The URL can be used to link to this page

217-251 WASHINGTON ST - BUILDING INSPECTION ZSR ck llgj The Commonwealth of Massachusetts M Department of Public Safety Massachusetts State Building Code(780 CMR) /J Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number. - Date Applied: -Building Official. - SECTION 1:LOCATION(Please.indicate Block#and Lot#for locations for which a street address is not available) Z17 ' Z51 VWhL/st&tetS{. S'Jou .' W4 07170 1 No.and Street V City/Town Zip Code Name of Building(if applicable) SECTION 2:PROPOSED WORK r Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below llh�- Existing Building❑ .Repair❑ 1 Alteration ❑ Addition❑ Demolition (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review re uired? Yes ❑ No ❑ Brief Description of Proposed Woxk: l`-(tcw t J 0,1e u`t a eK`s� �"zj r4 9 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.) Total Area(sq.ft.)and Total Height(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: Facto F-I❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑ 1: Institutional I-1❑ I-2❑ I-3❑ I-4❑ M: Mercantile❑ R: Residential R-113 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) G IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ I VA ❑ VB ❑ �\ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Trench Permit-. Debris Removal: Water Supp y: Flood Zone Information: Sewage Disposal: , Public 6' Check if outside Flood Zone❑ Indicate municipal A trench will not be Licensed Disposal Site required❑ r trench r Private❑ or indentiZone: or on sites stem❑ 4 t i c tre c o specify: ty - y permit is enclosed❑ Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable❑ Is Structure within airport app oach area? Is their revi completed? or Consent to Build enclosed❑ Yes❑ or No ly Yes 7No ❑ 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: SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner e I:z 1„,,eo, Sna64AVWe 0214 Name(Prinq No.and Street City/Town Zip Property Owner Contact Information: 2C — � 'M�ta c�(�z� x315 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 property owner's behalf,in all matters relative to work authorized by this building Permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 0 and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Aedf }�twtmsl✓�Pw�ir Company Name L `� ` _ - I�P/V{Vl W6�'6 VBLWtPf"A Name of Person Re ponsible for Const tion License No. and Type if Applicable 722 u 'Tyv�p ? ?sin, , 430 Streettt uAddress r]�� "' -� City/Town I( /� State L zip �_tmf_ ( ( ( i ILtiZ- - t.� Ltd[M cel(' )/I��IMd'!,(tDGb'Vy C6Nv Telephone No. business Telephone No. cell e-mail address SECTION II:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152.§25C 6 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes❑ No ❑ SECTION I2:CONSTRUCTION COSTS AND PERMIT FEE - Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ _ appropriate municipal factor)—$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose 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 true and accurate to the best of my knowledge and understanding. Please print and sign name Title Telephone No. Date Street Address City/Town State Zip G Municipal Inspector to fill out this section upon application approval: / Name - Date Demo � �� = z �— I�� - s�� _�_.�_-_.N.� i��rn�-� �— - - _ The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code (780 CMR) Building Permit Application to Construct,Repair,Renovate or Demolish any w Via. Building other than aOne-or Two-Family Dwelling Code and Other Requirements for Building Permits The Department of Public Safety has issued these building permit application forms so that municipalities across the state can move toward use of a single permit form and consistent permit application process. The MA State Building Code specifies the requirements of building permits and the applicant is advised to review and be familiar with these requirements in order to avoid some of the common permit application problems. Likewise the applicant should be aware that some municipalities require that the owner confirm, even prior to acceptance of the building permit application, that no outstanding property taxes, water fees, etc. exist. Filing Instructions 1.Please contact the city or town where the work will be done to ensure that the city or town will accept this application form and if any additional information is required, and obtain the correct mailing address. After doing so, print the application, fill in completely and then submit to the local city or town where the work will be done. 2.All applications shall be considered complete and will be reviewed if construction documents, specifications, fee, and other materials that may be required as indicated in the Building Permit Application are included with the application. 3.Please include a check for the Building Permit fee. The fee may be calculated using the information to be supplied in section 12 of the Building Permit Application. The check is to be made payable to the local city or town where the work will be done. "r. 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) No. and Street City/Town Zip Name of Building(if applicable) For the above described property the following action was taken: Water Shut Off? Yes IA//.No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Gas Shut Off? Yes U 0 ❑ Provider notified and Release obtained? Yes ❑ No ❑ Electricity Shut Off? Yes IVNo ❑ Provider notified and Release obtained? Yes ❑ No ❑ Ve G7QA Yes E�(No ❑ Provider notified and Release obtained? Yes ❑ No ❑ Other (if applicable) Yes ❑ No ❑ Provider notified and Release obtained? Yes b 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 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 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing BuildingSurve /Investigation 16 Energy Conservation Report 17 Architectural Access Review 521 CMR 18 Workers Compensation 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 Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address Ci Town State Zi Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Discipline Expiration Date Street Address Ci /Town State Zi i` y ;r \ 1 _ - � r l y • r r 07Y OF SALEK MMMSAML SEM BtnMW INPAi BMW 120WASIMGM tSM ET,3PROM AL(978)745.9595. BIIM FAXMV7449846 ERLEYDRiSQ7LL 1v&YCR 7 SZP�RRE Incl aRarrpLmucpxcn Y/BtnDlwaommmcR Construction Debris Disposa/Affidavit (required for all demolition and,renovation work) In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, and the provisions of MGL 00,S 54; Building Permit 81 is issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed " waste deposit facility as defined by MGL c 111,S 150A The debris will be transported by: (name of hauler) The debris will be disposed of in: (name of facility) (address o facility) 'gnature f1p I, t Date r CITY OF SALEM ROUTING SLIP New Construction a m-0 Certificate of Occupancy LOCATION 217 - 7-51 kkA ''SEDATE ASSESSORS ATE $ C, 93 Washington St. -k CITY CLERK DATE / 93 Washington t. PUBLIC SERVICES DATE f'6 120 Washington St. /�j P WATER I//BP -� DATE .A ,5"k 0' 120 Washington St. r CROSS CONNECTION DATE isTirt py¢p^�int Jefferson Ave 7 PLANNING DATE I I 120 Washington St. C0NSERVATI 120 Washington St. ELECTRICAL DATE 48 Lafayette St. FIRE PREVENTION ty DATE 29 Fort Avenue 7- 1 `t, vHEALTH f DATE q D I � ANr `!st:V�-n"wV 120 Washington S . BUILDING INSPECTOR DATE 120 Washington St. CkIN, i PV`°rfV 0 (Ok4( r"^ Account Type Address on Account (Account Number Vendor Name on Account (Meter Number k 217.221Washington �� — Water/Sewer 217 Washington St I22Ao08 _ City of Salem RCG Realty - 1526681788 1 Water/Sewer 221 Washington St 22A009 _ City of Salem RCG LLC(first bill to D'alessandro) 192612524 y F116" Water/Sewer 217 Washington St 009897 City of Salem Dodge Laundry 60781509 IWI I 231-251 Washington _ Water/Sewer 231 Washington St 8642 City of Salem RCG LLC '� ends057 ,�y�--D5L66,g2C ,' Water/Sewer 1231 R Washington St 22AO10 City of Salem RCG LLC 6Q7q, Q) shit V `z -► -3/,.' r vAers �c3�al o S e cs M lu Andrew Zimmermann From: Peter Schaeublin <pschaeublin@Salem.com> Sent: Thursday,June 02, 2016 3:35 PM To: Andrew Zimmermann Subject: RE: 217-239 Demo Plan Preferably removed but we will work with you. Lt. Peter Schaeublin Fire Marshal Salem Fire Department 29 Fort Avenue Salem, MA 01970 pschaeublin(c salem.com From: Andrew Zimmermann [azimmermann@rcg-llc.com] Sent: Thursday, June 02, 2016 11:27 AM To: Peter Schaeublin Ce: Tristan Smith; Jim Gagnon; admin(alnhdemolition.com; Laura Walters (lauraCa@nhdemolition.com) Subject: RE: 217-239 Demo Plan Thanks Peter.lust to confirm, if combustibles are demo'd and piled overnight,that would trigger off-hours fire watch? I think our plan is to demo and remove the combustibles initially and as quickly as possible but I don't know if immediate haul away is possible. Kevin—let's try and work this out logistically. Andre,,,7irnmerm:ann Development Manager RCG :1.7 ivaloo Street Suite 100 Somerville, MIA 02143 Off!ce 617 625 8315 Ce":415 215 6550 azimmermann@rcg-Ilc.com From: Peter Schaeublin [mailto:pschaeublin(abSalem.com] Sent: Thursday, June 02, 2016 7:21 AM To: Andrew Zimmermann Cc: Tristan Smith; Jim Gagnon; adminoInhdemolition.com; Laura Walters (laura(slnhdemolition.com) Subject: RE: 217-239 Demo Plan Mr. Zimmermann, That covers it but we also want to make sure that combustibles are not left piled on site after demo. Thank you for reaching out early n the process. If you should have any further questions for our office, please do not hesitate to call. Lt. Peter Schaeublin Fire Marshal Salem Fire Department 29 Fort Avenue Salem, MA 01970 1 r - oschaeu bl i n Casa lem.com (978) 745-7777 From: Andrew Zimmermann [azimmermann@rcg-Ilc.com] Sent: Wednesday, June 01, 2016 5:37 PM To: Peter Schaeublin Cc: Tristan Smith; Jim Gagnon; adminCalnhdemolition.com; Laura Walters (laura(anhdemolition.com) Subject: 217-239 Demo Plan Peter, Thanks again for meeting us on site today to review the demo plan. I wanted to follow up and reiterate my understanding of our conversation. Please let me know if anything we talked below is not correct. 