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0072 FLINT STREET, HALSTEAD SALEM STAT. BLDG 2 S1 , 313 . (P Ll L1e- 12-0 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: t SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 72 Flint Street Salem MA 01970 (Map#26 Lot#0091) Halstead Salem Station -Building 2 No.and Street City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here®or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ 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 W No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No M Brief Description of Proposed Work: -Foundation to 1st elevated slab construction of 42-unit apartment building(BLDG2). 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.) 14,066 SF 11 F SECTIONS: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 ❑ H4❑ H-5❑ I: Institutional I-1❑ I-2❑ I-3❑ I4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑ S: Storage S-1❑ S-2 O U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA IB ® IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 1 VA VB ❑ - SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: A trench will not be Licensed Disposal�Sfte IN Public M Check if outside Flood Zone❑ Indicate municipal® r required Private 11 or indentify Zone: AE or on site system❑ or trench or specify: _ permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable IN Is Structure within airport appipach area? Is their review completed? or Consent to Build enclosed❑ Yes❑ or No® Yes❑ No IN SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY 105 Person Edition of Code: 9th_Use Group(s): S-2 Type of Construction: 1 b Occupant Load per Floor: Does the building contain an Sprinkler System?: :YeL Special Stipulations: NOne SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Pro erty Owner DSF Salem Flint LLU 950 Winter St., Suite 4300 Waltham MA 02451 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Thomas W. Mazza, Managing Member- 781-250-5940 - 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) Of building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Daniel M. Skolski 978 965 3470 dskolski@dmsdesign.co 20038 Wt Mmings Center, Suite glRphone N [3everly e_mailaddress 01915 �C i ec Numbt8/31/2019 Street Address 3Cii[ty/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�pplicable 5 Tech Circle Amherst, NH 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 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® No ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor Total Construction Cost(from Item 6):$670,331.00 and Materials) 1.Building $ 670,331.00 Building Permit Fee=Total Construction Cost x$11 (Insert here 2.Electrical $ appropriate municipal factor)=$_7,373.64 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 670,331.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By enterin ow name be I hereby attest under the pains and penalties of perjury that all of the information contained in this app lica ' true and cc rate to the best of my knowledge and understanding. X Thomas W. Mazza Managing Member 781 250 5940 X Ple se print and sign ame Title Telephone No. Date 9 0 Winter St 4300 Waltham MA 02421 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: L1-17-I7' or 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 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 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 Discipline Expiration Date Street Address City/Town State Zip Rimantis M.Veitas 781 535 5816 rimas@veitas.com 34028 Registration Number Name(Registrant) Telephone No. e-mail address Structural Engineer 06/30/2020 69 Granite Street,Suite 101 Braintree MA 02184 Discipline Expiration Date Street Address Ci /Town State Zi 29370 George Dubin 617 376 8877 dubinengrs@verizon.net Registration Number Name(Registrant) Telephone No. e-mail address Sanitary Eng 06/30/2020 40 Willard Street,Suite 302 Quincy MA 02169 Discipline Expiration Date Street Address Ci /Town State Zi 20068 06/30/2020 James P Stroke Electrical Eng 40 Willard Street,Suite 302 Quincy MA 02169 CITY OF S.UEM. XLXSSACHUSETTS BUILDIING DEPARTMENT 130 WASHINGTON STREET,3"FLOOR TEL (978) 745-9595 FAX(978)740-9846 K1,NfBER.LEY DRISC01 L MAYOR THObtAB ST.P[Em DIRECTOR OF PUBLIC PROPERTY/BI:ILDLNG CO3-511SSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant InformationPlease Print Lenib[x Name(Busitx>ssiOrganizationilndividual): 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): 1.0 1 am a employer with -'J 4. ❑ I am a general contractor and 1 6. Q New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.: 7• ❑Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for me in any capacity. workers'comp.insurance. 9, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑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' 13.Q Other comp.insurance required.] •Any applivint that checks box#1 must also till out the section below showing their workers'compensation policy information. t 1 tomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new 2f idavit indicating such. =Contractors that check this box must attached an aklditional sheet showing the name of the stye-contractors and their workers`Comp,policy information. I am an employer that is providing workers'compensation Insurance for my employees. Below Is the policy and job site information. Insurance Company Name: Acadia Insurance Company Policy#or Self-ins.Lic.#: WCA5173208-14 Expiration 11/1/2019 Job Sire Address.. Assessors Map 26 Lot 91,95&97 -City/State/Zip: Salem, Ma Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations orthe DIA for insurance coverage verification. I do hereby certify under the pains and penaldes of perjury that the information provided above Is true and correct denature: Date. 2/11/2019 Phone#: 603/673-3200 EXT 214 OJrcial use only. Do not write in this area;to be completed by city or town ojrciaL City or Town: _ Permit/License# Issuing Authority(circle one): 1.Board of Ilealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other ..__ Contact Person: �_____ _ Phone#• FULCASS-01 KPETTIT '4�o�2vY CERTIFICATE OF LIABILITY INSURANCE DATE 10/24/2 01 8 1 7 0/24/2018 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 andorsement(s). PRODUCER NAMTACT Kathy M.Pettit Davis&Towle Morrill&Everett,Inc. PHONE FAX 115 Airport Road ac,No,Et):(603)715-9739 1(ANC,No):(603)225-7935 Concord,NH 03301 E-AAIL .kpettit@davistowie.com INSURER(S)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 POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTRMMID A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE FX OCCUR CPAS173204-14 11/01/2018 11/01/2019 DAMAGE TO RENTED 300,000 PREMISES Ea occurrence $ MED EXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2'000,000 POLICY 1X PR T FX LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: E A AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ X ANY AUTO CAA5173205-14 11/01/2018 11/01/2019 BODILY INJURY Perperson) OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident X HIRED X NON-OWNED (P OPERZt AMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE 10,000,000 EXCESS LIAB CLAIMS-MADE CUA5173207-14 11/01/2018 11/01/2019 AGGREGATE $ 10,000'000 DED I X I RETENTION$ 0 A WORKERS COMPENSATIONX I PER OTH- AND EMPLOYERS'LIABILITY STAT 1UTE J IER CA5173208-14 11/01/2018 11/01/2019 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT �FFICER/MEMBW�EXCLUDED? N/A 1,000,000 IAandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached N 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 rP 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 perit application by a m 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#2 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 #2 will have 42 apartments plus approximately 5,000 SF of commercial space-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 concerning': X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a'Final Constructi ocument'. Enter in the space to the right a "wet" or ^apt electronic signature and seal: ; , Phone number:978-965-3470 Email:dskolski4ldmsdesign.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 01 01 2018 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional w for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station-Building#2 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 #2 will have 42 apartments plus approximately 5,000 SF of commercial space-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 1 (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. �y 40 Willard Street,Quincy,Ma 02169 E Phone number:617-376-8877 Email:dubinengrs@verizon.net =� , Building Official Use Only -,Z 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 !4' v I To be submitted with the building permit application by a 1 t, /� Registered Design Professional au / for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station-Building#2 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 #2 will have 42 apartments plus approximately 5,000 SF of commercial space-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 Construction Control Document'. Enter in the space to the right a"wet" or of Ar electronic signature