INIT CONST. CONT DOC, AFTER FIRE, 11/19/2020 !3— —2 b
Initial Construction Control Document
is To be submitted with the building permit application by a
At
�rlt Registered Design Professional
s' t I for work 9th
per
theedition
ed t on of the
,e. Y °W Massachusetts State Building Code, 780 CMR, Section 107
Project Title: 233 Lafayette Street Renovation Date:11/19/2020
Property Address: 233 Lafayette Street, Salem,MA 01970
Project: Check(x)one or both as applicable: x New construction x Existing Construction
Project description: Renovation of a 26-unit building after a fire.
I Derek Rubinoff MA Registration Number: 20071 Expiration date: 8/31/2021 ,am a registered design professional, and
I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning':
X Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information,and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or c�S���PDR�c'S'0..
electronic signature and seal: 49 k`4`- e%Yo�c`
0VEST
o No.20071 cn
ROXBURY,
MA i
Phone number: 617-504-2599 Email: drubinoff@derekrubinoff.com qtni OF
10
04"
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.
Version 06 11 2013