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0040 REAR HIGHLAND AVENUE - BPA-18-86 1 CITY OF S.1LE:titl i NSSACHUSETTS BL•ILDING DEPARTII TINT 1_0 W ASH � LNGTON STREET, 3 FL.00R' TEL. (978) 745-9595 FA.X(978) 740-9846 KItIBER�L�.EY DRISCOLL AMAYOR THOMAS ST.PtEaRE DIRECTOR OF PUBLIC PROPERTY/Slum vt;owaassIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legibly ENFIELD ENTERPRISES, INC. Name i0asitwsa.Organizadotvindiviauuq: Address:- 30 Magaziner Place Springfield,MA 01104 (413)788-2688 City/State/Zip; Phone #: Are you an employer?Check the appropriate box: Ty pe of project(required): 1.0 I am a employer with 4. © 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet.; 7. [J Remodeling ship slid have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity, workers'comp, insurance. 9. 0 Building addition [No workers' comp. insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.n Electrical repairs or additions 3.0 1 am a homeowner doing all work right of exemption per MGL I I.Q Plumbing repairs or additions myself.[No workers'comp. c. 152,$1(4),and we have no 12.0 Roof repairs insurance required.)t employees.[No workers' 13 E]Oth rM nical comp.insurance required.] cha -Any applicant that checks box xl most also rill out the section belowshuwing their workers'compeomion policy information. ' t Ihmnvuwnrn who submit this affidavit indicating they ate doing all work mad then hire outside contractors,most submit a new affidavit indicating such. =Contractors that check Ibis box most attached an additional chap showing llw name of the subcontractors and their workers'camp.policy infomatim. lam an etnplayer that lr providing workers'co+npetlsation hrsarance far my employees. Below!s the poticy and Job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: ` Job Sire Address:40R Highland Ave., City/State/Zip: 1 Salem ,\ttach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 4 Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a ,4 7 fine up to S 1,500.00 und/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be-forwarded to the Oflice of Investigations ol'the DIA for insurance coverage veriticalion. 1 da hereby cceertlfy under d\m pains and penes a a that he infworation provided above is true and correct i ma 1 Ire• CV"�t� Cn•�ee•• t`ise.S y^N[� [)at•: G�/!�D�. Phone# Nl3 "?a Ifs BE OJjcia/f{,4e only. Do not write In this area,to be cwnpleted by city or town official City ar'rowrl: _. Permitfl.leense Issuing Awhority(eirele one): _ 1. Board of Ilealth 2.Building Department 3.City/fawn Clerk 4.Electrical inspector 5. Plumbing Inspector 6.Other Contact Phone#: _ . •v > _ - �.. t CITY OF SMY.M. AA ss.A cHUSETTS BL'A.DING DEPARTNI NIT 120 WASHINGTON STREET, 3' FLOOR T-El- (978) 745-9595 KIMBERLEY DRISCOLL FAX(978) 740-9846 WYOR T7:1ows ST.PmRRB DIRECTOR OF PI:BLIC PROPERTY/H1;ILDING CONL\RSSIONER APPLICATION FOR THE CONSTRUCTION, REPAIK RENOVATION, CHANGE IN USE OR OCCUPANCY,OR DENOU710N OF ANY BWLDING OR STRUCTURE This Seatba for Of clsl Use Only I B4iktlnq Permit,PtloJsot. 0atV.d 1 iy/ BuilcGng '�nsp�tor;: ��/ ,�' 3aes�/ Esttina4 Projad Ostew start End: Comments: 1.0 SITE IN00RUATION LoCatlon Naff"L Fairweather Salem BLllid(ng: Address: 40R Highland Avenue, Salem Assessm MaWBIOCI{: Lot/parcel: 2,Q QW�IIyFORt)AA710N 2.1 Owner of Land Name: Fairweather Preservation Associates Limited Partnership Address: 40 Court Street, Suite 650, Boston, MA 02108 jgige; (617)261.9898 li 12 Owner or lessee of building or sftciure Nam: Fairweather Preservation Associates Limited Partnership ems' 40 Court Street, Suite 650, Boston, MA 02108 Telephone: (617)261. 9898 3.0 AGENCY OR AUTHORITY AUTHORIZING CONSTRUCTION Agency Name: Not Applicable Address: Agency Project Number. Project Manager Name: Tel: 6.0 PROFESSIONAL CONSTRUCTION SERVICES: 6A General Contractor I ENFIELD ENTERPRISES, INC. Address: 30 Magaziner Place Springfield, MA 01104 Telephone: 1(413)788.2688 Fax: (413) 788.2479 Responsible In Charge of Construction: C. Christopher Katzer, Senior Project Manager 7.0 CONSTRUCTION DOCUMENTS -to be prepared by applicant Item 4 as Applicable 7.1 Plans (Note 1 this page) Submitted Incomplete Not Required 7.1.1 Architectural x 7.1.2 Foundation x 7.1.3 Structural x 7.1.4 Fire Suppression x 7.1.5 Fire Alarm 7.1.6 WAC x 7.1.7 Electrical x 7.2 Specifications x 7.3 Structural Peer Review 7.4 Structural Tests & Inspections Program x 7.5 Fire Protection Narrative Report x 7.6 Existing Building Survey x 7.7 Workers Compensation insurance x 7.8 Other Documents (Specify) x (Energy Narratives, etc.) Note I Areas of Design or Construction for which Plans are not complete at the time of this application must be identified herein. Work so identified must not be commenced until this application has been amended and proposed construction has been approved by the Department of Public Safety District Building Inspector having Jurisdiction. NQ " a, 9.0 COMPLETE THIS SECTION FOR WORK IN EXISTING BUILDINGS ONLY For new construction COMIDIate,sect Ion 8-0 Addition Existing Six(6) Renovation X Minor Number of Stories Renovated Change ln'Use No change New Demolition Existing Approximate year of Area per floor(so Renovated construction or renovation 1968 of existing building New, adell Description of Proposed Work: Ordinary repair and replacement. .91.1 USE GROUP AND CONSTRUCTION CLASSIFICATION(ExIadh9jou4c"Ings QnIYY1 Changer USE Group(s) ExisnNd PROPOSED in ONISTRUCTIO" Use Hazard Use Hazard Hazard 'CLASSIFICATION (note wti-categ") r Group Index '�Oroup- Index Index -Vv�# A Assembly 1A 8 Business is E Educational F Factory 29- H High Hazard 2C I Institutional 3A. M Mercantile R2 2 UNCHIkNGED 313 R Residential 4 1 S Storage SA U Utility 58 Mx Mixed Use Hazard Index Modifier Sp Special Use Note: Include Hazard Index Modifier for Construction Type as applicable . 6.-..m.�ci�m^"^r_xk:...:on�xu3 .t[�i•__.a:.t,._a 2v\ t,ra 1 13k 3 a to 9.0 CONSTRUCTION COSTS (See 780 CM;Appendix L) ' + Total Construction Cost Building Permit Fee Check Number 3 I y (1) =(1)x$0.001 1 , z �o , U66 ,2b 10.0 AUTHORIZATION OF STATE AGENCY FOR AGENT TO APPLY FOR BUILDING PERMIT(when applicable) 1, on behalf of the authorb*V State Agency or Authority, hereby authorize, to apply far the building permit for project number, Signature Date 11.0 SIGNATURE OF BUILDING PERMIT APPLICANT Rick Carriero Enfield Enterprises Inc.,as Agent for the Owner Name L.." �Oos2 L%P — C. (Sa (2m7 Signature Date 12. Certificate of Occupancy required on completion of project? _Yes X No Inspectors Note$: CITY OF S.U.&M. IN-L-ksSACHUSETTS BL'mmG DEPARTStENT • 120 WASHLNGTON STREET, 3w FLOOR "ILL (978) 745-9595 Fax(978) 740-9846 KIN IBERIEY DRISCOLL MAYOR DIRECTOR ST.PaERR& DIRECTOR OF PUBLIC PROPERTY/BUILDING CO%l!NaSSIO.iER CONSTRUCTION CONTROL DOCUMENT Project Title: Fairweather Salem Date: Project Location: 40R Highland Avenue, Salem Ordinary Repair and Replacement Work V-0 Scope of Project: In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code : I. Jose A. Guzman Mass. Registration Number 9726 being a registered professional Engineer rc 1 hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: ( ] Entire Project ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other(specify) for the above named project and that to the best of my knowledge,such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,all acceptable engineering practices and all applicable laws for the proposed project. Furthermore,I understand and AGREE that i shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code-required controlled materials. 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, in general, if the work is being performed in a manner consisleut with the cuubt,uction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building offic' eport as to the satisfactory completion and readiness of the project for occupancy. a�p,�p_ Signature and Seal of registered professional: 9 CITY OF SaZL.t11, 1UNSSACHUSETTS BUMDLNG DEPARnclENT 130 WASHINGTON STREET, 3"a FLOOR TEL (978) 745-9595 FAX(978) 740-9W KIJBERLEY DRISCOL.L MAYOR THoli,NS ST.PIERRa DIRECTOR OF PUBLIC PROPERTY/BUU.DLNG CO\L\(ISSIO.F-R SECONDARY CONSTRUCTION CONTROL DOCUMENT (for Professional Engineers/Architects responsible for only a portion of a controlled project) Project Title: Fairweather Salem Date: April 23,2007 Project Location: 40R Highland Avenue,Salem Ordinary Repair and Replacement Work. Scope of Project: In accordance with the sixth edition Massachusetts State Building Code,780 CIMR SECTION 116.0: 1 Jose A.Guzman Mass.Registration Number 9726(Architect) being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] Entire Project [)t] Architectural [ ] Structural [ ] Mechanical ( ] Fire Protection [ ] Electrical [ ] Other(specify) for the above named project and that to the best of my knowledge, such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,all acceptable engineering practices and all applicable laws for the proposed project. Furthermore, 1 understand and AGREE that I shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit. Upon completion of the work,I shall submit a final report as to the satisfactory completion of the above mentioned portion of the work. AR Signature and Seal of registered professional: - N 9726 olll OF CITY OF S.UF.M. 1LxsSACHLSETTS BuILDLNG DEPARTNM T N 120 WASHINGTON STREET, 3"FLOOR fib! TF-.I_ (978) 745-9595 FAx(978) 740--9846 K1gIBERLBY DRISCOLL MAYOR TI-oNw ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUn.DVgG CONINUSSIONER CONSTRUCTION CONTROL DOCUMENT Project Title: Fairweather Salem Date: ,® May 22,2007 40R Highland Avenue, Salem Project Location: _. Capital Improvements Work shall include: Boiler Replacement; Window Scope of Project: Replacement: Exterior Improvement to Stair/Elevator Tower: Interior Improvement to Common Areas, including Accessible Kitchen and Exterior Parking tot Improven aenta ln.accordance with SECTION It 6.0-1 16.4.2 of the 6th edition of the Massachusetts State Building Code : l Patrick Curran Mass. Registration Number 39596 being a registered professional�Srch,tect hereby CERTIFY that I have prepared.or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project ( ] Architectural ( ] Structural [ ] Mechanical [ j Fire Protection ( ] Mcctrical [X] Other(specif-y)----PJumbin _ for the above,named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. lhermore,I understand and :SCREE that I shall perform the necessary profess, 1 services and be present on the co _;ion site on a regular and periodic basis to determine that the work , "cceding in accordance with the documents roved by the building permit and shall be responsible for ollowing as specified in section 1 16.2.2: 1. Review of shop draw •s,samples and other submina f the contractor as required by the construction contract documents as sub ' ted for dte build ng mit, and approval for the conformance to the design concept. 2. Review and approval of the quality tro ocedures for all code-required controlled materials. 3. Be present at intervals ap riate to the stage of cc ction to become generally familiar with the progress and quay of the work and to determine, in eral, if the work is being performed in a manner cons iste with the construction documents. i shell subm' eriodieal(y, in a Corm acceptable to the building official, a pr ess report together with pertinent nen . Upon completion of the work, I shall submit to the building official a ' 1 report as to the %4 OF city completion and readiness of the project for occupancy, pp o2S, cy Do�C`*� g _PATra not Seal of registeredpw4ss,anai: s f E R I t#-"J MECHANICAL vA e No.'M96 dA The Maricor Group d 01 , w.v_;:w,.m .rir_orgresu June 4, 2007 City of Salem Building Department 120 Washington St, 3Id Floor Salem, MA 01970 This is to inform The City of Salem that I, Pat Curran, Massachusetts Registration 39596 has certified that I prepared or directly supervised the preparation of Plumbing design plans and specifications for: Project Title: Fairweather Salem Project Location: 40R Highland St, Salem Scope of Work: Capital Improvements Work including Boiler Replacement, Window Replacement, Exterior Improvement, Interior Improvement to Common Areas, including Accessible Kitchen and Exterior Parking Lot Improvements However, due to the discontinued operations of the engineering firm The Maricor Group New England, I will not be able to perform the necessary professional services during construction such as: 1. Review shop drawings and submittals for conformance to design concept. 2. Review and approve of quality control procedures for all code required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I will cooperate and transfer all information necessary for another Engineer to provide professional services during construction. (2" Pat Curran Page 1 of I V:\DWGS\06\06044.00 Fairweather Development\SubmittalsandAddendums bind\Plumb affidavid condition.doc 268 Summer Strect, Suite 200 • Boston. Massachusetts 02210 • Telephone 617.482.6281 • Fax 617.482.5262 Boston,Massachusetts - Portland, Maine • Presque Isle, Maine • Halifax, Nova Scotia • Moncton. Nev, Brunswick ' r • s - ° CITY OF SALEM. 