0 DOVE AVE - BPA-16-976 JACKET a SU LK,- 2-
The
The Commonwealth of massl lse` is `
i Department of Public Safety
Massachusetts State Building Cq%70rUGk3I4 P 4' 0 3
Building Permit Application for any Building other than a One-or Two-Family Dwelling
(Chis 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)
6-25 -Dt>Ja A"'11e CH�t-A
f�fl 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❑ 1 Demolition OK(Please fill out and submit Appendix'1)
Change of Use ❑ I Change of Occupancy ❑ 1 Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes V No O /
Is an Independent Structural Engineering Peer Revi w r quired? Yes ❑ No
Brief Des-riptionof Proposed Work: 4A d2f)
713
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.) I
Total Area (sq. ft.) and Total Fleight(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A=1. ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Factor F-1 ❑ F2❑ I H: High Hazard H=1 ❑ H-2❑ H-3 ❑ H-4❑ H-5 ❑
I: Institutional I-1 ❑ I-2❑ I-3 ❑ I-4❑ M: Mercantile❑ R: Residential R-10 R-2❑ R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑ and please describe below:
Special Use:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 11 113 11 IIA ❑ IIB ❑ IIIA ❑ 111B IV ❑ 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:
Public Er� Check if outside Flood Zone❑ Indicate municipal
A trench will not be Licensed Disposal Site ❑
required O or trench or specifv:
Private❑ or indenfify Zone: or on site system❑ permit is enclosed ❑ ¢t^j
Railroad right-of-way: Hazards to Air Navigation: k1 \ Historic -auniti'siori Nev ier+ r m<<�tis
- Not Applicable to--- Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed ❑ Yes ❑ or No ❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
c�r�tt_ P- U .
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Properly Owner n
�k !1( > lnt5µc 531 ./-411 AW e tq4 0/ 7 70
Name (Print) T o.and Street r� City/Town Zip
Property Owner Contact Informotidm
Z�rrrP G' Sbise.1 t @ Pe tt�e�s, Qf'j
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable, the property owner hereby authorizes
Name Street Address City/Town State Zip
to act on the propeity owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
(If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Name(Registrant) Telephone No. e-mail address Registration Number
Gi tr.'L
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor r
too—
Company Name
C-`3 E>Lp. 1ILl
Name of Person Responsible for Construction License No. and Type if Applicable
3 3 &1.&1 2-j " I `-f e�P 1<--j y dbW- -A219-ZS—
Street Address City/Town JState Zip
-- 6Q2-`J 050& "/s CO
fele phone No. business Tele h ne No. cell e-mail address
SECTION II:1NOIZKTR"'COD,PENSATION INSURANCE AIFEIUAVIT 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
and Materials) Total Construction Cost(from Item 6)_$
I. Building $ Building Permit Fee=Total Construction Cost x (Insert here
2. Electrical $ appropriate municipal factor)_$
3. Plumbing $
T. Adechamcal (l-tVAC) $ Note: Minimum fee $g (contact municipality)
5. Mechanical (Other) $
cl
Enose check payable to
6.Total Cost $ (contact municipality)and write check number here
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below, I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is truce and
acciu e to the best of my knowledge and understanding.
Please print anL ign na Title Telephone No. Date
Street Address City/ own State Zip q/ / /-
Municipal Inspector to fill out this section upon application approval: T�'' ">ti-Y C/�l!�`
Name Date
CITY OF SAL&N1, 'T 1ASSACHUSETTS
BL;u.DNG D1 P:1RTn1ENT
130 WASHINGTON STREET, Yo FLOOR
TEL. (978) 745-9595
FAX(978) 740-9846
KI.%,tB ,F,Y DIUSCOLL THOS ST.PWIM
MAYOR
DIRECTOR OF AC:BLIC PStOPERTYJBL'lI.T)ING CONL1(ISSIONER
Demolition Permit Sign-Off
(Supplement to permit application)
1 . hereby supply the following releases as part of the nn
application for a permit to demolish the structure located at "rT1j r,o (ti1e��'�.,✓
( & _ �_,_, ___ and shown on the Assessor's Maps
of as being on Map # Block # Lot #
The 8`h Edition of the Massachusetts State Building Code, 780 CMR, states in part: "A
permit to demolish or remove a building or stricture shall not be issued until a release is
obtained from the utilities, stating that their respective service connections and appurtenant
equipment, such as meters and regulators, have been removed or sealed and plugged in a safe
1.
manner."
utility to be Notified 4 . Notice Received b Date Received
Gas N 3
Telephone. S !1
1 Electric Gi's vca t n
Public Utilities (Munici al
Health Department_`
Fire Department f-e, e um,e ekJ FS 31
Other-
Other-
Demolition debris hauler: ... .
Location of licensed _
demolition debris landfill: uk) i K4A ,
Signature of Applicant Date: �l
Signature of Owner Date: 2 6
This sheet must by. urned to the Inspections Department along with a completed
application for a permit, a site plan, and any other applicable information and fees,
Demoperm.doc
Y e N H E E
Y P C
PEST CONTROL
24 August 2016
North Shore Medical Center
Attn: Gerson Cornier/ Paul Seeley
81 Highland Ave
Salem, Ma 01970
Subj: Rodent Demolition Certificate ICO Spaulding Building
Salem BOH,
The NSMC receives rodent control service specifically to the Spaulding building three times a
week. In preparation for the demolition of the Spaulding, additional exterior rodent control devices have
been installed.
