16 HOLLY ST - BUILDING INSPECTION (4) e ,
�.• �
Z�O �f CK 31 �j � �
v � The Commonwealth of Massachusetts I
Deputment of Public Safety i
� � MassathusettsStateBuildingCuiie('780CMg)
� Building Permit ApPlicatioa for any Building other than a One�or Two-Faauly Dwelling I
(fhiv Sectimi For OFficiat Use Oni } I
, Bud�ing Permit Nuaiber. Date Applied: gu�(�Ng p[g��; I
� SECfION 1•LOCATION(Plesse indiaM Block t and Lot k for locations for which a street addteae is nat avaiiable) i
� �iG �� )�✓1 �J� �Pr�R.+n. MA. 1SF' 1_Ic.rr�P� ���r�, I
� No.uui Street City/Town - Zip.Code Name uf Building(if applicabte)
�9ECFIOfY r PROPOSED WO1tK ' i'
� EdiHon of MA State Gxie use�l_ [E New CunstrucNon check lure O or checkall that apply in the two rows betaw '
Exi�Hng BuiWing Rep�ir O Alterahon� AJJitiun❑ Demulition O (Pleuse filt uut:u�d submit Appen�ix 1) I
Chstnge of Use O Change of Occupa�uy 0 Other ❑ Speci(y:
Are buiWiag pians and/or consuuction ducuments being suppli�d as paR of this permit appticaHon? Yes O Nu O
(s an[�ulependent Structurat Engineering P r Review requ�t Yes Q No � i
Brief DescripHon of Proposcrl Wwk s '�c�o q�„� ;
��s�11__ �NN2c7 i:�4-c�-_-- ,,... �i� [.l_=}-c-,c..�� ,ia 1 �=rt �
� n --- 4-..Lnn. 5� G '�., � '.
T j
, SECT[ON�COMPLEIE THIS SECftON IF WS'iING BUILDtNG UNDERGO7NG RENOVATiOIY,ADD1T'tON,OR I,
CliANGfi I1V USE OR OCCUPANCY
- Check here if an Existing Building L�vestigatioq aud Evalaation is eMl�i(See 780 CMR 3i) 4_:,-' �
Existing Use Group(s). Propcue�i Use Group(s): i
SECfION�BU[LDING HEIGHT AND AREA j
�. - . Existing Praposcv! �
� � No.of Floocs/Stories(Include basement levels)dz Area Per Ftoor(sq.ft) �
i
�. . 'CoFal Arm(sy.R)am1 To1al Helght(ft) I
I
SECTION rx USE GROUP(Check ass licable)
, A: Assembty A-1 O A-20 Nighdctub � A-3 O A-!O r15� B: .Buslness O E Falucstiowi 0 �
� F: Futo f-t O F2❑ H: Ht Huard Hd Q H-2 0 H3 0 H-{p H-5� ;
I: instituflonal I-L O. F2 0 [3� [-i❑ M: MercanHle 0 R ResidenHai `�10 R-Z� R-3 O R�4 O �
f . S: Srorage S-t❑ S2� U: [Jtility 0 Speciat Use O and lease�{escribe betow: � i
� Special Use:
i
SEC'fION&CONSTRUCT[ON TYPE(Check as a ticable) j
[A O IB O [IA O IIB O IIG� � I(IH ❑ tV p VA p VB p i
SECf[ON 7:SITE INFORMATtON(ref�to 780 CMR 111.0 for deWils on each item) �
Water SuPP�Y• �aod Zone�laforeiallon: Sesvage Dispasal: Treaeh Permit
Debris Removal: '
Publi2'�j Chc�:k if outside Fluai Zone� In.licate municipat�. �trench wdl nut be Licensed Dispusal SiDe �
