B-17-913 - 0401 BRIDGE STREET - Building Permit The Commonwealth of Massachusetts
Department of.Public Safety
o 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)
I. 401 Bridge Street Salem 01970 Mayor Jean A.Levesque Community Life CentE r
No.and Street City/Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used 8th If New Construction check here N 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:
Are building plans and/or construction documents being supplied as part of this permit application? Yes KI No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No M
Brief Description of Proposed Work:
Construct a new—20,800-SF wood and metal framed,2-story building to be used as a community center.
I-oun ation permit has been issue' . _ )--� e S 7 7�l
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 12,248/80 5
Total Area(sq.ft.)and Total Height(ft.) 20,323 2TV
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1❑ A-2❑ Nightclub ❑ A-3 K A-4❑ A-5❑ B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ if: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I Institutional I-1❑ I-2❑ d-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)
IA ❑ IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 1 IV ❑ VA ❑ VB W
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
A trench will not be Licensed Disposal Site IX
Private❑ or indentify Zone Chap 91 Appd or on site system❑ required M or trench or specify: : -.A
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable W Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes❑ or No IN Yes IN No ❑
SECTION 8:CONTENT OF'CERTIFICATE OF OCCUPANCY -'.
Edition of Code: 8th Use Group(s): A3 Type of Construction: 5B. Occupant Load per Floor: 100 GSF/
Does the building contain an Sprinkler System?: Yes Special Stipulations: See Plans person per floor
C NA U '
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@highrockdevelopment.com
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 ern-it application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Daniel Skolski, DMS Design,.LLC 978 966 3470 dskolski@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
Tim Boisvert CS-055439 3/2/18
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 - 860- 3711 tboisvert@tcdbuild.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❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor 3,702,869
and Materials) Total Construction Cost(from Item 6)_$
1.Building $ 3,536,619 Building Permit Fee=Total Construction Cost�0 (Insert
sert here
2.Electrical $ 454,550 appropriate municipal factor)=$ 11
3.Plumbing $ 177,100
Note:Minimum fee= 13(Atact municipality)
4.Mechanical (HVAC) $ 408,900 '-'Lt-
5.Mechanical Other $ 56,500 Enclose check payable to
6.Total Cost $3,702,869 (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.
Tim Boisvert
Please print and sign name Title Telephone No. Date
91 Hancock Road,Suite 3 Peterborough NH 03458
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval: `►I'�"+ �I
Name Date
t
. . 0 CA
3 703 , x
40 , 733 •
Initial Construction Control Document
Z
To be submitted with the building permit application by a
d Registered Design Professional
A for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Mayor Jean A. Levesque Community Life Center Date: 09/18/2017
Property Address: Bridge Street, Salem,Massachusetts
Project: Check one or both as applicable: ® New construction ❑ Existing Construction
Project description: New 2-story wood framed building.
I Jeffrey S.Nawrocki MA Registration Number: 34168 Expiration date: 06/30/2018 ,am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[ ] Architectural [X] 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.
tt1 o Bess
Upon completion of the work,I shall submit to the building official a Final Constr io Contr e �cg
a, JEFF EY S.
Enter in the space to the right a"wet"or NA ROCKI
electronic signature and seal: ST UCT RAL
o. 168
�s$14MAL I
Phone number: 603-433-8639 Email: jeff@jsneng.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Mayor Jean A. Levesque Community Life Center Date: 9/18/17
Property Address: 405 Bridge Street, Salem, MA
Project: Check one or both as applicable: X New construction ❑ Existing Construction
Project description: New office building approximately 20,000 square feet.
I Michael Denommee MA Registration Number: 49888 Expiration date: 6/3 0/18 ,am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[ ] Architectural [ ] Structural [ ] Mechanical
[X] 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 ��P�ZH OF f 114 c
electronic signature and seal: MICHAEL
DENOMMEE
MECHANICAL '
No.49888
Phonenumber: (978) 486-4301 �0 9 R ail: info@blwengineers.com
B ' - Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Initial Construction Control Document
To be submitted with the building permit application by a
d Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Mayor Jean A. Levesque Community Life Center Date: 9/18/17
Property Address: 405 Bridge Street, Salem, MA
Project: Check one or both as applicable: X New construction ❑ Existing Construction
Project description: New office building approximately 20,000 square feet.
I Michael Denommee MA Registration Number: 4 9 8 8 8 Expiration date: .6/3 0/18 ,am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[ ] Architectural [ ] Structural [X] Mechanical
[ ] Fire Protection [ ] Electrical [X] Other Plumbing
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 ficial a`Final Construction Control Document'.
�P,ZH OF 1,41gSS�
Enter in the space to the right a"wet"or �o�'� MICHAEL cyG`r�
electronic signature and seal: g DENOMMEE
MECHANICAL cn
No.49888
9 9F R �`Q
Phone number: (978) 486-4301 cFFc- S v�� mail: info@blwengineers.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
I
Initial Construction Control Document
To be submitted with the building permit application by a
f Registered Design Professional
for work per the 8th edition of the
SVe�� Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Mayor Jean A. Levesque Community Life Center Date: 9/18/17
Property Address: 405 Bridge Street, Salem, MA
Project: Check one or both as applicable: X New construction ❑ Existing Construction
Project description: New office building approximately 20,000 square feet.
I John C. P i e rga MA Registration Number: 48291 Expiration date: 6/3 0/18 ,am a
registered design professional, and I have prepared or directly supervised the preparation of all design plans,
computations and specifications concerning:
[ ] Architectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [X] Electrical [X] Other Fire Alarm
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 official a`Final Construction Control Document'.
SN OF M40sq
Enter in the space to the right a"wet"or JOHN C. �yG
electronic signature and seal: PIERGA �^
ELECTRICAL
No.48291
Phonenumber: . (978) 486-4301 CIS Email: info@blwengineers.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 06 11 2013
Initial Construction Control Document
z To be submitted with the building permit application by a
Registered Design Professional
for work per the 8a' edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Mayor Jean A.Levesque Community Life Center Date: 14 September 2017
Property Address: Bridge Street, Salem,MA
Project: Check(x)one or both as applicable: (X)New construction ()Existing Construction
Project description: New 2-story wood-framed community building, approximately 20,207 GSF. Use Group A-3
Assembly,construction classification Type VB(5B),full sprinkler coverage.
I, Daniel M. Skolski,MA Registration Number: 20038 Expiration date: 31 August 2018, 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 p® }• S ��x: Commonwealth of Massachusetts
electronic signature and seal: q�'� ��s �� t County of Essex
N, -L1038
Subscri and sworn to before me this �day
°. 20
Phone number: (978)965-3470 Email: dskolski@dmsdesign.com Yotad Public I.AURI A'.'STILIAN DS
NditcrY Public
y. wea Ith-`Af Massachusetts
-My;Xommission EXP res
Building Official Use Only
August 3, 2018
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.
I