28 GOODHUE ST - BUILDING INSPECTION (7) I
The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
{GPI u 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)
28 Goodhue St. Salem 01970 North River Apartments
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 GO or check all that apply in the two rows below
Existing Building❑ Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition W (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 ® a No ❑
Is an Independent Structural Engineering Peer Review required? Yes ❑ No
Brief Description of Proposed Work:
This is an application for foundation permit only.Scope includes Demolish existing brick structure�onsite-no utilities connected Install new
geo-piers,excavate and backfll for new foundations. _
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.) N/A N/A 4 2/314 FL= 19,106 SF
Total Area(sq.ft.)and Total Height(ft.) 74,189 51'-8"
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 ❑ A-2❑ Nightclub ❑ A-3 ❑ A4❑ A-5❑ 1 B: Business la E: Educational ❑
F: Factor F-1 ❑ F2❑ H: Hi h Hazard H-1 ❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ M: Mercantile ❑ R: Residential R-10 R-2® R-3❑ R-4❑
S: Storage S-1 ❑ S-2❑ U: Utility❑ Special Use❑and please describe below:
Special Use:
ICI - SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA [I IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ 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❑
, t
Private❑ or indentify Zone: A or mrsite system❑ required❑or trench or specify: Diaz Constructio
permit is enclosed❑
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable N Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed❑ Yes ❑ or No® Yes❑ No ❑ N/A
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:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
North River Canal LLC 282 Bennington St East Boston MA 02128
Name(Print) No.and Street. City/Town Zip
Property Owner Contact Information:
. Anthony Roberto 781 -592 - 6400
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes
Essex Builders Corp. 400 Blue Hill Drive,Suite 2C Westwood MA 02090
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 permit a2plication.
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 O and skip Section 10.1
10.1 Registered Professional Responsible for Construction Control
Brent.R.Goldstein P.E.
Goldstein-Milano LLC 761 _ s7o _ ggg0 36782
Name(Registrant) Telephone No. e-mail address Registration Number
125 Main Street Reading MA 01867 Structural 06/30/2014
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Essex Builders Coro
Company Name
Christopher Serino 59924
Name of Person Responsible for Construction License No. and Type if Applicable
400 Blue Hill Drive,Suite 2C Westwood MA 02090
Street Address City/Town State Zip
781-198_- 3466 781 - 953 - 1278 cserinoQcDessexbuilderscoro 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
and Materials) Total Construction Cost(from Item 6)_$ sing,143
1.Building-Foundations $ 509,143 Building Permit Fee=Total Construction Cost x nn7(Insert here
2.Electrical $ appropriate municipal factor)_$ 3,564
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ 25 00 (contact municipality) j
5.Mechanical Other $ Enclose check payable to
6.Total Cost $ 509,143 (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.
Super OtPllriPnt 781 1278
Please print,and sign name Christopher Serino Title Tele - ne No. Date
do Fccex RiMciprs Corp,400 RhiP H'll Drive'Ru to 2C Westwood
Street Address City/Town She /
Municipal Inspector to fill out this section upon application approval:
Na e Date
Appendix 1
For the demolition of structures the building permit applicant shall attest that utility and other
service connections are properly addressed to ensure for public safety.
Please fill in the information below and submit this appendix with the building permit
application. The building permit applicant attests under the pains and penalties of perjury that
the following is true and accurate.
Property Location (Please indicate Block # and Lot # for locations for which a street address is not
available)
28 Goodhue St. Salem 01970 North River Apartments
No. and Street City /Town Zip Name of Building(if applicable)
For the above described property the following action was taken:
Water Shut Off? Yes ® No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Gas Shut Off? Yes ® No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Electricity Shut Off? Yes ® No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
**No utilities are currently connected to structure onsite.
Appendix 2
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required for this. The applicant
shall fill out the checklist and provide the contact information of the registered professionals
responsible for the documents. This appendix is to be submitted with the building permit
application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
1 Architectural
2 Foundation X
3 Structural X
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 plumbing include local connections
9 Gas Natural,Propane,Medical or other
10 Surveyed Site Plan Utilities,Welland,etc.
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review 521 CMR
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work
so identified must not be commenced until this application has been amended and the proposed construction document amendment
has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit
fee.
Registered Professional Contact Information
Thomas P.Galvin
20285
in 1 n9raesa R Ascocia}ac Q7R-n7n - 4fi7F
Name(Registrant) Telephone No. e-mail address Registration Number
One Elm Square Andover _1dB 01810 Arch tact 08/31/2013
Discipline Expiration Date
Street Address City/Town State Zip
Brent R.Goldstein P.E. 36782
Goldstein-Milano LLC 781 - 670 - 9990
Name(Registrant) Telephone No. e-mail address Registration Number
125 Main Street Reading MA 01867 at�t,ral 06/30/2014
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zi Discipline Expiration Date
CITY OF SME:M, i/LkSSACHUSETTS
• BUILDING DEP,,RT%iE,-4T
' 120 W{SHINGTON STREET,3Pa FLOOR
TEL (978)745-9595
FAX(978) 740-9M
iISiBFRi FY DRISCOLL
MAYOR 'IHONIAs ST.PMRRIs
DIRECTOR OF PUB11C PROPERTY/BuILDL14G CO%L%MIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers `
Applicant Information Please Print Leeibly
Name(BusinessiOrganization/Individual): Essex Builders Corp.
Address: 400 Blue Hill Drive Suite 2C
City/State/Zip: Westwood,MA 02090 Phone #: 781-326-3466
Are you an employer?Check the appropriate box: Type of project(required):
I.El 1 am a employer with to 4. ❑ 1 am a general contractor and 1 6. ®New construction
employees(full and/or part-time).' have hired the sub-contractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have S. ❑ Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers'comp. insurance 5. ❑ We are a corporation and its I0.❑ Electrical repairs or additions
required.) officers have exercised their
3.❑ 1 am a homeowner doing all work right of exemption per MGL I I.[I Plumbing repairs or additions
myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs
insurance required.)t employees. [No workers' l3.❑Other,
comp. insurance required.]
Any applicant that checks box#I must also fill out the section below slowing their workers'compensation policy informant).
t I lomeowners who submit this affidavit indicating they am doing all work and then him outside contractors most submit a new affidavit indicating such
'Contractors that check this box mum attached an additional shun showing the name of the sub-contmebm and their wodmm'Wmp,policy infomaation.
lam an employer that is providing workers'compensation Insurance for my employees, Below is the policy and fob site
information.
Insurance Company Name:. Twin City Fire Insurance Company(NAIC#29459)
Policy#or Self-ins. Lic.#: OBWEQT3013 Expiration Date, 12v1/13
Job Site Address: 28 Goodhue St. —City/State/Zip:_ Salem, MA 01970
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fore
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations or the DIA for insurance coverage verification.
I do hereby certify under he pains and penalties of perjury that the information provided above is true and correct
Signature: !/ Date: /Z• /9 /,Z_
David J.O'Neil resident EssexBuildersCorp.
Phone#• For Questions related to this matter contact Sally Dube,781-326-3466 x 209
Official use only- Do not write in this area,to be completed by city or town orwhit,
City or Town: Permit/License#
Issuing Authority(circle one):
I. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector-
6.Other
Contact Person: Phone#'
Architects
TD
_LaGrasse & Associates, Inc. Joseph D.LaGrasse,ALA
- Thomas E Galvin,AiA
__
Architects, Engineers &Land Planners
]ulianna E.Hoch,12A
AFFIDAVIT
ARCHITECTURAL DESIGN
Permit No.
To the Building Commissioner:
1 certify to the best of my knowledge and belief,the plans and computations accompanying the attached
application concerning: North River Apartments Precinct:
Have been , in my professional opinion, prepared in accordance with the applicable requirements of the
8th edition of the Massachusetts Building Code and other pertinent laws and ordinance.
Thomas F. Galvin ��gREO�eyiT
0 5 F. F
L'
Z
No.20285 on
Architect-MA. Reg#20
MASS.
JD. LaGrasse&Associates �g
One Elm Square r[Ty OF tppSSP
Andover, MA 01810
978-470-3675
Then personally appeared the above-named Thomas F. Galvin and made an oath that the above
statement by him is true.
Before me,
d`�a'�6* '6 /
Laurie Levy
My Commission expires:
Date: /"l-a-/a
One Elm Square T 978.470.3675 1420 Celebration Blvd.
Andover,MA 01810 F 978.470.3670 Celebration,FL 34747
AA26001333
w .lagrassearchitectsxom
AFFIDAVIT
STRUCTURAL DESIGN
Permit No.
To the Commissioner, Inspection Services Department
Re:
I certify that to the best of my knowledge, information and belief, the structural drawings prepared by this
office and accompanying the attached application conceming the foundations for the new building at 28
Goodhue Street called North River Apartments in Salem, MA Ward have been, in my
professional opinion, prepared in accordance with the applicable requirements of the 8h ed. of the
Massachusetts State Building Code and other pertinent laws and ordinances.
OF
a y
BRE R. G
I< D TEl `r L Brent R. Goldstein P. E.
A w
6782
36782 ,
9FGI8'(QQ`�O Structural - Mass Reg. No.
SSONALE �
GOLDSTEIN-MILANO LLC
125 Main Street
Reading, MA 01867
seal 781-670-9990
Then personally appeared the above-named Brent R. Goldstein and made an oath that the above
statement by him is true.
Before Me,
My commission expires:
seal date
I
CITY OF SAL.EM. iNLXSSACHUSETrS
Bt.IR o=DEPARTMENT
130 WASHNGTON STREET, 3° FLOOR
o� TEL (978) 745-9595
Fmx(978) 740-9846
KI\{pERLEY DRISCOLL
ANYOR THo.%w ST.P1ERRa
DIRECTOR OF PUBLIC PROPERTY/BUILDNG CONNISSIONER
Construction Debris Disposal Affldavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section It 1.5
Debris, and the provisions of MGL c 40, S 54;
Building Permit 4 is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
(name of hauler)
The debris will be disposed of in :
(name of facility)
-- '(address of t'acil4y)
signature permit applicant
12 ^ 2 /�/z
date
CITY OF SALEM n
ROUTING SLIP
New Construction J(.
Certificate of Occupancy
LOCATIODf�tlE _T_ DATE
__:�, ASSESSO S DATE�a
93 Washingt t
CITY CLER DATE
93 Washington St.
UBLIC SERVICES DATE �Y
120 Was ngto St.
WATER DATE W (�
120 Washington St.
CROSS CONNECTION DATE
5 Jefferson Ave
PLANNING � , DATE I2 2 IZ
120 Washington St.
—� CONSERVATION DATE
120 Washington S .
ELECTRIC aZ DATE o2 2
48 Lafayette St.
FIRE PREVENTIO DATE
29 Fort Avenue
HEALTHwi DATE
120 Washington St. /
BUILDING INSPECTOR c�(„;A / ATE / * 3 1
120 Washington St. `�
J