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49-052 (2) 250 GLENDALE RD-LOT 1 BP-2017-0671 GIS 4: COMMONWEALTH OF MASSACHUSETTS Map:Block:49-052 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:New Single Family House BUILDING PERMIT Permit# BP-2017-0671 Project# JS-2017-001097 Est.Cost:$400000.00 Fee:$1848.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group:_ RAYMOND A GOULET 054782 Lot Size(sq. ft.): 81500.76 Owner: C I L REALITY OF MA INC Zoning: Applicant: RAYMOND A GOULET AT: 250 GLENDALE RD - LOT 1 Applicant Address: Phone: Insurance: 69 METACOMET ST (413) 537-1825 WC BELCHERTOWNMA01007 ISSUED ON:11/18/2016 0:00:00 TO PERFORM THE FOLLOWING WORK:CONSTRUCT 4 BEDROOM R-3 GROUP HOME POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Undergr und: Service: Meter: !z Footings: "/ c/ 47 .,/, „(5-"• Rougl : Rough: 1_ 11`f! '7 House#[7SQ Foundation: B f(+ g13./"/' �lM veway Final: Final: r c?..1- j l� f`'n Rough 3Fram / �P.% Gas: Fire Department Fireplace/Chimney:f.�t' \ 6- Rough: Oil: lnsulationr —4-1 t7�/�'� Final: Smoke: (6,p19 7 Final: (G'44-11 6;;Ca KS THIS PERMIT MAY BE REVD D BY T CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND RE TION Certificate of Occupancy , / Signature: / FeeType: Date Paid: Amount: Building 11/18/2016 0:00:00 $1848.00 212 Main Street, Phone(413)587-1240,Fax:(413)587-1272 Louis Hasbrouck -Building Commissioner i e0 ory, L' p&-rie-7-2e/9-77(77.1 /fi% /--;v/1-0/r- 6.7\S The Commonwealth of Massachusetts iy .t 4t e & fJ City of Northampton ,„ . Certificate of Occupancy In accordance with 780 CMR, (The 8th Edition of the Massachusetts State Building Code) this Certificate of Occupancy is issued to the premise or structure or part thereof as herein identified, y Identify Name of Building of Space Within ( Certificate No. V Issued to RaymondPermit# A. Goulet BP-2617-6671 Identify property address including street number, name, city or town and county Located at 250 Glendale Road Northampton, MA 01060 Use Group Classification(s) Residential Group Home R3 This Certificate of occupancy is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shalt allow for the use as herein described and in conformance with any and all conditions as identified below. It shall be posted in a conspicuous place within the space as directed by the undersigned. failure to post the certificate,failure to comply with conditions or, tampering with the contents of the certificate is strictly prohibited. Conditions of Use Residential Group Horne full fire suppression i Name of Municipal Date of Final Map/Plot Building Official Kyle J. Scott Inspection Dale 49-032 06/25y201.7 Building of Municipal /iG� �/I� Issue of p Signature Official CAI— Issuance Date Thai' r. 06/29J2477 Lot s"'fteport of Inspection/Test Annual Sprinkler Allied Fire Protection, Inc. June 1, 2017 11 East Fsk Avenue Springfield MA 61107 Property (413)9889638 fax(413)731-5184 CIL Group Home Fire Proteceoa Contractors/Saleamesi fInspecosdreseey/24 How SCIVIC e 250 Glendale Road Northampton, MA Inspection Ref: 8052 Print Date: 6/28/2017 Signatures Inspector-Printed sector-Signa a Date Corn leled I state that the information on this form is correaat the 1)^J� time and place of my inspection,and that all equipment David J. Brosseau /' 4` J tested at this time was lett in operational condition upon Y7 �- J n completion of this inspection except as noted. Owners Representitive-Print Owner's Representitive-Signatur Date Completed Except as noted,the buildings occupied with the same '_/ occupancy classification and hazard of contents as last Ray Goulet P' inspection. Also.the system e eof remainedtin servicef without modification and been free of actuation of devices or alarms. Fire Inspector-Printed Fi eI�nspr-Signature Date Competed I certify that I witnessed the inspection and test of the Northampton Fire Dept. / / / 0.. 0— G / ,9�/ life safety system at the above premises / Equipment Summary �! Site Inspected Unable to Serviced Failed DescriptionInspect Repaired Qty , Qty % Qty % Qty % Qty % Sprinkler Flow Test Inspector's test 1 1 100.0% 0 0-0% 0 0.0% 0 0.0% Sprinkler Inspection 1 1100.0% 0 0.0% 0 0.0% 0 0.0% Sprinkler Inspector's Test Valve 1 1100.0% 0 0.0% 0 0.0% 0 0.0% Sprinkler Valve Butterball 1 1 100.0% 0 0.0% 0 0.0%J 0 0.0% Water Based System Inspection Yes Gauges on wet pipe system in good condition and NA Is the water motor gong operating properly(if present) showing normal water supply pressure? Yes Alarm devices free from physical damage? Yes Hydraulic nameplate,if provided,securely attached to riser and legible? NA Valve supervisory switches indicate movement? Fire Department Connection Yes Visible and accessible? Yes Couplings and swivels not damaged and rotate smoothly? Yes Plugs or caps in place and undamaged? Yes Gaskets in place and in good condition? Yes Identification sign(s)in place? Yes Check valve is not leaking? Yes Automatic drain valve in place and operating properly? NA Interior free of obstructions(if caps are not in place)? NA Valve clapper operational over its full range(if caps are not In place)? Print Date: 6/28/2017 Page 1 of 2 Copyright 2002-2017 Life Safety Inspector, Onsite Software 'Report of Inspection/Test Annual Sprinkler June 1, 2017 Allied Fire Protection, Inc. Property: CIL Group Home Inspection Ref: 8052 Pipe All piping hydrostatic tested at 200 psi for 2 hours. Yes In good condition? Yes Free of mechanical damage and not leaking? Yes No external corrosion? Yes Properly aligned? Yes No external loads? Yes Visible pipe hangers and seismic braces not damaged or loose? NA Was an obstruction investigation conducted and the system flushed? Sprinklers NA Extra high,very extra high and ultra high temperature Yes Are sprinklers spaced properly to protect hazard? sprinklers tested? Yes Proper number and type of spare sprinklers? Yes Free of corrosion? Yes Free of obstructions to spray pattems? Yes Free of foreign materials including paint? Yes Free of physical damage? Yes Are all sprinklers in service dated 1920 or later? Yes Fast Response sprinklers in service for less than 20 NA Standard sprinklers less than 50 years old? If no test years?If"no'test sample now and every 10 years. sample now and every 10 years. Yes If sprinklers have been replaced,were they proper replacements? Flow Test Outlet Pressure(psi) Time Results System Connection FlowedSize - To comparable to S tatic Resid Static Restore prior test Sprinkler Riser Inspector's test 1/2 . Z Z,, 572 5 sec NA Inspectors Test Valve System/Location Alarm Reported Time to Alarm Smooth Bore Orifice Signage Easily Accessible sprinkler Riser Yes 30 sec Yes Yes Yes Valve Inspection List Inspection Location/Description Valve Type Size Secured aa iv `um c o w m v O 8 m � Q Sprinkler Riser Butterball 2" Pad Locked Ok Ok Ok Ok Ok-Passes Inspection S-Serviced on site X-Requires Service NA-Not Applicable Print Date: 6/28/2017 Page 2 of 2 Copyright 2002-2017 Life Safety Inspector, Onsite Software 250 GLENDALE RD - LOT 1 EP-2017-0534 COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Map: 49 Lot:052 ELECTRICAL PERMIT Permit: Electrical Category: WIRE NEW DWELLNG ALONG WITH FIRE ALARM&GENERATOR Permit# Electrical PERMISSION IS HEREBY GRANTED TO: Project JS-2017-001097 Est.Cost: Contractor: License: Fee: $250.00 JOHN MARTIN ELECTRIC INC MASTER ELECTRICIAN 12765 Owner: C I L REALITY OF MA INC Applicant: JOHN MARTIN ELECTRIC INC AT: 250 GLENDALE RD - LOT 1 Applicant Address Phone Insurance 27 EAST HILL RD (413) 537-9577 0 C- MONSON MA01057 ISSUED ON:12713/2016 0:00:00 TO PERFORM THE FOLLOWING WORK: WIRE NEW DWELLING ALONG WITH FIRE ALARM & GENERATOR Call In Date: Date Requested Inspection Date/SignOfr: Reinspect?: Trench/UG: c- /a ' /7 R/'`1 Special Instructions x Rough 3 -0) t/ ' ) ) QP, x Special Instructions:// pp.. n/�' Final: ( ?9 /1 /R ' 'S G n SRE Called In: 223 K'7 (0 �o �Qr`�p - ( - ) ( - /7 "Zit- 3 GP' a 3 `I 5-SS9 @Z - g 17 ,z- Signature: Fee Type:: Amount: DatePaid Electrical $250.00 12/13/2016 0:00:00 5377 212 Main Street,Phone(413)587-1244,Fax(413)587-1272-Inspector of Wires -Roger Malo . ,. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK V-" i—'t CITY N0r4444 w.to1VA MA DATE /.Z/OI//6. PERMIT# PP— � / n-Z JOBSflE ADDRESS o2Gj) 6(4,)do_ie wed OWNERS NAME R66 LLL POWNER ADDRESS TEL FAX TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: RENOVATION: REPLACEMENT: PLANS SUBMITTED: YES NO FIXTURES 1 FLOOR—. Ban 1 2 3 4 5 6 7 8 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM (Z 8(/. .2 DEDICATED GAS/OIL/SAND SYSTEM lS t/ Ltiii DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM DEDICATED WATER RECYCLE SYSTEM BM Q. DISHWASHER 1 DRINKING FOUNTAIN FOOD DISPOSERelacti&,rnnn �ing&,ias mgceLtionl FLOOR I AREA DRAM . v^^ tan INTERCEPTOR(INTERIOR) KITCHEN SINK I LAVATORY 9 ROOF DRAIN SHOWER STALL '.. SERVICE I MOP SINK TOILET "r. Ic3 gCis:NSP eir URINAL WASHING MACHINE CONNECTION - As s ° h'�l ArrrtI[:1/E) WATER HEATER ALL TYPES I2: WATER PIPING 1 OTHER INSURANCE COVERAGE: I have a amen iabiity insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES • NO If YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY .. OTHER TYPE OF INDEMNITY BONO OWNER'S INSURANCE WAIVER:I am aware that the licensee does nn havethe insurance coverage required by Chapter142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement CHECK ONE ONLY: OWNER AGENT 1 SIGNATURE OF OWNER OR AGENT I hereby certify that all of the details and information I have submitted or entered regarding this appiation are true and accurate to the of my knowledge and that all numbing work and installations performed under the permit issued for this application hill be in nce 4Mp11 Pe ' provision the Massachusetts state Plumbing Code and chapter 142 of the General Laps. ,f' PLUMBERS NAME David Fredenhurgh LICENSE# 11406 SIGNATURE .74 MP ' JP CORPORATION - #2344 PARTNERSHIP # LLC # COMPANY NAME D F Plumbing&Mechanical Contractors,Inc ADDRESS P.O.Box 1086 9 Stadler Street an .Beldmnown STATE MA ZIP 01007 TEL 413-3234116 FAX 413-323-7532 CELL EMAIL dfpkmbhagbSchedown©yahoo.mm _ _ c 0 lv /eif j J A r/ /