The weekly service and implementation of IPM principles has been in place for over a year and
will continue for the duration of both the demolition phase and construction phase of the project.This
includes the use of both monitoring bait and active rodenticide in tamper proof rodent control devices
and rodent burrows. All products are registered with the EPA and technicians properly licensed. All
rodent sightings will be recorded in the NSMC pest control log book for action to be taken by the
licensed service technician.
It will certainly be my pleasure to speak with anyone to explain the scope of service on the
NSMC campus. Please let me know if you have any questions.
Pest Wishes,
Galvin Murphy
MA PCO#29296
Yankee Pest Control
781-397-9923
1
" Initial Construction Control Document
To be submitted with the building permit application by a
s Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:8/22/16
Property Address: 81 Highland Ave., Salem, MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BG SF for an emergency department and med/surg inpatient beds; this
includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the Spaulding
North Shore building of 108,966 BGSF for psychiatric inpatient beds.The project also includes a new internal driveway
and a stand-alone fire pump room.
I Mario Vieira MA Registration Number: AR 20524 Expiration date: 8/31/16 , 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 Control Document'.
Enter in the space to the right a"wet"or
electronic signature and seal:
4y w
s MAN �C
Phone number: 857-383-1700 Email: mvieira@shepleybulfinc .corn �f4reof ►ss�ca
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 0611 2013
Initial Construction Control Document
I UT*
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC—Campus Consolidation—Emergency Department Date: August 17, 2016
Property Address: 81 Highland Avenue, Salem, Massachusetts 01970
Project: Check one or both as applicable: El New Construction ❑ Existing Construction
Project Description: New construction of 112,701 BGSF for an emergency department and med./surg. inpatient beds: this
includes a new, vertical circulation core connecting the new building to the existing hospital. Renovation of the Spaulding
North Shore Building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new, internal driveway,
and a stand-alone fire pump room.
I, Adam C, McCarthy, P.E., MA Registration Number: 40730 Expiration Date: 06/30/2018, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning I:
Architectural El Structural Mechanical
Fire Protection Electrical Other: Describe
for the above named project and that to the best of my knowledge, information, and belief such plans, computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or ��SHOFpu,_
electronic signature and seal: w
No.aorto N
Phone Number: (617) 737-0040 Email: McCarthygMcSal.com
gsst �
14018.008-North Shore Medical Center-Salem,MA-Campus Consolidation-Emergency Department-Initial Constructio
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an `x' project design plans, computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway,and a stand-alone fire pump room.
I,John W.Nelson,MA Registration Number: 39839 Expiration date: 06/30/2018,am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans, computations and specifications concerning':
_Architectural Structural _X_ Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form
acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Docume '
� q
Enter in the space to the right a"we["or y�pL.ZH OF MASSc
electronic signature and seal: ��� JOHN W yGN
g NELSON
o MECHANICAL
No. 39839
9�F 9 G/
/ONAL E�
Phone number: (508)647-9200
Email:jnelson@engsolutions.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8'h edition of the
UTb
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/sung inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds.The project also includes a new
internal driveway, and a stand-alone fire pump room.
I,John T. Sacharewitz,MA Registration Number: 50246 Expiration date: 06/30/2018,am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
_Architectural Structural Mechanical
Fire Protection X Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on
the construction site on aregular and periodic basis to:
1. Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form
acceptable to the building official.
Upon completion of the work, 1 shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or
electronic signature and seal: ��SN OF'�SS9
o JOHN i. cyc
oSACHAREWIR mr
ELECTRICAL H
No.50246
q99FoEP``v
Phone number: (508)647-9200 0 tsr
�`SS/ONAL ENG\
Email:jsacharewitz@engsolutions.com
Building Official Use Only
Building Official Name: Permit No.: Date:
-Note 1.Indicate with an `x' project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
. '' Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x) one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I, Stephen A.Coduri,MA Registration Number: 49910 Expiration date: 06/30/2018,am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning[:
Architectural Structural Mechanical
Fire Protection _Electrical _X_ Other:Plumbing
for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form
acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or ,sySH OF yyss
electronic signature and seal: `ads" Spy
STEPHENA. Gm`1
o CODURI
MECHANICAL
-0 9 No.49910 0 2
Phone number: (508)647-9200 FcSSt Ev�
Email: scoduri@engsolutions.com �-
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised. If'other'is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8`h edition of the
01 7 Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x) one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I,Stephen A.Coduri,MA Registration Number: 49910 Expiration date: 06/30/2018,am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
Architectural Structural Mechanical
X Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.) together with pertinent comments,in a form
acceptable to the building official.
Upon completion of the work, I shall submit to the building official a`Final Construction Control Document'.
Enter in the space to the right a"wet"or
electronic signature and seal:
E�'ViFt OF�t'�uS, \ter.
MSECHANOCAL
q P Na 49911,0/,�
is
Phone number: (508) 647-9200 F� G
0,�, � 1 s
Email: scoduri@engsolutions.com ✓_ < ^
Building Official Use Only
Building Official Name: Permit No.: Date:
Note I. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen,
provide a description.
