14 NEW DERBY STREET UNIT 9&10- AFFIDAVIT Initial Construction Control Document
q To be submitted with the building permit application by a
pop Registered Design Professional
for work per the ninth edition of the
ys Massachusetts State Building Code, 780 CMR, Section 107
Project Title:New Derby Street/ Units#9
 Date: November 19,2021
Property Address: 14 New Derby Street Salem,Ma.01970
Project: Check(x) one or both as applicable: New construction XX Existing Construction
Project description:The scope of work under this permit is the construction of two new residential loft units in
an existing warehouse space. The new work shall include but not limited to framing,electrica,mechanica and
structural systems throughout,interior wall partitions and finishes throughout.
I Peter Pitman MA Registration Number: 8749 Expiration date:Aug 2022,am a registered design professional,
and I have prepared or directly supervised the preparation of all design plans,computations and specifications
concerning':
XX 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 f
electronic signature and seal:
B4�N
Phone number:978-744-8982 Email:pfpitman@juno.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 01 01 2018