B-17-523 - 0401 BRIDGE STREET - Building Permit J.
The Commonwealth of Massachusetts
W
Department of Public Safety
P► 1 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)
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)
401 Bridge Street Salem 01970 Gateway Center
No.and Street City/Town Zip Code Name of Building(if applicable)
I SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here❑or check all that apply in the two rows below
Existing Building❑ Repair❑ Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ® Specify: Foundation
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 ❑ No ❑
Brief Description of Proposed Work: Install RAM aggregate piers and reinforced concrete foundation
FOUNDATION PERMIT ONLY
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.) 2 TBD
Total.Area(sq.ft.)and Total Height(ft.) TBD TBD
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ F B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H4❑ H-5❑
I: Institutional I-1❑ I-2❑ 1-3❑ I4❑ M: Mercantile❑ R: Residential R-113 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)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV ❑ 1 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 IN Check if outside Flood Zone❑ Indicate municipal IN
A trench will not be Licensed Disposal Site R
Private❑ or indentify Zone: or on site system❑ required❑or trench or specify:
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable❑ 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:
TNkcvr G
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
High Rock Bridge Street, LLC 275 Grove St.,Ste. 2-400 Newton, MA 02466
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
David Sweetser 617 - 663- 4975 _ dsweetser@ high rockdevelopment.Cm
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Thomas McGarrigle,C3 Architecture&Design,313 Congress St. Boston MA 02210
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)
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
Peter Terrat, DMS Design, LLC 978.965_ 3470 pterrat@dmsdesign.com
Name(Registrant) Telephone No. e-mail address Registration Number
100 Cummings Ctr.,Ste. 339C Beverly MA 01915 Architect
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
TCD Construction, Inc.
Company Name
Timothy Boisvert j - 0 S SL4 3°) 3- Z— t
Name of Person Responsible for Construction License No. and Type if Applicable
91 Hancock Road,Suite 3 Peterborough NH 03458
Street Address City/Town State Zip
603-924-3003 603 _ 670-3373 tboisyert(cDtcdbuild.com
Telephone No.(business) Telephone No. cell e-mail address
SECTION 11: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 0 No 0
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ 440,000
1.Building Foundation Only $ 440 000 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.M:.-,
Enclose check payable to
6.Tc SjC1VrAANJCLC ?a000
(contact municipality)and write check number here
3: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
44
Municipal Inspector to fill out this section upon application approval:
Name 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
1 _ .
i Project Title: Mayor Jean A.Levesque Community Life Center.- Foundation Date: 9 June 2017.
Property Address: Bridge Street,Salem,MA .
Project: Check(x)one or both as applicable: (X)New construction O Existing Construction
Project description: Excavation,aggregate pier supports, foundation, floor slab and an under-slab depressurization.
system.
I,Frank S. Vetere,MA Registration Number: 29834 Expiration date: 30.June 2018,am a registered design professional;
and I have prepared or directly supervised the preparation of all design plans,computations and specifications
concerning'
O Architectural (.) Structural (j Mechanical
O Fire Protection O Electrical (x)Other: Geotechnical and Environmental Barrier
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 ���jN GF`,�
electronic signature and seal ��
� FRANK tiG�
K S. =1
VETERE
.o 'A No.29834
9�F FG�
Phone number: 78172784807 Email: frank.yetere@gca:aom
Building Official Use Only
Building Official Name: Pen-nit No.: Date:
Note 1.Indicate with an Y project design plans,computations and specifications that you prepared or directly supervised. If'ot.her'is chosen,
provide a description.
i
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: Mayor Jean A.Levesque Community Life Center— Foundation Date: 9 June 2017
Property Address: Bridge Street, Salem,MA
Project: Check(x)one or both as applicable: (X)New construction ()Existing Construction
Project description: Excavation, aggregate pier supports,foundation,floor slab and an under-slab depressurization
system.
I, Jeffrey S.Nawrocki,MA Registration Number: 34168 Expiration date: 30 June 2018, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
O Architectural (x) Structural O Mechanical
O Fire Protection ()Electrical O 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 detennine 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 ��tµ OF VQ8d4
electronic signature and seal: o+ ems
JEFFREY S.
�+ NAWROCKI M
c STRUCTURAL
No.34168
JIM
Phone number: (603)433-8639 Email:jeff@jsneng.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.