Version 061 t2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:August 19, 2016
Property Address: 81 Highland Ave Salem MA 01970
Project: Check(x) one or both as applicable: New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/sure inpatient beds;this includes anew vertical
circulation core connectiniz the new building to the existing hospital Renovation of the Spaulding North Shore building of 108.966 BGSF for
psychiatric inpatient beds The project also includes a new internal driveway,and a stand-alone fire pump room.
I Jeffrey D Cyr, R.C.D.D. MA Registered Number: 181735R Expiration date: 12/31/2018, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning:
Architectural Structural Mechanical
Fire Protection Electrical X Other: Telecommunications
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. 1 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.
,,Op,TIONS D/
Upon completion of the work, I shall submit to the building official a `Final Coro ction UL d %Pcument'.
Enter in the space to the right a"wet"or o ®cs® '0
electronic signature and seal: ¢ v
Lu JEFFREY D CYR cc JEFFREY
b REG. ND. 181735R
b EXPIRES 12-31-18 a�
Phone number: 617-254-0016 Email: JCyr@brplusa.coCDD �I��, 6
m
Building Official Use Only l
Building Official Name: Permit No.: Date:
Note I.Indicate with an `x' project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
x b Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:8/22/16
Property Address: 81 Highland Ave., Salem, MA 01970
Project: Check(x) one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds; this
includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the Spaulding
North Shore building of 108,966 BGSF for psychiatric inpatient beds.The project also includes a new internal driveway
and a stand-alone fire pump room.
I Mario Vieira MA Registration Number: AR 20524 Expiration date: 8/31/16 , 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:
I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
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'.
cs` 10liGe
Enter in the space to the right a`wet"or �� Quo F
electronic signature and seal: y
N
Phone number: 857-383-1700 Email: mvieira@shepleybulfinch.com `��trxofY►s°�
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
version 06 11 2013
Initial Construction Control Document
I UT*
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8u' edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC—Campus Consolidation—Emergency Department Date: August 17, 2016
Property Address: 81 Highland Avenue, Salem, Massachusetts 01970
Project: Check one or both as applicable: H New Construction ❑ Existing Construction
Project Description: New construction of 112,701 BGSF for an emergency department and med./surg. inpatient beds; this
includes a new, vertical circulation core connecting the new building to the existing hospital. Renovation of the Spaulding
North Shore Building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new, internal driveway,
and a stand-alone fire pump room.
I, Adam C, McCarthy, P.E. MA Registration Number: 40730 Expiration Date: 06/30/2018, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning':
Architectural H Structural Mechanical
Fire Protection Electrical Other: Describe
for the above named project and that to the best of my knowledge, information, and belief such plans, computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or tN OF
electronic signature and seal: �y
U N0.40790
Phone Number: (617)737-0040 Email: McCarthy@McSal.com
�SStONALEN
14018.008—North Shore Medical Center—Salem,MA—Campus Consolidation—Emergency Department—Initial Constmcti avit
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an `x' project design plans, computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
R Registered Design Professional
for work per the 81h edition of the
.' Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x) one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I,John W.Nelson, MA Registration Number: 39839 Expiration date: 06/30/2018,am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
_Architectural Structural - X Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form
acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or N OF M48
electronic signature and seal:
goa JOHN
NELSON
MECHANICAL m
No. 39 39
Phone number: (508)647-9200 S/ONAL E
Email:jnelson@engsolutions.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description. .
Version 06 11 2013 -
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Ulf
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I,John T.Sacharewitz,MA Registration Number: 50246 Expiration date: 06/30/2018, am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
_Architectural Structural Mechanical
Fire Protection X Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications
meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the
proposed project. 1 understand and agree that I(or my designee)shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
I. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form
acceptable to the building official.
Upon completion of the work, 1 shall submit to the building official a`Final Construction Control Document'.
Enter in the space to the right a"wet"or ��ZH OFM,gsB
electronic signature and seal: ?� 9�
oy
JOHN
SACHARE v'
0
AREWITZ m
� ELECTRIC �
AL y
No.50
0 246
ISTE
9 96 O
Phone number: (508) 647-9200 �SSiONAI£NGx�
Email:jsaeharewitz@engsolutions.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note I. Indicate with an `x' project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description. -
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
R Registered Design Professional
for work per the 8`h edition of the
•''p Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem, MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description:New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I, Stephen A.Coduri, MA Registration Number:49910 Expiration date: 06/30/2018, am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
_Architectural Structural Mechanical
Fire Protection _Electrical X_ Other: Plumbing
for the above named project and that to the best of my knowledge,information, and belief such plans, computations and specifications
meet the applicable provisions of the Massachusetts State Building Code,(780 CMR), and accepted engineering practices for the
proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.) together with pertinent comments, in a form
acceptable to the building official.
Upon completion of the work, I shall submit to the building official a`Final Construction Control Document'.
Enter in the space to the right a"wet"or tH Of
electronic signature and seal: '�•C'•C'
y
STEPHEN A.
CODURI
MECHANICAL c*
q 9 N0.49910
/S T 8p'�
Phone number: (508)647-9200 SS/ON �+ f
Email: scoduri@engsolutions.com lifer
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date: 08/22/2016
Property Address: 81 Highland Avenue
Salem,MA 01970
Project: Check(x) one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;
this includes a new vertical circulation core connecting the new building to the existing hospital. Renovation of the
Spaulding North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new
internal driveway, and a stand-alone fire pump room.
