0015 SUMMIT AVENUE -, 667-1A BERTRAM TERR. B-15-546 t- T -7 �
15 5Umrn 1 r IW6 z4z,
The Commonwealth of Massachusetts
* ✓ (�� tp Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Peanut 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)
Lajal-1 R Sr/ N14 M 76 Bel :rz"Ce_
No.and Street Ci /Town Zip Code Name of Building(if applicable)
SECTION 2:PROPOSED WORK
Edition of MA State Code used_ If New Construction check here❑or check all that apply in the Vo ro4below
Existing Building❑ Repair❑ 1 Alteration ❑ Addition❑ Demolition ❑ (Please fill out and submiLAppeOix 1)
Change of Use ❑ 1 Change of Occupancy ❑ Other )(Specify:?" S a eK
� h
LA Are building plans and/or construction documents being supplied as part of this permit application? Yes 2'No IPE<
( Is an Independent Structural Engineering Peer Review required? Yes ❑ .111
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l�J)mo
Brief Description of Proposed Work:P—pi 0-0 Q 0`6(C� ejd;' �J Q a��t t li ( (4 PkL.
A. 90" 604 ctwl -r. 1r)"^. h-r AAL ( S g..i (IC))
d_03-(2.Q 4 anepyf C
to
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.)
Total Area(sq,ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A. Assembly A-1❑ A-2❑ Nightclub ❑ A-3 ❑ A-4❑ A-5❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1❑ F2❑ 1 H: High Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ 14❑ M: Mercantile❑ R: Residential R-10 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 ❑ 1 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❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
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:
c-4)tuic- n
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name an Addres f Property Owner s
Name(Print) No/.�and Street City/Town
Property Owner Contact Information: �f Q -J)//yam I�ILbl�a�Jal^^�
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
I6f CwJ--� N&crLt .2b kv✓Wk Dal 21a0 cr N q O 0
Name c-"viC.tg, 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)
If building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here 13 and skip Section 10.1
10.1 Registered Professional Res onsible for Construction Control ��11 p�� ,,
1f43 Ufff 1 QZ SG�PS IGlla/tnl//rL �Q
am Re trant) Telephone No. e-mail addr ss egistration Number
X �� j� I�� Pik 3� s
Street Address City/ own State Zip Discipline ExIfiraAon Date
10.2 General Contractor
T j C"N(L ckt.�- N"W�L Star vtcx- 3�0% C
Company Name C 5 L* 10760
C A-(L� C)cL\k iAn-S w /7&a 33
Name of Person Responsible for Construction License No. nd Type if Applicable —
IL P6,L 2-C4,0 ercj N� 0303P�
Street Address City/ToA State Zip
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' suance of the building permit.
Is a signed Affidavit submitted with this application? Yes No 13
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
Estimated Costs:(Labor
Item and Materials) Total Construction Cost(from Item 6)_$c VO
1.Building $ Building Permit Fee=Total Construction Cost x.11,00(Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $ (�(�
4.Mechanical (HVAC) $ Note:Minimum fee=$ La(contacct municipality)
5.Mechanical Other $ { Enclose check payable to l i J�
6.Total Cost $ 1 q5�� (contact municipality)and write ch number here
SECTION 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 accurat to th best of my knowledge and understanding.
Conk 6 altt nncs � t� ,�-� �t�es� r �3. 6 _ 6-C i
Please gr�nt anyl Sir, � ' Title Telephone Date
Oc I`.�o"aGlr w�f
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
John A.Boris,Chairman
Frank J.Milo, Vice Chairman 1
Peter K. Strout,Second Vice Chairman
- Maureen Call,TreasurerSALEM HOUSING
iJT G
William E.Luster,Assistant Treasurer
A U T $ - O R I - T - Y CardA. MacGown,Executive Director
June 41 2015
Carl Gallina
FGF. Construction.Network Services, Inc:
26 Kendall'Pond,Road
Derry,NH 03038 : -
Re: Exterior Railing Replacement at Bertram Terrace (667-1 A) -
NOTICE TO PROCEED
Dear Mr. Gallinas:
Pursuant to the terms of your Contract dated June 4,2015 for the replacement 6f exterior railings at. .
Bertram Terrace(667-1A),you are hereby notified to commence-work at the start of the business
day on June.8,2015. The time for the completion,set,forth in the Contract is 60:consecutive
calendar days, including the starting-dafe which establishes C August:6;2015 as the.Contract
ompletion Date. ;
You are informed that I have been appointed Contract Officer and am duly authorized to
administer your Contract for and in the name of this,Authority.
Please acknowledge receipt of this correspondence by executing and dating the two originals of
this Notice and returning one to this Authority.
Our tax exempt number is #046-003-930. .. "
Sincer
Ca A.MacGown
xecufive Director '.
Accepted:
By. Dated: .-
FGF Construction Network Services, Inc.
® 27 CHARTER STREET. - SALEM MA 01970-3699 .
978.744.4431 FAX 978.744:9614 • E MAIL mFbC@salemha.org
Equal Opportunity Employer - -
Addw John A.Boris,Chairman
Frank J.Milo,Vice Chairman
Peter K.Strout,Second Vice Chairman
Maureen Call,Treasurer
SAL EM HOUSING William E.Luster, Assistant Treasurer
A U T H O R I T Y Carol A.MacGown,Executive Director
May 27, 2015
Carl Gallines
FGF Construction Network Services, Inc.
26 Kendall Pond Road
Derry, NH 03038
Re: 258100 Exterior Railing Replacement at Bertram Terrace (667-1A)
Dear Mr. Gallines:
The Salem Housing Authority's Board of Directors has accepted your bid of$21,795.60 for the
replacement of exterior railings at Bertram Terrace(667-1A) as per the bid specifications.
As specified in the bid documents (see attached General Provision sheet for details), you must
submit the following information as soon as possible:
Certificate of Insurance for Workers' Compensation
Certificate of Insurance for General Liability
Certificate of Insurance for Automobile Liability
Certificate of Vote of Authorization(if applicable)
Proof of OSHA-approved construction safety and health course
Please remember that in order to perform work under contract you and your employees must be
in compliance with the requirements of Chapter 306 of the Acts of 2004 with regard to
successful completion of a course in construction safety and health approved by the United
States Occupational Safety and Health Administration that is at least 10 hours in duration.
Once you have submitted all of the information, you must sign a Contract and Notice to Proceed
for the above-mentioned work. Please call Debra Tucker, the Assistant Executive Director, at
(978) 7.44-4431_ext._115 in.orderto.make an appointment to sign.the,necessary documents.
Sincerely,
C of . MacGown
Executive Director
CAM:dt
Enclosures
File: quote award railings bertram
® 27 CHARTER STREET SALEM MA 01970-3699
978.744.4431 ' FAX 978.744:9614 - EMAIL: info®salemha.org
Equal Opportunity Employer
John A.Boris,Chairman
Frank J.Milo, Vice Chairman
Peter K. Strout,Second Vice Chairman
Maureen Call,Treasurer
SALEM HOUSING William E.Luster,AssistantTreasurer
A U T Hi 0 R I T Y Carol A.MacGown,Executive Director
EXTRACT FROM THE MINUTES OF THE
SPECIAL MEETING OF THE BOARD MEMBERS OF THE
SALEM HOUSING AUTHORITY HELD ON
WEDNESDAY,MAY 20,2015 AT 6:00 P.M.
The BOARD MEMBERS of the SALEM HOUSING AUTHORITY met in a SPECIAL
MEETING at the office of the Authority, 27 Charter Street in the City of Salem, Massachusetts
on WEDNESDAY, MAY 20, 2015 at 6:00 P.M., the place,hour, and date duly established for
the holding of such meeting. .
The meeting was called to order at 6:00 p.m. by John A.Boris, Chairman and upon a roll call,
the following answered present:
Present Absent
Maureen Call Frank J. Milo
William E. Luster
Peter K. Strout
John A. Boris
Also Present: Carol A. MacGown and Anne M. Cameron
The Chairman declared a quorum present.
MOTION
The following resolution was introduced by John A. Boris, Chairman,read in full, and
considered:
Peter Z-Strout moeed`to accep`TtIie price quotation submitted by FGF Network Services, Inc. for
Exterior Railing Replacement at Bertram Terrace (667-1A) in the amount of$21,795.00 and
authorize Chairman John A. Boris to execute a construction contract. Maureen Call seconded
the motion and the roll call vote was as follows:
Ayes Nays
Maureen Call
William E. Luster
Peter K. Strout
John A. Boris
The Chairman thereupon declared the motion carried.
81Page Board Extracts of 5 / 20/ 15
® 27 CHARTER STREET • SALEM MA 01970-3699
978,744.4431 ' FAX 978.744.9614 • EMAIL: info®salemha.org
Equal Opportunity Employer /
I
Typ.
[F
(E) Door_ Rails are to be
hot dip Galy.
and painted
black
Typ.
1-1/4. Materials for
SCH.40 all locations
TYR.
3' W-vr, tcS >.
—,/4" SCH.80 „
TYP. ; Round Base plates
8"X4" sleeved anchors
TYR
JTypical 100ty. Locations
Exterior Stair Rail
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Yes
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