Loading...
440 HIGHLAND AVENUE - BUILDING INSPECTION ..k 04/30/2014 17i31 5083394743 NITTANY CONSTRUCTION PAGE 04 I L !' o ,, The Commonwealth of Ma chusetts �`� irb ��(�'J�)�p�ent of Pubic Safety MasTattfusettF State Building Code(780 C.M. Building Permit Application for•any Building other than a One-or Two-Fam-1 1)w g _ (Thiss section Pox Official Use Ord ) ..._ - BuildutgPennhNumber: __- Date Applied: ^ Building Official; J SECTION 1 LOCATION(Please indicate.Black li and Lot S for locations for wh-srich a street addreAx is not available) �7-� Na,and Sheet City/Town Zip Code Name of Building(if applicable) 9ECry,TON 2;PROPOSEIT WORK m ..,.�_. �, Edition of MA State Code toed AM If New Construction check here O or check all that apply in file two rows below Existing Buiidingjl Repair b Alteration 0 1 Addition❑ Demolition 0 (Please fill curt and submit Appendix 1) Change of f7 Change of Occupancy © Other O Specify..--___ Are mulaing plans and/or construction documents behig.strpplied as part of this permit application? yes il No O Is an Independent Structural Engineering Peet Review required? Yes 0 No Ef Brief Description.ofproposed wark:_ ..r•,pet t. _. SfiCTI0iJ3:COMPLET'ETTIIS SECTION IP NGF IN USE O CIC UNDERGOING RENOVATION,ADDITION,OR \77, . CILANGEIN USE OE gCCUPANCY Check here if an EndsNng B—wilding Inveatrigation and Evaluation is enclosed($ae 78o CMR 34) 13 ._._ Fxiskiug Use Granp(s): �, Proposed Use Group(s): (j,�rs SECTION 4:BLBIAING HEIGHT AND AR1iA _ ...•...• Existing Proposed No.of Doors/Stories(indu is basement leveb)&Area Per Floor(sq.ft•) 1 Total Area(sq,ft.)and Total Height(ft.) SECTION 5:USE GRO_I.1P(Check as applicable) A: Assembly A-1 0 A-2❑ Nightclub Ci A-3 0 A-4 0 AS 0 B: BusinesF Q E: Eduearional. ❑ F: Pa F-10 F2 q H: Hisvh Hazard H-1❑ Il-2❑ .F{ f] H•4 H-5❑ L• ixrsNttdianai i-1 Cl 1-2❑ I-3© 1-4 Cl M: Mercantile e! R: Residential R-10 R-2 Q R-3 0 _Rol 0 S: Storage 5-I.❑ 5.1171 U: U61ity 0 Special Uae 0 and please describe below: Special Use /r _ SECITON 6:CONSTRUCTION TYPE(Check as applicable) I IA 17 iB f] rIA ❑ UR X IIIA ❑ IIIB ❑ IV o VA M- Vil M SECTION 7:SITE INFORMATION(refer to 790 CMR111.0 for details on each item) water Supply. Flood Zane Information: Sewage Disposal: Trench Permdt, Debris Removal: Public 7 Check if outside Flood Zane❑ Indicate mtmicipaI7 A breach will not be Lkc ed Disposal Site i Private 0 or indentify Zone:..-. or on site system© required JZi'or trench or specify: permit is enclosed 12 Railroad right-of-way: hazards to Air Nevi ahorc -�..,..._ g .�tA hliaklr�t2t11ntissicm Isnvy� �r<xeaA: Not Applicable Jd Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed❑ Yes M or No 1' Yes❑ No Cl WA. SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY -� Edition of Cade: Uae Group(s): • Type of Co trucdon: Occupant Load,per Floor: Does the building contain an Sprinkler System?;_Special Stiptilatioos: 04/30/2014 17:31 5083394743 NITTANY CONSTRUCTION PAGE 05 SECTION9: PROPLRTYOWNERAUT11ORIZA7,xON Name and Address of Propertyy Owner Name(P nl)�S1i-.F_r•ra. • F r Street, - ---Property Owner Contact Infnrnalion:Telephone No.(business) Telephone No, (cell -If applicable,the proputy owner hereby authorize, ) e-mail add�"(wec•i,12�(-w.2Grot +�.�.y,...... ;-�%-�__�."�.7,_/C� Name Street Address City/Town State 7_i to act on the roc owner's behalf,In: matters rclnHva 1:o work avthoriaed b this buildniK permit application SECTION 1.11:CONSTRUCTION CONTROL(Please fill out Appendix 2) !f building is leas than 35,000 ai.fi Mrncloeed a ace and/or not under Cnnataprhon Control then dheelr here tl and skip 5ec[ionl0.7.7a. Y Ref stared Pmfessinnal Res tensible fur Cmratzo cHnn Contcdl Na��egistrant) Telephone No, e-mail address _ Registration.Number Street Addreg5 City/Town, xpirat=-Dat- _ � State 7„ip Discipline Expiration Expiration take 113;2 General Contraeto, Company Name Name of Person Responsible for Construction Licenser No. and Type if Appilcablc �. 1_I►� _A ��Sixeet Addnss City/Town State Zip Tnlr.shone No,(business) _ Telephone No. cell � '" 6ECI'.ION 1L Y6,�R1:Fyr�S'COWP •I ON rN4 NCfi AFf7r7 VI'C h�-C=0.:]a"2.§1$C(6 --- A Workers'Compensatron instrrancc Affidavik from tkne MA Department of]ndu5lrial Acc;dents mast be compleeed and submitted with this apphcabatL Failure to provide this a.ffirlavrt m'll result in'Che denial of dxc issuance of the building permit, Is a sl crI Affidavit submtted with dris ayplicalion� Yes la Nu ❑ .._. GtirC3iOh112;GON5TRiICIION C051"5 AND PERMIT PEE Item - Esfhriated Costs:(Labor --- --- and rVlnterials) Talsl Cnnstrti.ction GnsC(from Item 6)'^$._�;�ZO p� 1.BuildinP tt/ 2.Electrical �— -�..c.. Building Permit Pea=•Tot'at Construction Costk' (lnaerL bere 3.Plumbing g Z l appropriate municipal factor)a S o 2. ._ �z ap I 4.Mechanical (riVAC) $ o e72 Note:Minimum fps=$_ „_(contnctmnnitipality) $.Mechanical (Other $ 6,Total Cosh Enclose. check payable to f - pob (contact m"Mcipali, )and write checl� number here SL•C'I'ION 13:81GNAT[JRE pT PCLII.DING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of per ury that all of the in&rmuhon cnntuined in thig apph e bes (ntion is true and accurate to tht f m knowledge and understanding, 2.­y-• 1� ALL„- 579. z� i36�r ase print and sign name �Wp S-t-. p yam„( kleT Title P TCIe h z_._- one 0. Date Street Address City/Town —_. State Zi n3 Municipal Jaspcctor to ffli out thisaecHan uponapplicationappmval: Name Da 04/30/2014 17:31 5083394743 NITTANY CONSTRUCTION PAGE 09 ;/A., - NITTcoN•01 MMCNAB CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDAWY) 3127/2014 THIS CERTIFICATE IS ISSUED AS..A MATTER OF INFORMATION ONLY.AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENb, 0&END OR ALTER THE COVERAGE AFFORDED By THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRbbUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certIflcatc holder is an ADDITIONAL,INSURED,the policy(les)must be endorsed. If SUBRO ATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may requlry an Endorsement. A statement on this certificate does not confer rights to the certificate holder In Ilea bfsuch andorsoment(s). PRODUCER CONTACT Delano,Olbson Insurance Associates,Inc, NAME: 36 Washington Street NaamE 237.1515 Sulta40 ir�. (AA E•MY,L 1 Ic NA:(781)237-1805 Wellesley Hills,MA 02481 Ano Ess: INSURERS AFFORDING COVERAGE NAIC4 INSURED INSUREk A:Vall Forge Insurance Company 20508 'INsuRERB:COnlmerce Insurance Corti An 34754 Nntany Construction,Inc, INSURER 0I Continental Casualty Co_ mpany 20443 Mansfield,MA 02048 South Main Stu 204 INSURER D:National Fire Insurance Co.of Hartford CPCTNF Mans INSUREAE:Acadia lnsuranceCompany 31325 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES 1, INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ' INDICATED, NOTWITHSTANDING ANY RWWREMENT, TERM OR CONDITION OF ANY CONTRACT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THEOR OTHER D HEREIN IS SU8J ESPECTTO WHICH THIS .EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN M POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL-THE TERMS, R A7 HAVE BEEN REDUCE BY PAID CLAIMS. LTR J. .TYPE DFINSURANCB pOWCYNUMOER MMroleY POD GENERALLIABILITY UNIDO LIMITS A X COMMERCIALGENF.RAL LIABILITY X X 60B8420351 EACH OCCURRENCE A 1,000,000 Q6130/2013 0613012014 PREMISES APwu"ncn, s 100100 CLAIMS-MADE OCCUR MED CXPIMy one reef) S 6,000 PERSONAL&ACV INJURY s V 11000,000 GENERAL.AGCREGATE a 2,000.00 CEN'L AGCRE GAT E LIMIT ER POLICY X' APPLIES P . PRO. LOC PRODUCTS-CCMP/OP ACC~ S 2,006,D0 . AUTOMOBILE LIABILITY S COMBINhU 'INCI.E LIMIT B ANYAUTO X X RZJ013 ,(Ea ece wt 1,ODD,000 ALL 11/28l2013 11/2812014 BODILY INJURY(Pcrprc.w) s AUTOS FD X SCHEDULED NO ` N-OWNPO BODILY N,AJRY(Parn¢Idnnl) S X HIRED AUTOS X. AUTOS PROPERTY GAM 4;E s P ft ACCIDENT X S UMBRELLA LIRE X OCCUR (' EXCESS LIAR EACH OCCURRENCE s 81000,000 GLAIMS�AOE X X 50HG420348 06130/2013 06/3012014 AOORGATE DIED .X RETENTIONS 10000 & 8,D00,00 WORKERS COMPENSATION S AND EMPLGYERS'LIhaILITY X M STATU- CTH- D ANY PRCPRIFTbRIPARTNFRrXECUTIVF Y/N X 5068509d88 10/04/2013 1010412014 B § 500,000 OrFIGERWEM NAP CWD&O% N/0. E.I. EACH ACCIDENT(Mandatary In NHI IIy%de6crIba Oder EL DISEASF-,FA EMPLOYEFs 500,00 DESCRIPTION OF OPERATIONS hnl. A Equipment Floater I DISEASE•POI II LIMIT s S00,0g 5089420351 08/3012013 06/30/2014 Leased&Rented 10000,E Builder's Risk CIMS149382 05/0112014 05l0112015 Special:--,Theft 1,370,00( DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Anaeh ACORD ial,Additional RamerRe SIMIM04,a mom a pace IS ,gN,mdj St6ta0:2640.214 450 Highland Avenue,Salem,MA Wel-Mart Stores,Inc.It's Subsidiaries and it's Aftliates ere Included as additional Insureds on a primary non contributory basis Including waiver of subrogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TI4R ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Wai-Mart 3toi•ss,Inc.It's Subsidiaries and[is Affiliates THE EXPIRATION DATE THEREOP, NOTICE NnLL BE OELMR D IN 2001 S.E,IOth$treat ACCORDANCE WITH THE POLICY PROVISIONS. Bentonville,AR T271 B AUTT4OOR2ED REPRESErNTA/T�VE• LAr u-la s✓. '.._.. .... _,' . ._.. ._.. """_`..• ®1938:2010 ACORD CORPORATION, All rights raserved. ACORD 25(20101061 The ACORD name and logo are registered marks of ACORD J 04/30/2014 17: 31 5083394743 NITTANY CONSTRUCTION PAGE 10 t .. Massachusetts -De artrhentof PuNic Safety Board of Building Regulations and Standards Construction Suyen isor License: C"96658 . . BENJAMIN R AAYIS / ' #a', 43 HENRV rb lurn Danie CT 062'39 Expiration Commissioner 07/2672014 l__ 04/30/2014 17: 31 5083394743 NITTANY CONSTRUCTION PAGE 06 Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections axe 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) No. and Street City/Town zip Name of Handing ,i£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 Oft? Yes❑ No ❑ Provider notified and Release obtained.? Yes❑ No❑ ---Yes 0 No ❑ Provider notified and Release obtained? Yes 0 No 0 Other(if applicable) Yes❑ No ❑ Provider notified and Release obtained? Yes ❑ No❑ Other. (if applicable) 04/30/2014 17:31 5083394743 NITTANY CONSTRUCTION PAGE 07 Appendix 2 Contraction Documents are required for structures teat 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"' Wwhere a Licable _ Item. Submittedrum .tote Nothe uired datml /tion _......_..ral .._.._._..—_..._.__— ._.... ,_._.._._essionrm ma re wire r t ecrcal 8 Plumbm include Local 4 Gas a:tural,Propane,Medical or otlurZ — 10 Su.me ed Site Plan Utilities,Welland,etc.) 11 eCi(ications 12 Struclural Peer Review . 13 Structural Tests&Inspections Pram ....._.—_.._.