1%LkSSACHUSETTS BUTI.DD;G DEPARTS1E1NT • #• 130 WASHINGTON STREET, 3° FLoOR b� TEL. (978) 745-9595 FAx(978) 740-9846 KI:LtBERLEY DRSSCOLL MAYORTHo;dtAs$T.PIEARS DIRECTOR OF PUBLIC PROPERTY/BI:TIDL4G CO.'XMISSIONER CONSTRUCTION CONTROL DOCUMENT Project Title: Fairweather Salem Date: May 22,2007 Project Location: 40R Highland Avenue, Salem Capital Improvements Work shall include: Boiler Replacement; Window Scope of Project: _. Replacement; Exterior Improvement to Stair/Elevator Tower; Interior Improvement to Common Areas, including Accessible Kitchen_and Exterior Park[ng.-lQt lLmprQy-e ,Prrtc—_,.- ._._._. In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code I Patrick Curran _ Mass. Registration Number 39596 being a registered professional�Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project [ ] Architectural [ ] Structural [X] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other(specify) _ for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the .Massachusetts State Building Code, all acceptable engineering practices and all applicable taws for the proposed project. rthermore, I understand and AGREE that I.shall perform the necessary professional services be present on the svuction site on a regular and periodic basis to determine that the work is proccedin accordance with the documen proved by the building permit and shall be responsible for the fallowin specified in section 1 16.2.2: 1. Review of shop dr. ngs,samples and other submittals oft ontractor as required by the construction contract documents as s fitted for the building pe rtd approval for the conformance to the design concept. 2. Review and approval of the quality c rocedures for all code-required controlled materials. 3_ Be present at intervals ap riate to the stage of co ction to become generally familiar with the progress and qua1- of the work and to determine, in g ral, if the work is being performed in a manner consts with the construction documents. I shall su it periodically, in a form acceptable to the building official, a pro ss report together with pertinent om his. Upon completion of the work, I shalt submit to the building official a al report as to the HOF factory completion and readiness of the project for occupancy. - PAIR re and Seal of registered professional: _. MECHANICAL y No:39596 r j ;; AJThe Maricor Group rA wyrty_rn=a.'corgr..0.is co..l May 22, 2007 City of Salem Building Department 120 Washington St, 3`d Floor Salem, MA 01970 This is to inform The City of Salem that I, Pat Curran Massachusetts Registration 39596 has certified that 1 prepared or directly supervised the preparation of Mechanical design plans and specifications for: Project Title: Fairweather Salem Project Location: 40R Highland St, Salem Scope.of Work: Capital Improvements Work including Boiler Replacement, Window Replacement Exterior Improvement, Interior Improvement to Common Areas, including Accessible Kitchen and Exterior Parking Lot Improvements However, due to the discontinued operations of the engineering firm The Maricor Group New England, I will not be able to perform the necessary professional services during construction such as: 1. Review shop drawings and submittals for conformance to design concept. 2. Review and approve of quality control procedures for all code required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I will cooperate and transfer all information necessary for another Engineer to provide professional services during construction. 4Cmurr Page I of I V:\DWGS\06\06044.00—Fairweatlier Development\SubmittalsandAddendums bind\meth affidavid condition.doc 268 Summer Street,Suite 200 • Boston, Massachusetts 02210 • Telephone 617.482.6281 • Fax 617.482.5262 Boston.Massachusetts • Portland, Mame • Presque Isle, Maine - Halifax, Nova Scotia • Yonc on. New Brunswick J CITY OF SM.EM, .%L `i.XSSACHUSETTS BUILDING DEPARTMENT • N. 130\XIASHLNGTON STREET, 3e°FLOOR ' bl TF.L (978) 745-9595 F-tit(978) 740-9846 K1.\C3 Ri RY DRISCOLL MAYORTiIOMAs ST.PIERRE DIRECTOR OF PUBLIC PROPERTY/BUILI)ING CO\NISSIONER �S pOFb9t5 c CONSTRUCTION CONTROL DOCUMENT CA Project'ride: Fairweather Salem Date: ._ May 22, 2007 _ 40R Highland Avenue, Salem SS/ N,tlEt� Project Location: .,_ Capital Improvements Work shall include: Boiler Replacement; Window Scope or Project Replacement; Exterior Improvement to Stair/Elevator Tower; Interior Improvement to Common Areas, including Accessible I itchen;_and Exterior Psl ;tag_LQLlmprovPmPnts W_ In accordance with SECTION 116.0-116.4.2 of the 6th edition of the Massachusetts State Building Code 1 _Nick Ferzacca Mass. Registration Number 43208 being a registered professional n meet Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: [ ] Entire Project f ] Architectural [ ] Structural [ J Mechanical [ ] Fire Protection [� Electrical [ ] Other(specify) for the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the proposed project. Fu rmore,I wrderstand and AGREE that 1 shall perform the necessary fessional services and be present on the cons coon sits on a regular and periodic basis to detemnine that th ork if proceeding in accordance with the documents a oved by the building permit and shall be responsibl r the following as specified in section 1 16.2.2: 1. Review of shop drawhn samples and other sub al of the contractor as required by the construction contract documents as submi for the build' permit, and approval for the conformance to the design concept. 2. Review and approval of the qualit ontrol pr dotes for all code-required controlled materials. 3. Be present at intervals ap priate to the stage of cons tru on to become generally familiar with _ the progress and quali of the work and to detemrine, in gene ], if the work is being performed in a nnanner cons iste with the construction documents, I shall submi eriodically, in a form acceptable to the building official, a pro ess report together with pertinent comments 'pon completion of the work, I shall submit to the building official a tal report as to the satisfac ry completion and readiness of the project for occupancy. Signature and Seal of registered professional: 9eL_ g 4.414 J rW SJ/1c ¢ g6o � 7a9 ' 3yds `� � tFS i --- ----------------------------------------------------- --- ------------------------------------------------------ ied person(s) personally appeared before.me and made an rK Notary Public (seal) Date Commission Expires 1- s.s. # a55 3 I e Acts of 1985 and Chapter 110, Section 5, of Mass. for four (4) years from the date of issue and shall be er oath mast be filed with the town clerk upon siness or partnership. dress a[ which such business is conducted and shall be any person who has purchased goods or services from IJ m hundred dollars ($300.00) for each month during which 4900 The Maricor Group Yvy✓y✓.mriro_rgrgu�corn June 4, 2007 City of Salem Building Department 120 Washington St, 3rd Floor Salem, MA 01970 This is to inform The City of Salem that 1, Nick Ferzacca, Massachusetts Registration 43208 has certified that I prepared or directly supervised the preparation of Electrical design plans and specifications for: Project Title: Fairweather Salem Project Location: 40R Highland St, Salem Scope of Work: Capital Improvements Work including Boiler Replacement, Window Replacement, Exterior Improvement, Interior Improvement to Common Areas, including Accessible Kitchen and Exterior Parking Lot Improvements However, due to the discontinued operations of the engineering firm The Maricor Group New England, I will not be able to perform the necessary professional services during construction such as: 1. Review shop drawings and submittals for conformance to design concept. 2. Review and approve of quality control procedures for all code required materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I will cooperate and transfer all information necessary for another Engineer to provide professional services during construction. jI �acca VADWGS\06\06044.00_Fairweather Development\SubmittalsandAddendums bind\Elec affidavid condifion.doc 268 Suminer Street,Suite 200 • Boston, Massachusetts 02210 • Telephone 617.4826281 - Fax 617.482.5262 Boston, Massachusetts • Portland, Maine • Presque Isle, Maine • Halifax, Nova Scotia . Moncton, New Brunswick