1. RCG/NH Demo will abate the building before fire suppression and electric disconnects occur.The site will be secured with a 6'construction fence with lockable gates prior to abatement commencing. 2. RCG/NH Demo will notify SFD the day final disconnects occur and request written sign off of property inspection for the purpose of filing a demolition permit with the city. 3. After receiving a demolition permit NH Demo will prioritize removal of combustibles from the buildings and pull the structures down as quickly as possible. 4. Fire Watch, as discussed today, will be required when demo crews are on-site demolishing the building, until combustibles are removed and the buildings are substantially torn down. 5. Fire Watch will not be required after the building structure has been demolished. 6. RCG/NH Demo will try to notify SFD 12 hours in advance of any demolition activities requiring a fire watch. Right now,we anticipate the following demo durations-subject to change at any time due to variability in utility disconnect scheduling. Abatement:June 27-July 1 Final disconnects:July 5 File for building demo permit:July 6 Demo Crew Mobilize:July 7 Andrew 7_imrnermann Developrnent Manager RCG 17 ivaloc Street Suite 100 Somervi le, Mrs 017.43 Off.cc 617 625 8315 C4iii Es,i s u`50 azimmermann@rcg-llc.com Please note the Massachusetts Secretary of Slate's office has determined that most entails to and from municipal officials are public records. FM I.please refer to: htto://www.see.state.ma.us/ore/l)reidx.htm. Please consider the environment before printing this email. 2 Salem Fire Department Outside Paid Details CContractor Pay Rates Effective May 2015 Regular Detail Rate: LTJ Minimum of four(4) hours: $220.00 Any portion in excess of four(4) hours: $55.04\per hour Five (5) hours: S275.01' If private detail extends past five (5) hours worked, the detail employee shall be compensated for eight (8) hours. Five plus (5+) hours: payment for eight(8) hours $440.00. Any portion in excess of eight (8) hours: $66.00 per hour. Holiday Detail Rate: The detail rate for Christmas Eve (1600 hrs. to 2400 hrs.), Christmas Day (0000 hrs. to 2400 hrs.),New Year's Eve (1600 hrs. to 2400 hrs.) and New Year's Day (0000 hrs. to 2400 hrs.) shall be ($70.40) Seventy dollars and forty cents per hour, with a minimum of four(4) hours. Officers/Firefighters/Details Requiring a Crew: In the event that an outside detail requires a team of firefighters consisting of a permanent/ temporary company officer(or higher rank) and a minimum of two (2) firefighters, such company officer shall be paid at the following rates: Minimum of four (4) hours: $264.00 Any portion in excess of four(4) hours: $66.00 per hour Any portion in excess of eight(8) hours: $77.00 per hour The detail rate for permanent/temporary company officers (or higher rank) for Christmas Eve, Christmas Day,New Year's Eve and New Year's Day shall be ($81.40) Eighty-One dollars and forty cents per hour for all hours, with a minimum of four (4) hours. Two hours minimum of($110.00) shall be paid in case of cancellation, unless the employee is notified at least one (1) hour in advance of the requested start time of detail. In the event that the contractor cancels the outside paid detail after the requested start time of said detail,the employee shall be paid a minimum of four (4) hours. Detail arrangements must be made 24 hours in advance by calling 978-744-1235 and asking for the Detail Officer. The City of Salem *Per MGL 44/53C shall charge a fee of 10%of the cost of the services authorized. A copy of the law can be obtained at http://www.mass.aov/legis/laws/me1/44- 53chtrn *This fee is reflected in the above rates. In the event we must use personnel from another city or town to fill a detail request, fees will . reflect current contractual rates set by the outside employee's community. ��`��-� bis CITY OF SSU EINI, l L-1SSACHUSETTS • BuiLDwG DEPAR-MENT 130 WASHINGTON STREET, Yo FLOOR $ TEL (978) 745-9595 FAX(978) 740-9846 KI%fBERLEY DRISCOLL MAYOR THOMAS STTIERRS DIRECTOR OF PUBLIC PROPERTY/BUILDING CONWISSIONER Demolition Permit Sign-Off (Supplement to permit application) hereby supply the following releases as part of the application for a permit to demolish the structure located at Z1-7 - Z5 ( Wim ¢ -..--------—. and shown on the Assessors Maps of_ ��as being on Map # `34 Block # Lot# b . X10 The 8'h Edition of the Massachusetts 'State Building Code, 780 CMR, states in part: "A permit to demolish or remove a building or structure 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 manner. r Utility to be Notified r . Notice Received by _Date Received Gas 0'Dorw e 7 ll za l c Telephone. Rj -de,,fz0VL (9 1Z 7 Zell Electric Del /1�4 (Orreo� — NC•-crid 7�d�lzDC� Public Utilities Munici al Health Department i_ A {30(• (0 2c 7 � Fire Deparrinent Other - Other- Demolition debris hauler: NP j]� I�CryC(�Q r Location of licensed dernolition debris landfill: i~ Signature of Applicant Date: _ -- - Signature of Owner �/� �uC c&(!:P, Date: L�{ This sheet must be returned to the Inspections Department along with a completed application for a permit, a site plan, and any other applicable information and fees: ]7emoperm.drn: .. Andrew Zimmermann From: David Knowlton <DKnowlton@Salem.com> Sent: Wednesday,July 06, 201611:01 AM �VV` To: 'Chris Ryan' Cc: Andrew Zimmermann Subject: RE: Dodge St - demo plan (2013-107) Thanks chris,the plan is approved. Please have a licensed drainlayer with the city pull a permit for the cut and caps on public property. The actual capping must be witnessed by salem dpw,your contractor will have to request the inspections as part of his permit to excavate and cut and cap. Once the cut and caps are completeda nd witnessed, I can sign off on the actual building demo permit. Thanks david _......------.._ ._ From. Chris Ryan [mailto:CRyan(&dci-ma com] Sent: Friday, July 01, 2016 4:47 PM To: David Knowlton Ce: azimmerman(o)rcg-llc.com Subject: RE: Dodge St- demo plan (2013-107) Hi Mr. Knowlton, I've included a revised demo plan with this email. It addresses your comments as to the water gates in Dodge St. Court, and the water mains to be capped near the Washington St. intersection. I've added the limits of Phase 1 demo and indicated the sidewalk to be left open (as Mr. Zimmerman pointed out in his email). Phase 2 demo will be done once RCG is in control of the city-owned parking lot parcel, and I believe that will happen after the Massworks work is complete, which includes placement of the new curb and temporary asphalt sidewalk along Washington Street which would be available for pedestrian use. If there are any more questions or comments, please let me know so I can resolve them quickly. Regards, Christopher A. Kvan, FIT Project Fngtneer Design Consultants, Inc. 120 Middlesex Avenue, Suite 20 Somerville, MA 02145-1104 T: (617)776-3350 x114 F: (617)776-7710 From: David Knowlton [mailto:DKnowlton2Salem.com] Sent:Thursday,June 30, 2016 5:39 PM To:Chris Ryan 1 Cc: azimmerman@rcg-Iic.com Subject: RE: Dodge St-demo plan (2013-107) Hi Chris, I think we are very close. I marked up three (labelled 1, 2, annd 3 on the attached plan) cut and caps on the water that need adjusting. Also, closing the city sidewalk in front of the building on the northeast side wil be problematic, peds will be forced into a very long detour to go north or south on that side of th street. Can the existing city sidewalk be relocated into the parking lot during the demo work?The pain should show temp ped directional signage you propose to use during