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32A-162 (15) BP-2022-0013 33.HAWLBY ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 32A-I62-00I CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRA( "I IN(i WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2022-0013 1'ERMISSIONIS HEREBY GRANTED TO: Project# ACOUSTICAL WALL Contractor: License: Est.Cost: 85000 D A SULLIVAN &SONS INC 053667 Const.Class: Exp.Date: 1 1/19/2023 Use Group: Owner: NORTHAMPTON COMMUNITY ARTS TRUST INC Lot Size(sq.ft.) Zoning: CB Applicant: D A SULLIVAN & SONS INC Applicant Address Phone: Insurance: 82 NORTII ST (413)584-0310 M('('200000932022 NORTHAMPTON, MA 01060 ISSUED ON:01/04/2022 TO PERFORM THE FOLLOWING WORK: ACOUSTICAL WALL 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: !louse # Foundation: Di-iveway Final: Final: Final: Rough Frame: (.as: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Huai: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: itymii)LQQ Ti oU Fees Paid: $595.00 212 Main Street,Phone(413)587-1240.Fax:(413)587-1272 Office of the Building Commissioner 1 - 13- r ----_. * l The Commonwealth of Massachusett�IN - 4 2022 r LOffice of Public Safety and Inspections Ii►; Massachusetts State Building Code(780 CMR) _____Building Permit Application for any Building other than a One-orTw¢P3.mily Dwelling ,,,,nn (This Section For Official Use Only) Building Permit Numbed "4")3 Date Applied: Building Official: SECTION 1:LOCATION 33 1-9 ii i tY Li h►oitr1/4 II Prod O/g 0 NOR`,/peral IOM T'f• hATS 1R1157' No.and Street City/Town Zip Code Name of Building(if applicable) Assessors Map# Block#and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below Existing Building Q' Repair 0 Alteration re Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes Er No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Q' Brief Description of Proposed VYorki _Ac9LjSTrc,tl Whit Rvc1l6 t 1C DR e Ufd I3t4CK QDX pfg4j ( Z IN f R WV. s otfLY 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) 0 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 VA-2❑ Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0 F: Factory F-1 0 F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0 I: Institutional 1-1 0 1-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-ID R-2 0 R-3 0 R-4 0 S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA ❑ IB 0 IIA 0 IIB 0 IIIA 0 IIIB 0 IV 0 VA VB 0 SECTION 7:SITE INFORMATION(refer to 780 CMR 05.3 for details on each item) Water Sup y: Flood Zone Information: / Sewage Disposal: Trench P mit Debris Removal: �V/ A trench w I not be Licensed Disposal Site Public Check if outside Flood Zone Indicate municipal required or trench or specify: Private 0 or indentify Zone: or on site system 0 permit is enclosed 0 Railroad right-of-w Hazards to Air Naviga • n: MA Historic Commission Review Process: Not Applicable Is Structure within airport ap roach area? Is their review completed? or Consent to Build enclosed 0 Yes❑ or No Yes 0 No 0 .{�� SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: i PIA Use Group(s): 4") Type of Construction: Does the building contain an Sprinkler System?: ye') Special Stipulations: Design Occupant Load per Floor and Assembly space: • SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Noll l4 MPfo tl cor1M uti►TY 4AU $f TRUST 33 1/1 WIlY sT IJDRt 4 PIPTh// ONO Name(Print) No.and Street City/Town Zip Property Owner Contact Information: RI crf4Ra 04Ci1R - - 4i3-557- 9i55 lmrl�srgihrA @ t. 404 Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: M4i S111L WV/ &2-8f l*okrYY Sr t/wr74mi W4 4m60 Name Street Address City/Town State Zip to apply for and 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 1) If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here Li Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals) Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor l,4 SY'IW ,4 4 soil , Ili Company Name MARK t!1L h/,1N CS • bS3 6 t7 /r/G1 2Ozj Name of Person Responsible for Construction License No. and Type if Applicable 82 . 84 thitly Sr ►IoRttq IforoW Nit D/it0 Street Address City/Town State Zip �l/3-SO 0316 411 -4;7_ 547- MhRge b' S ill Isv4N, CDM Telephone No.(business) Telephone No.(cell) e-mail address SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L c.152.§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 No 0 SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Estimated Costs:(Labor Item and Materials) Total Construction Cost(from Item 6)=$85,000.00 � Q pLerthdrec�'1.Building $ building Permit Fee=Total Construction Cost T 2.Electrical (TT appropriate municipal factor)=$___,ap 3.Plumbing ........s_ 4.Mechanical (HVAC) $ Note:Minimum fee=$ (contact municipality)5.Mechanical (Other) $ r� Enclose check payable to C(Ty o f A3 o1'Lt�i ,M,�"t v� 6.Total Cost $ 7J S j 000•v (contact municipality)and write check number here 4,60¢6 SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pa' s and penalties of perjury that all of the information contained in this application is true and accurate to the bes of y 41,I,i ge and understanding. mil p< S 111 L Ivii 4 PROS it.SENT 113 -SO_ 63/0 r2•2o 21 Please print and sigm name Title Telephone No. Date 82 . 8i rIDAN Sr NOR1)/4rifro/ Mif D/d`o MaRKeD'svlt►vitN. tom Street Address City/Town State Zip Email Address tfradriks.,„ NC, t1 14 _1 _ Municipal Inspector to fill out this section upon application approval: � 1 ') Name If ate 1.1 ,k, � -.-.- .�—N I ACOUSTIC 33 Rawls 'IMAM A WALLS AT ; ArtsTr,a � SK 65 .",tea;:«�—"•"' rI r \ '' t' .._..� 0�~ -�-.... WORK ROOM _._ 3z-- ,. I, ,{ .�" ilia :iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii !l 1 1 1 • ...oc r.rr.+,.r.. -1_ Ell ...iFirtit7.. EOWALL ExTERiOR ' �•, COL .e"r FURRED EXTERIOR WALL :4 - SEE STRUCTURAL .� .TYPE4DOUE&awrrro. WALL TYPE IA- N.. .•...1 ® °F :mum FOR STAIRS. WALL TYPE 4-DOABLE WALL WITH TARED EXTERIOR WALL Wi BATT INSTIL a ro _ AIM .. UNFINISHED SPACE -�__. 1A ACOUSTIC ISOLATION BRACES WRR ACOUSTIC ISOLATOR BRACES ---- -- --- L RE CATERING lI 'I' PIp 9 WALL TYPES — ;D o ,7,S'0 J __ V1 F; ac �/2 4'0' f 4'41 V2' . cXls 1B9 SF O. UP J t NEW STARS elYY � MET _ 1RP— T� 012,) 114,1 l I o .LATE 8 EXIT >7:20 EXIST ..0I2 ii i yLi.. RAIL/ I i E%IS BLUE • 1, `I NEW 5Y ' ' ' • i SUPPLY r.lei: .4. ,... -- I th( . I ACT • rs of 5/8"type-X G—T� I b n Work Room sic*.. __- 11111,130:1; A ^�` I ssro 1S0 I Ilk .I.l*..-` 1� 10'-0'TO BELOW NEW r—' r-- �►i l VI � , y \�i� �1 }�I,T,,,► I IT.r DUCTrCATWALK izi IIl- m..:��. WORK ; - - - - , I i mu:' .�..m BM SPACE ROOM I ... . . 1� I ._.. : O 1 ®' F STUD WALL AT 1 FLEX SPACE: I 2,569 SF . . S 3S/E'STUDS I PERFORMANCE AREA . : . —0'SOUND GATT NEW STUD WALL: O ..� M I —(2)sro ase NN I ..., . WALLTYP • ���Ir..� IV 3d/B'STUDS SECURED I I �1 ■ • RESILIENT SOUND filISOLATION CUPS.16'U.C. I !. _ i1 . ::I +3'SOUND GATT I _._ ._ a ___ I_� m�__,_ __�� _ __ _J _ __ _ , ` ` FUTURE -.(9)SB'TYPE•X GWBII -ems -- I :-- ■ �V1 it • STORAGE D II ; . Ill . 61:5 SF s III tari CORFUDOR I T 276'TO BELOW? � __I _�' r., ... : ■ • FLEX ROOM(LOOK I • LIIIIIIIIIE...„, —\—,— IT I :.--1 =. L---- _ :-. I SINGLE S ,1 1 WALL.(2)LAYER 41>: i, "" ._. 5!8"TYPE-X GWB- �' ! I ar0 ro woRK I ' I ,1f'' ,ROOM' FLOOR I WALL SECTION WALL SECTION:WORK ROOMWORK ROOM PLAN . . . . . . �� 2a SScats1/2'=1.0• O Wscale:Scale:1/4"=1'-0' O va =1-o • ,ELECTRICAL SPECIFICATION. • DEMOLRION GENERAL NOTES. GENERAL NOTFS' I el aaa+e.vamp. ,. nor mow so r.•A e<Wowb ewe 0, .onf kr,,. 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PAWL. m.▪smroe o roe Ta m MOO.IMMO a — -i .— ___I !•- .L_ a .- , - e . - m.w.I rw...a OWN.a CM..10..4 --"' •—•• _ \� m...•I Lama a°....w..r.mrm .o.v _ -- `, tom¢ IMMON too• MI OM. <.0 � O f.Yd - _ COMM.m CM.MOM .rm ms.wn. ' ram„. - _-I .. ...... .. ..... ...I.di ,a mn�'OW MRS IN•ZOOM o _ 4 or f _ .. s▪ .A.wROO roam. L.ION 11.1.106 Sale11 mad«p..111 .. ..F�.oa.. m ErxineeArg Services .. O.n 0.°`O 0 d vemlGrlt,K I. <. I<., '• .w..,...... as0 0 o o<, , o ,.„.R..t CO. s „sI I. PromLo e...Doi I SILIETCL L O 6 0 _._. 0 ,�2 0 T 0 °o...o-s.... LUMINAIRE SCHEDULE imen L 41, am.. NNW MM.10a NAM lir aA .,n `OwFP `.FIRM - •-.. A•• a ° A[M A N°Rm MR MO mO. OM WJO . P.A. WW1 no., WU WO e •aI 011l LID Wit, OM. OM MO Mo.r.m°�Q° ....F.as a RR.C.R Riga w. .•we 1.R ELECTRICAL IJCHnNG CATWALK PLAN "iOOim""""r'�• '~' .,m.., n 1W0•/r..'-." C �u.•1:�1 9 1.0 •.so n.•r. w.�Of m o04f fKM-a -•Y.r, R� w.O• OCCIa".0`,,.0..m'a°.o°"c °"° OMR a MP'°° 1"""°ac Kart WOrthampton ®'"a' a. 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OMR MOTFi r�rAJ POWER h SIGNAI CATWALK KmE 3 City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111 , S 150A. Address of the work: 33 H f t w Ve / '7( The debris will be transported by: 0, 4SUL , t, V1D)_ D 5 D The debris will be received by: Jft1LY t2ECYt4 N& Building permit number: Name of Per it Appli .nt X SOW A J4. J,F , iito 6 • Date / Signature of Permit Applicant 9 pp I �9)--Z2 The Commonwealth of Massachusetts Department of Industrial Accidents _ = Office of Investigations :sly`= ' 600 Washington Street `1��1= Boston,MA 02111 .