I, Stephen A.Coduri,MA Registration Number:49910 Expiration date: 06/30/2018,am a registered design professional, and I have
prepared or directly supervised the preparation of all design plans, computations and specifications concerning`:
_Architectural Structural Mechanical
X Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications
meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the
proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on
the construction site on a regular and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor
in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of
the work and to determine if the work is being performed in a manner consistent with the approved construction documents
and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form
acceptable to the building official.
Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or Of
electronic signature and seal: SN
of �yG
STEPHEN A.
C00UR1
MECHANICAL c4
No.49910
Phone number: (508)647-9200 �ocR�QtsTEPrC�a'�e
\ �Email:scoduri@engsolutions.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note L Indicate with an`x' project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen,
provide a description.
Version 06 It 2013
Initial Construction Control Document
To be submitted with the building permit application by a
A5 Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:Au2ust 19,2016
Property Address: 81 Highland Ave. Salem, MA 01970
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/sure inpatient beds; this includes a new vertical
circulation core connectins the new building to the existing hospital Renovation of the Spaulding North Shore building of 108,966 BGSF for
nsvchiatric inpatient beds The project also includes a new internal driveway,and a stand-alone fire pump room.
I Jeffrey D. Cyr R.C.D.D. MA Registered Number: 181735R Expiration date: 12/31/2018, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning:
Architectural Structural Mechanical
Fire Protection Electrical X Other: Telecommunications
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.
N`GpT1ONS DSS
Upon completion of the work, I shall submit to the building official a `Final Cons tion Co" G ent'.
/C.SI
Enter in the space to the right a"wet"or oLU
Z
electronic signature and seal:
W JEFFREY D CYR rn
REG. NO. 1817358
EXPIRES 12-31-18 a
COD• I I�
Phone number: 617-254-0016 Email: JCyr@brplusa.com 8 �G
E
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an`x'project design plans,computations andspecifications that you prepared or directly supervised.If`other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
• To be submitted with the building permit application by a
Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:8/22/16
Property Address: 81 Highland Ave., Salem,MA 01970
Project: Check(x)one or both as applicable:X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds;this
includes a new vertical circulation core connecting the new building to the existing hospital.Renovation of the Spaulding
North Shore building of 108,966 BGSF for psychiatric inpatient beds.The project also includes a new internal driveway
and a stand-alone fire pump room.
I Mario Vieim MA Registration Number: AR 20524 Expiration date: 8/31/16 ,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 Control Do t'.
Enter in the space to the right a"wet"or Ft ,
electronic signature and seal:
Phone number: 857-383-1700 Email: mvieira@shepleybulfinch.com Y'4S'C
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other' is chosen,
provide a description.
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: NSMC Campus Consolidation Project Date:8/22/16
Property Address: 81 Highland Ave., Salem,MA 01970
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: New construction of 112,701 BGSF for an emergency department and med/surg inpatient beds; this
includes a new vertical circulation core connecting the new building to the existing hospital.Renovation of the Spaulding
North Shore building of 108,966 BGSF for psychiatric inpatient beds. The project also includes a new internal driveway
and a stand-alone fire pump room.
I Mario Vieim MA Registration Number: AR 20524 Expiration date: 8/31/16 ,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 Control Dottirnt V.
Enter in the space to the right a"wet'or
electronic signature and seal:
Phone number: 857-383-1700 Email: mvieira®shepleybulfmch.com SS*
Of rs
Building Official Use Only
Building Otlienal Name: Permit No.: Date:
Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.
Version 06 1 12013 ,
City of Salem Sign Permit Application Worksheet ft' �
PIS
r' ffil
18-Aag-16 2U16 AUG 32 A $ 5Q
CVS(Highland Ave.Elevation) j
T 272 Highland Avenue
v Zoning(res/non-res) B2
Entrance Corridor(Y/N) Y
n Lot frontage 270 feet
iY Building or tenant frontage 100 feet
#of businesses on site 1
f Bldng dist from street center 140 feet
Multiplier 1.25
Bulldln Bladei`ns
maximum area permitted 124.38 sq ft
total proposed sign area 6.26 sq ft
sign 1
length 30.12 inches
height 14.96 inches
sign 2
length 30.12 inches
height 14.96 inches
sign 3
length 0.00 inches
height 0.00 inches
sign 4
length 0.00 inches
height 0.00 inches
sign 5
length 0.00 inches
hei ht 0.00 inches
to S ns
mmumma-
maximum area permitted 0.00 sq ft(per side)
maximum#of signs permitted 0 signs
maximum height permitted 0.00 ft tall
sign 1
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height 0.00 ft
sign 2
proposed sign area 0.00 sq ft
length 0.00 inches
height 0.00 inches
proposed sign height ft
Application meets guidelines set
forth in the Salem Sign Ordinance yes
Recommend approval yes
When added to existing approved signage,the proposal exceeds the
area permitted on the Highland Avenue facade by approximately 13.3
sq.ft.However,the building is permitted a total of 299.38 sq.ft.and is
only using 271 sq.ft.total on both elevations(Marlborough and
Highland).
(11P.t�.c O
Permit Number
c APPLICATION FOR PERMIT TO ERECT A SIGN
gj NOTE: BUILDING PERMIT MUST BE OBTAINED BEFORE SIGN IS ERECTED
Location, Ownership and Detail Must Be Correct, Complete, and Legible
= 8/15/16
1 Salem, Massachusetts
Date
To the Building Inspector:
The undersigned hereby applies fora permit to Y&Xrect, ❑Alter: ❑ Repair a sign on the following described buildings:
StreetAddmss Zoning ■
r� ❑ Urban Renewal Area ❑Entrance Corridor
N 11 272 Highland Ave, Salem ,MA 01970 B-1 ❑Historic District ❑ None
SCP 2010-C36-518 LLC
�- Telephone (412) 661-5233 15 floor Retail/pharmacy
CVS Pharmacy 2" floor
Address One CVS Dr,Woonsocket, RI 2895 3'°floor
Telephone 407-770-3047 Karen Rezuke 4n floor
E-mail Karen.Rezuke@CVSHealth.com How many businesses are in the building? 1
If a corporate body, name
of responsible officer Karen Rezuke
Frontage
Advantage Innovations, Inc Building 224 linear feet
Construction Sup
License No Applicant's Space(if multi-tenant) 224 linear feet
Address 310 Simmons Rd, Ste B, Knoxville,TX 3792 Property linear feet
Telephone 865-408-3103 Mail Sign Permit to:-
E-mail kelly@advantageinnovations.com ❑Sign Owner o Sign Erector gather:
7Portable
Si n 2 Si n 3
o Surface ❑Surface
ngle to Building o Right Angle to Building ❑Right Angle to Building
tanding o Free Standing ❑ Free Standing
❑Awning o Awning
(A-Frame) ❑ Portable(A-Frame) o Portable (A-Frame)
❑Other(specify) ❑Other(specify) c Other(specify)
Sign Materials 4 4 �,1Zu x Sign Materials Sign Materials
Vin 1 Decal G
Sin Dimensions Sign Dimensions Sign Dimensions
Sign Area 8>,fm" Sign Area Sign Area
�or.T l 2 . 2 s ft s ft sq ft
Sign Height(if free standing) Sign Height(if free standing) Sign Height(if free standing)
Estimated Cost of Net Work
g 1200.00
Existing Signs 1,
Type Sign Area To Be Removed? Sig O ner O.
surface 214 sq It c yes Oji i
o Right Angle to Building sq ft c yes ❑ no
❑ Free Standing sq ft o yes o no Sig O is Authoriz d Representative
❑Awning sq ft ❑yes o no
❑Other(specify) sq ft o yes ❑no
Pr' w r
internal Review
Planning&Community DevelopmeM Department Historical Commission
Building Inspector
oa,24no rev
Commonwealth of Massachusetts
(
Citv of Salem
120 Washington St,3rd Floor Salem,MA 01970(978)745.9595 x5841
Return card to Building Division for Certificate of Occupancy
Permit No. B.16-977
FEPERMIT TO BUILD
FEE PAID: $0.00 - ..
(DATE ISSUED: 9/2/2016
This certifies that ADVANTAGE INNOVATIONS, INC
has permission to erect, alter, or demolish a building „•_,272 HIGHLAND AVENUE Map/Lot: 80100.0
as follows: Signs SIGN PERMIT, AS APPROVED, FOR:
CVS @ 272 HIGHLAND AVE ,
t
Contractor Name: _, • -" ,
DBA:
Contractor License No: j t.
9/2/2016
. Building Official ,- Date
This permit shall be deemed abandoned and invalid unless the work authorized by this permit Is commenced within six months after issuance.The Building Official
may gram one or more extensions not to exceed six months each upon written request.
All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted.
All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. ,
j
I
This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the
work until the completion of the same.
The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials re provided on this permit.
H IC#:. -Persons contractIng with unregistered contractors do not have access to the guaranty fund'(as set forth in MGL c.142A)..
Restrictions: r
i
'A Building plans are to be available on site.
All Permit Cards are the property of the PROPERTY OWNER.
I
r
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code. 780 CMR, 7i11 edition OF SALEiM
Revised Junuarr
Building Perm! pplication To Construct, Repair, Renovate Or Demolish a /. :TRAY
One-or Two-Family Dwelling
This Section For O.ffi I Use Onl
Building Permil Num r• 11 4 1 Date Appli
Signature:
b //0
Building Cummissioned Inspector of Buildings J Date
SECTION I:SITE I ORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�Ol/P V e—
I.I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private O Check if es❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'or Record: 7
-5 70gZuc5`5!4 �GD I)1G�n rl," ,goe 1i4VP
Name(Print) I—� Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply)
New Construction O Existing Building❑ Owner-Occupied O Repalrs(s) ❑ Alteration(s) ❑ AdditiJC3
Demolition O -A I Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': O `X O' T �.,, 0
�z��o_k + ;11D
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OMCISI Use Only
Labor and Materials
I. Building is I. Building Permit Fee: S Indicate how tee is determined:
O Standard City/Town Application Fee
?. Electrical S ❑Total Project Cost"(Item 6)x multiplier x
3. Plumbing Is 2. Other Fees: S
4. Mechanical (IEVAC) S List:
5. Mechanical (Fire S
St ression Total All Fees:S
i Check No. Check Amount: Cash Amount:
6. Total Project Cost: S Ifs-0 0 Paid in Full 13 Outstanding Balance Due:
SECTION S: CONSTRUCTION SERVICES r
S.1 Licensed Construction Supervisor(CSL)
License Numbct lixpi®tion Date
Name ol'CSI.• I lulder List CSL Type(see below)
r Description
.Address U unrestricted(up to 35,000 Cu.Ft.
R Restricted Is2 Family Dwelling
Signature M Masonry Only
RC Residential Roaring Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
3.2 :R�Abl:ftrede Improvement Contactor(HtC)I IIC r FIIC Registrant Name Registration Number
Address Expiration Date
Signature relephune
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.1 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........D No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 re 2 t as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application. -
Siamure of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1 G 2/Y2� a y x-f-s F-r �Kj \ as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and
behalf.
, CC
Print Name
471
f d
St u of( ner - t orized Agen Date
Si under the airs and nalties of 'u
NOTES:
PLAnwner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
registered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration
am or guaranty fund under M.G.L.c. 1J2A. Other important information on the HIC Program and
truction Supervisor Licensing(CSL)can be found in 780CMR Regulations 110.R6and 110.R3,respectively.
2. substantial work is planned,provide the information below:
rs area ISq. Ft.) (including garage, finished basement/attics.decks or porch)
ng area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
). "Total Project Syuare Ftwtage"may be subslituled for"Tolal Project Cost"
►° IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Events For Rent Page 1 of 2
Status: Reservation
464 Lowell Street 978-535-5035 phone Contract#: 213686
Peabody, MA 01960 978-535-4561 fax Event Date: Thu 9/16/2010 9:OOAM
www.eventsforrent.com
Operator: KEITH R.
Customer# 8052
SHAUGNESSY KAPLAN REHAB HOSP. 978 8 5 825-8519
DOVE AVE
Salem, MA 01970
Qty Key Items Rented Part# Status Date Due Price
1 1900510 TENT FRAME 40X80 1900510 Reserved 9/17/2010 5:OOPM $1,850.00
10 200021000 TENT BARRELS(55 GAL) 200021000 Reserved 9/17/2010 9:OOAM $150.00
4 140012000 LIGHT HANGING GLOBE STRING 140012000 Reserved 9/17/2010 5:OOPM $200.00
19 180024000 TABLE ROUND 60" 180024000 Reserved 9/17/2010 5:OOPM $152.00
TABLES MUST BE PROTECTED FROM WEATHER AT ALL TIMES
PLEASE REFRAIN FROM STAPLING INTO TABLES FOR THE SAFETY OF OUR CLIENTS
AND STAFF
150 060018000 CHAIR SAM FLOG BLACK 060018000 Reserved 9/17/2010 5:OOPM $165.00
TO MAINTAIN QUALITY,PLEASE REFRAIN FROM APPLYING STICKER-LIKE
MATERIALS OR OTHER SUBSTANCES TO CHAIRS
19 170011800 TCLOTH RD 90"WHITE 170011800 Reserved 9/17/2010 9:00AM $190.00
City Key Items Sold Part# Status Each Price
1 650025000 LABOR CHARGE 650025000 Selling $1%00 $150.00
1 101970 DELIVERY&P/U SALEM,MA Delivery $50.00 $50.00
DELIVERY AND PICKUP
r
ery Date: Thu 9/16/10 9:00 AM Contact: ANN FOTHERGILL
uPhone: -
ess: DOVE AVE ; Salem, M
DELIVERY WILL BE ON THURSDAY MORN. 9/16/10 FOR EVENT FROM 6:00-8:OOPM
PICKUP WILL BE ON FRIDAY 9/17/10
DELIVERY WILL BE ON THURSDAY MORN 9/16/10 FOR EVENING EVENT FROM 6:00-8:00 PM
PICKUP WILL BE ON FRIDAY 9/17/10
THE LABOR CHARGE IS FOR EVENTS FOR RENT RETAINING BUILDING AND FIRE PERMITS FOR TENT ***
*** SKRH IS RESPONSIBLE FOR ALL RENTAL ITEMS DURING THE DURATION OF RENTAL PERIOD ***
PAYMENT DUE DATE IS 60 DAYS OR BY 7/5/10
Reservation fees are non-refundable
Payments made on this contract:
Rental/Sale Paid $2,907.00 on 06-Jul-2010 4:21 pm Check#3772852
Total Paid $2,907.00
Printed on 8/31/2010 8:42:11 am Modification#5
Software by Point-of-Rental Systems W W W.POINT-OF-RENTAL COM c:\por\Reports\Contract-Params.rpt
Contraui'#: 213686 SHAUGNESSY KAPLAN REHAB Events For Rent Page 2 of 2
HOSP.
RENTAL CONTRACT
'This is a contract.The back of this contract contains important terms&conditions including lessor's disclaimer from all liability Rental: $2,707.00
for injury or damage&details of customer's obligations. These terms and conditions are a part of this CONTRACT! Damage Waiver: $0.00
'If equipment does not function properly notify lessor within 30 minutes of occurrence or no refund or allowance will be made.
'RESERVATION FEES are NON-REFUNDABLE if cancelled. Sales: $150.00
'ALL rental items should be considered USED unless otherwise noted.