the demolition work. Thanks, give me a tial to discuss if you'd like david From: Chris Ryan [mailto:CRyan(adci-ma.com] Sent: Friday, June 24, 2016 4:22 PM To: David Knowlton Cc: azimmerman(c�i rcg-Ilc.com Subject: Dodge St -demo plan (2013-107) Hi Mr. Knowlton, Attached is a revised demo plan. I've added cut and cap locations, and I addressed your comments from your marked-up plan: -We were able to locate a 4" sewer service out of the building along Washington Street.That is now shown. We were not able to locate a second location of a sewer service leaving the building which held the billiards parlor. I don't believe that building has a basement. -the water services you indicated on your markup are now hatched as items to be removed -the catch basin on the south side of the property which had no pipe coming out is, upon inspection, a leaching catch basin. -the catch basins on the north side of the site that you highlighted are to be removed, and are designated as such. -the structures you thought were on the eastern side of the parcel were most likely our proposed deck drains that, due to their lineweight on the plans, may have been mistaken as existing structures. -the two manholes in the southwest corner of the existing building are electric manholes which are to be removed/relocated -the catch basin and DMH in the northwest corner of the site are in fact connected into the drainage in Dodge St, and are to be removed. If you have any other questions, please feel free to contact me on Monday. Regards, Christopher A. Ryan, EIT Project Engineer Design Consultants, Inc. 120 Middlesex Avenue, Suite 20 Somerville, MA 02145-1104 T: (617)776-3350 x114 F: (617)776-7710 Please note the Massachusetts Seeretary of State's office has determined that most entails to and from municipal officials are public records. FMf please refer to: hthr//www.see.state.nia.us/ore/preidx.litni. Please consider the environment before printing this email. 2 nationalgrid 40 Sylvan Rd Waltham MA 02451 July 14, 2016 RCG LLC Andrew Zimmermann 17 Ivaloo Street Somerville MA 02143 azimmermann(i4cg-1 lc.corn RE: Service Removal for Building Demolition. Dear Mr. Zimmermann, This letter is to confirm that,per your request,National Grid has removed the electrical service from 221-223 Washington Street, Salem MA as of 7/13/16. If you have any questions or need further assistance,please feel free to contact me at (508)357-4522. Sincerely, Deborah Correa Customer Fulfillment Ph #508-357-4522 Fax # 1-888-266-8094 deborah.correa@nationalgfid.com nationalgrid 40 Sylvan Rd Waltham MA 02451 July 14, 2016 RCG LLC Andrew Zimmermann 17 Ivaloo Street Somerville MA 02143 azimmermanu(cry rcg-llc.com RE: Service Removal for Building Demolition. Dear Mr. Zimmermann, This letter is to confirm that,per your request,National Grid has removed the electrical service from 231 Washington Street, Salem MA as of 7/13/16. If you have any questions or need further assistance, please feel free to contact me at(508)357-4522. Sincerely, Deborah Correa Customer Fulfillment Ph#508-357-4522 Fax# 1-888-266-8094 deborah.correa@nationalgrid.com nationalgrid July 11,2016 To: Andrew Zimmermann, Re: 217-251 Washington St. Salem,MA This letter is to notify you that our records now show that the gas service to 217-251 Washington St. Salem, MA has recently been cut(6/30/2016) and capped in the parking lot. There is no longer gas service to the premises. If you have any questions please feel free to contact me at 781-794-3532 Sincerely, Chris O'Donnell Sr. Gas Sales Support Representative National Grid 40 Sylvan Rd Waltham, Ma 02451 781-794-3532 Andrew Zimmermann From: Reed, Kathleen B (Kathy Reed) <kathleen.b.reed@verizon.com> Sent: Monday,June 27, 2016 2:02 PM To: Andrew Zimmermann Subject: RE: 1A1R7XL 217-239 WASHINGTON, SALEM This email serves as notification that disconnect was complete From: Andrew Zimmermann [mailto:azimmermann@rcg-Ilc.com] Sent: Monday, June 27, 2016 1:52 PM To: Reed, Kathleen B (Kathy Reed) Subject: [E] RE: SASR7XL 217-239 WASHINGTON, SALEM Hi Kathy, I assume the disconnect work is complete. Can you provide a letter that the work has been done? Thanks Andrew!Zimmermann De've;cprren, Vpnager. RCG 17 Suite 100 So!rerviile, MP,02143 Oi';ce 6 17 625 837.5 azim merma nn 2 rcg-Ilccom From: Reed, Kathleen B (Kathy Reed) [mailto:kathleen.b.reed@verizon.com] Sent: Monday, June 20, 2016 9:18 AM To: Andrew Zimmermann Subject: RE: 1A1R7XL 217-239 WASHINGTON, SALEM Sorry I was referring to the re-route job.The trim out for the addresses will be dispatched out this week.From: Andrew Zimmermann [mailto:azimmermann(aIrcg llc.com] Sent: Monday, June 20, 2016 9:14 AM To: Reed, Kathleen B (Kathy Reed) Subject: [E] RE: 1A1R7XL 217-239 WASHINGTON, SALEM I'm confused Kathy. I was looking for an update on crews being dispatched to disconnect service from the existing buildings on the site 217-251 Washington St. I understand that the cable material you are waiting on is likely for the cable relocation project that is separate. I'm looking for an update on the disconnects at the moment. Andrew 7_Insmc r nann Devel,lprr.en[ Manager RCG 17 iveloo Street Suite 100 Sc:nerri'le, tJ^:02143 Office 611 6,25 8315 t C,-!'d;.5 2'5 6550 azimmermann@rcg-Ilccom From: Reed, Kathleen B (Kathy Reed) [mailto:kathleen.b.reed(o)verizon.com] Sent: Monday, June 20, 2016 6:42 AM To: Andrew Zimmermann Subject: RE: 1A1R7XL 217-239 WASHINGTON, SALEM Andrew I can't give you a date at this time. We are wtg for the cables to be delivered.That process can take a few weeks due to the size of the cables. Kathy From: Andrew Zimmermann [mailto:azimmermann(abrcg-Ilccom] Sent: Friday, June 17, 2016 12:08 PM To: Tidman, Kelly; Reed, Kathleen B (Kathy Reed) Subject: [E] RE: 1A1R7XL 217-239 WASHINGTON, SALEM Kathy, An update on the timing of this would be appreciated. We are looking to file for a demo permit soon. Thanks, AZ Andi c!w Zimmermann Development Mar,-ager RCG 1.1 I,-aloo Si reef S,-ilte "00 Sornervilie, PAA 02143 Office 6:17 625 8315 azimmermann@rcg-Ilccom From: Tidman, Kelly [mailto:kelly.tidman(cDverizon.com] Sent: Thursday, June 16, 2016 2:24 PM To: Andrew Zimmermann; Reed, Kathleen B (Kathy Reed) Subject: 1A1R7XL 217-239 WASHINGTON, SALEM Kathy, That would be 1A1R7XL 7,eCly Tidman Verizon Communications Outside Plant Engineering 459 Main St. Saugus MA 01906 978-499-0641 781-941-7940 Eng Call Ctr: 866-686-1195 venzw/ 2 Andrew Zimmermann From: Larry Ramdin <Iramdin@Salem.com> D Sent: Wednesday,June 29, 2016 12:40 PM To: Andrew Zimmermann 5v J Cc: Tristan Smith;Thomas St. Pierre 4 Subject: RE: [City of Salem MA] Demo of 217-251 Washington Andrew, Yes, since there was no internal activity, I have no objections to the demolition of the buildings. I am concerned about the bait consumption outside the building, can I have a map of the site with the stations numbered with activity related to the traps e.g. if the activity observed is at location 5 or location 20 or both. Sincerely Larry Larry Ramdin MPH, MA, REHS, CHO, CP-FS, HHS Health Agent Salem Board of Health 120 Washington Street Salem MA 01970 978-741-1800 (office) 978-745-0343(Fax) Office Hours Monday- Wednesday 8:00 am—4:00pm Thursday 8:00— 7:00 pm Friday 8:00 am- 12:00 noon From: Andrew Zimmermann [mailto:azimmermann@rcg-Ilc.com] Sent: Wednesday, June 29, 2016 11:58 AM To: Larry Ramdin Cc: Tristan Smith Subject: RE: [City of Salem MA] Demo of 217-251 Washington Larry, We had Paige exterminating back to check the traps. The report is attached. Based on the below email, please confirm we are good to go on pest control before demo. I will be looking to collect department sign off next week in anticipation of filing for a permit soon after. Thanks ,AnJrew Zinmermann Development Manager RCG 1.7 'rsaloo Street Suite 100 Somcrvllle, MA 02143 Offre 617 625 8315 C:eil 1115 215'5511) azimmermann@rcg-Ilc.com 1 ___.-_wa_. .._ Prom: Larry Ramdin [mailto:lramdin(cbSalem.com] Sent: Wednesday, June 08, 2016 5:09 PM To: Andrew Zimmermann Subject: RE: [City of Salem MA] Demo of 217-251 Washington Andrew, Yes, if this is demo only then only one more check is necessary Larry Sent from my Verizon Wireless 4G 1AT smartphone -------- Original message -------- From: Andrew Zimmermann<azimmermannkrcg-11c.com> Date: 06/08/2016 4:31 PM (GMT-05:00) To: Larry Ramdin<lramdin(c)Salem.com> Cc: "Thomas St. Pierre" <TStpierrega,Salem.com>, Tristan Smith <tsmith ,rcg-llc.com> Subject: RE: [City of Salem MA] Demo of 217-251 Washington Hi Larry, I have some answers below and a question.Tristan and I will be your main contacts for this project. Andrew Zimmermann Development Manager RCG 17 Ivaloo Street Suite 100 Somerville, MA 02143 Office 617 625 8315 Cell 415 215 6550 azimmermann@rcg-llc.com -----Original Message----- From: Larry Ramdin [mailto:lramdin@Salem.coml Sent:Tuesday,June 07, 2016 9:41 AM To: Andrew Zimmermann Cc: Thomas St. Pierre;Tristan Smith Subject: RE: [City of Salem MA] Demo of 217-251 Washington Thank you for providing the information, there are some gaps and concerns I have 1- The Rodent plan does not accurately show the survey results and treatment plan, what we have is a bid and response to that bid,the documentation is sample forms that are not filled out. The survey results should indicate initial findings on the site and guide the treatment plan.The survey and treatment should begin at least 2 weeks prior to any construction related work. Our Pest Inspector will update the plan with findings. I believe where there was no information it was because no activity was found but I will have them update and return. 2-The frequency of inspections is monthly initially for a construction site is inadequate I suggest weekly for the first month of construction and then the schedule can be adjusted based on activity of rodents 2 i Page Exterminating, Inc. Invoice: 184507 Dater 06/13/16 30-A Maverick Street -Mr" Account: 9604 East Boston.MA 02128 BBB Route: 70 (617)567-1293 • Fax(6M561-3950 Pagextocotncast.net n 81LLTO: SERVICE TO: a� RCG LLC RCG LLC 76 LAFAYETTE ST. 217-239 WASHINGTON ST. SUITE 203 SALEMr MA 01970 SALEM, MA 01970 978-740--0006 978-609-0524 AML SERVICE DESCRIPTION: SERVICE INSPECTION AND TREAT PROPERTY FOR 225.00 RODENTS FOR PRE—DEMOLITION -MONITORING AND CONSTRUCTION THERE WILL BE iT6A'illLY�—vI{SIM DURING CONSTRUCTION FIRST VISIT ON 5/27/16 INSTALLED RTU RODENT PROTECTOR BAIT STATIONS TREAT IN BLDGS CALL 1/2 HR BEFORE TRISTAN' 978-740-0006 FILL OUT A SEPARATE INSPECTION REPORT TOTAL AMOUNT DUE — — 225.00 �� Supervisors and OparBtorsName and CorG1'«;ateNumtier �e,Y)Qr+`t/ " ' Pesticides t66Wiipjlled EPA Amt. Pesticides to be applied EPA Amt. Product for sale Oty. Cost Total O tads NA O Majaorc Grants 432.1255. 1448 I 072 NA O snap:rws NA 72 ' a claw GUR 175 Q papanciso 432JGs SnapTrapsift._.....':.._._.__... _ O Comae Place Pae 124558W O'raL=Gnnufar 2f91/67 Snag Traps W? "'_I Coreac nloz 12455.79 O Tasty 2791206 Bestyet O OtgontAvion IM1489 O Twoonust. 432.1373 F West/ght i O Fid? 655798 O Tmprld 432.1483 74en8x F7_Y M 13 Ron SVM 7173m256 O Yeudesa 102t-2M O Madorce FG 432.1257 O imndef 9144486 r _ r � CommentslRecominendatiorls:Pj„ft�. alt dn("t-S ''• Aj, C ),r1..�/ R-}rlVJ /h S ('ItCfL'tE bk4 Unea �l2. ylt s pttolin� �QIS / 6F Ui/!!N "ats {7 7heIn l rI-P !jJ Time Out—I—/— Accounts will receive a processing tea of$25 It they need multiple IPM books or history pest 60 days. CUSTOMERDATE AMOUNTPAID (oil invoices over 30 days are subject t*surchuges) Ly06- - °ca" r , D r 4 i QQ I 1 i 1 1 , f { + 1 t 1 , 17 F � h Vvtp51 �rTy I s �, 1 e f b � � 30A Nkmezrk Street ASSOCIATE Eagt Boston,UA 021.28 617•56 •1293 Fax 51'•SSt-3956 Bid & Work Specification for Integrated Pest Management (IPM) at RCG. LLC. C/o Tristan Smith 76 Layfayette St. Suite 203 Salem, MA 01970 978-740-0006 tsmith ct)rcg-llo.corn - Summary After evaluating the property's history with pests,, and evaluating the current situation, we hereby submit this proposal for Integrated Pest Management(IPM)services to be performed monthly while building is under construction. Description Integrated Pest Management(IPM) is a common sense approach to pest management that utilizes a variety of different control methods. Conditions that introduce pest, sustain their existence,and promote infestations are addressed first.By doing so,target pests are literally attacked from many different angles with less dependency on chemical rodenticides. Chemical products and procedure may still play a role in an IPM program, but by no means are the central focus of the overall plan. Considerable effort is also placed in pest exclusion,sanitary practices,and structural alterations(when necessary). A successful program requires the collaborative efforts of everyone involved in the management and maintenance of the building and construction site. Page Exterminating, IPM program is innovative,well planned,,and precisely executed. The Page Exterminating,Plan I. Meet with Tristan Smith or any other appropriate person(s)to explain the pest management program and answer all questions or concerns. 2. Provide RCG, LLC r 2127-233 Washington St. Salem,MA 01970 with a schedule of times and dates that our service technicians will be servicing the property. I Provide a notice at least 24 hours prior to any service requiring preparation and/or special precautions for the use of chemical products. 4. Educate the staff as to how they can help facilitate a quick, efficient elimination of pests in a manner consistent with the goats of the IPM program.Page Exterminating, offers to conduct a pest seminar(at no cost) to help the staff understand the rote they play in successful IPM. 5. Complete a pest management inspection and rodent monitor device assessment to building perimeter and construction site areas to control rodent entry,inhabitancy, or infestation, Monitoring devices will be dated,checked regularly, and replaced as necessary.All inspection and monitor device findings will be documented in a detailed IPM report. & Advise the Site Manager of an identified pest incident or problem. An assessment of the type and scope of the problem will be determined and presented to the building manager(in writing) in our IPM report. A specific action plan will be outlined after considering all options. Part of the plan will include sanitary and structural recommendations as they pertain to pest introduction and survival. All non-chemical methods (i.e. exclusion, trapping, etc.)will be considered and utilized first.When Page Exterminating, deems it necessary to use a chemical product, the product offering the least toxicity and human exposure will be used (i.e. baits, biological controls, etc.) 7. After a treatment has been performed an evaluation schedule to monitor the success and completeness of the procedure will be established. Each evaluation inspection will be documented by our technicians in our IPM report. At the end of the evaluation period,a final determination will be made by our technician as to the success of the procedure,and how to maintain and prevent further reinfestation. 8. Provide RCG,LLC ,@v � ,2127-23') Washington St. Salem, MA 01970 with detailed inspection reports. IPM reports identify problem areas.or potential problem areas, and serves to document all activities performed by Page Exterminating Quarterly summary IPM reports and client conferences are available to review past and future IPM plans. Yearly financial reports are also available on request, Our IPM reports are maintained in our Page Exterminating, INC, Log Book.which are left on-site for easy reference.The logbook also serves as a medium for your staff to note pest sightings and occurrences in between regular service visits. -Ilus enhances communication between RCG staff and Page Exterminating Services.INC. 9. Service tendered in-between regular visits are referred to assptcialsmices." Special service calls are performed at additional charge to all clients. 1. All Special service fees will he a ininimum of S100,00 depending on the service required. 10.Use only EPA and Massachusetts registered products. 11. Provide the Material Safety Data Sheets(MSDS) and sample labels of all products that will be used, upon request. 12. Pests covered by this program: Rodents. RCG, LLC (a-j 2127-233 Washington St.Salem, 141A 01970 performance 1. Keep clean and sanitary all areas necessary to facilitate the success of the IPM program. 2. Cooperate and perform all feasible requests made by the Service Technician with regards to structural improvements, sanitary practices, and pest exclusion recommendations. 3. A -A,and make easy access available for the Service Technician for necessan, inspections. Ito monitoring,and applications. 4. Notifying appropriate parties as to the intent of pest control procedures being performed. 5. Timely payment for all work performed Cost and Schedule of Services Initial Cleanout: TBD During the initial service the property will be baited for rodents. A Page Exterminating pest management professional will install, bait, anchor and label rodent protector bait stations inside and outside the premise at 217-233 Washington St, Salem, MA 01970. The PMP will also inspect the premises and dust any rodent burrows on the property. In addition,the initial service will include a site inspection report detailing any activity seen and any recommendations to minimize/eliminate future activity. Schedule(Frequency):Monthly Cost of Services: TBD During the monthly visit the property will be inspected/baited for rodents. A Page Exterminating pest management professional will inspect,bait, and label rodent protector bait stations inside and outside the premise at 217-231 Washington St. Salem, MA 01970. The PMP will also inspect the premises and dust any rodent burrows on the property. In addition, the PMP will complete a site inspection report detailing any activity seen and any recommendations to minimize/eliminate future activity. ff necessary, the cost to replace any rodent protector bait stations will be a one-time reduced, ee of $50.O0 per box(usually S 75.00 per bay) to install, bait, anchor, and label. We hereby submit this proposal for your consideration and respectfully request the opportunity to work with you. anessa Giovanniello XV— X— Page Exterminating(5/24/16) RCG, LLC- Vanessa Giovanniel lo, Operations Manager Tristan Smith, BBR Page Exterminating, Inc. 4 Invoice: 183525 Date: 05/27/26 30-A Maverick Street Account: 9604 East Boston,MA 02128 BBB . Route: 70 (617)567-1293 • Fax(617)56I-3950 IM PaBext®comcast.net BILL TO: SERVICE TO: RCG LLC RCG LLC 76 LAFAYETTE ST. 217-233 WASHINGTON ST. SUITE 203 SALEM, MA 01970 SALEM, MA 01970 978-740-0006 978-609-0524 AMT. SERVICE DESCRIPTION: SERVICE INSTALLED 20– 25125 RODENT BAITERS 7 STORE FRONTS INSTALLED 12 RODENT BAITERS 5 BASEMENTS INSTALLED 8 RODENT BAITERS RODENT BATTERS REG. PRICE @ $25.00 EACH 500.00 DISCOUNT @ $5.00 EA. –100.00 SERVICE INSTALLED 18 RTU RODENT PROTECTOR 900.00 BAIT STATIONS EXTERIOR OF BLDG. & FENCE LINE OF PROPERTY RTU'S REG. PRICE @$50.00 EA. DISCOUNT PRICE @ $40.00 -180.00 INCLUDED-ANY RODENT BURROWS ON THE OUTSIDE OF ENTIRE PROPERTY NO ADDITIONAL CHARGE MONTHLY CHARGE: $225.00 INSPECT/TREAT ALL BAIT STATIONS INSIDE & OUT SIDE OF BLDG. AND DUST ANY BURROWS Supervisors and Operators Name and certificate Number TOTAL AMOUNT DUE - 1,120.00 01448 Pesticides NA Q Madorwomras 432.1254 _71117-1 ' t_ 1372 ru O smpgapsNA 72 i � t a 0880 9444.175 O &apendsc 432.763 snapTr s t nl a —� 1 oCa*=PlacePac 1245486 0TahWGMMAar 278-3167 SmpTrepslM3 aconowBlar 1245679 oTahw 219-3208 Best Yet J O DupordAAon 100.1489 a Tempo butt. 432.1373 Fly Web Light , O Fxdtr 654798 O Temord 432.1483 Mantis F I O FIM Sfte 7173258 O Yerdeaa 1021.2593 r a MadorceM 432.1257 O wwor 9444-IW I I Comments/Recommendations: j Timetn _/_/_ Time Out—I—/— Accounts will receive a processing fee of$25 It they need multiple IPM books or history pest 60 days. CUSTOMERDATE • 3 �. • Q Ca4h O C1 err Page Exterminating, Inc. i Invoice: 183525 Date: 05/27/16 30•AMaverick Street 23 Account: 9604 East Bostpp,MAA2128 BBB ' Route: 70 (617)567-1293 - Fax(617)561-3950 Pagett@comcastnet BILL TO: SERVICE TO: RCG LLC RCG LLC 76 LAFAYETTE ST. 217-233 WASHINGTON ST. SUITE 203 SALEM, MA 01970 SALEM, MA 01970 978-740-0006 978-609-0524 AMT. SERVICE DESCRIPTION: 'SERVICE INSgECT;OTI AND TREAT fROPERTY FOR RODENTS FOR. PRE—DEMOLXTIOR MWITORING AND CONSTRUCTION THERE WILL BE MONTHLY VISIT DURING CONSTRUCTION FIRST VISIT ON 5/27/16 SECOND VISIT DURING THE MIDDLE OF NEXT MONTH INSTALLED RTU RODENT PROTECTOR Sat STATIONS TREAT IN BLDGS AND THE EXTERIOR OF- BLIJ(r CALL 1/2 EIR, BEFORE TRISTAN 420-740-0006 FILL OUT. A SEPARATE INSPECTION REPORT FRIDAY_BETWEEN 3-4 PM TOTAL AMOUNT DUE — -- --0.00 Supervisors and Operators Name and Confficate Number Pe s ilaiie-S,io'6'e, p-Ile"d* EPA AML Pesticides to be applied EPA Amt. Product for sale Gly. Cost ToMm ❑1448 NA ❑ f.+a=r oraraa 432.1255 072 NA ❑ ftyTrap NA 72 I O case 94M 175 ❑ sLapandse 432.763 SmoTraps(Ri O Cm7ac Plato Pac 1245586 Cl TatswGranutar 2T9J187 5 Tr o M -��-_-�_ v ca ftaalox 12455.79 O Tamar 2793206 best Yet ❑OuporitAvion 1041489 a Twhpo Dust 432.1371 Flyvlabilgls --1 ❑Fsdtr 855.798 ❑T432.1481 ' MarNS Fhr U91a 1a Fastsmke 7173258 10 vw4eua 1021.2593 O Maldorce FC 432.1257 , — ---_--� .— Olmader 9448.186 Comments7Recommendations: 8 FF-r S I rZW .A , _- _ 4 •.�a,CiL/.I.�L4'� I—/LGYLW .L.�.(/K.Q.� aL�✓''G�uvwu�ar�l�i Timeln S7�.+?- 9 B6 � 71meOut 3/(" Aeeo etsw 7eceIves recessing too ot 25 If they need Multiple IPM books or history past 60 days. DATE AMOUNTPAID (ail invoices ow 30 days subject • . O Cann OCl xt HOUSING SANITATION TRACKING REPORT L �C Al - hg Etterrttzurz , lr7c; C l`�° / 30A Bosgirl, A02 P 3 w I....V WV.. B. East ton,RLr1021?8 61 S6J-I?93 Fax W-561.390 LOCATION&APT# MATERIAL SANITATION INFESTATION COMMENTS Poor(P)Fair(F) Heavy(H)Moderate Good (G) (M)Light l N!A �' ry 5 aS i to 8 Va ez, '7 a To vti ; r 1 Cy DEMOLITION PLAN Proud to partner with: Servicing Southeast New Hampshire NH.VT.MA.ME • ' • Habitat NEW► for Humanity® NpSHI E � �EM.O.LITION A Division of Tayla Nixon Site Developers,Inc. Industrial •Commercial•Residential 792 Londonderry Turnpike I Auburn,NH 03032 1 T: (603)641-1111 I F: (603)647-8372 info@nhdemolition.eom Washington @ Dodge Demolition Washington St and Dodge St Salem, MA 1. ASBESTOS: Any necessary asbestos&hazardous materials abatement to be completed by New Hampshire Demolition 2. EQUIPMENT: The equipment intended to be used on this project are as follows: A. PC300(s)with grapple and or bucket,thumbs,hammer or pulverizer B. PC400(s)with grapple and or bucket, thumbs,hammer or pulverizer C. PC600(s)with grapple and or bucket,thumbs,hammer or pulverizer D. Bobcat(s)with grapple. E. Loader F. Truck and trailers 3. DEMOLITION: The procedure and sequence for the demolition work associated with this project are as follows: A. Owner to Cut and Cap water and Sewer,and notify utility companies B. NH Demolition will verify with utility companies that disconnection of any and all utilities,have been completed. C. Owner to obtain all required permits,demolition and erosion D. Removals of all identified hazardous materials have been removed by the contractor prior to the commencement of any demolition. E. NH Demolition will gut out building with bobcats and laborers,separating all materials. F. Excavator(s)will approach and dismantle buildings,one bay at a time,lowering material down to the ground. G. Excavator with grapple will begin picking at and dismantling building. Dismantling the structure continually in a safe manner,picking from top of building, lowering material to the ground. All loose material will be pulled down in a safe manner as we take down each bay,leaving no hanging objects. When all C&D material is removed,foundation and slab will be removed and crushed with footings. H. Fill foundation and all holes and voids with acceptable fill material and return site to acceptable grade 4. RECYCLING: NH Demolition intends to use the services of a recycling center to support the removals for this project.It is NH Demolitions intent to recycle all of the materials removed as a LEED project. Facilities to be used on this project are as follows: A. ERRCO is a full service demolition debris processing center. 270 Exeter Rd Epping,NH Washington @ Dodge Demolition Page 1 DEMOLITION PLAN B. Schnitzer Steel Industries,Inc. is a full service metal recycling facility supporting and participating in the LEED program. Schnitzer works with environmental consultants,and state environmental agencies to solve the problem of special waste disposal. 399 Willow St Manchester,NH C. Waste Management. 90 Rochester Neck Rd Rochester,NH Upon Completion of the project, ERRCO, Schnitzer Steel Industries and Waste Management will issue all recycling tickets and reports certifying the processing of materials to support LEED certification. 5. DRY CUTTING: There is to be no dry cutting on this job 6. DUST CONTROL: The procedure and sequence for the dust control associated with this project are as follows: A. NH Demolition to keep work sprinkled with water,using hoses,to minimize dust B. Owner/GC to provide available water hydrant within 100 feet of building to be demolished C. NH Demolition will provide 1.5" fire hose manned by laborers throughout take down of building,with a constant flow of water. D. Dust control will be conducted on a daily basis. Water sprays will be used on exposed soil,demolition, excavations and on excavated materials during loading to reduce emissions. Trucks hauling material from the site will be covered with tarpaulins or other appropriate covering that can be securely fastened.Trucks will also have sealed tailgates preventing deposition of material onto public ways. 7. SAFETY: NH Demolition will be responsible for project safety during the demolition of this project as well as keeping the staff aware of any safety precautions on site. All work will conform to OSHA requirements and standards. A. NH Demolition will complete daily inspections, evaluating the structure and detecting potential hazards. If at any time during the project,hazardous material, asbestos containing material, suspicious odors or substances are encountered, NH demolition will cease work immediately and notify RCG LLC superintendent. B. All employees will be required to wear appropriate Personal Protection Equipment (PPE) as specified by OSHA,Encore, and NH Demolition safety requirements. C. NHD Supervisor shall have a safety manual