— www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): D.A. Sullivan&Sons, Inc. Address: 82-84 North Street City/State/Zip: Northampton, MA 01060 Phone #: 413-584-0310 Are you an employer?Check the appropriate box: Type of project(required): 1. x❑ I am a employer with 26 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. I 7. Er Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ 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' comp. insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Policy#or Self-ins. Lic. #: MCC20020000932022A Expiration Date: 7/1/2022 Job Site Address: Northampton Community Arts Trust. 33 Hawley St. 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 day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify de the p ' s a penalties of perjury that the information provided above is true and correct. Signature: Date: 12/30/21 Phone#: 413-584-0310 Official use only. Do not write in this area,to be completed by city or town official City 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#: M • DATE(MM/DDIYYYY) ACORN CERTIFICATE OF LIABILITY INSURANCE 06/30/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Barbara Grynkiewicz NAME: Webber&Grinnell PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Exit: (NC,No): 8 North King Street E-MAIL bgrynkiewicz@webberandgrinnell.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Selective INSURED INSURER B: MA Employers/A.I.M. 12886 D.A.Sullivan&Sons,Inc. INSURER c: Darwin Select Ins.Co./BRECK Attn: Mark Sullivan INSURER D: 82-84 North Street INSURER E: Northampton MA 01060 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 7/1/22 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED 1,000,000 PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A S2444741 07/01/2021 07/01/2022 PERSONAL BADVINJUF2Y $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 3,000,000 POLICY X PRG LOC 3,000,000 JECT PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ A OWNED X SCHEDULED A9108782 07/01/2021 07/01/2022 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS XHIRED X NON-OWNED PROPERTY DAMAGE AUTOS ONLY _ AUTOS ONLY (Per accident) Underinsured motorist BI $ 250,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB CLAIMS-MADE S2444741 07/01/2021 07/01/2022 AGGREGATE $ 10,000,000 DEO X RLTLNTION$ 0 WORKERS COMPENSATION X STATUTE OTH- ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOPJPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 B OFFICER/MEMBEREXCLUDED? N N/A MCC20020000932022A 07/01/2021 07/01/2022 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes.describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Professional Liability C 03043363 07/01/2021 07/01/2022 Limit: $5,000,000 Deductible: $10,000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN "FOR INFORMATION PURPOSES ONLY" ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I • , Appendix 1 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. 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/Investigation 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. Registered Professional Contact Information Stott Ath1.4W _ Ot #/ sCorfeI'D Dig L4sdfilIr?;G6 egistration Number Name(Registrant) Telephone No. e-mail address 191 Pl14S41/1 S1 8202 NDRry41'fPT H M4 1/l6 iticf• Street Address City/ own State Zip Discipline Expiration Date i4ils afRftr1sr ',rt 80t-8SS- 80 91 482 "7 Name(Registrant) Telephone No. e-mail address Registration Number 9 W4s/l►111?K sr RIIri P/11 yr O57 / ElterR/t4L Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. I • Initial Construction Control Document Ic 6 To be submitted with the building permit application by a Registered Design Professional • r7 for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Date: Northampton Community Arts 12/3O✓2O21 Trust-Wodcroom Property Address: 33 Hawley St, Northampton, MA Project: Check (x)one or both as applicable: New construction X Existing Construction Project description: interior build-out of an existing space as a black box theater 8944 August 2022 MA Registration Number: Expiration date: ,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: X Architectural Structural 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: �•' �rf!'�Opp',,' °>, 413-585-0641 douglasetdouglaswchitects.com 1 Phone number: Email: g WIttittntIN l2 if li':a tr.;fy Building Official Use Only f y ,` I 04 Building Official Name: Permit No.: Date: fTNOF Note 1.Indicate with an'x' project design plans,computations and specifications that you prepare..... u..c....y aurc,r.ac... u vu.c. .� chosen,provide a description. Version Ol O1 2018