Private O or indentify Zone: or on site rystem O M'lu'vcri�ur trench ur sQecify: ` Z. I
permit is enclosed 0 1 .�S
lLulroad righEoF-way: F[azvJs to Air Navigation: 41.4 I lit�t rtii_G�inmi�ci��gl:qi�iinu!Yu}�_s5: �
Nut Applicable'� Is Structure within airport ap roach arra? !s their review completed? � I
nr Cunsent ro Build enclw�.tl❑ Y�s O ur No Yes❑ No � I
SECf[ON 8:COMENT OF CEItT[FICATE OF OCCUPr4�iCY �
Editian of Cixle: Usx Group(s): 'Cype of Coium�ctian: Qtupant Laid per Fl�wr. I
U�x�sthebuildingcuntain.mSprinklcrSystam?: .. S�mia�Sliptt4itions: _
c_r� �r� � p .� . 31 �1 �
i
'
SECTION 9: PROPERTY OWNER AUTFIORIZATION �"
Na md AdJress of Property Owner ` , s ` -
�� ���rdU 1"('�- Zl�i 1�i^�-�O�ttc� �✓� (vV-I� UL�..cc� lN:�. C� 1c1�lS
� N.me(Print) No.and Street � City/To�m Z�p
Prnperty Owner Contnct 6donnation:
`�1.•e.1c��, -1�.�sc.�n 7�l _ l0� �ooi 7o1_�S� (v3z7 �u/fZ�s�-G��vPiiz�s�/� ��
TiUe Telephone No.(business) Tclephone No. (cell) �mail aJdress
1(applicable,the property owner hereby aWhorius
N:vne StreetAddress City/Town Shte - Zip
to act on the ro er owners behalf, in all matters rdalive lo work authorind b this buildin ermit a lication.
� SECTION 30:CONSTRUCTION CONTROL(Pleaee flll out Appendix 2)�
If builJin is Iesa th�n 35,U00 cu.ft.of enclaseJ s ace enJ or not umler Construction Control then check here O and ski SecHon 30.1
10.1 Re istered Profesaional Ree onaible for Constmcfion Control �
Lta ��'�{'i- ��L-� �1''�9 ClAr /'. ✓eJ� ,�.c..�. �oe,3c�
Na�i(Re i�stmnt�I� Tclephone No. ��nail add� r�pss �eg�ist�rati�n�umb�
�( (�APc 11�2�n..oar��- MJ�� . A'rt' O I�l"�5 `�i"""_�' 3`� �
Strcet AdJress � City/Town 54�te Zip Discipline Expiration Date
10.2 General Contractor � � � � - �
--�'j�,.a.\ �� `CY r-�S�.._ �.���.,�-�--�^� •
.
Com�y N�me�
V�a� ""c-I'�5.�. (�-�'-. � !'�`J�� 13�
Name of Person Responsible for Constructiun Littnse No. and Type if A plicable
2i� (-'�s�� S-( �M.A��-�� (�, o���S
Street Address � - City/Town , Sth[e Zip /
�/_� /vo 1 �-�S G3z7 SC.J���ScG,�a�/��-�zo„�J� nJ.�T
Tcle hone No. business Tcle 6one No. cell �mail addrcss
SECTION 11:WORI:E1:5'CO��IPENSAPION WtiUlt:\NCE:V�FIU�\VI"I' M.G.L.c.152 25C 6
A Workers'Compensation Insur.ince Affialavit from the NIA Deparhnent of Industd:il Accidents must be completed and
submitted with�this applicafioa Fallure to provide this affidavit will result in the denlal of the issuance of the building permi[.
Is a si ned Affidavit submitted�vith this a IicaHon? � Yee 0 No O
SECI'ION 12 CONSTHUCTION COSTS AND PERMIT FEE
' ��e�� Eslunated Costsi(Labur
and Mahrials) Tot:il Cons Wctlun Cust((rom Item 6)_$
1. Uuilding g � Builaling Permit Fee=Tutal Construction Cost x_(Insert here
� 2.Elec�rical S l�JOd � appropriate municipal(ac[or)_$
3.Plwnbing . � D�O �
J.`lechanical (HVAC) $ !9�C> Nute:Minimum fee=$ (conthct manicipolity)
5.M��chanic:il Other - � Do� Enduse ch�rk payable tu
6.Total Cost 3 d � c7 (mntact munici ali )and wrile check number here
SECTiON 1 :StCNA7'URE OF 6UILDING PERhtTI APPLICAM'
6y entering my name beluw, f hereby attest under the pains,nd penalHes uf perjury tha[all of the in(drmation cuntain�vi in�his
application is true and accurate lo the best of my knowledge and understanJing.n
-d Y�✓\ d�v f G 15 c� 0t1�i.0..! �l�A.�^CCC� �� _�O _ IOJ2� I
. Ple.ue print and si> n. �e Tille Tclephune No. Date
/bUk/�2 Lrw..�� !�- c7 r�'rY`S'
S�mc� r �`� i1J � C� City/Tuwn Sta[e Zip
1� ✓
Alunicipal Inspector to fitl uut this section upon applitation approvaL•
Name Date
�C
� The Commonwealth of Massachusetts �
, n4� ' Deparhnent of Public Safety
A1aSsachusetls Statc BuilJing Cude(780 ChIR)
Building Pemiit Application for any 8uilding other than a One-or Two-Family Dwelling
- � .(This SecHon Fur Official Use Onl ) �
BuOJing Permit Number. Date Applicd: Building O((icial:
SEGTION 1 LOCA7'ION(Please indicite 61ock S and Lot M for IocaHone for wh3ch a street addreae is not available)
No.anJ Street City/Tmvn � Zip Cale � Name uf Building(if applicabir) I
� � SECTION 2 PROPOSED WORK �� - � �
EJition o(MA Sfate Code useJ_ If New Cunstructiun check herc O or check all that apply ui the iwo rows beluw
Existing BuilJing O Repai�O Altcr:itiun O Additiun O Demulitiun O (Ple.�se(ill uut:md submit AppenJix l)
- Change of Use O Change of Oca�p�incy ❑ Other ❑ Specify: .
Are building plans and/or consWclion d�xwnenls being suppGed as part of this permit application? Ycs ❑ fYu O
Is an IndependentStructural Engineering Pecr Revtew reyuired? � Yrs O No O
Brief Descriptiun of Proposed Work:
SECI'ION 3:COblPLETE THIS SECTION IF EXISTING BUILDWG UNDERGOINC RENOVATION,ADDITION,02
CHANCE IN USE OR OCCUPANCY � � � �
Ch�rk hcre if nn ExisNng Building InvesNgaHon and EvaluaHon is encloseJ(See 780 Cb1R 31) O -
ExistingUseCmup(s): � - � Propos�dUseCroup(s): � - �
. � � - � SECI[ON4IBUlCDINGHEIGHTAND�AREA � � � - � � � �
.. . . . -... . . _ . . . . . Existing .. Propo.ceJ �
IVu.of Floots/Sturies(include b.ssement levcls)&Area Per Floor(sy.ft.)_, � � � �-
Tutai Arca(sy.ft.)an�Total Height(ft.) � .. . . . � . ..
- - SECI'!ON 5:USE GROUP(Check as a Iitable) �
A: Asaembly A-1 O A-2❑ Nighklub O rY-3 O A�-i O A-5 O � �B: Dusiness ❑ E: EJucational ❑
F: Facto F-t O F2❑ - H: HI h Hazud H-1 O H-2 0 H-3 O H-{❑ H-5❑
1: InstituNonal 4l❑ I-2❑ 1-3❑ I-4 O M: MemanHle O R: Residenfial R-!O- � �R-2 O R-3 O � R-4❑
S: Storage Sl❑ � S2❑ � U: Utility❑ Speci.il Use O and lease describe beluw: �
.� Sptrial Use: � . . .
SECTION 6:CONSTRUCI(ON TYPE(Cheek as a Itcable � �
tAO 100 (L\ ❑ 1(B ❑ IIL� O IIIBO IV ❑ VA ❑ VUO
� SECfION 7:SITE INFORMATION(refer to 780 CMR i11A for detailn on each item)
4Vater Supply: Flood 2one Information: Sewage Disposal:
Trench Permif: Debris Removal:
� Public❑ Chc�k if oufside Fluod Zone❑ Indicah municipal❑ �trench will not be Lice��ud Dispusal Site❑
rcyuircd O ur tnnch ur speci(y:
Private❑ or inJenti(y Zone: or on site system O �rmit is endoseJ❑ �
Railroad rightof-wry: +fuads to Air Navigation: )_I�\I I�_t��r�r i_�nnnu,5��m R���;e.��P��kc.c �
Nut Applicable❑ Is StniUure within airpurt approach.vea? Is thcir review mmpleteJ?...---
- ar Cunsent�o Build enclosed❑ Ycg� or Nu❑ � Yes❑ No ❑ -
SECTION 8:CONTENT OF CERTIFICKI'E OF OCCUPANCY
Editiun ul Cnda: U.c Groupls): TYNe of Cunstniclion: Oecupxnt Load per Flour.
Docs lhc builJiny,cunlain,m Sprinklcr Systcm?: Special Slipulatiuns: . .
' � �
; CI'I'Y OF S.1i.E,�i, 1�'L�SS:ICHL"SETfS I
�3 BL'II.D�G DEPdRT�IE\7
' 12� W.i.SH4UGTON$7REET,3"FLOOR
'TEL (97�745-9595 �
F.t7t(97� 7�10-98�6 i
KIalBERLBY DRISCOL. I
�';�i11YOx ?HoaasST.P�RsB � . i
DIAECTU0.OF PL'BLIC pROpEATY/BI:IIDNG GO>LUiSSfOrEB
Workers'Compensation Insurance Attid•avih. Builders/ContmctoraUElectriciaas/Pfumban
.Annlieant lnfnrmatinn Pfcau Pr►nt Leetfitv I
V�7�11CU�usimssorganirauurvinJividid):��eJ,� �lL.�S'-C/� �Q.�e��Qv�' �,�'
AcWtcss: ZI� �'�JM�CJ�f�fi� S�•
City/State/Zip: "M�1C�/��� . C�`• h nek �813�9 �3Z.7 I
�
Are yoa an cmptoyv?C4eek�be appropriaro
Typa of prof eet(reqnire�; .
I.� 1 am a�mpbyer wi�6 4. ara a gcner�l cm�aactor aad 1 6, Q New eomitncpop � i
r.rnpbyees(full awUor�t-6ma).• haw hiee�i the�
2.0 I am a aole proprietor ix parmcr. tiwed oa t6e auacJ�!sl�ct.t 7.�R�liag
ihip noJ Irrw rw emptoyees Thes¢subcontrrcrors dsvo 8. �l7emolfdon ,
wotkinB'for mc in aay capuiry. workers'comp.irmirrace. i
�No workcrx'comp.iasurance� S. O We aea a eoqweation yp!iu 9• �B°��g�itinn �
rcquiraiJ - ofCiem have amreiaed Meb tO.Q l;larrieal repain or add'niom i
3.� !am a homcuwarr doiug all aork ' rigbt of asanption per MGi, 11.�PtwnEtng rrymlrs or oddiNoN I
mysclf.[A'o wakuaf wmp. ` 1� y t(4 N�� +w 12.Q Roof rcpairs �
inwrrnearequiced.) 'mP Y�I
comp.insuwner rcquued,) 13.0 OtFur i
•My arnlimm d�a a�aia box s�.uw ahw Ox rw we amim baoralowuq 4rir nortaa'eoa�mdmvoPry a�Gp�,
. '1l.wnrtuwae�w�Ao w6o�B Mb wMYvb�duY mdoiey W wskxd dim hne waideswd�us mm1 ad48 o nw alRdfvit iodiotfey,m6, i
�f'.m�nw�ws�iW afiaek�ib bmt wm bud�l m wiWwmi�sl slsv4�Oieoam NfAesubsemrabn aed�Aa4 woApeia� I
�R P�k!'ioW'ewuae.
!ura aa extp&ryn t/re!3r prevldJl�p,workers'eoiupeqmdon fntqraen o�m �
injeimaaoa I Y�P/�9'aec Bdow Is rhi polky airdJob sks �
Inxumnee Gm�pany V¢mr. l � S �i� ,,
Y��licy!I ur Sdf-itu. Lie,q:_ l��('_t /1O D/,L3 Expintion Date: � �/ 1� � � ���
Jub site A�: !� �n/�✓/ �i Cily/Statr/zip:�� /�/Lt�►: I
.lttaeb s wpr ol the��or&ers'eo ponsatlon decfaiatkn j
puU�y pa�e(shawlw�t6e poUcy nnmber aad e:pindoa duej. ,
t'�iturc w xc�wte cova�ayro as requiroJ unJ�Scction 2SA oP.1IGL e. 132 esn Irad w the impwitian oferiminal panalNes ofa I
tim:up ro Si,500.00 und/or one-year impri.mnmem,u wcll as civil p�eulW�s in tlm Porm of n STOP WORK ORDER am1 a finu
' s
�F up co 5?30.00 a Jay aylinst rhe violawr. Ile�lvix�i that a cnpy uf tltis uatcm�qft tnay br. fonvank:d to�he Am�e of
Inx�ytiga�iu�ss uf tho ntA for insw a covc •c vrrifu:•rtiaa. -
/dn horeby crnl�y undd�h / eHu ojpri/urydea!tAe injurmrt/!ar providrd uba e is trua nnJ corrrtt I
. �.•1 f C' ITJlCf � � / I
I
v
np;�•����,..,iy. Ou no�wiiu in 1gG orc;ta be cowplHed by city ai�own oQk&rL �
City q�Tuwn: _.. .__ YrrmiNf.leense q � � '
. � Issutug.lw6ority{circic uac): --• - -- ..---- . ._— �
j
t. tio•rrJ uf Ilral�h 2.IluilJla�;Deprrtn�ent .i,Ci�y!(unn C7erk i F.Iectrioal Lispectur 5. Plumbin�; lnspeerur i
6.�Ud�er _,_
' Cqnt�rlPerson:.._,.--"--_ ' _---.— Phonc.7: '����
' _"'— --- —._ .-.' . .-----� � - . ..._.. I
--_ - - -- '— ---..._-_.�_.� .
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QTY OF SALE MAS�A
: ; � C.EitJSE'I'I�
? BL�.�IIvc DEraxx�i.rr �
120 WA5HINGTpNgTREgT,3�PT.00R i
TEI-(978)745-9595 j
BIIvIBERLEYDRISQOLL F�7t(978)740-9846 i
NIAYOR TriOMAs ST.P�xRE
� D7REClOR OF YUBLICPROPERTY/BUIIDING�SSIONER i
�
i
Construction Debris Disposa/Affidavit
;
(required for all demolition and renovation work)�
i
In accordance with the sixth edition of the State Building Code, 780 CMR, Section 111.5 Debris, '
and the provisions of MGL c40, 5 54; Buitding Permit# is issued with the i
condition that the debris resuiting from this work shall be disposed of in a properly licensed �
waste deposit facility as defined by MGL c 111, S 150A. !
The debris will be transported by: i
� I
_� 2i _ Z cl► d5 q-, i
(name of hauler)
I
The debris will be disposed of in: !
�
�
� '
,-UitJ
(na e of facility) i
3°yd ���z i
(address of facility) ;
�il
i
i
Si ure f applica t
�
Date j
�
,
- CAlCS FOR SHEtDON FRISCH C B DERR
16 HOLLY ST. 30/7/2014
SAIEM,MA.
1.BEAM NO. 1-SIZE BEAM FOR 12 FOOT SPAN CARRYING 8.5 FEET TRIB.OF SECOND FLAOR
FLOOR DESIGN UVE LOAD=40 PSP ! " �y //
FLOOR DESIGN DEAD LO#D=10 PSF
� �.
w L M MAX SHEAR
(�/� (�) (�-�s) I�sl =.>.. - -e�.
425 12 7650 2550
TRY DOUBLE 117/8" LVL GOOD FOR 21275 FT-LBS AND 7897 LBS SHEAR
CHECK DEFLECTION;
w L E 1 DEFL L/360
(LB/IN) (INj (P51) (IN^4) {IN) (IN)
35.42 144 2000000 488.4 O.ZO 0.40 OK
1A.CHECK SAME CONDRION EXCEPT 12.5 FOOT SPAN
PLOOR DESIGN UVE IOAD=40 PSF
FLOOR DESIGN DEAD LOAD=10 PSF
w L M MAX SHEAR
(�a/�r) (�r) (Fr-�ss) f�as1
425 12.5 8301 2656
� TRY DOUBLE 117/8" LVL GOOD FOR 21275 FT-LBS AND 7897 LBS SHEAR
CHECK DEFLECTION;
w L E I DEFI L/360
(LB/IN) (IN) (PSI) (IN^4) (IN) (IN)
35.42 150 2000000 488.4 0.24 0.42 OK
� 2:BEAhA NO.2-SRE BEAM FOR 12 FOOT SPAN CARRYING 8.5 FEET TRIB.OF ATTIC FLOOR
FLOOR DESIGN UVE LOAD=30 PSF
FLOOR DESIGN DEAD LOAD=10 PSP
w L M MAX SHEAR
(�s/Frl t�) (Fr-�ssl I�ss1
340 12 6120 2040
TRY DOUBIE 117/8" LVL GOOD FOR 21275 FT-LBS AND 7897 LBS SHEAR
CHECK DEF�CTION;
w L E i DEFI L/360
(LB/IN) (IN) (PSI) (IN^4) (IN) (IN)
28.33 144 2000000 488.4 0.16 0.40 OK
2A.CHECK SAME CONDITION EXCEPT 12.5 FOOT SPAN
FLOOR DESIGN LIVE LOAD=30 PSF
FLOOR DESIGN DEAD LOAD=10 PSF
w L M MAX SHEAR
��e/FT) �FT) iFr-LBS) (�es)
340 12.5 6641 2125
TRY DOUBLE 117/8" LVL GOOD FOR 21275 FT-LBS AND 7897 LBS SHEAR
CHECK DEFLECTION;
w L E I DEFL L/360
(LB/IN) (IN) (PSI) (IN^4) (IN) (IN)
28.33 150 Z000000 488.4 0.19 0.42 OK
2B.CHECK 6 FOOT CANTILEVER ON BEAM 2
FLOOR DESIGN UVE LOAD=30 PSF
FLOOR DESIGN DEAD IOAD=10 PSF
w L M MAX SHEAR
l�a/�r) (� (Fr-tss) (�as)
340 6 6120 2040
TRY DOUBLE 117/S" LVL GOOD FOR 21275 FT-LBS AND 7897 LBS SHEAR
CHECK DEFLECTION;
w L E I DEFL L�360
ILB/IN) (IN) (PSI) (IN^4) (IN) (IN)
28.33 72 2000000 488.4 0.10 0.20 OK
_ 3.BEAM NO.3.S12E HEADER FOR 6 POOT WIOE SLIOING GLASS DOOR CARRYING 11 FEET TRIB
OF SECONO FLOOR
�_�_�----
FLOOR DESIGN LIVE LOAD=40 PSF
FLOOR DESIGN DEAD LOAD=10 PSF
w L M MAX SHEAR
(�/�) I�l (�r'-�ss) (�.ss)
SSU 6 2475 1650
TRY DOUBLE 5.5" WL GOOD FOR 4971 FT-LBS AND 3658 LBS SHEAR
CHECK DEFLECTION;
W L E I DEFL L/360
(LB/IN) (IN) (P51) (IN^4) (IN) (IN)
45.83 7Z 2000000 48.5 0.17 0.20 OK
4.SI2E FOOTING FOR COIUMN SUPPORTING BEAM 1 AND 2
TRY 24"z 24"X 12" DEEP FOOTING;
FOOTING
REACTION AREA SBP
(LBS) (SF) (LBS/SF)
BEAM 1 2656
BEAM 2 4165
TOTAL 6821 4 1705 OK
�R�� .. CERTIFICATE OF LIABILITY INSURANCE 5�i i2o°15'
TH� CERTIFICATE IS ISSUED AS A MAT7ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UAON THE CER7IFICATE HOLDER.THIS
. CERTIFICJITE DOES NOT AFFlRMATIVELY OR NEGATNELY AMEND, IXiEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFlCATE OF INSURANCE DOES NOT CONSTRUTE A CONTRACT BETWEEN THE 1SSUIPIG INSURER(S), AUTHORIZED
REPRESENTATNE OR PRODt10ER,AND THE CERTIFlCATE HOLDER
IMPORTANT: M tlre wrtificabe holder la an ADDITpNA1, Ilh4URED,the pofiry{fas)must�enGorsetl. If SUBR06ATION IS WAIVED,a�ject io
the tertns and conditions of the policy,certain poBcias may requtre an andorsemeN. A sfaOement on this wrtiticate Eces not confer Nghts to the
oeRifleate holder in 6eu ot such artdorsemeM(s .
vrrooueoe C�arciaZ 33aee . .
Carmen-iti.mball Insurancve Agency, inc_ . �Ne (978)922-0086 F ` ,.cs�e�sz:-ssae ,
48 Bec)cford Street � - - '
� � wsut� a�tNceoveu�e ru�et
uc
Heverly DF� 01915 mau�ewEsses Insurance Co
��� ix�e Wesco Insuraace C
u
Sheldon Erisch Dsvelapment� Tnc. ���:
PO BO% BSS INSIIRERD: �
218 Humphrey Street ���E:
Marblehead I� 01945 asu�nF:
iCOVERAOE3 � CERTIFlCATE NUMBER.�t521820300 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POL�C�S OF II�SURANCE LISiID BELOYJ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T}�POUCY PERIOD ;
INDICATED. NOTWITHSTAItlDIHG ANY REQU]RER9ENT,TERM OR CANDITfON OF ANY CONTRACT OR OTHER DOCUMENT Wi'ik RESPECT TO WHN:ii'IHIS !
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Job Site: 16 Hoily 8tsaet, 8alsm, E�
CERTIFICATE HULDER CANCELLATION
SHW LD ANY OF TXE A80VE DESCIBBED POLICIES�CANCELtm BEFORE
THF EXP6tATOW OATE THEREOF.. NOTICE NflLL BE DELfVERED IN
-City of Salem � ACCORDANCEWITX7'T�POLCYPROVISIONS.
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� Initial Construction Control Document
^ � To be submitted with the building permit application by a
�;
; Registered Design Professional
for work per the 8`h edition of the
s�e
'r Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title: Hollv Street Tenant Renovations(1 of 4 units) Date: February 29, 2016
Property Address: 16 Holly Street, Salem MA.
Project: Check(x) one or both as applicable: _ New construction x Existing Construction
Project description: Interior modifications to first floor right hand side unit. Renovation to including new kitchen and
bathroom renovations, new mechanical, electrical, ulumbing, fire alarm and sprinkler systems.
I Craig R. Bosworth MA Registration Number: 20030 Expiration Date: August 30, 2015, n�n a registered
design professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning:
Entire Project Architectural Siructural Mechanical
Fire Protection Electrical 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 1 (or my designee)shall perform the necessary professional services and be present on the
construction site on a 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. Such review shall not diminish or
relieve the Contractor of its submittal and other responsibilities.
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 perfarmed in a manner consistent with the approved
construction documents and this code. The Conhactor shall be responsible for perfonning the work in accordance with
the wntract documents and shall be exclusively responsible for its construction means,methods,sequences and procedures,
and for the construction safety.
4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 10'I.
When required by the building official, 1 shall submit field/progess 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 Docu
�
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Enter in the space to the right a"weY' or ��v�\G R, 8 S��TF
electronic signature and seaL• Q o c'�
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o � No. 20030 = �n
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NOTE: CEILIN6 ASSEMBILY REQUIRED AT ALL GEILING AREAS a � R
EFFECTED WITIIIN TI1E W/ORK AREA AS SI10WN ABOVE S�stem Description
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