30A-032 (9) CATALYST INTERIOR PLANNING + DESIGN
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EXISTING CONDITIONS PROPOSED SPACE PLAN
PROJECT NAME:
AMEDISYS: Northampton MA / Home Health USABLE SQUARE FEET + 2,910 usF
PROJECT ADDRESS: ISSUE DATE:
NOTE: JULY 7, 200"
320 Riverside Drive THIS DOCUMENT IS INTENDED FOR THE APPROXIMATE C+
REPRESENTATION OF EXISTING CONDITIONS AND/OR SCALE: NTS
Northampton, MA PROPOSED LAYOUT(S) AS DETERMINED AT TIME OF
ISSUANCE. ACTUAL CONDITIONS ARE SUBJECT TO CHANGE
AND MAY VARY WITHOUT NOTICE. ALL DIMENSIONS SHOWN SHEET:
ARE APPROXIMATE & ROUNDED TO THE NEAREST WHOLE S P 6
FOOT INCREMENT. THIS IS NOT FOR CONSTRUCTION.
3616 SEA GULL RD. VA BEACH, VA 23452 PHONE: 757.321.9814 FAX: 757.321.9774
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The Commonwealth ofMassacliusetts
. " Department of Industrial Accidents
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 Lezibly
Name ( Business /Organization/Individual): Marois Construction CO INC
Address: 262 Old Lyman Rd
City /State /Zip: South Hadley, MA, 01075 Phone #: 41 — —
Are you an employer? Check the appropriate box: Type of project (required):
1. ® I am a employer with 30 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. El I am a sole proprietor or partner-
These sub - contractors have
ship and have no employees 8. ❑ Demolition
working for me in any capacity. employees and have workers'
9. (] Building addition
[No workers' comp. insurance comp. msurance:$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
❑ officers have exercised their 11.
3. I am a homeowner doing all work ffi h id hi
❑ 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. ❑ Other
comp. insurance required.]
*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 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: AIM MUTUAL
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Policy # or Self -ins. Lic. #: WMZ80022930/2009 Expiration Date: 1 /1/7010
Job Site Address: 320 Riverside Dr, N. Hamp, 01062 City /State /Zip: 0l 067
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.
1 do hereby certify under the pains and penalties of perjury that the information provided above is true a correct:
Signature: Date:
Phone #: 413 - 533 -1320
Official use only. Du not write in this area, to be completed by city or town official,
City or Town: Permit/Licerse #
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 #:
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER. 110.11)H. „-
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
t doetr - amrifriv as Owner of the subject property
hereby authorize IWO eirSr&g.-71.
act on my behalf, in . aft; -14 e to work authorized by this building permit application.
.4,th" ■&(.4e(Sp „
Signature of Owl" Date
, as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge
and belief.
Signed under the pains and penalties _
Print Name
....
Signature of Owner/Agent Date
SECTION 12 - CONSTRUCTION. SERyICES .
10.1 Licensed Construction Supervisor: Not Applicable El
Joseph A Marois
Name of License Holder :
License Number
262_01c1 Iyman ?d South _Hadley, 016751
Address Expiration Date
6/8/10
Signatu Telephone
SECTION 13 ;1
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 building ['emit.
Sign No 40
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Version1.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROLPURSUANT TO 780 CMR 116 ( CONTAINING: MORETHAN- 35,000 C.F. O EN C:LOS E DSPACE)
9.1 Registered Architect:
_._.__.__..._..... _ . __._.__ ... w •._., ----- Not Applicable ❑
Name (Registrant): ------ ,.-- °-- -- -- -.. ---_N __...___.....
Registration Number
Address____ - _.. .___..____.._...__..._._._,...:
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
_ Signature Telephone Expiration Date
I
Name Area of Responsibility
Address mm Registration Number w _ __ „___.._..___._.__
Signature Telephone Expiration Date
i €
Name Area of Responsibility
Address Registration Number
^
Signature Telephone Expiration Date
M,...-,._ ...w....__..,._.L...._._,_ .,.... ...._-»__.
Name Area of Responsibility
°
~~---°-•- _ _ - _ Registration Number _ ^m
Address
— .._._.__ f _�._.._ �.__...
Signature Telephone Expiration Date
9 :3- General-Contractor _ _.__ . _ .
Marois Construction Company INC Not Applicable ❑
Company Name:
Joseph A. Marois i
Responsible In Charge of Construction
_262 Old Lyman Rd, South Hadley, MA, O1,H1,5_, __ {
Address __ __
;4 533 -1320
Signature Telephbhe
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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:
Rear
Building Height 3.D
Bldg. Square Footage
b q g 16
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces -
Existing
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DONT KNOW Q 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 ( DONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued: -� -
C. Do any signs exist on the property? YES 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 0
IF YES, describe size, type and location: �� " -� '�N.. ,......�._..____._..._......._ - ...._....