and seal: RMANTAS Ssq�y VEaas m STRUCTURAL U028 co Phone number:781-843-2863 Email:rimas@veitas.com Building Official Use Only o 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 �r\ Initial Const-ruction Control Document To he subinitted �.vith the buildincr permit appUcation by a ? Registered Design Professional -ork-per the ithith edition of the r"z1 for it y. A-lassitchusetts Slate Building Code, /80 CAIR, Section 70' Project Title: Halstead Salem Station- Building#21 Date: 1ehruary 14, 2019 Property Address: 72 Flint Street, Salem, �,MA Project-, Check(x) one or both as applicable: X New construction Existing Construction Project description: Ne,��, construction of a mixed-LISC prop—L, All residential units will be rentals, not, conclon-Liniun-is. Building 42 will have 42 apartments PIUS appl-4- .)ximateiv 5,000 SF of conimercial space--,-,-'ood de poduirn parkin- frame construction over one storN'of M-9a 4�1 1, Jalpes P. Stroke, MA Registration N-L.in-flber: 2"M68, 12.xpiration date: 0<>j30,'200<>j30,'2070,� ,'2020. yarn a registeredtlesion ' L professional, and I have prepared or directl,, supervised the preparation ofalldesign plans, Colnputations and . ificc pec -itions concerning': Architecturai Structural Mechanical Fire Protection X Electrical X Other: Fire Alarm for the above named project and that to the best of rnly knowlp&g(-', informattun, and belief SUCI-1 P1,111., the McISSilCbUSC.ttS State SUhdiM' Code, "80 coljlpLjt�jtjons ejid specifications moot the opplicaHle Provisions of 0 1 2 Z-1 0- 111y ;' r t1,10 prl-posej prc)iect. I undlerstand and de re- that I CIMT--�), and accepted engineering practices -iall pe.rform theriecessary nrofessinna! 5ervi;le.-� and' tie. present on the constru�'-tion site on a regulat Jesignee) sl alld periodic basis to: I Review, for conformance to this cc)de and the design conceF,t, shop dravvill" , samples and other submittals b%, the contractor in accordance with the requirements of the construction documents. 2. Perform th0 ClLltiEs for registered desig)i r.rofossicgals i-c, 780 C\.,[R Chapter 17, as applic bil. Be present at intervals appropriate to th(-' stage of construction to becorne generallv fill-niliar 0.,ith the progress and clijality of the work and to cletern-iine if tl-i,-'v"Ork is being perfon-ned in a manner consistent XAJith the approved ConStrjlCti011 docilMerlts and this cods. 1-1c, p-,yj, re.Oardir g t _-,i o 11, 1 - 1\ 1'eJ10v0s thy. c0)lt-r,'CtC1r Of it rO'-r f CM" '107. progress reports (see item 3.) together vvith pertinont When required by the building Official, I shall submit field ' 111) 0 2:7 comments,in a form acceptabte to the bUlldiFIDD official. Upon completion of the 4',orlk, I shill, sulornit to the blLijlcfiing, official a'Final Construction Control Document'. Enter in the space to the right a "%,vet' of electronic signature and seal: 17 V11 I GD Consult ii ,.,s S I P Q KE "A t' .J�j -11, 40 Wfllard.SLroet,Qairl' _884. 7 ,7 Phone number.617-37 Email: dub nom's verizon.nel 2, PJA Builcling Offil-ird LIS1- C)II11.1 7 "1 i 4,41 [Building Official Name. 1'emlit No.: Date: li 'otllor' is Note 1. Indicalt,V-zith all t provide a de4criv'601-1- Initial Construction Control Document 14 = To be submitted with the building permit application by a ' d Registered Design Professional h for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station-Building#2 Date: February 13,2019 Property Address: 72 Flint Street,Salem, M A 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 #2 will have 42 apartments plus approximately 5,000 SF of commercial space-wood frame construction over one story of at-grade podium parking 1, 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. f7gyr�� 40 Willard Street, 02169 �'✓ Quincy,Ma Phone number:617-376-8877 Email:dubinengrs@verizon.net r i k', Building Official llse Only Building Official Name: Permit No.: Date: Note 1. Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised. If'otherr is chosen,provide a description. Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional 4 �t for work per the ninth edition of the Y'v Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station-Building#2 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 #2 will have 42 apartments plus approximately 5,000 SF of commercial space-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 continents,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 Willard Street,Quincy,Ma 02169 Phone number:617-376-8877 Email:dubinengrs@verizon.net Building Official Use Only i^ � 1 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.