'ALL deliveries are strictly TAILGATE deliveries unless otherwise arranged. Delivery Charge: $50.00
'EFR is not responsible for and will not secure rental items Won customer vehicle upon pickup of items-customer is responsible
for securing items to his/her vehicle for safe transport to&from Events For Rent. Misc.Charges: $0.00
'Unless declined,I agree to the Damage Waiver charges for the rental items for which Damage Waiver is offered. D.W.C.is
offered on only selected items. Subtotal: $2,907.00
'Events For Rent reserves the right to apply appropriate charges to Master Card,
Visa,Discover or American Express for late,lost or damaged items.
'Upon receiving rental items,I acknowledge receipt in good order of the items rented.
'1 certify that I have read and agree to all terms of this contract. Massachusetts $0.00
6.25%:
TOTAL: $2,907.00
SIGNATURE: PAID: $2,907.00
SHAUGNESSY KAPLAN REHAB HOSP.
AMOUNT DUE: $0.00
Printed on 8/31/2010 8:42:11 am Modification#5
Software by Point-cf-Rental Systems W W W.POINT-OF-RENTAL.COM c:\por\Reports\Contract-Params.rpt
r
The Commonwealth of Massachusetts
Board of Building Regulations and Standards CITY
Massachusetts State Building Code. 780 CMR, 7i11 edition OF SALEiM
Revised Junuarr
Building Perm! pplication To Construct, Repair, Renovate Or Demolish a /. :TRAY
One-or Two-Family Dwelling
This Section For O.ffi I Use Onl
Building Permil Num r• 11 4 1 Date Appli
Signature:
b //0
Building Cummissioned Inspector of Buildings J Date
SECTION I:SITE I ORMATION
1.1 Property Address: 1.2 Assessors Map& Parcel Numbers
�Ol/P V e—
I.I a Is this an accepted street?yes no Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Area(sq 11) Frontage(11)
1.5 Building Setbacks(R)
Front Yard Side Yards Rem Yard
Required Provided Required Provided Required Provided
1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Zone: _ Outside Flood Zone?
Public❑ Private O Check if es❑ Municipal❑ On site disposal system ❑
SECTION2: PROPERTY OWNERSHIP'
2.1 Owner'or Record: 7
-5 70gZuc5`5!4 �GD I)1G�n rl," ,goe 1i4VP
Name(Print) I—� Address for Service:
Signature Telephone
SECTION 3: DESCRIPTION OF PROPOSED WORK"(check all that apply)
New Construction O Existing Building❑ Owner-Occupied O Repalrs(s) ❑ Alteration(s) ❑ AdditiJC3
Demolition O -A I Number of Units_ I Other ❑ Specify:
Brief Description of Proposed Work': O `X O' T �.,, 0
�z��o_k + ;11D
SECTION 4: ESTIMATED CONSTRUCTION COSTS
Item Estimated Costs: OMCISI Use Only
Labor and Materials
I. Building is I. Building Permit Fee: S Indicate how tee is determined:
O Standard City/Town Application Fee
?. Electrical S ❑Total Project Cost"(Item 6)x multiplier x
3. Plumbing Is 2. Other Fees: S
4. Mechanical (IEVAC) S List:
5. Mechanical (Fire S
St ression Total All Fees:S
i Check No. Check Amount: Cash Amount:
6. Total Project Cost: S Ifs-0 0 Paid in Full 13 Outstanding Balance Due:
SECTION S: CONSTRUCTION SERVICES r
S.1 Licensed Construction Supervisor(CSL)
License Numbct lixpi®tion Date
Name ol'CSI.• I lulder List CSL Type(see below)
r Description
.Address U unrestricted(up to 35,000 Cu.Ft.
R Restricted Is2 Family Dwelling
Signature M Masonry Only
RC Residential Roaring Covering
Telephone WS Residential Window and Siding
SF Residential Solid Fuel Burning Appliance Installation
D Residential Demolition
3.2 :R�Abl:ftrede Improvement Contactor(HtC)I IIC r FIIC Registrant Name Registration Number
Address Expiration Date
Signature relephune
SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.a 152.1 2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide
this affidavit will result in the denial of the Issuance of the building permit.
Signed Affidavit Attached? Yes ..........D No...........O
SECTION 7a:OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
1 re 2 t as Owner of the subject property hereby
authorize to act on my behalf,in all matters
relative to work authorized by this building permit application. -
Siamure of Owner Date
SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION
1 G 2/Y2� a y x-f-s F-r �Kj \ as Owner or Authorized Agent hereby declare
that the statements and information on the foregoing application are We and accurate,to the best of my knowledge and
behalf.
, CC
Print Name
471
f d
St u of( ner - t orized Agen Date
Si under the airs and nalties of 'u
NOTES:
PLAnwner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor
registered in the Home Improvement Contractor(HIC)Program),will W have access to the arbitration
am or guaranty fund under M.G.L.c. 1J2A. Other important information on the HIC Program and
truction Supervisor Licensing(CSL)can be found in 780CMR Regulations 110.R6and 110.R3,respectively.
2. substantial work is planned,provide the information below:
rs area ISq. Ft.) (including garage, finished basement/attics.decks or porch)
ng area(Sq. Ft.) Habitable room count
Number of fireplaces Number of bedrooms
Number of bathrooms Number of half/baths
Type of heating system Number of decks/porches
Type of cooling system Enclosed Open
). "Total Project Syuare Ftwtage"may be subslituled for"Tolal Project Cost"
►° IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
Events For Rent Page 1 of 2
Status: Reservation
464 Lowell Street 978-535-5035 phone Contract#: 213686
Peabody, MA 01960 978-535-4561 fax Event Date: Thu 9/16/2010 9:OOAM
www.eventsforrent.com
Operator: KEITH R.
Customer# 8052
SHAUGNESSY KAPLAN REHAB HOSP. 978 8 5 825-8519
DOVE AVE
Salem, MA 01970
Qty Key Items Rented Part# Status Date Due Price
1 1900510 TENT FRAME 40X80 1900510 Reserved 9/17/2010 5:OOPM $1,850.00
10 200021000 TENT BARRELS(55 GAL) 200021000 Reserved 9/17/2010 9:OOAM $150.00
4 140012000 LIGHT HANGING GLOBE STRING 140012000 Reserved 9/17/2010 5:OOPM $200.00
19 180024000 TABLE ROUND 60" 180024000 Reserved 9/17/2010 5:OOPM $152.00
TABLES MUST BE PROTECTED FROM WEATHER AT ALL TIMES
PLEASE REFRAIN FROM STAPLING INTO TABLES FOR THE SAFETY OF OUR CLIENTS
AND STAFF
150 060018000 CHAIR SAM FLOG BLACK 060018000 Reserved 9/17/2010 5:OOPM $165.00
TO MAINTAIN QUALITY,PLEASE REFRAIN FROM APPLYING STICKER-LIKE
MATERIALS OR OTHER SUBSTANCES TO CHAIRS
19 170011800 TCLOTH RD 90"WHITE 170011800 Reserved 9/17/2010 9:00AM $190.00
City Key Items Sold Part# Status Each Price
1 650025000 LABOR CHARGE 650025000 Selling $1%00 $150.00
1 101970 DELIVERY&P/U SALEM,MA Delivery $50.00 $50.00
DELIVERY AND PICKUP
r
ery Date: Thu 9/16/10 9:00 AM Contact: ANN FOTHERGILL
uPhone: -
ess: DOVE AVE ; Salem, M
DELIVERY WILL BE ON THURSDAY MORN. 9/16/10 FOR EVENT FROM 6:00-8:OOPM
PICKUP WILL BE ON FRIDAY 9/17/10
DELIVERY WILL BE ON THURSDAY MORN 9/16/10 FOR EVENING EVENT FROM 6:00-8:00 PM
PICKUP WILL BE ON FRIDAY 9/17/10
THE LABOR CHARGE IS FOR EVENTS FOR RENT RETAINING BUILDING AND FIRE PERMITS FOR TENT ***
*** SKRH IS RESPONSIBLE FOR ALL RENTAL ITEMS DURING THE DURATION OF RENTAL PERIOD ***
PAYMENT DUE DATE IS 60 DAYS OR BY 7/5/10
Reservation fees are non-refundable
Payments made on this contract:
Rental/Sale Paid $2,907.00 on 06-Jul-2010 4:21 pm Check#3772852
Total Paid $2,907.00
Printed on 8/31/2010 8:42:11 am Modification#5
Software by Point-of-Rental Systems W W W.POINT-OF-RENTAL COM c:\por\Reports\Contract-Params.rpt
Contraui'#: 213686 SHAUGNESSY KAPLAN REHAB Events For Rent Page 2 of 2
HOSP.
RENTAL CONTRACT
'This is a contract.The back of this contract contains important terms&conditions including lessor's disclaimer from all liability Rental: $2,707.00
for injury or damage&details of customer's obligations. These terms and conditions are a part of this CONTRACT! Damage Waiver: $0.00
'If equipment does not function properly notify lessor within 30 minutes of occurrence or no refund or allowance will be made.
'RESERVATION FEES are NON-REFUNDABLE if cancelled. Sales: $150.00
'ALL rental items should be considered USED unless otherwise noted.
'ALL deliveries are strictly TAILGATE deliveries unless otherwise arranged. Delivery Charge: $50.00
'EFR is not responsible for and will not secure rental items Won customer vehicle upon pickup of items-customer is responsible
for securing items to his/her vehicle for safe transport to&from Events For Rent. Misc.Charges: $0.00
'Unless declined,I agree to the Damage Waiver charges for the rental items for which Damage Waiver is offered. D.W.C.is
offered on only selected items. Subtotal: $2,907.00
'Events For Rent reserves the right to apply appropriate charges to Master Card,
Visa,Discover or American Express for late,lost or damaged items.
'Upon receiving rental items,I acknowledge receipt in good order of the items rented.
'1 certify that I have read and agree to all terms of this contract. Massachusetts $0.00
6.25%:
TOTAL: $2,907.00
SIGNATURE: PAID: $2,907.00
SHAUGNESSY KAPLAN REHAB HOSP.
AMOUNT DUE: $0.00
Printed on 8/31/2010 8:42:11 am Modification#5
Software by Point-cf-Rental Systems W W W.POINT-OF-RENTAL.COM c:\por\Reports\Contract-Params.rpt