392 HIGHLAND AVE - BUILDING INSPECTION The Commonwealth of Massachusetts
Department of Public Safety
Massachusetts State Building Code(780 CMR)
Building Permit Application for any Building other than a One-or Tvoro.Fa!mk Dw n
(This Section For Official Use Only)
Building Permit Number: Date Applied: - IBuilding Offici
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for whi s adds' of
Se J°m
No.and Street City/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 two rows below
Existing Building R'- Repair❑ 1 Alteration P!l� Addition❑ Demolition 0 (Please fill out and submit Appendix 1)
Change of Use El' Change of Occupancy IT I Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes IS— No ❑
Is an Independent Structural Engineering P2 Review required? /J Yes k No ❑
Brief Description of Proposed Wnork: /t-e n;?2 2 _7- 1
4
7o-a,
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) O
Existing Use Group(s): Ice., E� ...'C—LA Proposed Use Group(s): 6 'r
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❑ I B: Business I:: 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❑ I-4❑ 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 13 IIA ❑ IIB ❑ IIIA 17 IIIB ❑ 1 IV O I VA O VB
SECTION 7.SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Trench Permit: Debris Removal:
Water Supple: Flood Zone Information: Sewage Disposal: Licensed Disposal Site E
Public I3 Check if outside Flood Zone Indicate municipal A trench will not c P
Private❑ or indentify Zone: or on site system❑ required�j 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❑ I Yes O or No❑ Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: c'Jse Group(s): U Z- Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?:�'bL Special Stipulations:
SECTION? PROPERTY OWNER AUTHORIZATION
Name and of Property Owner
ame t� No.and Str et City/Town Zip
Property Owner Contact Information:
Title Telephone No.(business) Telephone No. (cell) a-mail address
If applicable,the property owner hereby authorizes
ply rAIDSnC;17,N.e /Z ez&% r rt/ y A-6-1v� p j
Name Street Address City/Town State Zip
to act on the propertyowner's behaff,in all matters relative to work authorized by this building permit application,
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
f 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
c, KY . Si N 9
jan(Re is ant ele hone No. e-m dress Re tstration Number
t U� M k 4G m Q1LD A9c-i- . 31 A4
Street Address City/Town State Zip Discipline xptr lion Date
10.2 General Contractor
/�
v of l S E �.. L c vP
Company Name
'1)4i +I- -\ 1r Z,G of
Name of Person Responsible for Construction License No. and Type if Applicable
Street gqA��d��drress City/Town State Zip
c4 A _( <'T .r4 aJ el,0
Telephone No.(business) Tele hone No. cell e-mail address
SECTION 11:WORKERS'CONIPENSATION 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,N No El
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ V7G/CYX7,Ca
1.Building $ 0�LW o Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ . 0,90 appropriate municipal factor)_$
3.Plumbing $ -p•Ob 0
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ --
Enclose check payable to
6.Total Cost $ 3/G oao (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.
Please print and sign name Title Telephone No. Date
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
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
3 Structural p.-
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC w
7 Electrical i1
8 Plumbing include local connections x
9 Gas(Natural,Propane,Medical or other A
10 Surveyed Site Plan tilifies,Wetland,etc. j X
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Surve /Investi anon
16 Energy Conservation Report
17 Architectural Access Review 521 CMR
18 Workers Compensation Insurance
19 Hazardous Material Miti ation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
`Areas of Design or Construction for which plans we 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
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-ma l address Registration Number
Street Address City/Town State Zi Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town/Town State Z Discipline Expiration Date
i
JUN/25/2014/WED 01 : 50 PM FAX No. P, 001
6/25/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY ANtI CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT
AFFIRMATIVELY OR NEGAnVELYAMENb, EXTEND OR ALTER THECOVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSURANCE DOES
NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRObUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the ceWNtate holder iF an ADDITIONAL INSURED,the POHcy(IeS)IRVSt be Ondoreed. I(SUBROGATION IS WAIVED,subject to the terms and Gondil one
of the polity,certain policies may require en endonn ment. A statement On this G rtificate does not confer rights to the ceHlRcsfe holder In f B I eU Of Suth endorsements(s)
PRODUCER CONTACT Charles L.Hoffman
Roffman Inst)rance Services,Inc. PHONE 7 FA'((A/C,No.EM): 81 235-D087 (AIC Nd.:)
PO BOX 9002 E-MAIL
Wellesley,MA 02492 9002 ADDRESS:
PRODUCER
f,11STfMFR ID 4 __
INSURERS AFFORDING COVERAGE NAICit
mgUREp INSURER A: Atlantic Charter Insurance Company VDAC 44326
St.John Coll). INSURER It
INSURER C:
120 Cedar Street INSURER D:
Wellesley,MA 02481 INSURER E:
INSURER F:
COVERAGES; CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE ADDL Into*
LTR IN80. WIS POLICYNUMBER POLICYEFF9GTIVE POLICYEXP(RATION LIMITS
OENEpgL LIgBILITV PATH IMMOoNY) DATE(MMIDwW) On Th4Pand)
EACH 000URRMCE S
COFAIERCW.OEIn:ggLUPBILITy OWµ 8 TO RENTED PREMISES
CUIMB=M ❑ OCCUR ❑❑ oesunep. S
MEDEI (P Myonommn,r) j
PERSONALAADVINJUR/ j
OENL AOOREOATE UMITAPPUEB PER GENERALMOREOATE j
POLICY ❑PROJECT ❑ LCC PROOUGTS'COMPIOP FDO S
AUTOMOBILE LIABILITY
ANYAUTO C EINEOSNOLEUMIT a
(Ea
Aµ O,OWNBOALITOS ILYI O
N
❑❑ JIJRY
p plgn
BCHEDIAEOglROg
P ) j
BODILY IWURY
NWEDMITOa (Ee Aaxde.Qn0 j
NONOMDEDALMOS PROPERTY DAMAGE j
(Ee Axltlenp
IUMBRELLA ❑ OCCUR
LIABILITY EACH OfiCURRENCE B
EXCRBS FAB❑ CWMB MADE
❑❑ AGGREGATE j
OEOULTIBLE S
a
RETENTION
a
A MPLVIORKERS YO ERBC'LIABILIryNANO WCVQII587UQ Q5/2'7/2QI4
Am PROPRIET0"ARtNEMXtCVTNE YIN DS/2'//,ZD1S X STATUTORY MRs OTHER
OFFICERIM MBEREXCLUDED] N' "A ❑ Policy Covera e State;MA EACH ACCIDENY IQQ QQQ
M-M.WIV III NH }� g to S
Ilyy,EmeNe unOcr BPECUL PgOVIgION00gtlry
DISEASE-POLICYLIMIT j 500,000
OISEASE-EACH EMPLDYEE a 100,000
OTHER ❑❑
bEBCRIPTION OF OPEAgTIONSILOCATONBNEHICLEB(AXp[b ACORp TOI,Addirwngl RerlleMs ScpeNh,IrTwn 5 Pane la Rwlrctl)
SHOULNE
D ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 9E96RE THE
CiNCi{ry[V Of SRIem EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
aSshingtonStreet 12 GAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.
12
Salem,Na 01970 BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES.
iHORIZED REPRESENTATIVE /t
ACORD 28(2006/OS)
Page t Plt
CERTIFICATE HOLDER COPY 01983-E008 ACORD CORPORATION.All righls rcacrved.
9,®f Massachusetts -Department of Public Safety
v Board of Building Regulations and Standards
Comm uctiun superrisur
License CS-001915 "
DA VID G STJOHN`
8 SHEREDAN CII2 -
WELLESLEY MA 02481' y _
J,.G.... .�tl • '� r,r + Expiration
Commissioner 10/29/2015 -
j
=' Office of Consumer Affairs and Business Regulation
a 10 Park Plaza- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 102465
"1? � `- ? Type: Private Corporation
Expiration: 7/2/2018 Trq 253887
ST. JOHN CORP. j
David St. John r
120 Cedar Street
Wellesley, MA 02481
Cpdate Address and return card.Mark reason for change.
SCA1 C,, 20M-05111 - Address Renewal ❑ Employment Lost Card
C��_ I i
c �{.oururnrut+eve/�c/f'llu�ac�rucl('
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
Q - ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _
gistrabon 102465 Type: Office of Consumer Affairs and Business Regulation ,
N Expiration 7/2/2016— Private Corporation 10 Park Plaza-Suite 5170
'Expiration:
_ Boston,MA 02116
ST.JOHN CORP. -
David St.John
120 Cedar Street g Qo v
a—
Wellesley. MA 02481 - Undersecretary Not valid without ' nature
'e;'
CITY OF Siu Era. N'LA SSACHUSMS
BUILDING DEPARTMENT
• a• 120 WASHINGTON STREET,3m FLOOR
dj TEL. (978)745-9595
FAX(978)740-9846
KIMBERLEY DRISCOLL
MAYOR THontAs ST.PIERRB
DIRECTOR OF PUBLIC PROPERTY/BUI DII4G COMMISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Analicant Information J T Please Print Le bly
Name(BusintscOrfanization/Indivithrtl):�� / eJ1�hly /02 0
Address: -dryry U ( iocl ,r- S
City/State/Zip: S je!N O>)"/S/Phone
Are you an employer?Cheek the appropriate box: Type of project(required):
L�1 am a employer with_ ? _ 4. ❑ I am a general contractor and 1 6. ❑New construction
employees(full and/or part-time).* have hired the subcontractors
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.: 7. ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. g, El Building addition
(No workers comp.insurance 5. El We are a corporation and its
required.) officers have exercised their 10.❑ Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL l 1.❑Plumbing repairs or additions
myself.[No workers'comp. c. 152,§I(4),and we have no 12.❑Roof repairs
insurance required.)t employees.[No workers'
comp. insurance required.] 13.❑Other
Any applic nt that chucks box d I must also fill out the section below showing their workers'compensation 1.
polity infurmmioe.
Itnmeownat who submit this affidavit indicting they ate doing all work and then him outside c penud rs smut submit a new alRdavil iodising such
Comrastors that check this box most anachsd an additiotnl chat showing the name of the sub-00mractots and their workers'comp,policy infornmtion.
l am an employer that is praviding workers'compensation insurance far my employees. Below is the pollcy and job site
information. /1 /
Insurance Company Name:Q f_&qY/L` :z,/
Policy#or Self-ins.Lie.#-- C I/ 17 / J ,rj� rf&7) Expiration Date: S�0 Ih
Job Site Address: City/Stale/Zip:-'s iq-/p th 0)R O l 9 7L)
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 fine
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 urlhe DIA for insurance coverage verification.
l do/tereby cert fypr/der a naJtles of perjury that the information provided above is true and correct
i,n t ire• % Date•.
Phan #:
Official use only. Do not write in this area,to be completed by city or town ofciaL
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Ileallh 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
L-k-a (A T- v-v
NFL
C
poaolr_ro CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
�+ e 120 WASHINGTON STREET, 3RD FLOOR
SALEM. MASSACHUSETTS O 1970
TELEPHONE: 978-745-9595 EXT. 380 -
.N7tr6 W� FAX: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
CONSTRUCTION CONTROL AFFIDAVIT
Project Number Date: June, 20, 2014
Project Title: Amanti Business Office Renovation
Project Location: 390 Highland Avenue, Salem,MA 01970
Name of Building: Amanti Business Building
Scope of Project: Convert an Exist. Residential Building Into Business Office Building w/ 2nd Floor Addition
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, i
Robert H. Griffin, PE . MASS. REGISTRATION NO, 36686 BEING A REGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
Civil XXX Architectural Structural Mechanical
Electrical Fire Protection 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.
I FURTHER CERTIFY 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 FOR 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 building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures foi all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construcUon specified in the accepted engineering practice standards listed in r
Appendix I.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR- UPON COMPLETION
OF THE WORK, I SHALL SUBMIT A FINAL REPORT AS TOT E SATISF CT RY COMPLETION
AND READINESS OF THE PROJECT FOR OCCUPANCY.
Signadu
SUBSCRIBED AND SWORN TO BEFORE ME THIS DAY OF 2004
My commission Expires:
Notary Public
r
t .
�3 �Z
-.
i ��
�1Z6 �
-�
I
•, .J
v��rnnmr�„,4 CITY OF SALEM, MASSACHUSETTS
PUBLIC PROPERTY DEPARTMENT
» 120 WASHINGTON STREET, 3RD FLOOR
SALEM, MASSACHUSETTS 01970
' \ TELEPHONE: 978-745-9595 EXT. 380
q`�>•NrnB W� FAX: 978-740-9846
KIMBERLEY DRISCOLL
MAYOR
CONSTRUCTION CONTROL AFFIDAVIT
Project Number. Date: jut-ia 2p%zo�1.
Project Title: kVorr1T( bu,54HF�� OFLGIi F-040IP<[1_OH - _--- --- -
Project Location: !j!W b b1L Nkr,7 4\lr-f f iENI,.A/A . Ot 9
Name of Building:
f-�►aVF�"C11-lry Gd`t �xt5?thlb ��t�EK?Ib•L� ?.mot-pb.
Scope of Project: tN?-o ctl5t140*-�2 OF:fEIG� 151.►�.2. w/2H�' t ooR, �Dt71ot�6
IN AC ORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUIDING CODE, I
� �( J, atPLN MASS. REGISTRATION NO.a�—zq I_BEING A REGISTERED
PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY
SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND
SPECIFICATIONS CONCERNING:
Civil Architectural X Structural Mechanical
Electrical Fire Protection 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.
I FURTHER CERTIFY 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 FOR 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 building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required control materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in
Appendix 1.
PURSUANT TO SECTION 116.4, 1 SHALL SUBMIT PERIODICALLY, A PROGRESS REPORT
TOGETHER.WITH PERTINE C fu NTS TO THE BUILDING 10SPECTOR. UPON CO PLETION
OF THE WORK, I SHALL �S L REPORT AS TO T SATIS TO Y COMPLETION
AND READINESS OF . CCUPANCY.
a
ay e
SUBSCRIBED AND S • O THIS -l!g 2t DAY OF - 2000
„ in - My commission Expires:
N ry Publk -tk1y,'w`auL—
Initial Construction Control Document
To be submitted with the building permit application by a
a Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Amanti Business Office Renovation Date: June 26, 2014
Property Address: 390 Highland Avenue, Salem, MA 01970
Project: Check(x)one or both as applicable: New construction x Existing Construction
Project description: Converting an existing residential building into business office building with a second floor addition.
I Terry A:Louderback MA Registration Number: 29641 Expiration date: June 30, 2014, am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning :
Architectural x Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans, computations and
specifications-meet the applicable provisions of the Massachusetts State Building Code, (780-0MR),and accepted
engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, 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. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
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 deterinme if the work is being performed in a manner-consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or OVA of Mq
electronic signature and seal: �s�`F SsgO9
g� TERRY ASHTON N
0 LONERBACK
1 STRUCT A
Q L
o. 61a
90 G E
Phone number: 617-926-6100 Email: tlouderback@souzatrue.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.Indicate with an`x' project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen,
provide a description.
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: A44✓ zXa4 Date: o l
Property Address: 6?ed tJ+,w— --
Project: Check one or both as applicable: ❑ New construction Z;-<stiting Construction n
Project description: At4gqL& e e800r "� Oc/ 1%� ��iilBLdr
I Gary P. Nangle MA Registration Number: 35871 Expiration date: 6/30/2016 am a
registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design
plans, computations and specifications concerning:
[ ] Entire Project [ ] Architectural [ ] Structural n y ] Mechanical
[ ] Fire Protection [ ] Electrical [/ij�ther �j >; dye tic Q, li .
for the above named project and that such plans, computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee) shall perform the necessary professional services and be present on the
construction site on a regular and periodic basis to:
1. Review, 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. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, I shall submit field/progress reports (see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'.
►AA►AA.4
Ili OF�
Enter in the space to the right a"wet"or �o`'� GARY P.
electronic signature and seal: NANGLE m
ELECT AL
No 8711
.o P
Phone number: 978 777-7650 ► 9 toNa ;i�� Email: gpnangle@nangleengineering.com
s•�
Building Official Use Only
Building Official Name: Permit No.: Date:
Trial Version 10 09 2012
Initial Construction Control Document
g To be submitted with the building permit application by a
d Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Amanti Business Office Renovation Date: June 20,2014
Property Address: 392 Highland Ave., Salem, MA 01970
Project: Check(x)one or both as applicable: New construction X Existing Construction
Project description: Converting an existing residence building to business office use w/2 nd floor addition
1 Steven L. Forte MA Registration Number: 32550 Expiration date: 6-30-16 , am a registered design professional,
and I have prepared or directly supervised the preparation of all design plans, computations and specifications
concerning:
Architectural Structural X Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted
engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and periodic basis to:
1. Review, 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. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, 1 shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'.
Enter in the space to the right a"wet"or
electronic signature and seal: sTEVEN L.
FORTE
MECHADMAL
No.32550
Phone number: 978-7770484 E il. sforte@forteengineering.net
""r�11bL
Building Official Use Only
Building Official Name: Permit No.: Date:
Note I. Indicate with an'x' project design plans,computations and specifications that you prepared or directly supervised. if'other' is chosen,
provide a description.
Version 06_11_2013
Initial Construction Control Document
To be submitted with the building permit application by a
a Registered Design Professional
for work per the 81h edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: koc,,eI5�1 Date: 6 ZG
Property Address: C39 �9^ ��Y /'T✓lE ; L � i9
Project: Check one or both as applicable: 0 New construction �//ting Construction L c /
Project description: J J� 7 it P tic eW d7 �G Q / 9
c
I Gary P. Nangle MA Registration Number: 35871 Expiration date: 6/30/2016 am a
registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design
plans,computations and specifications concerning:
[ ] Entire Project [ ] Arc itectural [ ] Structural [ ] Mechanical
[ ] Fire Protection [ ectrical [ ] Other
for the above named project and that such plans,computations and specifications meet the applicable provisions of the
Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee) shall perform the necessary professional services and be present on the
construction site on a regular and periodic basis to:
1. Review, 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. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
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 if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'.
JiOF s�
Enter in the space to the right a"wet" or °
c GARY P.
electronic signature and seal: 3�g �N
NANG m
a u ELECTRICAL
No. 3 71
i
Phone number:
978777-7650 NnlEt
s NAL Email:
gpnangle@nangleengineering.com
aia
Building Official Use Only
Building Official Name: Permit No.: Date:
Trial Version 10 09 2012
9265�
E. AMANTI & SONS, INC.
.. 390 HIGHLAND AVE. PH. 978-7454144' - - - 53-179/113
.SALEM, MA 01970 -
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301
Eastern Bank
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