onsite with procedure requirements to address unanticipated contact with oil, chemicals,or hazardous material during project. D. NH Demolition will notify DigSafe E. NH Demolition employees are aware of emergency services located in Salem, MA and all applicable phone numbers will be posted on the jobsite. Washington @ Dodge Demolition Page 2 �Un�cx' - GENERAL NOTES 1.PHASE 1 OF SITE DEMOLITION TO CONSIST SOLELY OF EXISTING BUILDING DEMOTION Z AND REMOVAL OF MATERIALS.SIDEWALK PATHFOUNDATIONREMAIN E WALL ALONG WASHINGTON DEMOLITION STREET ro REMAIN.FRO E HALL SIDEWALK R REMNN OPEN WRING RHASE I.SEE ENT \\ \ NORTH PLANS FROM KHALSA REMAIN FOR SPECIFIC INFORMATION REGARDING EXTENT OF _ FOUNDATION WALL TO REMAIN AND DETAILED DEMOTION NOTES \�p, \ ®,�� _ 2.ALL WORK PERFORMED AS PART OF THIS PRc ECT SHALL CONFORM TO THE CITY OF \ i I I b \ _ .: SALEM.DEPT.OF PUBLIC WORKS AND ANY OTHER AGENCY WITH AUTHORITY W TICS 7 AREA. \ �. I Iz SEE•MASSWORKS UTILITY RELOCATION'PLANS PREPARED `� ,,,:, E310,0 s• r p \\ BY NEW ENGLAND aML EN 'NG CGRP., SALEM.MA. ".2` C ®I O- SeT MI 3.CONTRACTOR TO MAINTAIN WOW AREA W A CLEAN TINCTION.NO CONSTRUCTION I Y I I Tai SPECIFIC INFOMATION OF RELOCATED UTILITIES ` („j O_ DEBRIS SHALL BE ALLOWED TO ACCUMULATE WITHIN THE WOPo61TE AND NO DIRT, GRAVER'-ETC.SHALL BE ALLOWED TO ACCUMULATE ON THE PUBLIC RIGHT-OF-WAY. i 4.AREAS OUTSIDE THE UNITS OF PROPOSED WORK DISTURBED BY THE CONTRACTOR'S w � ��VE EXIST CLOFOR NEW OPE7GIf. OPERATIONS SHALL BE RESTORED BY THE CONTRACTOR TO THEIR ORIGINAL / REMOVE E14SIW0 CONDITION AT THE CONTRACTOR'S EXPENSE. REMOVE EXIST , CONCRETE WALK \ TREES a SHRUBS •n,�..•m.` /•GRASS SAIIWT LINE —_--- "---- -�-- --- '•"a REIDGTE S.SEE PRO.EAND (TYPI CT SPECIFICATIONS IN RELATION TO EROSION CONTROL MEASURES TEMPORARY UID11E5 DURING CONSTRUCTION. E705f CURB 6.SEE DETAIL SHEET C72 FOR CATCH BASIN SILT SACK AND TEMPORARY \ 'p-"-,�, �._ -=-- -__ R NEN DRIVEWAY OPENING CONSTRUCTION ENTRANCE DETAILS 7.SEE OPERATION AND MAINTENANCE PLAN PREPARED BY DESIGN CONSULTANTS•INC. RFNmvE EXIST 11 ' �" . REMOVE EXIST N / FOR CONSTRUCTION-PHASE MNNTENANCE PROCEDURES ' 7REE5! q�qVvyINi.�iw® \ TREESQ m i1 env.x.e •,n�TL®1- _ (TSI) WT- 4J /\ (TYP) - d f REMOVE EOSTWG V - �Alp� •r sm -- -/-(�H o p TBITUMINOUS® , CONCRETE ID -{ PAVEMENT RipECITFAY i LIMIT OF 4Y \a\ SEWER REMOVAL g� I ABANDONED {{�, Salem Gateway:S' � p OH o/ INSTALL Fi0901 74 Washington and y,^ -- CONTROL BARRIER ON DOMMIREAM mGF FMWDWEEXIST FURB � Dodge Street " ` Sd ArD GDSE DUT •1- - •� ,-T —— F105f DRIVEWAY OPENSNO 6� COS,WG.�.�.�� - .�. ..� _. , E , CM F�ORINE EXIST CUM ® Salem, MA- (@ a \f r anXlm4DusariGETE r_ R`var:r; •_,___�� .« oPETmImN1Y�'A4v° . \ 4 PAVEIET7T �TSSSSSi �. (6HLCAI>_ E ._ _,,......� i .- II �, ,� � I I DESIGN TEMPORARY , w l `; .yA7� _ '�,.w�, tljq♦��\jam.°'Ap , T `�1 -�"' ' ,.- _ .�Ea `i `°E DEVELOPMENT EXISTING CONSTRUCRON FENCE ',. •-,WT Alm /�7...a`.' "" `;y;; ..I'�\\G[- CQIOEIE NAII(4 - - -. ,iaf ARCWm PETRI((TYP /I l r �,r\ \ "' ��Y` --' ••` -- ;. :i-�:� „,, i} 4, ,:.,.,-- PLANS ELECTRIC MANHOLE ro j' ' ` /7 `� �._�-=---G• -'A- ert M1� qq .• 'I'?til ? d 1 t I PROP•EDT SACC CATCH FRnEcrvcp REMAIN I I I + art AND• R is ..r'A �r yam •(' -jl `��- ¢�� I /� 1 BASIN INSERT(TIP.) r ,}I CAP O .� I {.@�i T )I PLUG DRAW AT OWN RtMo GNAW AT al !1 /%/ , e.�AEWVE s7 /�YV/-//9 `` / y •.ijI-.y:w.' � -w "''," p `E s «elmmNo m(•.PHA�SE.La1-s,.�I > l 9 w•; i ;, ^I�-1I-.,II k j�i1= - caaacTE cEN EXCAVATE EXISTING PROP•mr SACO1TT] uw,IES AFfTW BITUMINOUS LIGHT PO LE SN. STREET DCN BASIN INSERT aFLocATIGm) NOTM REMOVE DOSI I PAVEMENT ZC FUZE HYDRA N T CONCRETE DRILL HOLE IN STONE BWIID FOUND ' PAVEIENT I= ® DRAW MANHOLE Ly SEWER Yytl¢ •';�iSs• �:ayd IF' ,�/` /•'�/�/;G//.J J/ ,I //♦`z/��/'.-\j` `. -R" Y r , nao.TrEs) I MANHOLE ELECTRIC.MANHOLE TEMPORARY ® m ELECTRIC MNOC CONSTRUCTION FME� MAIIDICP ACCESS/ RAMP Am G ,F- PROP SILT SACIr CATCH TREEmwat6y 3 OATEN VALVE(GATE)CE BASD (TSTABILIZED ENTRANCE PEI gOTmWFF OEC GATE REV(SEE DETAIL SHEETS) mmIGET-SEE "` WATnrG I ® -SILT SOXX•CATCH BASIN INSERT "`,�,• 8 c .i I I -. I "Ig I: I I - - -TEMPORARY PHASE I CONSTRUCTION FENCE D 9�x .,.�I....e.r , - ./' I TEMPORARY PHASE 2 CONSTRUCTION FENCE cfzt ��'�/°/ �J/ j//\'- d///'tea^// ,�,+�77r.J/'�I77]""/f/�"A'/9'F- +�-.�`•°�m �2�-', y°•.vc \I �I �� e,w . m'_.. sjT Qa w-.ma63i°mr_v_ �,VTI �,a'` ST,YII `ssT.-,a s.- s ./¢!- �y!ij�ri(��/�TI'IeI iI I SI {i�,�(•, \\�•'`•\ BE REMOVED �\\ \\ t\--e�O`®`\-v•,+\.-\Oti+-\.• \REMOVE EXISTING / STORM DRAIN TO BE RE MO VED BITUMINOUS S S- SANITARY SEWER TO BE REMOVED CONCRETE IREMOVE EXISTING PAWEM V— WATER TO BE REMOVED N ` PAIE39M INSTALL EROSION TELECOM TO BE REMOVED TELECTRIC REMOVED ed CABLE TV/COMM. LINES TO BE RE MOVED CONSTRUCTION FENCE AROUND, IR �YADTAIN PARKVG IERSITE PEROCE "ASE I) EXTENT OF PHASE I DEMOTON PAN I) ANDTo VERIFY TEMPORARY TEMPORARY CONSTRUCTION ENMANCEI ATR FENCE I CAPA AS .vm0 NECESSARY is MAINTAIN PARKING CNkT i ;j I. I ii(PHASE 1) PRASE SI`IT E PREPARATI2 OW 41 DEMOLITION TE EX6TWG PLAN ,�/A', p .e.- _��w.w•wws� --� 571�F!Mf/Ki' - -•�� `--- I y1 j m �® I DODGE- SIAEE! COURT c J -�-'--t"i'_w " . •" �ie..�_ _ QUA ICwETE� ,e-.-_._.-.-��,,i / /5/�j�/ � +l P` � N �s, 7•: !u� _!1 (`_ � ^-•--�m""T`1\ '�L—'mss:.osiri:.-.'xvZ'Z' jam• _„�a-?- S'A"^-'g.�J_ T T T _ /% � ? � I 1!7r.:L- •Lv •� ' ......v -- -•_ � _ s..-.. -..cx.�`�'�.�Y �'�[ I �_�'-=1 .�-.� -_-_ SLEET WIRE REMOVE EXIST 7REE .. �� '- I : >tiI I U� •li 'I __ ••��•e �� ECONCRETE XCAVATE EXISTING GUT AND CAP .f7A RWMINGUS --__. C2 REMOVE • O IETAWNG WALL �T4PAVEMENT DR BY SSI/ CHK BY.WAK 0�-T-�T- 200 440 PROD NO.-2013-107 ILLL�FEET DATE 7.10.14 SCALE I-0. rte..r,_1. r.. u ....0 ar-. .Yale..fv.reO.-., (if'IIK'•.i.o :4 P V ! Y (+ '\ Nits111111 >- .. � �pp y��gly9pj�I1y[f� N . gill gg � !I gel PN u \ lip 9 t , �\ ./if 't II ` t O 19 •� '1 � r' a •'i • •�* 1@�Ill .CN J. a el i °, R y rt a rK �r I 11 1 da I \ _ I •�• • �� • a --• �• •r wo.•m i I u I , E 1 � I o•��1 aceveeeeq� I i i i •i71� HOW � ( 41 r A cm) ZR IS s Fn a cN O N 00 a �° = N E OE 0JnON TO CONSIST SOLELY OF EXISTING BUILDING OEMOUTION `\ �• -- �_ — O,u ` f S WTDMLWTH FOIADATa11 MALL MONO WASHINGTON MOLEST WING SIDEWALKLAIJ% TO(SLAIN OPEN AIJ-A -HASE 1. SEE N STREET - IALSA OESIM FOR SPECM INFORMATION REGARDING EXTENT OF \ 1 �� ,• L• TO REMAIN AVO DETAILED DEMOLITION NOTES CRUM AS PART OF THIS PROJECT SHALL CONFORM TO THE CITY 6 F PUBLIC WOOS AND ANY OTHER AONCY WITH AUTHORITY IN THIS • � `� \at, �`. _ter—_ I LNVTAU,WORK AREA IN A DEAN CONDITION.NO COAIRUCRON HE ALLOWED TO ACCUMULATE WITHQN THE WOROSTE AND NO OItT. iAll.BE ALLOWED TO ACVUMULATE ON THE PUBLIC RIGHT-OF-WAY. a• INr e��- \• TEE UNITS OF PROPOSED WM aSRBED BY THE CONTRACIDRS u `\ C $ �+r-� f1 C 1` , l ptBT CII® ABE RESTOEL BY THE CONTRACTOR TO THEIR ORIGINAL le HE CONTRACTOR'S OP06L _1 oW � r NEW11DYEWAV af1D18 iWMIC DYE EXISTING �ELW:Gl1O6 IN RELATION TO ER090A COHTRGL VEASNR6 AN] �xJ��- ` ��/ riREE$f 9W� °Rr'^"M". f W SAWCUT LDE UTIES DNaa COSTRUCTN>N, / I (EYP) `` -�r—�-_` (TYP) \ EEIGST T `TANQ TC BASIN SLT SAC(AND TEMPORARY DETAILS. IETF \ —�� e _ sem--' �D ULT • �O4MiO ANO MAINTENANCE PLAN PREPARED By D6NN CONSULTARTS.INC. TOH-PHASE MAINTENANCE PROS I REMOVE EXIST 1 � �`�• REMOVE tta•'T ` �� / � — \ IIEF,S•SIDEBS 1 N.Hw \tall IRE6 f SHRUBS L REMOVE oomw r \a _"'u I ti o•`uAxF, , -w - _ _ -- _ — `T a ; / D I OO1OElE PAWEMT '\ L4MCRNMS U761TT RELOG1noN•PLANS PREPARED lWM01WL \ •`'�� 0 f a ',�W "- ... u 1 ` 6A I B I l I I ENGLAND CML ENGL®ENG CORP.. SHIM,w EE{ I ECPIC INFORMATION OF RELOCATED UTILITIES .��4 ,4 r INSTALL EROSIONCONTROL BARIVER ♦a..eTONDOIAH RM- OVE E5Oi n EXIST DRIVEWAY OPENING -��y.i• AT ISLAND TO CLOSE OLrT �-LUMM��F� f'..�.. --�AND CAP -, PAVEIMIT R RE10LE EXIST OIfD AL -^� / _ r .-�"Y�`-Jam♦ - ,-T.. -_-,..,� ,• e. •�= l ( Vic• Y I I I I ETN NEW DRIEWAY 1 I..WI ,y + '. r� '.tri_ J/-,,\.�� o�• �p�Thy�-s• �'••„„�� A..a i � li i�� a ;�� I�snWaT IEE 1 �' aPEaND❑ CO61R1/CiM1 FETItf 1 ] / CAP ARD NiINIa POMETFA I I/I l •\•' 1---- 1 _ - "lid e v Tm... •) I I ; I tr ♦\•\ •' '.a T �{ . r >y ':.: J ...�OIT ua CAP -ELECTRK.MMMDTE"lO / l JJ1 l �1••= CII PROP$T SAW GT04 REMAIN I i/d s / nR A� ' I -,`��T _ t- . . s�i �-4 N S . •: { - - . BASH I�FT(il'P) 1f l 'I ll CAP lr T (, y' 4 ;,:>. R ,,.`• 1_ 1 p - r� �a ti �' �";✓.sOTIEIMl1.7.DEa.�15 E.m POST{ kR)I'3K}i .7rs<}+'1)('N YyJ.it_:.''fAr;f`'Rn si{E_L_1�:5 f-r•sN.•Tu,.s.fityyr k `rr" o1 <'"' 1`\ Y Ws •�3 j )a II � !Is` t Pvw.c a IWAWA T OM DRAIN AT CO EXCAVATE EISTLAi s�zMica,PROP'SILT SACK,CATCH fElA.Al0M(TLE Q B� IISR (TPJ la URR POE. t Y L ^i r {{ I If PAVEMENT x / i I c L. L aEMOVE nama0usa� I L I DII�SIL T STREET SIGNSIGNDOHOLE IN STONEOU BOUND R t I ' �•\ /i ' .� I 1,N e t hl-;•y;t U2 5 ,'.[r ` '`y ODIIOETE I I I . L'FIXE HYDRAA'T DRAIN MANHOLE f /�+. . " - ° t fL ✓.1 U �I r r: Tr. 1 'y v,- PAVFImIT-\ 7711 i JP. / '>. arm`N s` c1•ti } ..i1le ' r` ,7a:`.ts::y" I L !—I ® SEWER MANHOLE fcf + •� ,� FIM m TEIECOW.MANHOLE AND GATES nft)'. "I'•5' I I 7 I I O ELECTRIC MANHOLE PROP�Ml`SAW`� ,/ \./ / 1 • e / r `� •!pJ\ (SEELITRmICLWISNS�n ElIDDYIf W V'HI•�Ai�#HHN-N!�Efr• I � / / �l• i kI. I -I_ 3 GTO1 �QY �AOfISs / RAMP STABILIZED CONSTRUCTION FENCE BASIN Df¢RTp AMMPERIV RATER VALVE(GATE) MEAL n@PHASE i GS VALE(GATE) 00TE9)Wh WATER SWT-Orr 41J� 4 S I Q: N•• J_ 1A 'SILT 5000'CATCH BASIN INSET 1 1 \ _ �♦ I TEMPORARY PHASE 1 CONSTNUC TEMPORARY PHASE I CO6nENi +... ' ' �s YrT `'�� IEINDYE omTow TBR TO�rEMOAEo v ~/ REMOVE EASIILD -,"N' , <,P N 1 E •' COME ' s e� �ry I I9� Lbs �_..D•-J STOW DRAM TO BE REMDN . ! s jn rj'`) i`.s Y PAwmir /- ' {• I _ L: —s— SANITARY SERER TO BE REL �1 a �BLEEQIIHAIiI. SIO I � -=r , ,•N,��i.;>i Ys - I T` p al I I r�X� —.- WATER TC BE REMOVED PAVF'ImNT 3kJ f y ES INSTALL EP�OII f" :♦ ' \ U P H I i I [�a —.I TELECOM TO BE REMOVED CONTROL BAN 6 1 YNITAN PNDOtl 1a —E— ELECTRIC TO 8F RON CMOVED P� A�• / / 1 ia-, AROUND PFiDETFR I / ,t; := SIRE PEIDRIEIi�•" E7 �aaNe_n.y sIu�P1Ag T) ) I I I —u�. CABLE ry/CDMM LINES TO ONA E 1) OON 70 Ho a xcinr wus EXTENT OF PHASE I mama f / //♦ .n / / TrwA CAPRA. IAIDiS , a ' CONSUMLIM MAINTAN PARIaND •'c 3 •�+. si, J }rTE�ARY 0..:00 1 I ARaRD PFimETFR I I z I - ® TEMPORARY CONSTRUCTION ENI / (PVL 1) I ' .. °' ` I �6-.[` � ` PMIg: '/• !W � _ ^' 1 �• I �, - �-- I VALE EMSO7M0 _ � :}"All- •; c� �! .[o//�/ •_�•_� :.c3a�s� �� •� 1 OOAW S7PEFf QW/YIcalloom _-.�cr-�.-_.__._- rt. �).• I. I avowSILT wwr �� -•�.- -tel ./ rEMLorE EOSTTTEE I i t a / t T� HTS ^ A I I��rETLGYAIF EXISE6 !� IEENoaE E7�TJ i —_� uo ° = 1 _ BITUMINOUS PPAVEMENTT / \ / RISED f . �� •_ / 1 xYnun„ee.ne oai.v , ( � ., � A I 1 / rA.ur wu 41 , I je `A Cita of Salem, Massachusetts l Fire Department 48 Lafayette Street Davu(W. Cody Salem, Massachusetts 01970-3695 fire Prevention Chief Tel 978-744-1235 a 978-744-6990 `fax 978-745-4646 dcody@salem com 978-795-7777 Demolition • Before a structure can be demolished, the Salem Fire Department shall conduct a .✓ preliminary demolition inspection, to ascertain any conditions which may require afire watch or other preventative measures to be taken before, during, or after the demolition process. Minimum of two weeks notice required to schedule appointment / • A permit to demolish or remove a structure shall not be issued until the preliminary inspection has been conducted and a report of requirements necessary to prevent life safety hazards has been obtained by the applicant. / • The inspection report shall include but not limited to: cutting and welding permit,./ fire watch, on site storage of materials, underground storage tank compliance.... • Proof of utility disconnects. ✓ / • The requirements outlined in the report shall become a part of the restrictions of the demolition permit issued by the Building Inspector. *Fire watch patrol Salem Code of Ordinances Sec. 20-124 October 5, 2010 CITY OF SALEM of SALEM, MASSACHUSETTS q ENGINEERING DEPARTMENT !sem %qRg 120 WASHINGTON STREET 4TH FLOOR SALEM, MA 01970 Phone: (978) 745-9595 x5673 Kimberley Driscoll Fax: (978) 745-0349 Mayor DAVID H. KNOWLTON, P.E. CITY ENGINEER October 25, 2011 Water, Sewer and Drainage Requirements Regarding the Demolition of Structures within.the City of Salem In accordance with the provisions of the General Laws of the Commonwealth of Massachusetts and the Salem Water and Sewer Department, the following regulations governing the demolition of structures within the City of Salem shall be followed. This regulation is made in the interest of protecting the city's water, sewer, drainage and public way infrastructure at each connection located within the City of Salem, as well as to prevent conditions which may cause danger to public safety, result in water loss, or damage to city or private property due to water or sewer loss or back-ups, or cause pollution of the city's storm water receiving waters. 1. Prior to demolition of structure, a licensed plumber shall ascertain where all water, sewer and drainage lines are located entering and leaving said structure. The plumber shall make a determination of existing or prior use of each line, including,.but not limited to domestic, commercial or industrial use; irrigation; fire suppression; sewer, storm drain or septic system; roof drain; or sump pump. After all lines have been located, the plumber shall make a formal written report with plans of all lines found to the City Engineer. 2. Once the plumbers report has been reviewed and approved by the City Engineer, a Registered Professional Civil Engineer (hereinafter referred to as "the Engineer") shall make a determination of the point of origin or discharge on each city main, for each line identified in the plumbers report. The Engineer shall also ascertain the location, use, and point of origin or discharge of any other lines on the property that may or may not be affected by the demolition or connected to the structure. The Engineer shall provide the City Engineer, for review and approval, a stamped plan of the property and adjacent City utilities, indicating the results of his investigations. 3. A request to the Department of Public Services, for assistance in shutting down any water main, prior to cutting and capping it, shall be made only after the City Engineer has approved the written reports and plans described above. Water, Sewer and Drainage Requirements Regarding the Demolition of Structures October 25, 2011 Page 2 4. Prior to demolition of the structure and immediately following item 43 above, a City of Salem licensed drain layer shall cut and cap the water, sewer and drainage lines at the city main and arrange for an inspection by the Department of Public Services prior to backfill. Backfill, compaction, temporary and permanent paving will follow to current city standards. 5. In the event that the lines will be used immediately after demolition for construction purposes, a set of plans and/or drawings, stamped by a Registered Professional Engineer, describing the lines to be used during construction, must be provided to the City Engineer for review and approval, prior to obtaining a building demolition permit. Prior to receiving approval to re-use any lines, the lines shall be inspected for condition and capacity. Sewer and drain lines proposed for re-use shall be inspected by a Licensed Drainlayer with closed circuit television equipment and a copy of the resulting DVD shall be submitted to the City Engineer for review. Water lines proposed for re-use shall be inspected by a Licensed Plumber and a written report shall be submitted to the City Engineer for review. Any other lines identified shall be abandoned as described herein. 6. A demolition permit shall not be issued until the items above have been completed and the Department of Public Services has conducted an inspection and signed off on the water and sewer portion of the Building Department prerequisite Utility Disconnections Required Form: fithproved by: D H. Know Ic City Engineer \\Saletndc0l\WaterAdmin\dlaowlton\My Documenthniscellaneous\demo regulations water,sewer and drainage 1-30-09.doc • w CITY OF SALEM, MASSACHUSETTS 1P BOARD OF HEALTH 120 WASHINGTON STREET,4"'FLOOR P111711CH@Slth Prevent.Promote.Protect. TEL. (978) 741-1800 Fax(978) 745-0343 KIMBERLEY DRISCOLL 1ramdinna,sa1em.com - - LARRY RANWIN,RS/Rf;HS,C1 10,CP-FS MAYOR HILAL'ni AGENT DEMOLITION OF STRUCTURES Prior to demolition of any building the following information shall be provided to the Board of Health Asbestos testing report. o If asbestos is found, provide an Asbestos Notification form ( ANF) 001 and an asbestos clearance certificate with application • A pest control report from a licensed Pest Control Company. o If pests are found provide a treatment plan and certification from the pest control company that pests have been effectively controlled has to be submitted J. A Dust mitigation plan indicating what measures will be instituted to ensure dust from the demolition project does not migrate over the property line. • If the structure was built before 1978; The Demolition contractor has to be licensed Lead Safe Renovation Contractor by the Department of Labor Standards and their employees trained in the use of Lead-safe work practices. Additional information may be required based on the nature, location and length of the project The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Building Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (flhis Section Fur Official Use Onl ) 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) 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 Cl or check all that apply in the two rows below Existing Building❑ Repair❑ Alteration ❑ Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1) Change of Use ❑ Change of Occupancy ❑ 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of.this permit application? Yes ❑ No ❑ Is an Independent Structural Engineering Peer Review required? Yes ❑ No ❑ Brief Description of Proposed Work: 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): IProposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor.(sq. ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION 5:USE GROUP(Check as a licable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-1❑ A-5❑ B. Business ❑ E: Educational ❑ F: Facto F-1❑ F2❑ - If: High Hazard H-1❑. H-2❑ H-3 ❑ H4❑ H-5❑ I: Institutional I-1❑ 1-2❑ 1-3❑ 14❑ M: Mercantile❑ R: Residential R-1❑ R-2❑ R-3❑ R4❑ S: Storage S-1 ❑ - S-2❑ U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Check as applicable) I ❑ in IIA ❑ fill IIIA ❑ Hill C3 !V ❑ TVA ❑ V13 SECTION 7.SITE INFORMATION(refer to 780 CIOR 111.0 for details on each item) Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit: Debris Removal: Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ required❑or trench or specify: Private❑ or indenti Zone: or on sites stem❑ fY Y permit is enclosed❑ Railroad rightof-way: Hazards to Air Navigation: \I�\I li_nori.�_,imnussion t:r�;�e�„ Not Applicable❑ Is Structure within airport approach area? Is their review completed? or Consent to Budd enclosed❑ I Yes❑ or No❑ 1 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: ___ SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Name(Print) No.and Street - City/Town Zip Property Owner Contact Information: Title Telephone No.(business) Telephone No. (cell) a-mad address If applicable,the property owner hereby authorizes Name Street Address City/Town State - Zip to act on the property owner's behalf,in all matters relative to work authorized by this budding permit application. SECTION 30:CONSTRUCTION CONTROL(Please fill out Appendix 2) If building is less thvu 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here D and skip Section 10.1 10.1 Registered Professional Responsible for Construction Control Name(Registrant) Telephone No. mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor - - - Company Name Name of Person Responsible for Construction License No. and Type if Applicable Street Address City/Town State Zip Tele hone No. business Telephone No. cell e-mail address SECTION 11:-WORKERS'COMPENSA'T'ION INSUItaNCh'AI:FIUAVf1' M.G.L.c.152.§25C(Q) A Workers Compensation Insurance Affidavit from the NIA 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 0 No O SECTION 12.CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)_$ 1. Budding $ Building Permit Fee=Total Construction Cost x_(Insert here 2.Electrical $ appropriate municipal factor)_$ 3. Plumbing $ d.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality) 5.Mechanical Other $ Enclose check d able to p'Y" 6.Total Cost $ (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,1 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. Please print and sign name Title Telephone No. Date Street Address City/Town State Zip Municipal Inspector to fill out this section upon application approval: Name Dile The Commonwealth of Massachusetts Department oflndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FH.ED WITH THE PERMITTING AUTHORITY. Applicant InformationTO Print Legibly Name(Busmess/Orgamxation/ladividual): Address: City/State/Zip: Phone M Are you an employer?Check the appropriate box: Type of project(required): L❑I am a employer with employees(full ar/mpart-time).• 7. ❑New construction 2.❑I am a sole proprietor er pumemship and have m eemployces working for�in $, Remodeling soy capacity.[No workers'comp,insurance required.) ❑ g 3.❑I am a homeowner doing all womk myself.[No workers'comp.issuance required.]f 9• ❑Demolition 4.�1 am a homeowner and will he hiring centractos M conduct all work m mm property. I will 10❑Btti]dmg addition ensure shat all contractorstitherhare workers'compemapoa insurance or m sole 11.❑Electrical repays or additions proprietors with m employees. 12.E]Plumbing repairs or additions 5.❑1 am a general contractor and I here beret the subconimc ors listed on the amched sheet. These sub-conbacmrs have employees and have workers'comp.insmasres 13.❑Roof repairs 6.❑We are a cerpomtion and its offioas have exercised dmir right of exemptim per MGL c. 14.❑Other 152,§I(4),and we have an employees.[No workers'comp.Temce enquired-] ;Any applicant that checks box Ali must also nu out the section below showing their workers'compensation policy information. ?Homeowners who submit this affidavit indicating they are doing as wok and than him outside contractors must submit a new affidavit indicating such. tContrsctors that check this box must attached an additional shed showing the mane of the subconnagors and state whether or not those entities have employees. Ifthe sub< tractus have employees,they most provide their workus'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below it the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M Expiration Date: Job Site Address: Cit,/Statelzip. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiratlon date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 thepauts andpenahtes ofperlrrty that the information provided above Is true and correct Suture: ate Phone M Ostial use only. Do not write in this area,to be completed by city or town oJjiciaL City or Town: Permit/License# [6. ssuing Authority(circle one): .Board of Health 2.Building Department 3.City/rown Clerk 4.Electrical inspector 5.Plumbing Inspector Other ontact Person' Phone#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perndt/license number which will be used as a reference number. In addition,an applicant that must submit multiple pemrit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia The Commonwealth of Massachusetts �} Department of Public Safety jB Massachusetts State Building Code(780 ChIR) ` Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number. Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Black 0 and Lot C for locations for which a street address is not available) tit- a f (31 C) No.and Street City/Town Zip Code Name of Budding(it applicable) SECTION 2:PROPOSED WORK Edition of MA State Code used_ If New Construction check here O or check all that apply in the two rows below Existing Building O Repair 13 1 Alteration ❑ I Addition❑ 1 Demolition (Please fill out and submit Appendix I) Change of Use ❑ 1 Change of Occupancy Cl 1 Other ❑ Specify: Are building plans and/or construction documents being supplied as part of.this permit application? Yes O No Is an Independent Structural Engineering Peer Review required? - Yes ❑ Nlb V Brief Description of Proposed Work: \ SECTION 3:COMPLETE THIS SECTION IF WSTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CIv1R 34) ❑ Existing Use Cioupjs): - I Proposed Use Group(s): SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor,(sq.ft.) Total Area(sq.ft.)and Total Height(ft.) SECTION S.USE GROUP(Check as applicable) A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 O A4❑ A-5❑ B: Business ❑ E: Educational ❑ F. Facto F-1❑ F2❑ H: Hi h Hazard H-1❑, H-2❑ H-3 ❑ 1440 H-5❑ 1: Institutional I-1❑ 1-2 CI ❑ 14❑ M: Mercantile ClR: Residential R-113 R-2❑ R-3❑ RYI C! S: Storage S-1❑ S•2❑ I U: Utility❑ Special Use❑and please describe below: Special Use: SECTION 6.CONSTRUCTION TYPE(Check as applicable) IA ❑ IH ❑ IIA O IIB D IIIA ❑ II►B ❑ IV ❑ 1 VA ❑ VB ❑ SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item) Water Supply: Flood Zone Informatiom Sewage Disposal: Trench Permit Debris Remova4 Public❑ Check if outside Float Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑ Private❑ or indenti Zone: or on sites stem❑ permit i ❑or trench or specify: � y permit is enclosed❑ Railroad right-of-wry: Hazards to Air Navigatiarr: �1-�I I:a..ri.-C,.�umiatig�Kra i��.�_I'r.k.... Nut Applicable❑ Is Stmcture within airport approuh arca? Is their review completed? or Consent to Budd enclosed❑ Yes❑ or No O Yes❑ No ❑ SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Cade: Use Group(s): Type of Construction: Occupant Load per Floor: Does the building containan Sprinkler System?: Special Stipulations: QTY OF SALFJK MASSAaABETl S BUW1WDEPAiMMW 120 w, acmrvsVJWr,3mROO r 71st, 715-9595: $Ii�ERIlYDRI PArPM7449846 1"YO t DJMMSTYMU Dnmc imc+rtuucrxanwy/suunna;CCMM Construction Debris Disposa/Affidavit (required for all demolition and,-renovation work) in accordance with the sbrth edition of the State Building code, 780 CMR, Section 111.5 Debris, and the provisions of MGL M,S 54; Building Permit#I is Issued with the condition that the debris resulting from this work shall be disposed of in a properly licensed waste deposit facility as defined by MGL c 111,S 150A. The debris will be transported by. (name of hauler) The debris will be disposed of in: Rk 0-0 (name of facility) vY� '(address-of facility) 'gnature f l 11cant Date