34 ST PETER STREET - AFFIDAVIT Final Construction Control Document
r � 1 To be submitted at completion of construction by a
Registered Design Professional
for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR,Section 107
Project Title: Mother Teresa of Salem Date: 12-10-2021 Permit No. 12>~ Z 1--4 2:5*
Property Address:34 St Peter Street, Salem, MA oi97o
Project: Check (x) one or both as applicable: New construction Existing Construction (x]
Project description: Conversion of i5t floor existing school building into an adult day care center.
I Margelin Gace, MA Registration Number: o5 ggg Expiration date: o8lpJ2022, am a registered design professional,
and I have prepared or directly supervised the preparation of all design plans, computations and specifications
concerning:
Architectural x Strucdral Mech)ical
Fire Pr ection Electra al Over:
for the above named project. I, or my designee, have performed the necessary professional services and was present
at the construction site on a regular and periodic basis.To the best of my knowledge, information, and belief the work
proceeded in accordance with the requirements of 78o CMR and the design documents approved as part of the
building permit and that I or my designee:
i. Have reviewed, 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. Have performed the duties for registered design professionals in 78o CMR Chapter 17, as applicable.
3. Have been 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 was performed in a manner consistent with
the construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 78o CMR 107.
Enter in the space to the right a "wet" or
electronic signature and seal:
Q-�'ELiN
Q' C�
No. 50899
p BOSTON
Phone number: 617-905-9134
MASSACHUSE rn
Email: mgace@gacedesignstudio.corn
�7�y Cf
Building Official Use Only
Building Official Name:
Permit No.:
Date: