11 Goodhue Street - Routing Slip CITY OF SALEM
ROUTING SLIP
New Construction \
Certificate of Occupancy C
LOCATION C" tJ DATE
ASSESSORS DAT;
x 93 Washington t. I
CITY CLERK I m(/r� DATE a I
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X 93 Washington 9t.
PUBLIC SERVICES DATE 2,1 2 b022
120 Washington St.
f C WATER e e DATE �../ZO 1
120 Washington St. �lY; lipyr InS I�e�
CROSS CONNECTION Ll�ATE_ZA /W
5 Jefferson Ave
yC PLANNING DATE SL Q ZDZZ
` 120 Washington St.
CONSERVATION DATE Z Z Z
120 Washington St.
ELECTRICAL DATE
48 Lafayette St.
FIRE PREVENTION DATE
29 Fort Avenue
HEALTH DATE
120 Washington St.
BUILDING INSPECTOR DATE
120 Washington St.
Final Construction Control Document
A It
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: 11 Goodhue Residences Date: 02/02/2022 Permit No. B20523
Property Address: 11 Goodhue St., Salem, MA
Project: Check(x) one or both as applicable: FV/1 New construction ❑Existing Construction
Project description: New construction of a 3-story building containing 5 Townhouse units.Type VB construction,sprinklered.
I Jai sing Khalsa MA Registration Number:6042 Expiration Date: 08/31/2022, 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 ❑Electrical ❑ Other: Describe
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 780 CMR and the design documents approved
as part of the building permit and that I or my designee:
1. 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 780 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 co
�ERED AR�y�
Nothing in this document relieves the contract regarding the provisions of 780 CMR 107.
4r
Enter in the space to the right a "wet" or
electronic signature and seal: l GE
� MA rJ
Phone number: 617-591-8682 Email: jkhalsa@tkgeast.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 01 01 2018