•..._. _ _ r 14 Fire Protection.Narrative Re nrt ^•- Gd�o, n Ttuildrn Svry Investi anon, y conservation Report r. tecture]Access Review ers Compensation Insurance �. dous Material Miti atien.l7ncumenration "��-_ ` 5 >ci 'r.. 5 set eci() r "Arras of Design or Construction for which plain%arc not complete at the time of application.submittal must be identified�heretn.Work so identified must not be commenced until this application has been amended and the proposed construction documentamendment has been approved by the authority having)trrisdicfiom.Work started.prior to approval maybe subjected to triple the arigirral permit fee. Registered Professional Contact Information �V,4Z+�-_rut2'.-__ '�L8_•.6.>Z-.�,� c�rt,-r�,,.".,,•-•-•,rz.c�Coas Name(Re�rri,tr nt) Telephone No. C-mail address Registration Number '�"rr $. �-('A.Ge.ttrr iuz— Street Address City/Town State 7.,i Discipline Expiration Date Name(Registrant) Telephone No, a-mnR address Registration Number Street Address Ct /Tovm ------^..__ State T..Zi _. ..Discipline Expiration Date Name(Registrant) - Telephone No, e-mail address Registration Number Street Address Ci Tnwm statez. '"""" Discipline Expiration Date 04/30/2014 17:31 5083394743 NITTANY CONSTRUCTION PAGE 06 CITY OF SAUM, NaSSACHUS=S ' BL'Q.DLNG DEPARTNfE1NT - ' 120 WASHINGTON STREIrr.3'o FLOOR ` TEL(978) 745-9595 PAX(978)740.9846 ICI%fBERLF-Y DRISCOLL MAYOR I fodtas S'r.Pm 3JtE DIRECTOR OF PUBLIC PROPERTY/RUMDING CONMISSIONER Workers' Compensation Insurance Affidavit: Builders/Contractors/Elect riciaM/Plumbers An lica,/F Information pl _ t F eeibly Name(BusineoiOrganizadorvindividuap: Address: 9o5b So L4irN fv*,) IJ ST S 11 i k,e City/State/zip; Phone H: SUS 33d1-y�L4 Are you an employer?Check the appropriate box; Type or project(Inquired): 1.].�1 am a employer with la 4, D 1 am a general.cotmaclor and I employees(full and/or pan-time).' have hired the auircon¢actors 6• ,❑�/Naw consWction 2_❑ 1 am a sole Proprietor or parmec, listed on the artached sheet t 7. E�Remodeling ship and have no employees These sub-contractors have 11. ©Demolition working for me in any capacity. workers'comp.insurance. 9. []Building addition (No workers'camp,insurance $. ❑ We are a corporation and its required.] Officers have exercised their 10.❑ Etectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MOL I I.©Plumbing repairs or additions myself[No workers'comp. C. 152,�1(4),and we have no 12.[ Roof repairs insurance required.)t cmplayeea.(No workera' t3.©Other COMP.insurance required.) Any Bppliknm tins cheeks box III mwe also fill nut lhrseGipe bBlow ahowina tbdr waken'cnmpmanim polky Infun on naa . m t Itm uwnnr who submit IN%affidavit imlirating They am doing all work and than hire ounideeallmetata must nibmit a new afrawit indieming Buck. 'Cummetors that abmit Chia box revel anaehed an nrWitiend sheet shawinx the ,,e ofIhe,ubeommck"and khcle wotketa'comp.policy infonnarina. I nm art erttployor that is providing rverkera'compensation hisuronee for my employees .below Is rke policy and fob me information. -� r Insurance Company Name:_ �Il O(\P''1 �l e-e ,J'�ISU Ray-le Q . CJ 1— qpr4, 1 I (� Policy#or SelFim,Li..#: 5o5 So o V Expiration Date: I o y Job Site Address: 415 Yl� D ve . City/Stawzip: SAIey mA oig-io Attach a copy of the workers'compensation policy declaration page(showing the policy numbor and expiration date). Failure to secure coverage as required under Section 25A of MCL c. 152 can lead to the imposition of criminal penalties of a tine up to S 1,500.00 and/or one-year imprisonment,as well as civil pt-•nattics in the form of STOP WORK ORDER and a Pine or up to$250.00 a day against the violator. Be advised that a Copy of this statcatent maybe forwunicd to the Office of Invesligalions•of the DIA for insurance coverage verilicatian. l do hereby certify tinder the palms and pcnelrler ofperiytyy/ r the lnfGrtrrarlon provided above s spit&and COrrecL 51k✓til Dore' `7 'x• S 3�-y14 Offhio!use Only, Do nor write in this area,to be coin eyed by C&y or town ofelal City or Town: ---- PermitiLlcense# Issuing Authority(circleone); 1.Board of Health 2.Building Department 3.City/TOtvn Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Persona Phone#: ( 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'Y'where applicable No. Item Submitted Incomplete Not Required 1 Architectural / 2 Foundation 3 Structural J 4 Fire Suppression / 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbin include local connections 9 Gas(Natural,Propane,Medical or other 10 Surveyed Site Plan Utilities,Wetland,etc. 11 Specifications 12 Structural Peer Review 13 Structural Tests&Inspections Pro am 14 Fire Protection Narrative Report 15 Existing Building Survey/Investi ation i• i16 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) r *Areas of Design or Construction for which plans me 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 �L Z�tltz3 �— � 3l• l� Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number •>v tom.-.�1�, � �— Street Address City/Town State Zi Discipline Expiration Date Name(Registrant) - Telephone No. e-mail address Regi�stration Number Re Discipline Expiration Date Street Address Ci /Town State Zi Date: February 26, 2014 To: Tom St. Pierre C Y N T E RFG Y A pE C City of Salem Inspectional Services 120 Washington St., 3d Floor Salem, MA. 01970 978-745-9595 David Skinner(918)877-6000 x369 Subject: Wal-Mart Store#2640 450 Highland Ave. Salem, MA. 01970 Limited Remodel CC: File VIA: Fed X 2-day Transmittal Tom, Please find enclosed three (3)sets of plans for your review of the limited remodel project to the Wal- Mart Supercenter store#2640 in Salem. Additionally, I've enclosed a copy of the permit application. This project will consist of a limited, mostly cosmetic interior remodel to the existing store, with finish and flooring upgrades, tune-up/replace doors, some new sales floor coolers/freezers, and new exterior paint&signs. The General Contractor is"to be determined" after plan approval and the Wal-Mart bid process. The approximate construction cost is $400,000. If you have any questions, please do not hesitate to call. Sincerely, David Skinner Cyntergy AEC, 320 S. Boston, 12`n Floor Tulsa, OK, 74103 (918) 877-6000 x369 (918)877-4000 (fax) Cyntergy AEC 320 S.Boston Ave., le Floor Tulsa,Oklahoma 74103 Telephone 918-877£000 Fax 918-877-4000 LETTER OF TRANSMITTAL NITTANY CONSTRUCTION INC. 905E South Main St., Suite#204 • Mansfield, MA 02048 TEL.: (508)339-4747 FAX: (508)339-4743 City of Salem Inspectional Services Date: 4/28/14 120 Washington St., 3rd Floor Salem, MA 01970 Attn: Mike Lutrzykowski Re: Building Permit Payment 450 Highland Ave (Wal-Mart) WE ARE SENDING YOU: Drawing(s) Specification(s) Sample Subcontract(s) Submittal(s) Transmittal Only Letter(s) Change Order(s) x Other: Check COPIES7 DESCRIPTION 1 4/28/14 Building Permit Fee for 450 Highland Ave(Wal-Mart) THESE ARE TRANSMITTED as checked below: FOR RESPONSE SUBMITTALS BEING RETURNED AS: FOR INFORMATION&USE Approved As Corrected X AS REQUESTED Not Approved/Revise&Resubmit FOR SIGNATURE&RETURN Revise&Resubmit as Corrected FOR REVIEW&PAYMENT Furnish as Corrected REMARKS: _Please find the enclosed Building Permit Fee check for the Wal-Mart Remodel at 450 Highland Ave. Thanks and any questions please call. CC: SIGNED: Ben Davis File �I _