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217-251 WASHINGTON ST & 11-13 DODGE ST - BUILDING INSPECTION �q on c f zos ` The Commonwealth of Massachusetts hh Department of Public Safety Imo. V 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) BuildingPenuitNumber. Date Applied: Building Official: SECTION 1:LOCATION (Please indicate Block#and Lot#for locations fo t available) 217-ZS1 W�c'�rns{ynSt 007D DOE)GG S�5 mix n tr/e_et Ci Town Zi Code re u' i if applicable) No.a d5 City p VS ( pP ) SECTION 2:PROPOSED WORK Edition of MA State Code used if New Construction check here Wor check Al that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix I) Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Y/ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ltd" No ❑ Brief Descriptionof Proposed Work: F r. 0• S, M oc '-, YPDi�2 c acs z 5jrudEre e6vnJtAxm . medvm ' .v.. t H I V 12 le ) All, acS6r..`cri['/1 if�� Qxx-i2 ,%Gw� •c 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)ix Area Per Floor(sq. ft.) 3 30,,6:,0 C 4� Total Area(sq. ft.) and Total Height(ft.) 26 SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑ F: Factor F-1 ❑ F2❑ H: High Hazard H-1 ❑ H-2❑ H-3 ❑ HA❑ H-5 ❑ I: Institutional 1-1 ❑ I-2❑ I-3❑ 1-4❑ M: Mercantile❑ R: Residential R=I❑ R-2❑ R-3❑ R-4❑ S: Storage S-1 ❑ S-2 2renG.I U: Utility❑ Special Use ❑ and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE (Check as applicable) IA IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 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 d Check if outside Flood Zone❑ Indicate municipal A trench will not be Licensed Disposal Site Private 13or indentify Zone: or on site system❑ required❑ or trench or specify: permit is enclosed ❑ Railroad right-of-wa Hazards to Air Navigation: I ,y4A![ititoric C:ocnnu5sian (2go icw Pang�}s: Not Applicable C 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: � / +}rkus pt_�s & �ild4¢t� itM-oW " /10 •-W7-wty" doll-G " 5c-0-t ' Px • FC)e_ P v SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner eG, k( t 17 l5�• svc,.e l ut I l P a� Nmn4Print) No.and Street #ICS City/Town Zip Property Owner Contact Information: -NA Fi CCL4 lL UL--"? - 331 ry+aI gV-1,Ee@ rel -'Ile .lOn Title Telephone No. (business) Telephone No. (cell) e-mail add ss If applicable, the property owner hereby authorizes gc-Li Lu- 17 lvcdw sk 160 GW,4AV10e _tNA 0zI'i "Name /1P 'a 7^if nnYvvnwa,w Street Address City/Town State Zip to act on the propertV owner's behalf,in all matters relative to work authorized by this building ermit 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❑and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control •` rVfrc. ei SGL V�t _ l- 8 ' 19"@t4uPe •y; , fay7 Name (Regi§ ant) Telephone No. e-mail address Registration Number z1� 14� --e'00sr« � un(le -#-A,-- 621g3 _&.h_ 9--31 -17 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor StIswevyle �s11�d21 $ ��5 `N1C Compahy Name TcA AN s's� CS - 06 � 6`Z`d Name of Person Responsible for Construction License No. and Type if Applicable SS Cla�l w 'V> • jgl//&rlCa 41A- 0/A 7-11 Street Address City/Town State Zip X41 _ ?53_ 663.- sXA @ Stntrerrle 6u% Y . n e f "Cele phone No. (business) Telephone No. cell e-mail address SECTION 11:t1'ORKEP",'COMPENSATION INSURANCE AITIDAVIT 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 a lication? Yes VNo ❑ SECTION 12:CONSTRUCTION COSTS AND PERMIT FA Item Estimated Costs: (Labor and Materials) Total Construction Cost(from Item 6) _$ �� 6Pl(� ( � 'l. Building $ Building Permit Fee=Total Construction Cost x�_( (Insert here 2. Electrical $ appropriate municipal factor)_$ Ti MD. 3. Plumbing $ -L Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5. Mechanical (Other) $ Enclose check payable to Ce4zi -C&A 1, 6.Total Cost $ 411000"000 (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 true and accurate to the best of my knowledge and understanding. S4R / Mikan Conjva( Aisat arldpigname TAtle " llephe�� Z� Date V , / K on Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Date The Commonwealth of Massachusetts Department of IndustrialAccidems Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Supreme Builders & Design,inc Address: 58 Glad valley Dr City/State/Zip: Billerica, MA 01821 Phone #:781-953-6036 Are you an employer? Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 2 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hued the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑■ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.; required.] 5. ❑ We area corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L❑ Plumbing repairs or additions myself.m se ' right of exemption per MGL Y (No workerscomp- 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] "My applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they aredoing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Travelers Policy#or Self-ins. Lic. #:7PJUB-4768P16-5-13 Expiration Date: 7/21/16 Job Site Address: 217-251 Washington St City/State/Zip:Salem 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 $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 of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of per that the information provided above is true and correct � � Signature: ����1/`�'— Date:9/23/16 Phone#: 781-9536036 Oficial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: CY7 YOFS&EA4 MASSAMSE77 BruDDcDZrasZMDrr 7kr. »s-mss. BIA�ERIEYDR6S Z PArPMAUL9M �� 7How�sS7'.P� Dmsc7citca'rLmxma*r/sterGoommmx m Construction Debris Disposa/Aff�idovit (required forall demolition and.renovation workf in accordanw with the sucth edition of the State BuMiw Code, 780 QMR, Section 111.5 and the provisions of MGL coo,S54; Builds g Permitfi is issued with the condition that the debris resulft from this work shall be disposed of in a prgwd y licensed waste deposit facility as defined by MGL c 111,S 151. The debris will be transported by: © CU YI -fytj (name of hauler) The debris will be disposed of in: 26,aA CUA. to (name of facility) (address of facility) Signature of applicant Date 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: Washinaton & Dodae Date: 09/19/16 Property Address: Washington & Dodae Street Project: Check one or both as applicable: 0 New construction ❑ Existing Construction Project description: The building will provide 64 new residential units 3 studios 35 one-bedroom units 19 two-bedroom units and 7 three-bedroom units In addition there will be a community room and deck 3 Live/Work units 5 retail snag and 5 office spaces There will also be one level of surface parking above two levels of structured parking. I .lai Singh Khalsa MA Registration Number: 6042 Expiration date: ng/,In/17 ,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 [ ] 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 I shall submit to the u Blit tial a`Final Con64ru ent'. t Cyd Enter in the space to the ri a"wet" tiN Y, c+A electronic signature and sea No,8042 CAMBg10pE. MA J Phone number: 617-591-8682 Email: ' ft Building Official Use Only Building Official Name: Permit No.: Date: 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: Washinaton & Dodoe Date: 09/19/16 Property Address: Washinaton& Dodge Street Project: Check one or both as applicable: 2 New construction ❑Existing Construction Project description: The building will provide 64 new residential units 3 studios 35 one bedroom units 19 two-bedroom units and 7 three-bedroom unite In addition there will be a community room and deck 3 Live/Work units 5 retail spaces and 5 office spaces, There will also he one level of surface parking above two levels of structured parking I .lohn Wood MA Registration Number: 45670 Expiration date: g/3n/16 am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural [ ] Structural W1 Mechanical [VJJ 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 H ficial a`Final Construction Control Document'. Enter in the space to the right a"wet"or d electronic signature and seal: No.4567o " - ,o�F,9FQIST'cP�� - Phone number: SloNAL Email: iohnwt7a alliedrnnsultina_net Building Official Use Only [Building Official Name: Permit No.: Date: Version 06 I1 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: Washington & Dodae Date: 09/19/16 Property Address: Washington & Dodge Street Project: Check one or both as applicable: 10 New construction 0 Existing Construction Project description: The building will provide 64 new residential units 3 studios 35 one-bedroom units 19 two-bedroom units and 7 three-bedroom units In addition there will he a community room and deck 3 Live/Work units 5 retail Spaces and a office spaces Thera will also he one level of surface parking above two levels of structured I Minantas M Vaitac MA Registration Number: UO;)A Expiration date: F/3n/7n1R ,am a registered design professional, and 1 have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Architectural V 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.)to rtinent comments, in a form acceptable to the building official. OF MqS Upon completion of the work,I shall submit to the building official a`Final Const mc otgltalKflMSn VEITAS m Enter in the space to the right a"wet'or v TRUCT L y electronic signature and seal: f N 28 ibNAL�'� Phone number: 781-843-2863 Email:jjMa (a veRa�cpm Building Official Use Only [Building Official Name: Permit No.: Date: Version 06 11 2013 A 0-tcs 3q - OqDi� CITY OF SALEM ROUTING SLIP New Construction ✓ F4`"d'r16Vv1 P l awl l ©H%Lr d Certificate of Occupancy LOCATION Zi - ZS1 W. t4, v� DATE ASSESSORS DATE 93 Washington St. pp CITY CLER P liDATE 9-0 -Ao1,6 93 Washington St. PUBLIC SERVICES ATE %ll jo;leyaq uo :jaaul8u3 jolunp 120 Washington St. R.7:-: tc7 � Z WATER t DATE 120 Wash4ngton St. /J CROSS CONNECTION wtQ/ ATE 5 Jefferson Ave Ju r Enginee .'C>n behalf of Qavld H. Knowlton, P.E. City Engine( PLANNING&-, �� �� DATE 7/2 / 120 Washington St. ql v1 i Ilk CONSERVATION DATE "' i 120 Washington St. ELECTRIC / DATE o2 g j 48 Lafayette St. `` x FIRE PREVENTION ATE may)_ ss04 �1hlA�- 40-1N 29 Fort Avenue !! HEALTH V 4c-V" `' DATE 111-6119 low 120 Washington S . BUILDING INSPECTOR DATE 120 Washington St. Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure for public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location (Please indicate Block# and Lot # for locations for which a street address is not available) 717 - Z51 VIM 01470 No. and Street City/Town Zip Name of Building(if applicable) For the above described pro/perry the following action was taken: Water Shut Off? Yes M �Vo ❑ Provider notified and Release obtained? Yes R No ❑ Gas Shut Off? Yes M� o ❑ Provider notified and Release obtained? Yes 01"No ❑ Electricity Shut Off? Yes EY No ❑ Provider notified and Release obtained? Yes 19"'No ❑ I elero"u Yes CKNo ❑ Provider notified and Release obtained? Yes El"No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) 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 3 Structural X 4 Fire Suppression x 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review y 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report - 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other S ecif 21 Other(Specify) 22 Other(Specify) *Areas of Design or Construction for which plans 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 � £, w toot'2. Name(Regis ant) Telephone No. e-mail addres Registration Number 17 h.APD Si5td e4U1 (e suit- ozi43 _14rc� B-PI-t7 Street Address City/Town State Zip Discipline Expiration Date Zi dyC78L-8_q- 8b YtuadP.VV!k4-COIN. - '34OZ$- Name(,Registrant) Telephone No. e-mail address Registration Number l 631 Gt ,if %-& 9"r-entyey— D�L�(.� J" 0( Street Address Ci /Town State Zip -i- Discipline Expiration Date - jou„kG..t4e cv�our e .re 4Sro7o / 48856 504 w� /,414A(s 1 l'�fief .' - K� �t Name(g ant) Telephone No. a-mail address Registration Number 215 U ,4 7?�&f PJ sodh XA ©t77 tR Street Address City/V_ State Zip Discipline Expiration Date see dz f�eG¢o� � Ci vi I 0vt" kwldseerc 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 a licable No. Item Submitted Incomplete Not Required 1 Architectural 2 Foundation 3 Structural 4 Fire Suppression 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing include local connections 9 Gas Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 S ecifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Com ensation Insurance 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) -Areas of Design or Construction for which plans 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 Blair Hines 617-735-1180 bh@badassociates.com 1090 Registration Number Name(Registrant) Telephone No. e-mail address 318 Harvard Street, Suite 25 Brookline MA 02446 Land. Arch. 01/31/2017 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address City/Town State Zi ._-_----..............._'. ........"'_.""' Registration Number Name(Registrant) Telephone No. e-mail address Discipline Expiration Date Street Address Citv/Town State Zi Andrew Zimmermann From: Michael Roper <mroper@tkgeast.com> Sent: Tuesday, September 20, 2016 11:50 AM To: Andrew Zimmermann Subject: Professional contact permit info Attachments: Salem Profession contact info (Allied Consulting 09-20-16).pdf, doc02124920160920093204.pdf, Salem Profession contact info_BHDA.PDF; 2017_ 001.pdf Andrew, Please see attached info. Wayne Keefner Reg. No. 41313 Exp Date: 6/30/18 Discipline: Civil 120 Middlesex Ave,Somerville, MA 02145 617-776-3350 wkeefner@dci-ma.com Michael Roper, Assoc. AIA KD I 1 17 ivaioo s'. suite 400 somer dle ma 02143 1617 591 8682 ext.264 t 617 591 2066 1 j eA, , t w J i nckl� hdm Woe& Massachusetts ,Board of Building Reil. License:-CS-0694 Construction Su SCOTT B ALLISON 58 GLAD VALLEY DR BILLERICA MA 0182 t v* CAExPitation: ���'" tRfI'Ii717S51fIn #; ,n', 04/22/2017 .