg performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsit)rlit-,7
regarding IIIE? pj-0cjSi01-1.S Of 78C)1U7.7.
When required bar the building,official,. I oail submit field;'progress reports (see item 3.) together ,vith pertinent
coi-ninents, in a Form acceptable to the building., oFficial.
Upon completion of the work, I slid1l SLI11111it to the Mlildfrla offlC al a `Final Construction Control Dokjlnient'.
Enter in the spacc,to the right a"wet" or
electronic signature and seal:
CD Coii5ultmf En linccrs, lii,
1.
Si)WflLir,d5tre-e,L,S T 0,4
46
Phone number:67"1-376-8877 Fmail: PFCa
Building Qffkii'?!Use only E10NA1
Building Official Name.Pennit No.:
T
Date;
Note 1. 1 ndi,I-Ae ivii I i an'-,' rroj,-c! d(-Jol I pl«11.s, ctonnrut.fxmt-and c;pocificatixv-7 thea pley'urcd
clio,:cn,provide a
LN Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Halstead Salem Station-Building#1 Date: February 13,2019
Property Address: 72 Flint Street,Salem, MA
Project: Check(x) one or both as applicable: X New construction Existing Construction
Project description: New construction of a mixed-use project. All residential units will be rentals,not
condominiums. Building#1 will have 80 apartments with wood frame construction over one story of at-grade
podium parking.
I, George Dubin, MA Registration Number: 29370 Expiration date:06/30/2020, 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 Document'.
Enter in the space to the right a"wet" or
electronic signature and seal:
GD Consulting Engineers, Inc.
40 Willard Street,Quincy,Ma02169
Phone number.617-376-8877 Email:dubinengrs@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.
Initial Construction Control Document
u To be submitted with the building permit application by a
r '
Registered Design Professional
s` for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Halstead Salem Station-Building#1 Date: February 13 2019
Property Address: 72 Flint Street,Salem, MA
Project: Check(x) one or both as applicable: X New construction Existing Construction
Project description: New construction of a mixed-use project. All residential units will be rentals,not
condominiums. Building#1 will have 80 apartments with wood frame construction over one story of at-grade
podium parking.
I, George Dubin, MA Registration Number: 29370 Expiration date:06/30/2020, 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
electronic signature and seal:
GD Consulting Engineers,Inc.
40 Willard Street,Quincy,Ma 02169 c
Phone number:617-376-8877 Email:dubinengrs®verizon.net rr
Building Official use Only
Building Oficial Name:Pennit No.:Date: At-
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