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67-71 FLINT STREET, HALSTEAD SALEM STATION, BLDG 3 X2.5; L4Vcj . (-I ctctt -� The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a 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) 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 r Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: 4� Are building Plans and/or construction documents being suPP lied as part of this permit application? Yes PC No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No M Brief Description of Proposed Work: -9 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.) 2 story pprox. 6,607 Total Area(sq.ft.)and Total Height(ft.) 13,294 SF 15'.3" SECTIONS:USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 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 O R-3❑ R4❑ S: Storage S-1 13S-2❑ 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 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Debris Removal: it Perm : Water Supply: Flood Zone Information: Sewage Disposal: TrenchLicensed Disposal Site C$1 Public M Check if outside Flood Zone❑ Indicate municipal® A trench will not be P Private❑ or indentify Zone: AE or on site system❑ required❑x or trench or specify: permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process. Not Applicable It Is Structure within airport appigach 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): R-2 Type of Construction: bb Occupant Load per Floor: Does the building contain an Sprinkler System?: Yes Special Stipulations: None SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Pro erty Owner DSF Salem Flint LLG� 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 - tmazzaadsfadvisors.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❑and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Daniel M. Skolski 978 965 3470 dskolski@dmsdesign.com 20038 ` uW,miriA Center, Suite �glRohone NoBeverly e-maij,ac),dress 01915 ��'Reucf Numb t8/31/2019 Street Address 3CiiCty/Town M/S�tate 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 ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$_2,317,242.42 1.Building $ 1,764,882.42 $11 Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ 170,000.00 appropriate municipal factor)_$ 25,489.67 3.Plumbing $ 175,000.00 4.Mechanical (HVAC) $ 207,360.00 Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check payable to 6.Total Cost $ 2,317,242.42 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By enterin my namInAme low,I hereby attest under the pains and penalties of perjury that all of the information contained in this applica ' n tru anccurate to the best of my knowledge and understanding. X Thomas W. Mazza Managing Member 781 250 5940 X Please print and sign Title Telephone No. Date 95(l WintP.r Vit. Suite 4300 Waltham MA 02421 Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: ~f 7 Name779�__ 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 1 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 1 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 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 Engineer06/30/2020 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 James P Stroke 20068 06/30/2020 40 Willard Street,Suite 302 Quincy MA 02169 Electrical Eng CITY OF S.,UM, TNLkss.,kCHUSETTS idol) BUHMMIG DEPARTMENT 130 WASHINGTON STREET,3"n FLOOR TEL. (978)745-9595 FAx(978)740-9846 KIMBER. EY DR.ISCOLL MAYOR THOMAS ST.PIERRS DIRECTOR OF PUBLIC PROPERTY/BUMDLNG COS NIMICINER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busine Organization/lndividual): Fulcrum Associates Inc Address: 5 Tech Circle City/State/Zip: Amherst, NH 03031 Phone 1#: 603/673-3200 EXT 214 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with -'J4. El am a general contractor and 1 employees(full and/or part-time).• have hired the sub-contractors 6 New construction 2.❑ 1 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• Q Building addition [No workers'comp.insurance S. ❑ 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 I.l.❑Plumbing repairs or additions myself.[No workers'comp. C. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees.(I`'p workers' 13.❑ comp.insurance required.] Other, •Any applicant that checks box ell must also fill out the section below showing their worken'compensation policy information. 'l lnmeowners who submit this affidavit indicating they are doing all worts and then him onside contractors must submit a new affidavit indicating suck =Cuntm tors that c9teck this baa moat attached an additional sheet showing the name of the oath►contractors and their worker•romp,policy information. !am an employer that is providing►vorkers'compensation Insurance for my employees, Below Is the policy and job site information, Insurance Company dame: Acadia Insurance Company Policy#or Self-ins.Lic.M WCA5173208-14 11/1/2019 Expiration Date: 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 or the DIA for insurance coverage verification. !do hereby rertyfy under the pains and penalties of perjury that the information provided above Is true and correct i 1n,t ire: Date 2/11/2019 Phone 11 603/673-3200 EXT 214 OJjcist use only. Do not write in this area,to be completed by city or town aIciaL City orTown: __ PermittLicense# 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 CERTIFICATE OF LIABILITY INSURANCE DATE F10/24/20118 / Y) 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(ies)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 Road (A/C,No,Ext):(603)715-9739 AIC,No):(603)225-7935 Concord,NH 03301 EDDAIE 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-WkPOLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY EACH CH OCCURRENCE CLAIMS-MADE [X]OCCUR CPAS173204-14 11/01/2018 11/01/2019 PREDAMAGEMISES Ea TO RENTEDoccurre $ 300,000 nce MED FRCP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY 1 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000'000 POLICY j�T LOC PRODUCTS-COMP/OP AGG 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED 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 AUTOS ONLY X AUTOS ONLYY PPerr ardent AGE A X UMBRELLA LIABX OCCUR EACH OCCURRENCE 10'000'000 EXCESS LIAR CLAIMS-MADE CUA5173207-14 11/01/2018 11/01/2019 AGGREGATE $ 10'000'000 DED I X I RETENTION$ 0 A WORKERS COMPENSATION X PER OTH. AND EMPLOYERS'LIABILITY STATl1TE_. ER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN WCA5173208-74 11/01/2018 11/01/2019 E.L.EACH ACCIDENT 1000'000 FFICERMI M EXCLUDED? N/A 1 E.L.DISEASE-EA EMPLOYE $ 000,000 (as andatory n ) r 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 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 TION DATE For Informational Purposes Only ACCO DANRCE WITH THE POLICY PROVISIONS.NOTICE WILL BE DELIVERED IN 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 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. 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 ment'. Enter in the space to the right a "wet" orRF-D^Pf�, electronic signature and seal: 4Q y Phone number:978-965-3-170 Email:dskolski@dmsdesign.com o ° Building Official Use Only ° a� 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 010 1 2018 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 1 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,hlc. 40 Willard Street.Quincy,Ma 02169 Phone number:617-376-8877 Email:dubinengrs@verizon.net Building Official Use Only � Builduig 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 ' i I 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: �Pti�" �Ass1 RPAANTAS °y VEITAS m STRUCTURAL .34028 v~, Phone number:781-843-2863 Email:rimas@veitas.com GIsTE Building Official Use Only s ON 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 Pet"nit application by a Registered Design Professional for work-per the Witth editimi of the Milssachusetts State Building Code, 780 CMR, Section 107 Project Title: Halstead Salem Station - Building 43 Date: February 13, 2019 Property Address: 67& 71 Flint Street,sajorn, NI; Project: Check(x) one or both as applicable: X New construction Existing Construction Project description. \leiv ccnistructioll of a n-lixed-use project. 'MJ 1-eSidellti8l knits will be rentals, nut col"dorniniurns, BUildil-10'#3 will have 8 tOW"houses with wood franle construction. el I 1, Tallies P. Stroke, 'MA Registration Number: 20065 Fxpiration date: 0(y"30/2020, air; a registereddesigll ,i� professiollid, and I have prepared or directiv supe of supervised tile preparation ti all design plans, ccfnputations and S;)ecifications concerning< Architectural Structural Mechanical Fire Protection X Electrical X Other: Fire Alarm for the above named project and that to the best of my tulowie-cip, information, and belief such plans, cornputations and specifications 0-100t tile applicable provisions of the Ma.tisc0lusetts State Building Code, (780 C-MR), and accepted engnineoring practices for the proposed project. I Understand and agree that I (or my z:1 - designee) shall perform the nece5sary professional services and be present on the constructi 0 site oil a regular 0 f - Oil S or and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, sdinples and other submittals by the, contractor in accordance -,vith the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CVIR C.-h apter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar 1,vitil t1l. e progress and quality of the work and to determine if thev-ork is being performed in amanner consistent vvith the, approved coils truc ti,-),) document,-; and this code. Nothinc,in this docum��nt relieves the contractor of its responsibilit,,, regarding the provisions of 780 C-NIR '10/71 ��> I .. 0 Whell 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 bLulding official a'Final Construction Control Document'. Enter in the space to the right a "vvet" or electronic signature and seal.- GD Consulting JAW S P. ' ,EnginRers,; STP 401vy is Villard Street,Qilul�V,Nl�'.021(19 Phone number:617-376_8877 Email: d u binen arsJgverizon.net Building Official Ilse 011/ySION t Iry Building Official Name: Permit Na.: Date: Note 1. 1 iiLfik:ato wi 0i an proj(,ct design pians, coin r utia ticins a n ci sppe,fwai ioj,s that you Tlrepar„'d or d ir(:,t]v xi nervi N,0- ti Initial Construction Control Document a To be submitted with the building permit application by a ' Registered Design Professional for work per the ninth edition of the Vo J9 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 02169 4 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 v 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, 1 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. ti 40 Willard Street,Quincy,Ma 02169 Phone number:617-376-8877 Email:dubinengrsQverizon.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