17C-253 (2) �a
Zoning Board of Appeals - Decision City of Northampton
Hearing No.: ZBA -2010 -0007 Date: September 11, 2009
MOTION MADE BY. SECONDED BY VOTE COUNT: DECISION
Malcolm B.E. Smith Elizabeth Silver 3 Approved
MINUTES OF MEETING:
Available in the Office of Planning 8 Development.
1, Carolyn Misch, as agent to the Zoning Board of Appeals, certify that this is a true and accurate decision made by the Zoning Board and
certify that a copy of this and all plans have been filed with the Board and the City Clerk on the date above.
1 certify that a copy of this decision -has been mailed to the Owner and Applicant.
/bi
ifU»
NOTICE OF APPEAL
An appeal from the decision of the Zoning Board may be made by any person aggrieved and pursuant to MGL Chapt 40A, Section 17 as
amended, within (20) days (30 days for a residential Finding] after the date of the filing of this decision with the City Clerk. The date of
filing is listed above. Such appeal may be made to the Hampshire Superior Court with a certified copy of the appeal sent to the City Clerk
of Northampton.
GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc.
/Q - 615 gip(
Zoning Board of Appeals - Decision City of Northampton
Hearing No.: ZBA- 2010 -0007 Date: September 11, 2009
APPLICATION TYPE SUBMISSION DATE:
Special Permit 8/12/2009
Applicant's Name: Owner's Name: SL } k 'Z,JO,9
NAME: NAME:
Siegel Signs CLINICAL & SUPPORT OPTIONS INC
t
ADDRESS: ADDRESS: '
179 West St. 111 Federal Street
TOWN: STATE ZIP CODE TOWN: STATE. ZIP CODE
Haffield MA 01088 GREENFIELD MA 01301
PHONE NO; FAX NO PHONE NO FAX NO
773 -1314 (511)
EMAIL ADDRESS. EMAIL ADDRESS
Site Information: Surveyor's Name:
STREET NO r, SITE ZONING: COMPANY NAME:
: 7r. , , GB(100)/
+ ACTION TAKEN: ADDRESS:
FLORENCE MA 01062 Grant
MAP: BLOCK: LOT: MAP DATE: SECTION OF BYLAW:
y
�fi A 01 Chpt. 350- 7.4: Signs Permitted in any °B" TOWN: STATE ZIP CODE:
Page: District
2635 267 PHONE NO.: FAX NO.:
EMAIL ADDRESS.
NATURE OF PROPOSED WORK:
Replace ground sign.
HARDSHIP:
CONDITION OF APPROVAL:
FINDINGS:
The Zoning Board issued the special permit for the ground sign based on the information submitted in the application.
The Board found the following criteria in section 7.4 to be met:
(a) There are unique features to the structure, the orientation of the structure, the location or setback of the structure, or the location of
establishments in the structure, especially affecting such structure or establishment, but not generally affecting the zoning district in
which it is located, which restrict the visibility of wall sign(s) otherwise allowed by this chapter.
(b) Said ground sign is located in the same lot as the structure or establishment being advertised.
(c) Said ground sign shall not exceed a height of 10 feet, nor have a surface area greater than 80 square feet in the CB or GB Districts.
The ground sign will be 12.5 square feet and 4.6' tall.
COULD NOT DEROGATE BECAUSE:
FILING DEADLINE: MAILING DATE: HEARING CONTINUED DATE: DECISION DRAFT BY: APPEAL DATE:
8/11/2009 9/5/2009 _ 9/17/2009
REFERRALS IN DATE: HEARING DEADLINE DATE: HEARING CLOSE DATE: FINAL SIGNING BY: APPEAL DEADLINE:
8/29/2009 10/16/2009 9/10/2009 9/24/2009 10/1/2009
FIRST ADVERTISING DATE: HEARING DATE: VOTING DATE DECISIDN DATE:
8/27/2009 9/10/2009 9/10/2009 9/11 /2009
SECOND ADVERTISING DATE: HEARING TIME: VOTING DEADLINE. DECISION DEADLINE:
9/3/2009 5 :30 PM 12/9/2009 1/13/2010
MEMBERS PRESENT: VOTE:
Elizabeth Silver votes to Grant
Malcolm B.E. Smith votes to Grant
David Bloomberg votes to Grant
GeoTMS® 2009 Des Lauriers Municipal Solutions, Inc.
The Commonwealth of Massachusetts •
Department of Industrial Accidents
t Office of Investigations
600 Washington Street
` Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): & i 9 L - 0/20/) ] c)) L J t o C � l 0 O-)
A d d r e s s : ' / ( G/ + S
City /State /Zip: ER / Phone #: Lf / 3 -
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
6. ❑ New construction
Ioyees (full and/or part- time).* have hired the sub - contractors
2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers'
g Y P h' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 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#1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City/State /Zip:
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 cer ' • under the pains and penalties of perjury that the information provided above is true and correct.
t
Signature: IF ' ��G� = -- -� Date:
Phone #: (f ,, y 7 _� .
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 #:
Version1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
._._- _... ...._ ._.._.. , as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
p ( 1, ..__ A R.S'EN L � as Owner /A.thoriz .
• gen ereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
an. belief.
Signed under the pains and penalties of perjury
Print Name
cam /� ( _.
N Signature of ‘caner /Agent Ci. V r e; Date S to
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder .
��ff jp- ��) LL P Yom- cu r�L r
_..._. G /. 7.m.. m P ..___ . _ ..n, . 87 / ..1
License Number
. _..1� l ._ _._SJ g\/ 1. ? .... _ / ..__.._. ...___ ... _. 1 _ . (? )
Expiration Date
Sign ture Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.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 building permit.
Signed Affidavit Attached Yes No 0
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 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name (Registrant): ___,_.___ __._.._.._..„
Registration Number
Address
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
}
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
t
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date d ..
9.3 General Contractor
. _ ___ _
0 04 . 72.Ea' ? ..._. 2i 1 .G ' . .. :.._. /2 „C IS20 1 &_...._____ : Not Applicable ❑
Company Name:
Responsible In Charge of Construction
q fc . }-1a C+- S i EXY _1 kr 1 n .._..
Address 0e1 4 ) I i / D O -- C I ___ . . _„,....., „ .., .. „ „
Sign ure Telephone
Version 1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ., .,_.. , _ ..
Frontage .,
Setbacks Front _......_.
Side L: ,._.._ R. _..,._.._.. L...- .-....__.. R. _._ ..
Rear
Building Height
Bldg. Square Footage .„
Open Space Footage % ,
.
(Lot area minus bldg & paved
parking)
# of Parking Spaces _.
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW 0 YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page °._ and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO "DON'T KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained
, Date Issued:
C. Do any signs exist on the property? YES 0 NO 0
IF YES, describe size, type and location: '+
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO
IF YES, describe size, type and location:
E. Will the construction activity disturb (clearing, grading, exc ation, or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES (9 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
V
Version1.7 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 ❑ Demolition Repairs ❑ Additions ❑ Accessory Building ❑
Exterior Alteration Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here. , AJ i ' EX 7i "& G ��t L
Of Proposed Work:
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 ❑
E Educational ❑ 2B - P ❑
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 ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
----
S Special Use ❑ Specify: ,._ ._
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: Proposed Use Group.._...
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34).
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1 st
1'
_. _., . _ ._., _,_,_ _„ ,___ . 2 nd
2 nd
3 rd 3rd
4th 4m _...
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 0 Zone Outside Flood Zone❑ Municipal ❑ On site disposal system
r'
lr ii ' i II Version1.7 Commercial Buildin & May 15, 2000
- - - ' Departmentuse only" w
City of Northampton Statat , %ift$
MAY 4 LO uilding Department Curb C & y P �i
ii s m^x+s .m' °3 m lie
212 Main Street 5; a Sewet!s@ lkvarlali r k*
a
. 100 U�lter /Ut✓e l l A uaila b iit
Room
Northarrlpton, MA 01060 Twa se s o Str Hirai Flans . .
_.. --- .. - ' phone 41345871240' Fax 413- 587 -1272 PiotISitt Plans
Other Specify .� : - E,
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR 13F�0 ,P SH I ANY BUILDING
OTHER THAN A ONE OR TWO FAMILYDIIELI_._ ,
SECTION 1 - SITE INFORMATION
1.1 Property Address:
This sect `(to 6e bo toted by office
4,; % AL lvt 6 1 /Vl J T . Map Lot Unik
J
Zone Overlay Dist `�
Fl-^C YC& N Lc., /
CB District
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
C rS .0, _. N...... ..._,... ....,.._ -----
Name (Print) Current Mailing Address
Signature Telephone
2.2 Authorized Agent:
' Name (Print) ' au i o �., .'1 1 M
Current a iling Addre
Signature X t(1�� Telephone
I, SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building - (a) Building Permit Fee
2. Electrical ---- - (b) Estimated Total Cost of
Construction from (6) _,,.,., _
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) J t 2 ,
5. Fire Protection
6. Total = (1 + 2 + 3 + 4 + 5) C)C� -) , U\D Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
5 /2y rd
Building Commissioner /I spector of Buildings Date
x
BP- 2010 -1059
GIS # COMMONWEALTH OF MASSACHUSETTS
ock:° IIc - 253 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit # BP- 2010 -1059
Project # JS- 2010- 001560
Est. Cost: $3000.00
Fee: $55.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PHILLIP WALDRON 88999
Lot Size(sq. ft.): 18948.60 Owner: C S 0 INC
Zoning: GB(100)/ Applicant: PHILLIP WALDRON
AT: 29 NORTH MAIN ST
Applicant Address: Phone: Insurance:
46 HIGH ST (413) 422 - 2252
ERVINGMA01344 ISSUED ON:5/25/2010 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL NEW EXTERIOR DOOR & ROOF
OVER DOOR
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:
FeeTvpe: Date Paid: Amount:
Building 5/25/2010 0:00:00 $55.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo
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Exhibit 3 - Change Work Order
4-_
Date: Change Order 4-1
it
Bill to: Job Description:
Qty Description Unit Price Line Total
Subtotal
Sales Tax NA
Total
Makc Check:, N\dble to Pioneci \C\ tchoilder
Thank you for your business!
235 Eastcln .\o, cinte. SpriiTtield. Vitt, 01109 Phou 4 1 O-1 l'u\ 4 '13--8 7( )
Finail Genek@PVRebui IdersCDC.org
5/21/2009 Page 13 of 13
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S
Exhibit 2 Notice of Cancellatioa
Today's Date is Monday Mav 18. 2009
CSO may cancel this transaction, without any penalty or obligation, within three business
days from the above date (i.e. Wednesday May 20, 2009).
If CSO cancels, any property traded in, any payments made by CSO under the agreement,
and any negotiable instrument executed by CSO will be returned within ten business days
following receipt by the seller of CSO cancellation notice, and any security interest arising out of
the transaction will be canceled.
If CSO cancels, CSO must make available to the seller at CSO residence, in substantially
as good condition as when received, any goods delivered to CSO under this agreement, or CSO
may if CSO wishes, comply with the instructions of the seller regarding the return shipment of
the goods at the seller's expense and risk.
If CSO does make the goods available to the seller and the seller does not pick them up
within twenty business days of the date of CSO'S notice of cancellation, CSO may retain or
dispose of the goods without any further obligation. If CSO fails to make the goods available to
the seller, or if CSO agrees to return the goods to the seller and fail to do so, then CSO remains
liable for performance of all obligations under the contract.
To cancel this transaction, contact Gene Kennedy by telephone at (413) 636 -3960 (if not
available leave a voice message with including the date of the call), AND mail or deliver a
signed and dated copy of this cancellation notice or any other written notice, or send a telegram
to: Pioneer Valley Rebuilders C.D.C., at 235 Eastern Avenue, Springfield MA 01109, not later
than midnight of Wednesday May 20, 2009.
CSO hereby cancels this transaction (Date)
( CSO'S Signature)
(CSO'S Printed Name)
5/21/2009 Page 12 of 13
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)
Two crisis rooms (Interview and Tr iw.le carpe; and
labor
Project Total with flooring)
24,425
2. Materials and /or Equipment CONTRACTOR will supply: (
Materials and Equipment to complete the scope of work described above
3. Materials and /or Equipment CSO will supply:
Specification of paneling
4. Materials not to be used:
Materials judged to be of substandard . ty or value by HOMECSO or CONTRACTOR
G.K. SO
CONTRACTOR INITIALS INITIALS
5 U
Li
5/21/2009 Page 11 of 13
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1 1 office - workstation C8
price for industrial carpet (and hall between: C7 &
C8) installed including materials
director - workstation C7
price for industrial carpet (and hall between C7 & -
C8) installed including materials
supervisor - (pink room) workstation C6
pending floor inspection near adjoining bathroom to be
wall - to he determined pending 'look and see' determined
bathroom (blue) 1,191 10
1,201
remove tub and tub casing
install shower unit cso
bathroom (end of hall) 595 5
600
remove and dispose of shower unit
patch and prepare fixture holes for paint (after
fixture removal)
-an nre aarc fn_�_ _ r n�,aint
\
!�j need c -- • •• - D. - r • - - -
�i V
AND 144441eii4i41ill l4$d- 1t n atc-c ms -
Project Total (without flooring)
19,860
Project Total (with flooring)
flooring - entire house including linoleum and
carpet (with pad) and labor as discussed on Friday 3,740
5/8/09)
5/21/2009 Page 10 of 13
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prepare walls for paint (tape and skim coal as
needed)
I I
room 1 (handicap) 2,382 50
2,32
repair ceiling - furring strips and new sheetrocl:
and prepare for paint
prepare walls for paint (tape and skim coat as
needed)
I }
bathroom #1 (adjoins room 1 wall) 2,278 275
2,55
remove tub
replace walls (as needed) and prepare for paint
replace subfloor (as needed)
price for floor (linoleum) installed with materials -
bathroom #2 (adjoins pantry wall) 2,278 275
2 ,553
gut and replace ceiling and prepare for paint
remove and replace subfloor
price for floor (linoleum) installed with materials -
crisis interview
price for floor (carpet) installed with materials -
crisis triage
price for floor (carpet) installed with materials -
crisis entry waiting area
price for floor (carpet) installed with materials
SECOND FLOOR
room 3
repair ceiling - furring strips and new sheetrock 1,139 50
and prepare for paint 1,189
room 4
need price for floor (separate prices for carpet -
AND linoleum) installed including materials
5/21/2009 Page 9 of 13
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Exhibit 1 - Scope of Work
For property located at: 29 North Main Street, Florence MA 01062
L Description of work to be performed by CONTRACTOR:
Scope of Work CSO PVR supplies Total
Labor supplies basic
major materials
materials (sheetrock,
screws, joint
compound,
etc)
FIRST FLOOR
kitchen 2,977 175
3,152
remove and dispose of cabinets and counters
remove ceiling
install new ceiling and prepare for paint
prepare walls for paint
install new cabinets and countertops eso
price for floor (linoleum) installed with materials - -
pantry 1,786 100
1,886
remove existing ceiling
install new sheetrock ceiling and prepare for paint
price for floor (linoleum) installed with materials - -
living room
price for floor (carpet) installed with materials - -
first floor hall 1,786 25
1,811
fix ceiling cracks and prepare for paint
prepare walls for paint
price for floor (linoleum) installed with materials - -
respite office 2,382 50
2,432
repair ceiling - furring strips and new sheetrock
and prepare for paint
5/21/2009 Page 8 of 13
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NOT U7VDEk5UAND, c O SHOLID (_?.)NS7_,iLT 14 AN X7I BEFORE SIGNING.
This Agreement is signed and sealed on / . 2009.
PIONEER VALLEY REBUILDERS C.D.C. CS) '"Th
By: Z."
-
Gene Kennedy
. A L,
5/21/2009 Page 7 of 13
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12. MISCELLANEOUS:
This Agreement is a Massachusetts contract. contains the entire agreement between
CONTRACTOR and CSO, any representations or warranties not expressly contained in it are not
a part of the Agreement. and it is binding upon the parties" heirs, executors, successors and
assigns. This Agreement may be modified only by an instrument in writing signed by both
CONTRACTOR and CSO.
This Agreement is subject to and is intended to comply with the provisions of Chapter
142A of the Massachusetts General Laws and its corresponding regulations.
13. LIENS:
Under Chapter 254 of the Massachusetts General Laws, CONTRACTOR, and any
subcontractor that CONTRACTOR has a written contract with, may obtain a lien, commonly
known as a "mechanic's lien ", against the property where the work is being performed.
CONTRACTOR presently has or intends to enter into a written contract with the following
subcontractors:
Wilson Fuller
CONTRACTOR will give CSO the names of all subcontractors with which
CONTRACTOR enters into a written contract. CSO should be aware that any person who
performs work on CSO'S property may also obtain a lien upon CSO'S property under Chapter
254 without a written contract.
CONTRACTOR will provider the CSO with written Lien waivers from all subcontractors
at the time of final payment.
14. RIGHT TO CANCEL CONTRACT:
CSO MAY CANCEL THIS AGREEMENT IF IT HAS BEEN SIGNED BY A PARTY
THERETO AT A PLACE OTHER THAN AN ADDRESS OF THE CONTRACTOR OR HIS
ATTORNEY, WHICH MAY BE HIS MAIN OFFICE OR BRANCH THEREOF, PROVIDING
CSO NOTIFIES THE CONTRACTOR IN WRITING AT HIS MAIN OFFICE OR BRANCH
BY ORDINARY MAIL POSTED, BY TELEGRAM SENT OR BY DELIVERY, NOT LATER
THAN MIDNIGHT OF THE THIRD BUSINESS DAY FOLLOWING THE SIGNING OF
THIS AGREEMENT.
SEE THE ENCLOSED NOTICE OF CANCELLATION FORM FOR EXPLANATION
OF THIS RIGHT.
By signing this Agreement, CSO acknowledges that CSO has received a complete and
original signed copy of the entire Agreement and attached Exhibits. CONTRACTOR may not
start work until after this Agreement has been signed.
NOTICE: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. THIS IS A
LEGALLY BINDING AGREEMENT, IF THERE ARE ANY PROVISIONS WHICH CSO DOES
5/21/2009 Page 6 of 13
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result of an act of government and due to CSO'S fault or negligence or as a result of an act
within CSO'S control: or if the work shall be stopped or delayed either in whole or substantial
part. for a period of thirty (30) days due to failure to make a payment on time or make
CONTRACTOR feel secure; or, if CSO should commit a material breach of any of CSO'S
responsibilities or obligations under this Agreement, then CONTRACTOR may, upon giving.
CSC) seven (7) days written notice, terminate this Agreement and recover from CSO payment for
all work performed; for any unpaid costs of and fees for the work; for any liability, obligations,
damages, commitments. and /or claims that CONTRACTOR may have incurred or might incur in
good faith in connection with this Agreement: as well as receiving payment for
CONTRACTOR'S attorney's and legal fees and all lost anticipated gross profits on the work not
performed as of the date of the termination.
7.2 If the work is stopped or delayed, either in whole or substantial part, for a period of
thirty (30) days under any order of any court or other public authority having jurisdiction, or as a
result of an act of government and due to CONTRACTOR'S fault or negligence or as a result of
an act within CONTRACTOR'S control; or if the work shall be stopped or delayed either in
whole or substantial part, for a period of thirty (30) days; or, if CONTRACTOR should commit a
material breach of any of CONTRACTOR'S responsibilities or obligations under this
Agreement, then CSO may, upon giving CONTRACTOR seven (7) days written notice,
terminate this Agreement and recover from CONTRACTOR payment for all work unperformed
under this contract that was paid by the CSO; for any liability, obligations, damages,
commitments, and /or claims that CSO may have incurred or might incur in good faith in
connection with this Agreement; as well as receiving payment for CSO' S attorney's and legal
fees and all lost anticipated gross profits on the work not performed as of the date of the
termination.
8. NOTICE:
Notice will be deemed to be given to CONTRACTOR or CSO if delivered in hand or if
sent by certified mail, return receipt requested, to the address listed on the front page of this
Agreement.
9. WARRANTIES:
CONTRACTOR will grant CSO, as part of the Total Price, all warranties on rights under
the provisions of 780 CMR R6 and M.G.L. c. 142A but are specifically limited to one (1) year.
SOME STATES DO NOT ALLOW LIMITATIONS ON HOW LONG AN IMPLIED WARRANTY
LASTS, SO THIS LIMITATION MAY NOT APPLY TO CSO.
10. EXHIBITS:
The following Exhibits have been attached to this Agreement:
Exhibit 1- Scope of Work
Exhibit 2 - Notice of Cancellation
Exhibit 3 - Change Work Order
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CONTRACTOR intends to hire the following subcontractors tc> assist CONTRACTOR in
the work:
Name and Contact Information (Registration Number not applicable for floor covering installers,
see note below).
Wilson Fuller Flooring
18 Randall Street
Agawam, MA 01001
262 -2861
"Note: there are several exemptions to the registration requirement. Contractors who do
not need to be registered include installers or providers of central heating and air
conditioning, energy conservation devices, landscaping, interior painting, wall and floor
coverings, fencing, freestanding masonry walls, above ground pools, shutters, awnings,
ground level patios, driveways and certain licensed professionals such as architects,
electricians and plumbers who provide services that are exclusively within the scope of
their profession..."
- Citation from Mass.Gov Office of Consumer Affairs and Business Regulation (OCABR)
(http: / /www. mass. gov/? page1D= ocaterminal &L= 5 &LO= Homc &L 1= Consumer &L2 =Hou
sing +Information &L 3= Information+ on+ I - Lome +Improvement &L4 = Planning +a +Project&
sid= Eoca &b= terminalcontent &f= hiring, a contractor &csid =Eoca)
These may not be all the subcontractors that CONTRACTOR may hire, and
CONTRACTOR may decide not to hire anyone or all of the above subcontractors, which
decision shall be at CONTRACTOR'S sole discretion.
If CSO asks any subcontractor to make changes or substitute materials without first
obtaining CONTRACTOR'S written subcontractor agreement, CSO takes the risk that CSO'S
changes may adversely affect another part of the work; CSO may inadvertently create project
delays and expenses. If CSO makes such changes or substitutions, CSO will pay
CONTRACTOR any additional subcontractor charges related to CSO'S request, plus an
additional Fifty (50 %) percent of those related charges.
6. INSURANCE:
CONTRACTOR shall purchase and maintain liability insurance for protection of all
claims under workman compensation acts and other employee benefit acts, claims for damages
because of bodily injury, including death, and from claims for damages, other than to work itself,
to the property which may arise out of or result from CONTRACTOR operations under this
Agreement.
7. RIGHT TO TERMINATE CONTRACT:
7.1 If the work is stopped or delayed, either in whole or substantial part, for a period of
thirty (30) days under any order of any court or other public authority having jurisdiction, or as a
5/21/2009 Page 4 of 13
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begins or material is ordered (not to exceed one -third (iii) of the total contract price OR
the actual cost of any material or equipment of a special order or custom made nature
which must be ordered in advance of the start of the work) to assure that the project will
proceed on schedule.
4.2 A payment of eight thousand. two hundred twenty five dollars even. ($8225 dollars)
is due within 7 days of being invoiced.
4.3 A payment of eight thousand, two hundred twenty five dollars even, ($8100 dollars)
is due within 7 days of successful building inspection by Cite of Northampton at the
completion of the contracted project.
All sums not paid before substantial completion of the work will be due and payable upon
completion.
Payments due and unpaid under this agreement shall bear interest, if deemed necessary
by the CONTRACTOR, from the date payment is due at the annual rate of eighteen percent
(18 %), or at the maximum legal rate, which ever is less. In the event that CONTRACTOR
incurs costs or expenses in collecting any payment due and unpaid under this Agreement, CSO
shall pay such costs and expenses including reasonable attorney's fees.
If CSO fails to make any payments when they are due, then CONTRACTOR may
immediately stop work. CONTRACTOR may choose not to resume work again until CSO is
current with the payments and CONTRACTOR feels secure in obtaining the remaining
payments. If there is stoppage in work due to CSO'S failure to pay on time or to make
CONTRACTOR feel secure that the remaining payments will be made, such delay shall
automatically extend the date of substantial completion.
ANY DEPOSIT REQUIRED UNDER THIS AGREEMENT TO BE PAID IN
ADVANCE OF THE COMMENCEMENT OF WORK SHALL NOT EXCEED THE
GREATER OF ONE -THIRD OF THE TOTAL CONTRACT PRICE OR THE ACTUAL COST
OF ANY MATERIAL OR EQUIPMENT WHICH MUST BE SPECIAL ORDERED OR
CUSTOM MADE, WHICH MUST BE ORDERED IN ADVANCE OF COMMENCEMENT
OF THE WORK, IN ORDER TO ASSURE THE PROJECT WILL PROCEED ON
SCHEDULE. NO FINAL PAYMENT MAY BE DEMANDED UNTIL THE AGREEMENT IS
COMPLETED TO THE SATISFACTION OF BOTH CONTRACTOR AND CSO.
CONTRACTOR MAY NOT REQUIRE CSO TO PAY PART OR ALL OF THE
BALANCE NOT YET DUE UNDER THIS AGREEMENT BECAUSE CONTRACTOR
DEEMS HIMSELF TO BE INSECURE. HOWEVER, IF CONTRACTOR DEEMS HIMSELF
TO BE INSECURE, CONTRACTOR MAY REQUIRE, AS A PREREQUISITE TO
CONTINUING ANY WORK, THAT THE BALANCE OF FUNDS DUE UNDER THIS
AGREEMENT, WHICH ARE IN CSO'S POSSESSION, SHALL BE PLACED IN A JOINT
ESCROW ACCOUNT REQUIRING BOTH CSO AND CONTRACTOR SIGNATURES FOR
ANY WITHDRAWAL.
5. SUBCONTRACTORS:
5/21/2009 Page 3 of 13
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IT IS CONTRACTOR'S OBLIGATION TO OBTAIN THESE PERMITS AS C ETS
AGENT. IN THE EVENT THAT CONTRACTOR DOES NOT OBTAIN T i-IESE PERMITS.
AND CSO OBTAINS THEM. OR IF CONTRACTOR 1S NOT REGISTERED WITH THE
BOARD OF BUILDING REGULATIONS, CSO WILL NOT BE ENTITLED TO OBTAIN
ANY BENEFITS FROM THE GUARANTEE FUND ESTABLISHED UNDER
MASSACHUSETTS GENERAL LAWS, CHAPTER 142A.
CONTRACTOR'S obligation to obtain permits is limited to those permits directly related
to performing the work CONTRACTOR agrees to do. To the extent that other permits or
governmental or regulatory agency approvals such as but not limited to zone changes, variances,
special permits. site plan approvals, or approvals of conservation commissions, are required to be
obtained before CONTRACTOR can obtain such permits, it is CSO'S obligation to satisfy such
requirements and CSO shall meet those requirements at CSO'S cost.
3. STARTING AND ENDING DATES:
CONTRACTOR will apply for the permits within 5 days of the signing of this
Agreement, or CSO satisfying any conditions required to be met prior to the permits being
issued, which ever date is later. CONTRACTOR will start work within 5 days of obtaining
necessary permits. CONTRACTOR expects to have the work substantially completed within 6
weeks of commencing work.
If CONTRACTOR is delayed at any time in the progress of completing the work due to
acts of God, war, civil commotions, accident, governmental regulations or policies, any act or
neglect of CSO or by any separate contractor, or by change orders, or by labor disputes, fire,
delay in transportation, unavailability of materials, adverse weather conditions, unavoidable
casualties, difficulty in obtaining fuel, electricity, services or supplies from the sources from
which they are normally obtained, or other causes reasonably beyond CONTRACTOR'S control,
then CONTRACTOR may reasonably extend the date for substantial completion. If the work is
not substantially completed by the ending date, as extended, CONTRACTOR will not be liable
to CSO for any incidental or consequential damages CSO may incur due to such delay.
If CSO is supplying any materials or equipment to be used in the work, CSO shall have
such materials and equipment delivered to the work site not less than 1 day before they are
needed for the work. If they are not delivered on a timely basis, CONTRACTOR will not be able
to schedule work dependent upon them and the date of substantial completion will be extended
due to such delay.
4. TOTAL PRICE AND PAYMENT SCHEDULE:
The total price for performing the work and supplying the materials under this Agreement
is, twenty four thousand, four hundred twenty five dollars even ($24,425 dollars).
Payment against work completed and materials delivered will be made within ten days
from when CONTRACTOR informs CSO that CONTRACTOR has reached different
completion stages. Final payment will not be demanded until the work is completed to both
parties' satisfaction. Payment will be made in the amounts as set forth below:
4.1. A deposit of eight thousand, one hundred dollars even, (8100 dollars) before work
5/21/2009 Page 2 of 13
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/- t PIONEER VALLEY BUILDE. S
A COMMUNITY DEVE OPi4ENT CORPORATION
235 EASTERN AVENUE. SPRINGFIELD MA 0110P
Construction Supervisor License CS 054917 Hone Improvenent Contractor License 153979
PHONE 413 - 827 -7060 EMAIL GENET( @PVREBNILDERSCDC.ORG FAX 413 -827 -7066
BUILDING — REMODELING AGREEMENT
Pioneer Valley Rebuilders Community Development Corporation, whose Federal Tax
Identification Number is 41- 2100128 and Home Improvement Contractor Registration Number
is 153979 (expiration 1/29/2011), (hereinafter "CONTRACTOR ") is entering into this
Agreement with Clinical & Support Options, Inc., of 111 Federal Street, Greenfield MA,
Massachusetts 01301 (hereinafter "CSO "). Gene Kennedy acted as salesperson in arranging
this Agreement.
ALL RESIDENTIAL CONTRACTORS AND SUBCONTRACTORS MUST BE
REGISTERED WITH THE MASSACHUSETTS BOARD OF BUILDING REGULATIONS
AND STANDARDS, UNLESS SPECIFICALLY EXEMPT FROM REGISTRATION.
INQUIRIES CONCERNING REGISTRATION SHOULD BE DIRECTED TO:
DIRECTOR, HOME IMPROVEMENT CONTRACTOR REGISTRATION
ONE ASHBURTON PLACE, ROOM 1301
BOSTON, MA 02018
(617) 727-8598
1. SCOPE OF WORK:
CONTRACTOR will perform the work set forth in Exhibit 1 - Scope of Work
(enclosed) on CSO'S property located at 29 North Main Street, Florence MA 01062.
If CSO would like to change any work to be performed or materials used,
CONTRACTOR will make such changes as requested by use of Exhibit 3 - Change Work
Order (enclosed), which may also change the total price and extend the date for completion.
CONTRACTOR reserves the right to make minor changes in any plans and to substitute
materials of equal or better quality.
Should CONTRACTOR encounter any unknown conditions below the surface of the
ground or concealed or unknown conditions in any existing structure, CSO agrees to make an
equitable adjustment with CONTRACTOR under a CHANGE WORK ORDER, which shall
increase the total price and extend the date for substantial completion of the work.
2. PERMITS:
To perform this work CONTRACTOR, or a subcontractor CONTRACTOR hires, will
obtain on CSO'S behalf the following permits: Building Permit
5/21/2009 Page 1 of 13
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Fire Protection Systems Narrative Report
Section 1— Building Description
a) Building "Use" Group — (R1) Residential
b) Total square footage of building : — 7,000 sf
—2,800 sf on first floor, —1,950 sf on second floor
c) Building height: —30'
d) Number of floors above grade — 3 (two floors of living space, unoccupied attic)
e) Number of floors below grade —1 (basement)
f) Type of Construction — VB
g) Site access arrangement for emergency response vehicles — 29 North Main Street is a
freestanding building, approximately 93 feet long by 42' wide with access along the side
(southeast) length of 93 feet from a driveway to a parking lot, along the front (southwest) from
North Main Street, and from the rear parking lot. Greater than 75 percent of the perimeter of the
building is fully accessible by a fire truck.
Section 2 — Applicable Laws, Regulations and Standards
a) 780 CMR code sections "Fire Protection Systems Requirements"
903.2.8 Group R. An automatic sprinkler system installed in accordance with 780 CMR 903.3
shall be provided though all buildings with a Group R occupancy. For Use Group R Buildings
with an aggregate building area of 12,000 sf or more, the sprinkler system shall be designed and
installed in accordance with NFPA 13.
903.3.1.2 NFPA 13R Sprinkler Systems. When allowed in buildings of Group R, up to and
including four stories in height, automatic sprinkler systems shall be installed throughout in
accordance with NFPA 13R.
There is an existing automatic sprinkler system in place, which will need to be tested and repaired
as necessary.
915.0 — Fire Department Connections — as required per the City of Northampton Fire Department.
920.0 — Fire Extinguishers — as required — see drawings for locations.
Smoke detectors to be provided as required per code — see drawings for locations. The existing
building has a fire alarm system servicing all three floors of the building.
A new fire alarm system will be installed as part of the renovations.
Report Conclusion:
Based on the initial investigation and analysis of the building per the Massachusetts State
Building Code, Chapter 34, no hazardous conditions exist or will result from these alterations.
Respectfully submitted,
i
Margo Jones, AIA, Principal Architect
Chapter 34 Review — 29 North Main Street, Florence
Margo Jones, Architects Page 4 of 4
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780 3404.10 Existing fire and party walls:
No work being proposed affects existing fire and party walls.
780 3404.11 Fire protection systems:
The work under this project includes repairs to an existing fire protection system.
780 3404.13 Enclosure of stairways:
No work being proposed affects existing enclosed stairways.
780 3404.17 Fire hazard to adjacent buildings:
No change in use group or occupancy ratings altar fire hazard to adjacent buildings. No change in
exterior wall ratings is required.
780 3404.18 Accessibility for persons with disabilities:
The work being performed amounts to less than 30% of the full and fair cash value of the
building and the work costs less than $100,000, therefore only the work being performed is
required to comply with 521 CMR.
780 3404.19 Energy Conservation:
No work being proposed under this project affects building mechanical systems related to energy
conservation.
780 3407.2 Energy Provisions for Existing Buildings, Compliance:
Alterations to the lighting only include new overhead lighting at offices and renovated bedrooms.
New energy efficient fluorescent light bulbs will be installed in new surface mounted ceiling light
fixtures.
780 3408.0 Structural Requirements for Existing Buildings
780 3408.3 Classification of Existing Building.
Pre -1975 — The building was constructed approximately 1900. (Prior to 780 CMR, the
Massachusetts State Building Code.)
3408.4.2 Level 1 Work. Work that is not specified for Levels 2,3,4 or 5. The renovations to 29
North Main Street constitute Level 1 Work. There is no structural work proposed and no existing
structural elements of the building are affected. Level 1 constitutes the lowest level of work on
an existing building.
3408.6 Structural Investigation of Existing Buildings.
3408.6.1 Level 1 Work.
3408.6.1.1 Responsibility of the SER. (Structural Engineer of Record)
Whenever there is any structural work for Level 1 Work, the SER shall perform the following
tasks... There is no structural work being proposed.
3408.6.1.2 Responsibility of the Architect.
The architect of record shall verify that the changes to the existing building are in fact Level 1
Work, and so certify on the construction drawings.
Chapter 9, FIRE PROTECTION SYSTEMS
Fire protection systems are required in existing buildings where required by 903.0. and 903.2
Automatic fire suppression systems are required in use group R -1, per 903.2.8.
Chapter 34 Review — 29 North Main Street, Florence
Margo Jones, Architects Page 3 of 4
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780 3400.4 Special Provisions for Means of Egress.
780 3400.4.2. Fire Escapes. Fire escapes shall be permitted only as provided for in 780 CMR
3400.4.2
780 3400.4.2.2. Existing Fire Escapes. Existing fire escapes shall be continued to be accepted
as a component in the means of egress in existing buildings only.
780 CMR 3402.0 IMPLEMENTATION
3402.1 Building Permit Application Requirements for Existing Buildings. A building permit
shall be required for any work regulated by 780 CMR 34.00.
780 3404.0 Continuation of same use group or change to a use group resulting in a change
in hazard index of one or less:
Change in use from I -1 Institutional to R -1 Residential: original Hazard Index of 4, current
Hazard Index of 4. No change in hazard index.
780 3404.3 New Building Systems:
No new mechanical systems are being proposed. Individual components of an existing building
system may be repaired or replaced without requiring that system to comply fully with the code
for new construction unless specifically required by 780 CMR 3408.0.
780 3404.4 Alterations and Repairs:
The work proposed under this project is to replace flooring, repair plaster and gypsum board
walls and ceilings, and paint throughout. The existing fire sprinkler system will be inspected and
repaired as necessary. Egress lighting and exit signage will be upgraded. Existing egress through
bedrooms will be eliminated, with all first and second floor egress through open, common space.
780 3404.5 Number of Means of Egress:
No work being proposed herein will affect existing means of egress from the building. Existing
exits meet the requirement of 780 CMR table 1018.1 Every floor or story of any existing
building shall provide at least the number of means of egress as required by 780 CMR 3400.4 and
which are acceptable to the building official. The existing egress path through bedrooms shall be
eliminated, with those rooms no longer serving as bedrooms, but rather for daytime occupancy
only, to allow continuation of the path of egress travel.
780 3404.6 Capacity of Exits:
No work being proposed herein will affect the capacity of existing exits, which are adequate.
780 3404.7 Exit signs and lighting:
Exit signage will be updated to meet egress requirements. See floor plan for layout of exit signs.
780 3404.8 Means of egress lighting:
Existing egress lighting will be maintained. Additional egress lighting will be added as necessary
to meet code requirements. See floor plan for extent of egress lighting.
780 3404.9 Height and area limitations:
No work being proposed affects the height and area limitations of this building. Per the 7
edition of CMR 780, State Building Code, Table 503, Residential R -1 use, Type VB
Construction, allowable area per floor is 7,000 sf and number of stories is 2. The current building
has 2,800 sf at the first floor and has two stories of occupied space.
Chapter 34 Review — 29 North Main Street, Florence
Margo Jones, Architects Page 2 of 4
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Chapter 34 Code Review
Renovations to M A R G O JONES
29 North Main Street - Florence Architects
Northampton, MA
Clinical & Support Options
May 22, 2009
Project Description:
The following is an analysis of the Massachusetts State Building Code, Chapter 34, 7`'' edition,
for the building located at 29 North Main Street in Florence. The building is a three story wood
framed building, sited on 0.44 acres near the center of Florence. Originally a turn of the century
Victorian mansion, it was last used as a rest home. The building encompasses approximately
7,000 SF of space. There are living spaces on the first and second floor, and a full attic at the
third floor. The main house has a full height basement, with a crawlspace at the rear ell.
The building is Construction Type VB. The building is zoned in a general business district.
Work proposed includes some new flooring, upgrading of lighting and some plumbing repairs.
New painting of walls and ceilings and patching of plaster walls as necessary. No structural work
is being proposed. The work will include renovations to the existing kitchen area and changing
of some bedroom spaces to general staff office space. The existing fire sprinkler system is to be
inspected and repaired as needed.
780 503 Area Use Classification:
Most recent area use classification is for a Rest home, which falls under the "I -1 "- Institutional
use group, with a hazard index of 4.
Rest homes are licensed by the Massachusetts Department of Public Health, provide 24 -hour
supervision and supportive services for individuals who do not routinely need nursing or medical
care. Rest homes provide housing, meals, activities and administration of medications for
individuals who need a supportive living arrangement.
The proposed use of 29 North Main Street, is to be a clinical crisis center, with residential
occupants where the occupants are primarily transient in nature. The use group classification is
"R -1" — Residential, with a hazard index of 4.
Occupant Load Table 1004.1.2
Residential Occupancy : 2,800 square feet gross living area at first floor, 1,950 square feet gross
living area at second floor = 4,750 sf (approximately 1,000 square feet of office space at 100
square foot area per occupant = 10 persons.) 3,750 sf of residential occupancy at 200 gross floor
area per occupant = 18 persons
Total Occupancy: 28 persons
780 602 Class of Construction:
VB Unprotected wood frame exterior walls are unchanged.
Chapter 34 Review — 29 North Main Street, Florence
Margo Jones, Architects Page 1 of 4
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M A R G O JONES TRANSMITTAL
Architects
INCORPORATED
308 MAIN STREET, SUITE 3A PROJECT # 0901
GREENFIELD, MA 01301 -3201 1;'\$ — ' DATE: May 26, 2009
413 - 773 -5551 FAX: 413-773-5552
ojjice @margojones. corn
Louis Hasbrouck
TO: Building Inspector RE 29 North Main Street
City of Northampton (Former Florence Rest Home)
Building Department Clinical And Support Options —
212 Main Street Proposed Crisis Clinic
Northampton, MA 01060
ENCLOSED: NO. DATE DESCRIPTION:
X Copies 1 May 22, 2009 Chapter 34 Code Review
X Prints 1 May 26, 2009 EX1 and Al — Existing and Proposed Floor Plans
Shop dwgs. (paper copy to follow)
Forms
Other
ACTION: REMARKS:
No Exceptions taken Dear Louis,
Make correction(s) noted Attached please find a Chapter 34 Code review of the proposed
change in use of 29 North Main Street. Also attached are floor plans
Amend and Resubmit showing existing conditions and proposed plans for 29 North Main
Street.
Rejected
Please do not hesitate to contact our office with any questions or items
For your approval that require clarification.
x For your use Sincerely,
x For your review
Margo Jones, AIA
TRANSMITTED BY: Margo Jones, Margo Jones Architects
COPIES: Karin Jeffers, Patrick Lavelle, Joanne Jackson; CSO
4
om: Hart To: Joanne Date: 5/25/2009 Time: 8:24:22 PM Page 4 of 4
Room #6: Attic:
Install one paddle fan /light Install one switch
Test all receptacles Install three keyless lights
2 Floor Stairway: Cellar:
Install one 4ft fluorescent light Install Sub -Panel 20 circuit main lug
Install one GFI receptacle by panel
TOTAL: $18,800.00
4
Vim Hart To: Joanne ♦ Date: 5/25/2009 Time: 8:24:22 PM Page 3 of 4
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Office /Interview Room: Crisis Interview Room:
Provide & install 18in round light Install one 4ft fluorescent light
Test all receptacles Test all receptacles
2nd Floor back stairs: Crisis / Trauma Room:
•
Install two emergency lights in wire Install three old work receptacles
mold Install one 4ft fluorescent light
Install one emergency light
Back Hallway: Install one exit light
Install 4ft fluorescent light with cover
Install one three prong receptacle 2 Floor Bathroom (blue):
Install one GFI receptacle home run
Office Mgr Room #3: Install one 4ft fluorescent light & switch
Replace light with 4ft fluorescent light Install one fan / 1 switch (not vented)
Test all receptacles
Small Hallway:
Director's Office Room #4: Install two 4ft fluorescent lights / one
Install one exit /emergency light switch in wire mold
Install one 4ft fluorescent with cover Install one exit light
Install one receptacle
Install one A/C receptacle Bedroom #7:
Install one paddle fan /light
Supervisor's Office Room #5: Test all receptacles
Install one 4ft fluorescent with cover
Test all receptacles Bedroom #8:
Install one paddle fan /light
Records Room: Test all receptacles
Replace light with one 4ft fluorescent
with cover Laundry Room:
Install washer receptacle home run
Server Room: Install dryer receptacle 220 home run
Install two receptacles Install one GFI receptacle home run
Remove 8ft light Install one 4ft fluorescent light
Install one 4ft 2 lamp fluorescent with
cover 2 Floor Front Hallway outside
laundry room:
Back Bathroom (blue): Install one 3way switch
Install one GFI receptacle in wire mold Install one 4ft fluorescent light
Provide & install one 18in round light Install one exit /emergency light
Crisis Waiting Room: Room #9:
Install one emergency light Install one paddle fan/light / one switch
Install one exit light Install one 4ft fluorescent light / 1 switch
Test all receptacles in wire mold
Install one exit /emergency light
Test all receptacles
4
ern: Hart To: Joanne Date: 5/25/2009 Time: 8:24:22 PM Page 2 of 4
/
JOHN HART ELECTRIC
31 SAN SOUCI DR
SOUTH HADLEY, MA 01075
(413) 222 -1905
May 25, 2009
Electrical Proposal
For
Clinical and Support Options
Job Location — Rest Home in Florence, MA
Kitchen: Office:
Install refrigerator receptacle home run Replace two old lights with two new
Install six GFI receptacles in counter 41amp 4ft fluorescent lights with covers
Run new home run for dishwasher All receptacles to be grounded
Run new home run for 220volt stove Install 220 volt air conditioner receptacle
Provide & install four 4ft fluorescent by window
light with cover
Install combination Emergency /Exit First floor bedroom #2:
light Replace box in ceiling
Provide & install paddle fan with light
Pantry: Test all receptacles
Install 21amp 4ft fluorescent light with
cover and new switch Hall bath #2:
Test all receptacles Install GFI receptacle home run
Install one switch
Dining Room: Provide & install wall fluorescent light
Test all receptacles in wire mold
Front Hall: Bathroom #1:
Replace old lights with new 2 lamp 4ft Install GFI receptacle home run
fluorescent lights with covers Install one switch & light in wire mold
Test all receptacles Provide fluorescent light
Install one exit light
Install one emergency light Hallway by Kitchen:
Install one combination emergency /exit Replace light with 4ft fluorescent with
light cover
Install two exit lights
Install one emergency light
f
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Page ONE of ONE
Proposal
M.J. MORAN, INC.
4 South Main Street • Haydenville, MA 01039
Phone: (413) 268 -7251 Fax: (413) 268 -9375
PROPOSAL SUBMITTED TO: Phone: DATE:
Clinical and Support Options 413- 773 -1314 05/20/09
ADDRESS: JOB NAME AND LOCATION:
111 Federal Street Florence Rest Home Fire Sprinklers
Greenfield, MA 01301 Florence, MA
ATTENTION: DATE OF PLANS: MASS. SALES TAX INCLUDE IN PRICE JOB FAX:
Joanne Jackson N/A ID YES ONO 413 - 774 -1197
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR:
Plans, material, labor and equipment necessary for alterations to an existing fire sprinkler system as outlined below.
Scope:
• Replace all fire sprinklers with new
• Replace fire department connection with new type
• Install backflow preventer
• Install sprinkler system for porch
• Add sprinkler to rear entry
• Add sprinkler to small office
• Add sprinklers to four closets
Includes:
• Engineered stamped drawings
• Permit fee to Northampton Fire Department up to $600.00
• Permit fee to water department up to $100.00
Excludes:
• Wiring of electrical devices
• Work off of normal business hours of 7:00 a.m. until 3:30 p.m. Monday through Friday
• Work not listed under scope
Notes:
• Price assumes adequate water supply and alterations to service main or the addition of a fire pump will not be
necessary.
• Price is contingent upon acceptance of M.J. Moran's scope outline by approving authorities
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
TWENTY THOUSAND NINE HUNDRED AND 00/100 DOLLARS ( $20,900.00)
PAYMENT TO BE MADE AS FOLLOWS: 10% DEPOSIT, PROGRESS BILLING NET 30 DAYS
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from the above AUTHORIZED 772iGCl.«•
specifications involving extra costs will be executed only upon written orders, and will SIGNATURE:
become an extra charge over and above the estimate. All agreements are contingent CONRAD POULIN
upon strikes, accidents or delays beyond our control. Owner to carry fire, tomado and NOTE: THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT
other necessary insurance. Our workers are fully covered by Workmen's Compensation ACCEPTED WITHIN 20 DAYS.
Insurance.
Acceptance of proposa l The above prices, specifications and conditions
are satisfactory and are hereby accepted. You are authorized to do the work as specified. SIGNATURE.
Payment will be made as outlined above. SIGNATURE:
DATE OF ACCEPTANCE:
#
Page ONE of TWO
Proposal
A A PA M J. MORAN INC.
' 4 South Main Street, Haydenville, MA 01039
Phone No. (413) 268 -7251
PROPOSAL SUBMITTED TO: PHONE: 413.773.1314 DATE: 5/20/09
CSO
ADDRESS: JOB NAME AND LOCATION:
111 Federal St. Florence Rest Home
Greenfield MA. No Main St
01301 Florence MA
ATTENTION: DATE OF PLANS: MASS. SALES TAX INCLUDED IN PRICE JOB PHONE:
JOANNE JACKSON ❑ YES NO
WE HEREBY SUBMIT SPECIFICATIONS AND ESTIMATES FOR
Material labor and equipment necessary for plumbing and heat repairs at above referenced location.
PLUMBING
First Floor: Cap gas and remove and repipe new kitchen sink
Half Bath: Pipe new corner Iay. and water closet; replace lead waste line; replace cracked 4" cast
iron waste line.
Full Bath: Pipe new shower in place of existing tub; if room for water closet replace with new and
new lavatory
Second Floor:
Full Bath: Replace existing tub with piping for new shower; replace water closet and lavatory
Front Bath: Remove and cap water closet, shower and lavatory; install new laundry tray and new
waste, vent and water piping for laundry connection.
All plumbing fixtures by others, hazardous material abatement by others, cutting and patching of
walls by others, price includes repairing of existing water piping found to be leaking.
PRICE FOR PLUMBING WORK $13,950.00
HEATING:
Service gas fired boiler in rear of basement;replace all radiator air vents and angle radiator valve
we Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of:
dollars ( )
PAYMENT TO BE MADE AS FOLLOWS:
Net 30
All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from the above AUTHORIZED
specifications involving extra costs will be executed only upon written orders, "and will SIGNATURE: LL4 DrY1 Afj■
become an extra charge over and above the estimate. All agreements are contingent
upon strikes, accidents or delays beyond our control. Owner to carry fire, tornado and
other necessary insurance. Our workers are fully covered by Workmen's Compensation NOTE: THIS PROPOSAL MAY BE WITHDRAWN BY US IF NOT
Insurance. ACCEPTED WITHIN 30 DAYS.
Acceptance of proposal— The above prices,
specifications and conditions are satisfactory and are hereby accepted. You are SIGNATURE:
authorized to do the work as specified. Payment will be made as outlined above.
SIGNATURE:
DATE OF ACCEPTANCE:
—
4
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I ACS F811 DATE (MWDD/YYY1)
TM. CERTIF TE CF �LIABILI Y INSURANCE 06/01/2009
PROUIJCE}t -bone. (411)/$1 =14ru 'Fex 413= l31 =9ti39 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
INSURANCE CENTER OF NEW ENGLAND ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
P 0 BOX 1175 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
WEST SPRINGFIELD MA 01090 -1175 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
INSURERS AFFORDING COVERAGE NAIC #
INSURED INSURER A: Aim Mutual Ins Co- Assigned Work Comp
PIONEER VALLEY REBUILDERS COMMUNITY DEVELOPMENT INSURER B:
C INSURER C:
ORP —
235 EASTERN AVENUE INSURER D:
SPRINGFIELD MA 01109 INSURER E:
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TNrc'SWV.S RE17.. NAMED APLIOG APL/Q 4OR A'ri.E °OL'C5r ri10•A WUICATt2,'• W WfW.KRWDAIR,
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT W1TFI RESPECT TO WHICH THIS CERTFICATE MAY BE 193UED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREN 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS
LIR INSRD DATE IMMND/YYI DATE (MMIDOVYYI
GENERAL LIABILITY EACH OCCURRENCE $
. COMMERCIAL GENERAL LIABLI I Y DAMAGE TO RCNTCD $
PREMISES (Ea occurence)
-- CLAIMS MADE ? OCCUR I I M00 . ExP (Any one persont $
III RSQ' 4L & ?f'J.I41 Wf $
111111 I GENERAL AGGREGATE_ $
GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG. $
POLICY n JECT n LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
. ANY AUTO (Ea accident) $
ALL OWNED AUTOS I I 1 person)
I $
II SCHEDULED AUTOS I r
HIRED AUTOS I I I I (Per accident) 1$
M
BODILY INJURY
NON -O D ALTOS
PROPERTY DAMAGE
(Per accident)
GARAGE LIABILITY AIJ I 0 ONLY - to ACCI 1 $
II ANY AUTO OTHER THAN EA ACC $
AUTO ONLY AGG $
EXCESS / UMBRELLA LULBILTTY EACH OCCURRENCE I $
■ OCCUR I ` CLAIMS MADE (AGGREGATE I$`
. DEDUCTIBLE I I $
RETENTION $ 1$
WORKERS COMPENSATION AND AWC7019283012009 05/10/09 I 05110/1 0 t STA 1
OTHER
EMPLOYERS' LIABILITY iV�v I
A &WV eEMM *RTflRNMi R
71RIEYPI`Ia$ I E.L. EACH ACCIDENT $ Qe,ppp
oPPICEIVWIEMCER EXCLUDED? I E.L. UISEASt -EA EMPLOYEE I $ 100,000
SPECIKiROVIS under below E.L. DISEASE - POLICY WIT 1$ 500,000
OTHER:
l
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 10 DAYS WRITTEN NOTICE TO
THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SG SHALL IMPOSE NO
City of Northampton OBLI CATION OP LIABIL;T: OP ANN YiHC IJPONA THE It IGURE+'t, rr' ^v AGIghrr : OP R
OP • --
Building Inspector
Northampton, Ma. AUTHORIZED REPRESENTATIVE
Attention: 413587 -1272 Dean M. Florian, •
ACORD 25 (2001/08) Certificate # 42400 RI ACORD CORPORATION 1988
The Commonwealth of Massachusetts
Department of Industrial Accidents u jILiL A
Office of Investigations •
; 600 Washington Street r j F
Boston, MA 02111
www.mass.gov /dia
Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians /Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual):
Address:
City /State /Zip: Phone #:
Are you an employer? Check the appropriate box: Type of project (required):
1. ❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part- time).* have hired the sub - contractors 6. El New construction
listed on the attached sheet. 7. ❑ 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 h$ve workers' 9. ❑ Building addition
No workers' comp. insurance comp. insurance.
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3. ❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, §1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
'An} 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 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 nacre 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.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self-ins. Lic. #: Expiration Date:
Job Site Address: City /State /Zip:
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 nr to $1, St10 O(1 and /nr mw-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 under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
Phone #:
•
Official use only. Do not write in this area, to be completed by city or town official
ity 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 #:
. 1
k
Version1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER" REVIEW; (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CON . CTOR APPLIES FOR BUILDING PERMIT
I, __e ..... , as Owner of the subject property
hereby authorize to
act on my behalf, in all matters relative to work authorized by this building rmit application
Signature of Owner Date
, >i> (4./ f . 2 7 ,- -411C , as Owner /Authorized
Ag nt hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
Q` and belief.
*fried under - pa s ' penalties of perjury.
Cs
Print i =ce
(4)1/4 q _ , ,
Signature of Owner /Agent Date
SECTION 12 - CONSTRUCTION SERVICES NONE — A K cM 1 TEc r `'`'/ e4../mM -(- E1JT(I p( lib T — ATTActith
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder
l� \ License Number
a..
I ∎ Address �� Expiration Date
Z.
Signature Telephones._,
SECTION 13 - WORKERS' COMPENSATION INSURANCE AFFIDAVIT,! (M. G. 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 building permit.
Signed Affidavit Attached Yes 0 No 0
IF
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 CMR 116, (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
/y ( (- U U rd � • Not Applicable
Name (Registrant):
Re Number
0( b oa
S
Address
,
n� t ��� 5-17 0 + ^A Expiration Date
Signature ! � , Telephone
9.2 Registered Professional Engineer(s):
F
Name Area of Responsibility
Address Registration Number
•
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
plot.1 VAtA.6`i RE- 4 rg .......... Not Applicable
Company Name:
Responsible In Charge of Constructio
° g S C., �,„ . .... ?O?& -.. _ -0.(— *.._IMF_. _....1,6_1 _. ._.,_ M
-_ Address_
Signature Telephone
,
It(
Version1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled 'n by
Building Departmegt�
Lot Size
Frontage _.
Setbacks Front
Side L. _ ...,,., R.....__., -_._ L....,.
Rear ......_
Building Height
Bldg. Square Footage
Open Space Footage ,, _,.,
(Lot area minus bldg & paved ,_ .
parking) -
# of Parking Space _..... _ ._.... _
-
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW ( YES 0
IF YES: enter Book '. Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained (3 , Date Issued:
C. Do any signs exist on the property? YES G NO 0
IF YES, describe size, type and location: E.XI 51 N l
D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO 0
IF YES, describe size, type and location: . NOT b 6.7 6 2M Usi 6
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 0
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
•
Version1.7 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 ❑ Demolition ❑ RepairsA Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work: G G6 C7 Q�-� cA l -- 5 S - 1 rF6oA ft LA2M. S `IS T-c/ N AND SNP (ac&
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE t (LS
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A -1 ❑ A -2 ❑ A -3 ❑ 1A 1 ❑
A-4 ❑ A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B . b, . +❑
F Factory ❑ F -1 ❑ F -2 ❑ 2C ❑ ,
H High Hazard ❑ •.3`A, _* L044. -41 k. Ca - .
1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential a R -1 ZI R -2 ❑ R -3 ❑ 5A ❑
S Storage ❑ S -1 ❑ S -2 ❑ 5B A
U Utility ❑ Specify:
M Mixed Use ❑ Specify
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND /OR CHANGE IN USE
Existing Use Group: T v Pro Use Grou ._...._ _.__.
Existing Hazard Index 780 CMR 34) . _ , „_ _ , ___ Proposed Hazard Index 780 CMR 34) ._...._.. ._ _,_ ,. __.
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor (sf)
1st /"
1
2nd 2nd
� 3
4 a' , e
4 tn
Total Area (sf) Te al Proposed New Construction (sf)
Total Height (ft) �1�
Total Height ft
r
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❑
i
S
Versionl.7 Commercial Building Permit May 15, 2000
D epartmen t use on
City of Northampton Status of Perm'#
Building Department Curb- Cut/Dnveway P e r mtt "
212 Main Street Sewer /SepticAvailabilit
Room 100 Wate r/WelrAvatiabiltty
— 2
,,, ,, ; �uu9
i No harrlpton, MA 01060 Two Setso #SfructuraC "Plans
phone 41.x- 587 \1240 Fax 413 - 587 - 1272 Plot/Site Plans
OtherSpecify
u
1 . �
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
1.1 Property Address: This section to be completed by office
Map Lot Unit
.Q .). ,4�crr frt
Zone Overlay District
P � QQ ���� - ., Elm St District CB District
2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
D (Print) 1., LOAI _ _ . �.. ,._ l� . ..41 f1 .5. , ` C__ .... N i r! 9 �SM1C . .. . 1 n ` >I�WT .
Name � Current Mailing Address: �f � Jz I
Di Qt►v�, k. cs S
Wit' � s ''`' h 1 1 3_ 77'313(3 f ±b - _.. fir ...._
Signature � ` r / Telephone Z//3 y7 N 2 ;jp(' lc ff
/ 2.2 Autnortz . A•ent
A A TONS SCE 14t(1
Name (Print) Current Marling Address ..�
Signature Telephone
ECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
cgmpleted by permit applicant
1. Building 1,3j 1 ci i od (a) Building Permit Fee
2. Electrical '
i 01 fl.; . _ _r . �._ _ µ (b) Estimated Total Cost of
� �"
r O C C from (6) __ . ._..:... _ ._........'
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) t? . 00 / / / UtJ D
5. Fire Protection 1 , ._..
6. Total = (1 + 2 + 3 + 4 + 5) Zc� c iv0, vo
62A64. '
2. 64 , C9 ® Check Number 36-7,3 3 - 1 ��
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner /Inspector of Buildings Date
i
File # BP- 2009 -1012
APPLICANT /CONTACT PERSON MARGO JONES ARCHITECT
ADDRESS/PHONE 308 MAIN ST SUITE 3A GREENFIELD (413) 773 -5551
PROPERTY LOCATION 29 NORTH MAIN ST
MAP 17C PARCEL 253 001 ZONE GB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out /
Fee Paid 3 W� 326-TO
Tvpeof Construction: REPAIR SHEETROCK, ELECTRICAL,SPRINKLER/ALARM SYSTEM
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO PRESENTED:
'LApproved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission _ Permit DPW Storm Water Management
Demolition Delay
//"---"L"P 06/0j4/009
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
BP- 2009 -1012
GIS #: COMMONWEALTH OF MASSACHUSETTS
k 4 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2009 -1012
Project # JS- 2009 - 001457
Est. Cost: $62884.00
Fee: $376.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: PIONEER VALLEY REBUILDERS COMMUNITY DEV_
Lot Size(sq. ft.): 18948.60 Owner: CLINICAL & SUPPORT OPTIONS INC
Zoning: GB(100)/ Applicant: MARGO JONES ARCHITECT
AT: 29 NORTH MAIN ST
Applicant Address: Phone: Insurance:
308 MAIN ST SUITE 3A (413) 773 -5551 WC
GREENFIELDMA01301 ISSUED ON:6/2/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: REPAIR SHEETROCK,
ELECTRICAL,SPRINKLER /ALARM SYSTEM
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 6/2/2009 0:00:00 $376.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo