scjg_K&LPermitSignatureVersion 06_11_2013
Initial Construction Control Document
To be submitted with the building permit application by a
Registered Design Professional
for work per the 8th edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Kosher Kitchen at Jordan House Date:July 16, 2014
Property Address: Jordan House in the Smith College Quadrangle on Paradise Road, Northampton Massachusetts
Project: Check (x) one or both as applicable: X New construction X Existing Construction
Project description: Modification of former Kitchen Space into a residential ktichen, dining and auxiliary spaces to serve
the Hillel Community as their Kosher Kitchen and dining area.
I Dan Lewis MA Registration Number: 31737 Expiration date: June 30, 2016 , am a registered design professional, and I
have prepared or directly supervised the preparation of all design plans, computations and specifications concerning1:
Architectural Structural X Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief 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 I (or my designee) shall perform the necessary
professional services and be present on the construction site on a regular and 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.
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 performed in a manner consistent with the approved
construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official, I shall submit field/progress 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 Document’.
Enter in the space to the right a “wet” or
electronic signature and seal:
Phone number: (603) 352-4841 Email: dan@kohlerandlewis.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1. Indicate with an ‘x’ project design plans, computations and specifications that you prepared or directly supervised. If ‘other’ is chosen,
provide a description.