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Massachusetts - Department of Public ' dfet Boa of Building Regulations and Standards Construction Supervisor License License: CS 17276 Restricted to: 00 ROBERT T BARTLETT JR PO BOX 327 • N HATFIELD, MA 01066 * ., --- -� Expiration: 10/27/2011 • ( ommissioner Tr#: 4.892 J. M. GRENIER ASSOCIATES, INC. 787 HartfordTurnpike LAND PLANNING CIVIL ENGINEERING Shrewsbury, MA. 01545 Tel: 508- 845 -2500 Fax: 508-842-0800 July 7, 2011 Mr. Louis Hasbrouck, Building Commissioner City of Northampton 212 Main Street Northampton, Massachusetts 01060 Dear Commissioner Hasbrouck, OWNER: CONTRACTOR: GE Healthcare (formerly MicroCal, LLC) Hampshire Construction Co., Inc. 22 Industrial Drive East 327 West Street Northampton, Massachusetts 01060 North Hatfield, Massachusetts 01066 SCOPE OF WORK: As shown on the attached Floor Plan the work consists of the construction of three 2x4 stud wall partitions for a 9' X 12' Inspection Room, within the existing Machine Shop area, and the installation of a double 3' X 7' pass door through the existing masonry wall in the Machine Shop to the Shipping area. Due to the limited nature of the work within the existing building, I request that you, as the Building Commissioner, waive the requirement that the construction documents be prepared by a registered design professional (Construction Control) in accordance with the Massachusetts State Building Code, 780 CMR , 8 Edition, Section 107.1, Exception. Section 107.1, Exception states: "The building official is authorized to waive the submission of construction document and other data not required to be prepared by a registered design professional if it is found that the nature of the work applied for is such that review of construction documents is not necessary to obtain compliance with this code ". Thank you for your consideration in this matter. If you have any questions regarding this matter please contact the contractor. Respectfully submitted, JOHN M. GRE IVIL NIER H No. 47812 _ - -gig asrE / ssroNAt ' John M. Grenier P.E. A CORD DATE (MM /DD/YYYY) M CERTIFICATE OF LIABILITY INSURANCE 07/07/2011 PRODUCER (413) 527 -5520 FAX (413) 527 -5970 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Finck & Perras Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 6 Campus Lane HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR p ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Easthampton, MA 01027 INSURERS AFFORDING COVERAGE NAIC # INSURED Hampshire Construction Co Inc & INSURER A: General Casualty 24414 Evergreen Corporation INSURER B: Hatfield Equipment Co, Inc INSURER C: Box 327 INSURER D: North Hatfield, MA 01066 -0327 INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION _ TYPE OF INSURANCE POLICY NUMBER _ (MM /DD/YY) DATE (MM /DD/YY) LIMITS GENERAL LIABILITY CCI0396222 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100 000 PRFMI.SFS (Fa nrrurenrel , _ CLAIMS MADE I X I OCCUR MED EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY I JEC7 I] LOC AUTOMOBILE LIABILITY CBA0396222 04/01/2011 04/01/2012 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A X HIRED AUTOS BODILY INJURY $ X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS /UMBRELLA LIABILITY CCUO396222 07/01/2011 07/01/2012 EACH OCCURRENCE $ 1,000,000 7 OCCUR I I CLAIMS MADE AGGREGATE $ 1,000,000 A $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND CWCO396222 04/29/2011 04/29/2012 I TORY I M TS I X I EMPLOYERS' LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL G E Heal thcare MicroCal 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Bio- Science Corp BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 22 Industrial Drive East OF IND UPON THE INSURER, ITS A i OR REPRESENTATIVES. Northampton, MA 01060 AUTH RfE J � y�� _ ( J ( / � JlJe 11 //l ACORD 25 (2001/08) ©ACORD CORPORATION 1988 The Commonwealth of Massachusetts ,...-,..-.=1,:___...; Department of Industrial Accidents ' ., Office 'of Investzgatzons 5,_--h- 600 Washington Street Boston, MA 02111 - www. mass.govfdia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): Hampshire Construction Co., Inc. Address: 327 West Street North Hatfield MA 01066 (413)'247 -5024 City /State /Zip: Phone #: Are you an employer? Check the appropriate box: Type of project (required): . am a eneral contractor and I 1 I am a employer with 4❑ I g 6. ❑ New construction employees (full and/or part- time).* have hired the sub - contractors listed' on the attached'sheet. 7.. j Remodeling __ 2. ❑ I am -a sole. proprietor or partner- _- ship and have no employees These 'sub= contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' Y P tY 9. ❑ Building addition [Noworkers' comp. °'insurance `° comp: - .insurance $. ----- . required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions ❑ officers have exercised 11. �. I am a homeowner doing all work ffi h id their ❑ Plumbing repairs or additions myself. m o workers' right of exemption per MGL Y [N comp. 12.0 Roof repairs insurance required.] t - - -- - - - .. _c. 152, §1(4), and we have no employees. [No workers' 13. Other . comp. insurance required.] *Any applicant that checks box #1 rust also fill out the section` below showing their workers' compensation policy information. t Homeowners who submit this a iidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. 1 am an employer that is providing' workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Finck & Perras Insurance Policy # or Self -ins. Lic. #: CWCO396222 Expiration Date: 04/29/12 Job Site Address: 22 Industrial Drive City /State /Zip: Northampton, MA 01060 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 $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 $250.00 a d. • gainst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of I ►. ,for ance coverage verification. I do hereby cert , F�• he ,,.' /n,'p' a ties of perjury that the information provided above is true and correct. Sienature: / Date: q K./l/y Phone #: (413) 247-5024 ; I Official use only. Do not write in this area, to be completed by city or town official — iry or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: Version1 Commercial Building Permit May 15, 2000 SECTION 10- STRUCTURAL PEER REV /EW (780 CMR 11011 ) ; Independent Structural Engineering Structural Peer Review Required • Yes 0 No SECTION 11 - OWNER; AUTHORIZATION TO COMPLETED-WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING. PERMIT I, .. as Ownerofthesubjectproperty hereby authorize R� Ez _ 7 6.4 le act on behalf, ' all matters re - ive to wor, authorized by this building permit application. it (-47)1, Zd ` Signature of Owner Date , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under_the pains and penalties offyerg izaaE2T 7' 804 E7 LE Print Name Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION: SERVICES 10.1 Construction Supervisor: Not Applicable ❑ Name of License Holder :',80,436 2? !x 'ZILG-. / . , Lt ..- .. - -_ License Number '_32' �/E`� � T, E'7,. d/27. / /47P151• / /144, i 23 04.7 20 / 1 Address Expiration Date di/ / .7673 ' 2 c7DT Signature / Telephone SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT (IGLG L c 152 § 25C(6 )) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the •uilding permit. Signed Affidavit Attached Yes ` 4•9 - - No Versionl.7 Commercial Building Permit May 15, 2000 8. NO RTHAMPTON ZON]ENG. Existing , Proposed Required by Zoning This column tore.filled in by Building Department Lot Size S- • Frontag _ Setbacks Front Firg Side L: R: 7 L: R:, 3 I Rear - Building Height f 3O Bldg Square Footage /,} i7 1711 % /1241) ' % I Open Space Footage % --, -- --- (Lot area minus bldg & paved p ._.: parking) # of Parking Spaces I r Fill: ...._:�__. ,�_...........w_..,, ,...�.._..�....w... _. ....__w�_T_.._.�,� .� — t (volume & Location) A. Has a Special Permit / Variance /Finding ever been issued for /on the site? NO DONT KNOW YES IF .,YES, date issued: r IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book ! 1 ' Page _ and /or Document # B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES r IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 04 , Date Issued: OZ. SUt ('Zod C. Do any signs exist on the property? YES'` NO IF YES, describe size, type and location: i 6(ZOVNIO MOUNITE P, 114 will o a OF ._. l_ls4-l7_US74 ...Es '(_ *..pQ►uEW4`(' D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO , -44 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO ��• IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version1.7 Commercial Building Permit May 15, 2000 SECTION 9- PROFESSIONAL • DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS .AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CIVIR 116 (CONTAINING 'WORE TI1AN 35,000 C.F. OF ENSLOSED SPACE) 9.1 Registered Architect: . 1 Not Applicable Name (Registrant): 1 Registration Number Address , Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): _.. I , Name _ _ ___ _____ _ Afea of Responsibility _ = i 1 ' Address Registration Number _ -- - - 1 - , Signature Telephone Expiration Date r - • I I . . — , .,.... .. Name Area of Responsibility ; 1 = Address RNistration Number i 1 ' Signature Telephone Expiration Date I --- ---- — --- Name Area of Responsibility ; 1 ,._. _ Address Registration Number Signature Telephone Expiration Date -- r = Name Area of Responsibility r— -- Address Registration Number 4 , 4 Signature Telephone Expiration Date 9.3 General Contractor -------- 9 --------- Not Applicable 0 -44A leE _CON67 ' ' _ - Company Name: — /5__A—g_7,:k. 7r = e- L- c,t 4 -2./ Go Responsible In Charge of Construction ---_ ; 5Z1_, e .67,:eet 7, /274 /7P ___Adsiseas_ _if - 50Z , W3 Signature ' V V • • • •• • ''' Telephone Version 1.7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations -'Existing Wall Signs 0 Demolition❑ Repairs ❑ Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing 0 Change of Use ❑ Other ❑ Brief Description 'Enter a brief description here. C4N572L)6 3 ' 57(i° W`4"6 Fo `l X /2 IAISPEL7 /D4 .! Of Proposed Work: ; POOH Wi nit/Ai ' ; EX / 14/41 . /144614/"E . SHOP . /' 74L2- 'oOIZ i N M461NMl2Y INAt.L I f5E7Wi~'Etii /1444.141NE 5/- P ? 5/4/ AA /,VLs ARCA. SECTION 5 USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) ' CONSTRUCTION TYPE A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑ A-4 ❑ A -5 ❑ 1B ❑ B Business ❑ 2A I ❑ E Educational 0 2B r F Factory ❑ F -1 F-2 ❑ 2C ❑ - H - High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 .. ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R -1 ❑ R -2 ❑ R -3 ❑ 5A ❑ S Storage ❑ S -1 ❑ S -2 ❑ 5B L ❑ U Utility Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: I COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE Existing Use Group: € . F1 i Proposed Use Group: 1 1 Existing Hazard Index 780 CMR 34 }: v 3 Proposed Hazard Index 780 CMR 34): '; 3 . SECTION. 6 BUILDING HEIGHT AND AREA - /41 (4e 50 1 24-U S _ BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION = OFFICE USE Floor Area per Floor (sf) 151 1 of 2 _________ 2nd 2nd _ 3rd 3 4 m 4y, Total Area (sf) Total Proposed New Construction (sf) Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7'Commercial Buildin_.Permit Ma 15, 2000 City of Northampton Air ,? Building Department 1 " , 4 k � , i ` .; . 212 Main Street iis a " 1 Room 100 pA & g*iii, ` Northampton, MA 01060 , �- x •yr -,; " phone 413 -587 -1240 Fax 413 -587 -1272 l �Wa ?n APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 :- SITE INFORMATION This section to be completed by office 1.1 Property Address: - 22 ZNDO571214 Pizi e_ `3I Map- (� Lot ) Unit ° G� _,, Overlay District -- - ' Eim Si rs, ,, CB D ` SECTION! 2 PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: Name (Print) Current Mailing Address: ha0 A4 lTCr1F..t , / QI O Q Signature Telephone 2.2 Authorized Agent: 20�27 7; ,4g , 71.. , Er - R Q - /3AX 2 0, L.. 7P/ . ,,�G _.,? � Name (Print) Current Mailin Address: _, ___4 ©� _ 066 /3 " 24 7 ;502 , _ _,_,_ _ _...._ , Signature Telephone SECTION 3 - ':ESTIMAT CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee - , ____ _____. __ 2. Electrica oO (b) Estimated Total Cost of 1 000 5 1 00u . , i Construction from (6) ___.__'_ . _ __ 3. Plumbing = Building Permit Fee 4. Mechanical (HVAC) --- ---.._ _._......� 8 -_• — _ ____. 5. Fire Protection µW " 6. Total = (1 + 2 + 3 + 4 + 5) ,400 2 . Check Number This Section For Official Use Only Building Permit Number Date Issued _Signature:_ 6 7/1 Buil o mmissioner /Inspector. Buildings Date l INDUSTRIAL DR BP-2012-0073 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 19 - 012 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PERMIT Permit # BP- 2012 -0073 Project # JS- 2012- 000110 Est. Cost: $13000.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HAMPSHIRE CONSTRUCTION CO INC_ Lot Size(sq. ft.): 101930.40 Owner: GE Healthcare (formerly Microcal) Zoning: GI(100)/ Applicant: HAMPSHIRE CONSTRUCTION CO INC AT: INDUSTRIAL DR Applicant Address: Phone: Insurance: P 0 BOX 327 (413) 247 -5024 NORTH HATFI ELDMA01066 ISSUED ON: 7/20/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: Interior Partitions POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 7/20/2011 0:00:00 $78.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner INDUSTRIAL DR GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 19 - 012 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Non structural interior renovations BUILDING PER1VIIT Permit # BP- 2012 -0073 Project # JS- 2012 - 000110 Est. Cost: $13000.00 Fee: $78.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HAMPSHIRE CONSTRUCTION CO INC Lot Size(sq. ft.): 101930.40 Owner: GE Healthcare (formerly Microcal) Zoning: GI(100)/ Applicant: HAMPSHIRE CONSTRUCTION CO INC AT: INDUSTRIAL DR Applicant Address: Phone: Insurance: P 0 BOX 327 (413) 247 -5024 NORTH HATF I ELDMA01066 ISSUED ON: 7/20/2011 0:00:00 TO PERFORM THE FOLLOWING WORK: Interior Partitions POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: 74 j/ House # Foundation: Driveway Final: Final: Final: 8., i' " ( Rough Frame: row./ if r " Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: cfre. VIA / t�•l IS THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. f T 1 Certificate of Occupanc /1 Signature: t /�� FeeType: Date Paid: Amount: Building 7/20/2011 0:00:00 $78.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner