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0067-0071 FLINT STREET, HALSTEAD SALEM STAT. BLDG 3 :s I , ot SC' .�c-r--i� 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) 1 1 Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address is not available) 67-71 Flint Street Salem MA 01970 (Map#26 Lot#95,97) Halstead Salem Station -Building 3 No.and Street City/Town Zip Code Name of Building(if applicable) f t SECTION 2:PROPOSED WORK Edition of MA State Code used--9b If New Construction check here®or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration 13Addition 13Demolition ❑ (Please fill out and submit Appendix 1) Change of Use 13 Change of Occupancy ❑ 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 of 8-unit townhouse building(BLDG3). 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.) 3,476 C SF 10'.5" 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 I-1❑ I-2❑ 1-3❑ 1-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3 a 'R-4❑ S: Storage S-1❑ S-2 l] U: Utility❑ Special Use❑and please describe below,-__- Special elow;Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB ® IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ VA ❑ VB..Q SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Permit: Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site MPublic M Check if outside Flood Zone❑ Indicate municipal® A trench will not be P required©or trench or specify: Private❑ or indentify Zone: AE or on site system 1:1 required is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable It Is Structure within airport apprpach 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: Does the building contain an Sprinkler System?: Yes Special Stipulations: None SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner DSF Salem Flint LLC 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) a-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 ermit 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 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Daniel M. Skolski 978 965 3470 clskolski@cIrrisclesign.com 20038 wt W,.1 Center, Suite 13'�'c one N°Beverly e-maij,�cjdress 01915 �c ifed?Numb t8/31/2019 Street Address City/Town -" dress 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, 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 .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 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 178,000.00 1.Building $ 178,000.00 $11 Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)=$_1,958.00 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 178,000.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name el ,I hereby attest under the pains and penalties of perjury that all of the information contained in this applicatio i true and a urate to the best of my knowledge and understanding. X Thomas W. Mazza Managing Member 781 250 5940 X2 J-Mll Please print and sign name Title Telephone No. Date 950 Winter St. Shite 4300 Waltham --Mk 02421 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: 1�l7 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 Incom Tete 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/Investiation 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 S ec' *Areas of Design or Construction for which plansare 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 Cummins 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 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 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 ScUEMI itiY.3SSACHUSETTS • BUILDG`G DEPARI-M&iT ` 130 WASHINGTON STREET,3'°FLOOR TEL (978)745-9595 FAX(978)744.9846 KEMB R i EY DKMOLL MAYORTHoNtAs ST.PIERRS DIRECTOR OF PUBLIC PROPERTY/BUIMLNG CONmasSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lealblx Name(Busirxss:Organizatiorvindividuai): Fulcrum Associates Inc Address: 5 Tech Circle City/State/Zip: Amherst, NH 03031 Phone 9: 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. ❑ 1 am a general contractor and 1 6. []x 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.: ? E]Remodeling ship and have no employees These sub-contractors have S. ❑Demolition workingfor me in an capacity. workers'comp.insurance. Y P rY• 9. E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL ILEI.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp.insurance required.] •Any applicant that checks box M I must also fill out the section below showing their workers'compensation policy information. I Inreownem who submit this affidavit indicating they ate doing all work and then hire outside contrrctots must submit a new affidavit indicating such. :Cuntracton that check this box must attached an additional sherk showing the name of the sub-couttactons and their wotkeo'comp,policy inranmation. I am an employer that Is providing workers'compensation Insurance for my employeex Eetow Is the policy and fob site information. Acadia Insurance Company Insurance Company Mame: Policy#or Self-ins.Lic.#: WCA5173208-14 Expiration Date: 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 51,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 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 and penalties of perjury that the information provided above is true and correet Signature: Date: 2/11/2019 Phone#: 603/673-3200 EXT 214 Official use only. Do not write in this area,to be cumpleted by city or town ojficiat 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#: FULCASS-01 KPETTIT ,4COROQ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �/ 10/24/2018 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 endorsement(s). PRODUCER CONTACT Kathy M.Pettit NAME: Davis&Towle Morrill&Everett,Inc. P"CN;,Et), ) (A/(603 715-9739 JF 115 Airport Road c,No:(603)225-7935 Concord,NH 03301 EDORIE :kpeftit@davistowle.com INSURERS AFFORDING COVERAGE NAIC S 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 LTRMMIDOfYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE OCCUR CPA5173204-14 11/01/2018 11/01/2019 DAMAGE PREMISES ETO RENTED rence 800��QQ a occur MED EXP(Any oneperson) 10,000 PERSONAL&ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY j�T IFX� LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: COMBINED SINGLE LIMIT 1,000,000 A AUTOMOBILE LIABILITY a 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 Lx NON-OWNED rP OPE dent AMAGE $ AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X 10 OCCUR EACH OCCURRENCE I000,000 EXCESSLIAB CLAIMS-MADE CUA5173207-14 11/01/2018 11/01/2019 AGGREGATE 10,000,000 DED i X I RETENTION Z A WORKERS COMPENSATION X STATUTE _ ER AND EMPLOYERS'LIABILITY WCA5173208-14 11/01/2018 11/01/2019 1,000,000 ANY PROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT �FFICER/MEM13W EXCLUDED? N/A 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE H es,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Informational Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) C 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Initial Construction Control Document IF To be submitted with the building permit application by a 1 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#3 Date: February 13,2019 Property Address: 67&71 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#3 will have 8 townhouses with wood frame construction. 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 Construction C i ment'. RED Aq, Enter in the space to the right a "wet" or electronic signature and seal: c • a• Phone number:978-965-3470 Email:dskolski@dmsdesign.com o o o t, Building Official Use Only �4 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 012018 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#3 Date: February 13,2019 Property Address: 67&71 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#3 will have 8 townhouses with wood frame construction. 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 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. 40 Willard Street,Quincy,Ma 02169 Phone number:617-376-8877 Email:dubinengrs@verizon.net Building official use only KY T 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 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#3 Date: February 13,2019 Property Address: 67&71 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#3 will have 8 townhouses with wood frame construction. 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 electronic signature and seal: ,�."�R � Ss9�y vErrAs m STRUCTURAL + 0.U028 y Phone number:781-843-2863 Email:rimas@veitas.com GISTE Building Official Use Onlys=PIT 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 `pl * To be submitted with the building permit application b - a Registered Design Professional � work-per thettritlt erli�tic��r of the Mitssachusetts Strrtn Builrli;ig Cave, 780 CNIR, Section 107 Project Title: Halstead Salem Station- Building#3 Date: Feb ruary 13, 2019 Property Address: 67& 71 I lint Street,Salem, NIA Project: Check(x) one or both as applicable: X New construction Existing Construction Project description: New construction of a nixed-use project. All residential units swill be rentals, nut cotu7orriiniutns. 13uiidi,hg#3 will helve 8 tov,'nhouses with wood frame construction. 1, James P. Stroke, NIA Registration uniber: 20066 Expiralion date: 06/30/2020, am a registered design profe�ssional, and t have prepared or directly supervised the preparation of ail desigih plans,computations and specifications concerningi: Architectural Structural Mechanical Fire Protection X Electrical X Other. Fire Alarm for the above named project and that to the best of my lalowiedge, information, and belief such pians, computations and specifications meet the applicable provisions of the Xlassachusetts State Building Cocle, (_780 CNIR), and accepted engineering practices for the proposed project. I understand and agree that I (or my esignee) shall perform the ie cessary 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, Sllop drdWingS, Sdmples and Other Submittals by the contractor in accordance with the requirellle.7lts of the COilStr'LlCtLOn doCUMentS. 2. Perform the duties for registered design professionals in 780 CNIR Clapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar rlith Elle progress and quality of the work and to determine if the v,,ork is being performed u7 a mariner consistent with the approved construction documents and this rode. Nothing in this document relieves the contractor of its responsibility regarding the provisions,of 780 C1IMR,,707. 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 w-ori , I shall submit to the budding,official a 'Final Construction Control Document'. Enter in the space to the right a or A•fAA A�tH� Miss electronic signature and seal: JAmE P. GD Consulting Engineers,Inc. STROKE• n;e 0 bljillard Slee .Qtzul�y,TVta.02-1c,9 Phone number:617-376-8877 Email:d u binengrs',Aver izon.net Et(tzirling Official Use C)uly ,,�, Building Official.None: Permit NO.: Date: Note 1. Indicat,l t ilh an 'x' project design glans,c.ontpEttaticros and spt�c i fwal ior,a thi iL you prepare-d c)r djrcti'Lly sunarrvi5nr'3_ fii''rnh�r' r� Initial Construction Control Document µ To be submitted with the building permit application by a Registered Design Professional Jt for u?ork per the ninth edition of the Y° Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station-Building#3 Date: February 13,2019 Property Address: 67&71 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#3 will have 8 townhouses with wood frame construction. 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,lnc. 40 Willard Street,Quincy,Ma 021.69 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 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#3 Date: February 13,2019 Property Address: 67& 71 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#3 will have 8 townhouses with wood frame construction. 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. sv`r 40 Willard Street,Quincy,Ma 02169 � Phone number:617-376-8877 Email:dubinengrs@verizon.net r 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