51 LAFAYETTE ST - BUILDING INSPECTION (5) - --i/���
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 Two-Fa 'ly e g
(This Section For Official Use Only)
Building Permit Number: Date Applied: Building Offic' --
SECTION 1:LOCATION(Please indicate Block#and Lot#for locations for which a street address i not
51 JAPAyErrc Sr 'SALC-m �D-zSY
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® Repair❑ 1 Alteration ❑ 1 Addition❑ 1 Demolition ❑ (Please fill out and submit Appendix 1)
Change of Use ❑ Change of Occupancy ❑ Other ❑ Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes N No ❑
-Is an Independent Structural Engineerin Peer Review required? Yes ❑ No
Brief Description of Proposed Wnork: uILD•n'1G kNiieeoRFFlbdl/rs l�if'dloyE + �e�l.nfc� /F5
�REWOOC t FrA In A,.O `KEPLAc.f
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4.BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
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❑ 1 B: Business ❑ E: Educational ❑
F: Facto F-1 ❑ F2❑ H: High Hazard H-1❑ H-2❑ H-3 ❑ H-4❑ H-5❑
I: Institutional I-1 ❑ I-2❑ I-3❑ I-4❑ 1 M: Mercantile❑ R: Residential R-113 R-2❑ R-3❑ R-4❑
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 ❑ IIA ❑ HB ❑ IHA ❑ HIB ❑ I IV ❑ 1 VA ❑ VB ❑
SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal: Trench Permit Debris Removal:
Public❑ Check if outside Flood Zone❑ Indicate municipal❑ A trench will not be Licensed Disposal Site❑
Private❑ or indentify Zone: or on site system❑ Te permit
i ❑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❑ Yes❑ or No❑ 1 Yes❑ No ❑
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction: Occupant Load per Floor:
Does the building contain an Sprinkler System?: Special Stipulations:
SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner% paw be --1e4T;E5
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:7 r'c I �
�L-_CM- C1199 __ a rvrobell�a ylAn�n_S7:L PS Clam
Title Telephone No.(business) Telephone No. (cell) mail address
If applicable the property owner hereby authorizes ,n^
�hA1rGbT 'YaoDFRTiES All Irlhr� ST SU;TC oZ li fT7rZ RO5f _fM ()-2176
Name Street Address City/Town State Zip
to act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2)
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 ' I
IIMOTNY 12. /TTLf 0'-7�0- F4DQ -t),ff�v�nool�nAssoc-mw TiSo27H
Name.11(Registran1, p T^elephone No. e-mail address Registration Number
0NF NASWIAkTON ..77 LouE2 NLf_ 038a0 CNI� dR,� R014 -
Street Address City/Town State Zip Discipline Expiration Date
(10.2 General Contractor
7JP.�l �0�24[�,JGi �NC
Company Name
?au� Mti In,oyER,J 10 13-zz t^sL
Name of Person Responsible for Construction (� License No. and Type if Applicable
SSti .�aCOL� -il & A ozi3c
Street Address City/Town State Zip
HI-]z1L- 99 6oz- 8153 ��u�.wc�ooern�6nuconfioc�,na.cah
Tele hone No.(business) Telephone No. cell Tom— e-maA address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT M.G.L.c.152 9 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 Iff No ❑
SECTION 12•CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)_$ 3 7 3+000. 00
1.Building $3 7 3 Building Permit Fee=Total Construction Cost x (Insert here
2.Electrical $ appropriate municipal factor)_$
3.Plumbing $
4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)
5.Mechanical Other $ Enclose check payable to C 17-y Or SAe_E,W
6.Total Cost $ (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
a licati 1o^1pnA1 is true and accurate to the best
o�f my knowledge and understanding. / �-/ p p
Or 9t C � fKG41FCT I4� h�,A(n E7C b) -�- 9911_
Please print and sign name Title Telephone No. Da
SH Sr !�I?>ZIGvr-ro,3 MA D213S
Street Address City/Town State Zip
Municipal Inspector to fill out this section upon application approval:
Name Date
Appendix 1
For the demolition of structures the building permit applicant shall attest that utility and other
service connections are properly addressed to ensure for public safety.
Please fill in the information below and submit this appendix with the building permit
application. The building permit applicant attests under the pains and penalties of perjury that
the following is true and accurate.
Property Location (Please indicate Block# and Lot# for locations for which a street address is not
available)
No. and Street City/Town Zip Name of Building(if applicable)
For the above described property the following action was taken:
Water Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Gas Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Electricity Shut Off? Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
Yes ❑ No ❑ Provider notified and Release obtained? Yes ❑ No ❑
Other (if applicable)
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
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing include local connections
9 Gas(Natural,Propane,Medical or other
10 Surveyed Site Plan(Utilities,Wetland,etc.
11 Specifications
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investi ation
16 Energy Conservation Report
17 Architectural Access Review 521 CMR _
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work
so identified must not be commenced until this application has been amended and the proposed construction document amendment
has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the original permit
fee.
Registered Professional Contact Information
I'a.srwt /-ITT,E 603_ 2- gyro _t
r _btt/e�Jra642as5cC.Goh 35a7y
74
Name(Registrant) Telephone No. e-mail address Registration Number
l�vEl�As,iaaron� ST uEx A//- 0382,9 Gulp Ta.-o 201y.
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zi
Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Discipline Expiration Date
Street Address City/Town State Zi
The Commonwealth of Massachusetts
yff Department of Public Safetyn: m; Massachusetts State Building Code (780 CMR)
yJ`ssb ?`^Q�a. Building Permit Application to Construct, Repair, Renovate or Demolish any
Building other than a One-or Two-Family Dwelling
Code and Other Requirements for Building Permits
The Department of Public Safety has issued these building permit application forms so that municipalities
across the state can move toward use of a single permit form and consistent permit application process.
The MA State Building Code specifies the requirements of building permits and the applicant is advised to
review and be familiar with these requirements in order to avoid some of the common permit application
problems. Likewise the applicant should be aware that some municipalities require that the owner confirm,
even prior to acceptance of the building permit application, that no outstanding property taxes, water fees,
etc. exist.
Filing Instructions
1.Please contact the city or town where the work will be done to ensure that the city or town will accept
this application form and if any additional information is required, and obtain the correct mailing
address. After doing so, print the application, fill in completely and then submit to the local city or
town where the work will be done.
2.All applications shall be considered complete and will be reviewed if construction documents,
specifications, fee, and other materials that may be required as indicated in the Building Permit
Application are included with the application.
3.Please include a check for the Building Permit fee. The fee may be calculated using the information to
be supplied in section 12 of the Building Permit Application. The check is to be made payable to the
local city or town where the work will be done.
i I
i CITY OF SM.EE. I t NL LsSACHUSETTS
Bug-DING DEPARTSIEN'T
' . 120 WASHINGTON STREET, 3-FLOOR
T Fj_ (978) 745-9595
FAS(978) 740-9846
KINigFRT RY DRiSCOLL
T
LE MAYOR Hams ST.PSERRB
DIRECTOR OF PUBLIC PROPERTY/BUIIDING COhL\IISSIONER
Workers' Compensation Insurance Affidavit: Builders/Contractor9/Electricians/Plumbers
Applicant Information Please Print LegiblX
Name(Busilwss orginization/Individual): /OC-
Address: 84 nxo J
City/State/Zip: MA Qal3S Phone H: 617 -
Are you an employer?Check the appropriate box: Type of project(required):
1.9 1 am a employer with_;�r5_ 4. ❑ 1 am a general contractor and 1 6. ❑New construction
employees(full and/or part-time)." have hired the sub-contractors
2.❑ 1 airs a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling
ship and have no employees These sub-contractors have 9. ❑ Demolition
workingfor me in an ca acit . workers'comp. insurance.
Y P Y 9. ❑ Duilding addition
(No workers'comp. insurance 5. ❑ We are a corporation and iu
required.]
officers have exercised their ME] Electrical repairs or additions
3.❑ 1 am a homeowner doing all work right of exemption per MGL I 1.❑ Plumbing repairs or additions
myself. (No workers'comp, C. 152,§1(4),and we have no 12.❑ Roof repairs
insurance required.)t employees.(No workers' ll.®Other ic,.rr�_oyF i�e«tbts
comp. insurance required.)
'Any upplicam tar clacks box 01 must also Nr out the section bdoW showing their workers'compena ition policy information.
I fvneowners who submit this affidavit indicating they am doing all work and then hire oulsidn contractors most submit a new affidavit indicating such.
:Contractors that chuck this box most attached an additional sheet showing Iho name of the sub+rflractcms and their workers'enmp.policy intimation.
I am art employer that Is providing workers'compensation insurance for my employees. Below Is this policy and Jab site
Information. r-+
Insurance Company Name: t. NAlCTI S
Policy At or Sclf-ins. Lic. p: 01 e 3795`1ly;Z_ Expiration Date:_.Alf- M . ZOI"3
lub Site Address: 51 4e eA7E7'rE 57 City/State/Zip: &+4erm /LI'.4 nl c70
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 N4GL 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 penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. De advised that a copy of this statement may bo forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify unnderthe paai�ns cud penuftles of perjury Mot the information provided above is true and correct.
Si„n.tltic: t wk or Date, 2. 11 I
Poe#: 17 - 779 - 0-5S11
Official use only. Do nor write in this urea,to be completed by city of town offichat
City or Town: PermidLlcense
Issuing Aushorny(circle one):
1.Board of lleallh 2.Building Department 3.Citylfawn Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other _µ- -_----
Contact Person: _-- ___ Phone n:
CITY OF SL11.EM, tiWS.xcHUSETTS
BUILDL\G DEPARTMENT
N 120 1' ASHQJGTON STREET, 3" FLOOR
` TEL (978) 745-9595
Y
FAx(978) 740-9846
K1IBERj-F-Y DRISCOLL
AYOR THo.%w ST.PIERRs
DIRECTOR OF PUBLIC PROPERTY/BUILDL\G CONL-IISSIONER
Construction Debris Disposal Affidavit
(required for all demolition and renovation work)
In accordance with the sixth edition of the State Building Code, 780 CMR section 1 t L5
Debris, and the provisions of iMGL c 40, S 54;
Building Permit # is issued with the condition that the debris resulting from
this work shall be disposed of in a properly licensed waste disposal facility as defined by MGL c
111, S 150A.
The debris will be transported by:
l�Nt rEr� O `v r t I
(name of hauler)
The debris will be disposed of in :
(name of facility).______
(address of facility)
signature of permit applicant
--
�l ilatu .
Icbns�i�:,I,H:
NOBLIN & ASSOCIATES L. L. C.
CONSULTING ENGINEERS
ONE WASHINGTON STREET
SUITE 3050
DOVER, NEW HAMPSHIRE, 03820
PHONE (603)740-9400
FAX (603) 740-9339
October 10, 2012
Project#11198NH
Mr. Brian Keene
Bay Contracting
332 Washington Street
Suite F-2
Brighton,MA 02135
RE: Derby Lofts Condominium
Salem,Massachusetts
Dear Mr. Keene:
Please accept this letter as authorization to proceed with the Exterior Facade Restoration on the
South (Derby Street)Elevation of the Derby Lofts Condominium. The contract price for this
work shall be$373,000.00.
If you are in need of additional information,please do not hesitate to contact us.
Sincerely,
Timothy D. Little,P.E.
Senior Project Manager
cc: Rachel Campbell, Harvest Properties, LLC
f - CONTRACT
This AGREEMENT is made as of the day of - in the year r520/2
I
i
Between the Owner: Derby Lofts Condominium Trust
c/o Harvest Properties, LLC
441 Main Street
Suite 206
Melrose, Massachusetts 02176
and the Contractor: Bay Contracting
332 Washington Street
Suite F-2
Brighton, Massachusetts 02135
The Project is: Building Envelope Repairs
Derby Lofts Condominium
Salem, Massachusetts
The Engineer is: Noblin&Associates, L, L. C,
One Washington Street
Suite 3050
Dover, New Hampshire 03820
The Owner and Contractor agree as set forth below:
ARTICLE i
THE CONTRACT DOCUMENTS
The Contract Documents consist of this agreement, Standard General Conditions of the
Construction Urifracf, Supplementary General Conditions, Drawings, Specifications, Addenda
issued prior to the execution of this Contract, and Bid Documents, and are as fully a part of this
Contract as if attached to this Agreement or repeated herein.
i
ARTICLE 2
THE WORK
I
2.1 The Work shall include the Base Bid and Alternate#1, as described in the Specification
and shown on the Plans bearing the title"Building Envelope Repairs, Derby Lofts
Condominium, Salem, Aassachusetts" prepared by the Engineer.
i
2.2 The Contractor agrees to perform the Work,as described in the Specification and shown
on the Plans.
ARTICLE 3
DATE OF COMMENCEMENT AND FINAL COMPLETION
3.1 The date of commencement shall be the date of this Agreement, as first written above,
unless a different date is stated below or provision is made for the date to be fixed in a
notice to proceed issued by the Owner.
3.2 The Contractor shall achieve Final Completion of the entire Work within 360 days from
the date of commencement.
i I
Page#1 of 3
ARTICLE 4
CONTRACT SUM
r4.1 The Owner shall pay the Contractor in current funds for the Contractor's performance of
the Contract the Contract Sum of$ $1,414.000.00 subject to additions and
deductions as provided in the Contract Documents.
4.2 Unit Prices are as follows:
Description Contract Unit
Quantity Price
1. Wall Sheathing Repl. (Base Bid) 1000 s.f. $ 12.50 /s.f.
(250 s.f./elevation)
2. Metal Framing Repl. (Base Bid) 100 Lt.. $ f0.00 A.f.
(251.f./elevation)
3. Window Replacement.Additional cost to provide replacement windows instead of
reinstalling existing window as part of window opening flashing work.
Large Hung Window 10 units $ 1950.00 /unit
(Derby Street Elevation)
Small Hung Window 10 units $ 1620.00 /unit
(Derby Street Elevation)
Large Projected Window 10 units $ 2025.00 /unit
(Derby Street Elevation)
Small Projected Window 10 units $ 1320.00 /unit
(Rear Elevation)
Large Fixed Window 10 units $ WD .00 /unit
(Derby Street Elevation)
Small Fixed Window 10 units $ 1350.00 /unit
(Derby Street Elevation)
4. EIFS Resecurement(Alt#2) 400 S.f. /s.f.
5. Misc. Repairs $ 70.00 /man hour
6. Material Markup 20 %
ARTICLE 5
PROGRESS PAYMENTS
5.1 Based upon Applications for Payment submitted to the Engineer(for review and
approval) and forwarded to the Owner, the Owner shall make progress payments on
account of the Contract Sum to the Contractor as provided below and elsewhere in the
Contract Documents.
5.2 Each Application for Payment shall be based upon the Schedule of Values submitted by
the Contractor in accordance with the Contract Documents. The Schedule of Values
j shall allocate the entire Contract Sum among the various portions of the Work and be
prepared in such form and supported by such data to substantiate its accuracy as the
Engineer may require.
I
5.3 Applications for Payment shall indicate the percentage of completion of each portion of
the Work as of the end of the period covered by the Application for Payment.
5.4 The amount of each progress payment shall be the approved percentage of completion
(less previous payments) less 10% retainage. Payments shall be made within 30 days
from the date of approval of the Application for Payment.
i
i
Page#2 of 3
I
ARTICLE 6
FINAL PAYMENT
Final Payment, constituting the entire unpaid balance of the Contract Sum, shall be made by
the Owner to the Contractor when (1)the Contract has been fully performed by the Contractor
including the submission of all warranty related paperwork, (2) a final Application for Payment
has been submitted and approved and (3) Release of Liens forms from all subcontractors and
suppliers have been submitted.
ARTICLE 7
TERMINATION OR SUSPENSION
The Contract may be terminated or suspended by the Owner or Contractor as provided for in
the General Conditions.
This agreement is entered into as of the day and year first written above and is executed in at
least three original copies of which one is to be delivered to the Contractor, one to the Engineer
for use in administration of the Contract and the remainder to the Owner.
;
i
I
OWNER CONTRACTOR
I
(Signature) (Signature)
i
i
m92LeNE / ALIS T �/4tlStet° ku IVc o Entil 1(:Q6A'Sr-j a CitA
(Printed Name and Title) (Printed Name and Title)
i
i
I
i
I
i
I
i
i
i
I
I
I
I
I
j Page#3 of 3
i
i
NOBLIN & ASSOCIATES L. L. C.
CONSULTING ENGINEERS
ONE WASHINGTON STREET
SUITE 3050
DOVER, NEW HAMPSHIRE, 03820
PHONE (603) 740-9400
FAX (603) 740-9339
December 20, 2012
Project#1 1198NH
Mr. Tom Daniel
Economic Development Manager
City of Salem Planning Dept.
120 Washington St, 3rd Floor
Salem,MA 01970
RE: Derby Lofts Condominium
Salem,Massachusetts
Dear Mr.Daniel:
The Derby Lofts Condominium is presently preparing to begin an exterior facade repair project.
Noblin & Associates has prepared the plans and specifications for this project,and is currently
overseeing the work as the Association's technical representative.
The scope of work for this project can be summarized as follows:
1. Removal,flashing and reinstallation (or replacement if necessary) of the existing windows
and doors above the first floor level of the building. Replacement windows will be aluminum
framed units to aesthetically match the existing aluminum clad windows as closely as
possible. This work is necessary to address improper flashing of the window and door
openings which have contributed to water infiltration issues in the building.
2. Removal and replacement of the existing synthetic stucco system on the building with a new
exterior stucco system with complete waterproofing underlayment and flashings. The
replacement stucco system will aesthetically match the existing system as closely as possible.
This work is necessary to address improper flashings in the existing synthetic stucco system
which have contributed to water infiltration issues in the building.
As noted above, the new materials incorporated into this project will be "in kind",to match the
original materials as closely as possible,while upgrading the building systems to address previous
installation deficiencies and meet the current building code requirements.
Mr.Tom Daniel December 20,2012
City of Salem Planning Dept. Project#11198NH
Page #2
If you are in need of additional information, please do not hesitate to contact us.
Sincerely,
Timothy D. Little, P.E.
Senior Project Manager
Cc: Michael Lutrzyowski,City of Salem Inspectional Services
Rachel Campbell,Harvest Properties
Paul McGovern,Bay Contracting
Ralph Noblin,Noblin &Associates
REGISTERED ARCHITECTURAL AND ENGINEERING S RVI S
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER:
PROJECT TITLE: Building Etivelope Repairs.Derby Lofts C'ondominimn
PROJECT LOCATION: Derby Street in.Salem,Massachitsetts
NAME OF BUILDING: Derby Lofts Condominium
SCOPE OF PROJECT: E[FS Repair 8• plashing&Wirs
In accordance with Section 116.0 of the Massachusetts Stale Building Code,L Timothy D.Little
Mass. Registration No. 35274 Civil 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 X 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.
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
L Review,for conformance to the design concept,shop drawings,samples and other submittals which are submitted by the
contractor in accordance with the requirements of the construction documents.
2. Review and approval of the 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
ofthe work and to determine,in general,if the work is being performed in a manner consistent with the construction
documents.
Pursuant to Section 116.4,I shall submit periodically,a progress report together with pertinent comments to the Building
Department. Upon Completion of the Work,1 shall submit a final report as to the satisfactory completion and readiness of the
project for occupancy.
Signature �1
Subscribed and sworn to me this <? day of NgV2MbP r 2012
�� • KAREN S.MkLf 1RD,Nowy Puw
x en u1 i Rt 0 C t cox MY Cantrnl000n E It..dtry 14 2M3
NOTARY PUBLIC My Commission Expires On
A-
"-�• Massachusetts- Depailment of Public Safety
.1 Board of Building Regulations and Standards
�/ C;nstruat'w.❑ Suoe:viaor ;_icense
License: CS 104924 d
PAUL MC GOVERN 1t v w t
7 ANS�LM TERREACE x"
BRIGkiTQN, MA )2135
Expiration: 911 512 01 4
(bwinis�tinu•r Tr#: 104924
rW
W I�
l
i