E. WII 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.
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\/crsiool7 Commercial Building Permit May 15, 2000
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`
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SECTION CONSTRUCTION SERVICES FOR �PROJECTS LESS THAN t5,oUn
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations 0 Existing Wall Signs [] Demolition 0 Repairs [II Additions [] Accessory Building 0
Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change � Use 0 Other
___ __
Brief Descript_. ir
cv Proposed vxo,x �� � / ' �
����=°~~~~~-'' '- ^-����_� ^ _ -'4x.gl ~^ .____
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE -`^
USE GROUP (Check as applicable) TYPE
A Assembly A-1 [] A-2 [] A-3 [] 1A 1 []
^~ A-4 [] A-5 0 1B []
B Business ^ 2A 0
r E Educational 0 2B , | 0
F Factory 0 F-1 0 F-2 [] 2C 0
H High Hazard 0 3A 0
1 Institutional [] 1'1 0 1'2 [] 1'3 [] 3B 0
K0 Mercantile 0 4 []
R Residential 0 R-1 [] R-2 [] R-3 0 5A [] '
s Storage [] S-1 0 S-2 [] 5B I []
-- ----- -- --- --------- -^-- --�
U Utility 0 Spacify:1
_ ___ ______________
M Mixed Use [] Gpedfy�F— - ----------------- -- _7
_ ` ,
S Special Use [] Specify: ' -- ---
----
COMPLETE THIS GEGTON
Existing Use Group L__-_- Proposed Use Group -__-�___�,
�------ (
Existing Hazard Index 780 CMR 34): _ __ _ / Proposed Hazard Index 7O0QNR84y. , _/
SECTION 6 BUILDING HEIGHT AND AREA •
BUILDING AREA EXISTING PROPOSED NEW : 7
Floor Area per Floor (sf)
_. /
m ''- ------ 1 * � � • �
1 ` 5333 �____ ` � . '
___ '
_- � � .
� 5333 ■
�___-�___-__'�
�" ! -' � '
a —
�
_ - �^.
----------- ----- 4
411' L _--_-
.
Total Area (s | 1»^u»» To�|PmposadN . �
-------------
Total Heigh (ft) __ _____, _ --' -- ---- �
Total Height ft L _________
. -, .
7. Water Supply (M.G.L.c40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public El Private 0 Zone __x______ j Outside Flood Zoneo Municipal 0 On site disposal system
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Version1.7 Commercial Building Permit May 15, 2000
eiYaltitioltilee76
City of Northampton
statu ,:pf...dRe ..I.i'if - -. •.::•:,-:':
: 1...n- i . , ,,, ,,,lawlif04 , i;,.. , -
, ' ' Building Department eurb:Z:ItitinfrVewbS k:', ertri --"Na:7" wwv.z4P- 1
\ 212 Main Street
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Room 100 1/11a4.k.. V.=
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Northa7pton, MA 01060 Vikia41ifo
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phone 413-587-1240 Fax 413-587-1272 Blotlye:Plans-_,.....-- ip.,,
APPLitfacoN TO :CONT1CT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
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SECTION 1 - SITE INFORMATION
1.1 Property Address:
. This section to be completed byoffice
0
'1 1
Map Lot Unit
320 Riverside Drive 1
Northampton, MA, 01062 ' ' Zone Overlay District
N ., ■ , . , :'
CS District
SECTION 2 . PROPERTY OWNERSHIP/AUTHORIZED-AGENT
2.1 Owner of Record:
CF Properties, LLC
320 _Rimeis,ide Dr ive
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Name (Print) Current Mailing Address:
Rober . i 7...,
. Air ! Northampton, MA, 01062
---- 4T1 1 5119211t IT
Signature A i 0: ' Ari 4 frAr r ...6-4, :41111. Telephone
7 OP 2.2 Authorize An nt:
John Williamson # !Williamson Commercial Properties
Name (Print) Current Mailing Address:
— - -1--
1 1 Monarch Place Springfield, Ot144
Signature Telephone 413-736-9400
SECTI qs . ESTIMATED CONSTRUCTION COSTS
. . .
. .
Item Estimated Cost (Dollars) to be ,: . . ' - 0ffloialUse Only
completed by permit applicant • •' .:•. . - -- -
1. Building $., 38135.50 (a) Building Permit.Fee
2. Electrical '''----- -------- (b)'Estitnated Total Cost of
COnstructiOn frOrn (6) _____________
3. Plumbing 7-------------- 'Building Permit Fee
- .
4. Mechanical (HVAC)
5. Fire Protection _ , ...
6. Total = (1+2 +3+4 +5) 48828.50 Check NOmber
.
/97 907, Ko
11;
This:Seetion„Fot Offidial :Use Only
Building Permit Number Date
Issued
Signature:
_
Building Commissionei/Inspector of Buildings Date _ . __
File # BP- 2010 -0203
APPLICANT /CONTACT PERSON MAROIS CONSTRUCTION CO INC
ADDRESS /PHONE 262 OLD LYMAN RD SOUTH HADLEY (413) 533 -1320
PROPERTY LOCATION 320 RIVERSIDE DR
MAP 30A PARCEL 032 000 ZONE SI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 4 497 9 ;? ' Fee Paid /91
Typeof Construction: RENOVATE INTERIOR FOR AMEDISYS HOME HEALTH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 016757
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
A pproved 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
47 4a502
Signature of Building fficial 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.
320 RIVERSIDE DR BP -2010 -0203
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 30A - 032 CITY OF NORTHAMPTON
Lot: -000 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 -0203
Project # JS- 2010 - 000250
. Est. Cost: $48828.50
Fee: $292.80 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: MAROIS CONSTRUCTION CO INC 016757
Lot Size(sq. ft): Owner: CFP PROPERTIES LLC
zoning: SI Applicant: MAROIS CONSTRUCTION CO INC
AT: ;21 i'v c i E Di:
Applicant Address: Phone: Insurance:
262 OLD LYMAN RD (413) 533 -1320 Workers
Compensation
SOUTH HADLEYMA01075 - 2653 ISSUED ON :8/27/2009 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE INTERIOR FOR AMEDISYS HOME
HEALTH
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
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Underground: Service: Meter
• Footings:
Rough: Rough:! i 9 /o5° House # Foundation:
l ° , ovei 9 Driveway Final:
Final: Final: n/ /
/ D f
CPAatia b.
Rough Frame:
/vii b/G Trti
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:®'
THIS PERMIT MAY BE REVOKED BY THE CIT OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATT • N. S. � /
Certificate of Occu • anc = ,.. Age signature:
FeeType: Date Pail : Amount:
Building 8/27/2009 0:00:00 $292.80
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo