19027 116 HIGHLAND AVE RENOVATION INITIAL CONTROL AFFIDAVIT 4-10-2019Version 01_01_2018
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: 116 Highland Ave Mixed Use Date: 04/10/2019
Property Address: 116 Highland Ave. Salem , MA
Project: Check (x) one or both as applicable: New construction X Existing Construction
Project description: The work to be done at 116 Highland Ave. Salem , MA includes the interior renovation of
the level 2 to add 3 new dweling units. New rated partitions will be added between each unit as well as non
rated interior partitions. No structural members will be altered.
I Darguin Fortuna MA Registration Number: 951922 Expiration date: 08/31/2019 , am a registered design
professional, and hereby certify to the best of my knowledge, information and belief that I have prepared or
directly supervised the preparation of all design plans, computations and specifications concerning1:
Architectural X
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. The contractor shall be
responsible for performing the work in accordance with the contract documents .
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports (see item 3.) together with
pertinent comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a ‘Final Construction Control Document’.
Enter in the space to the right a “wet” or
electronic signature and seal:
Phone number: 978-818-5109 Email: Dfortuna@flow-design-studio.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an ‘x’ project design plans, computations and specifications that you prepared or directly supervised. If ‘other’ is
chosen, provide a description.