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39-063 (3) CONSTRUCTION CONTROL AFFIDAVIT PROJECT NUMBER: DATE: January 13, 2012 PROJECT TITLE: New Office Building PROJECT LOCATION: Atwood Drive, Northampton, MA NAME OF BUILDING: Office Building NATURE OF PROJECT: New Construction IN ACCORDANCE WITH SECTION 107.6.2.2 OF THE MASSACHUSETTS STATE BUILDING CODE, I, Kevin R. Seaman REGISTRATION NO. 38130 BEING A REGISTERED PROFESSIONAL ENGINEER HEREBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS, AND SPECIFICATIONS CONCERNING: X HVAC (Lobby Core Only) ARCHITECTURAL STRUCTURAL FIRE PROTECTION ELECTRICAL OTHER (SPECIFY) FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE, SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE ENGINEERNG PRACTICES, AND ALL APPLICABLE LAWS AND ORDINANCES FOR THE PROPOSED USE AND OCCUPANCY. I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE RESPONSIBLE FOR SUCH AS SPECIFIED IN SECTION 780 CMR 107.6.2.2, 8 EDITION OF THE MASSACHUSETTS STATE BUILDING CODE. SEAL SIG ATURE I I L ■ C 1 STAIR 3 0 Ell Mil I ® ® 81 ®jfr C 4' - IBC2009 708.14.1 REQUIRES AN ENCLOSED ELEVATOR LOBBY AT EACH FLOOR WHERE THE ELEVATOR SHAFT ENCLOSURE f B CONNECTS MORE THAN THREE STORIES li , 11 • • ■ UPPER CABINETS _ � 83 STORAGE 4 93 DN ,/ INDICATED IK CHENETTE BY DASHED LINE 1 (330) • ( 303) = •• = ••• : •:•:•:•: • MENIIMI SWING 3 SWING 4 al A CONFERENCE M11111.1111 ROOM 3 i . !M (334) (332) * TOILET � � HALL 16 (322) .. �: I 1 (326) STAIR 1 V 92 91 (328) 84 LOBBY _ -k (301) 1 49) :...X - :;1 89 HALL 17 (324) WAITING 2 m (302) / 9 0 88 87 1 II J 64 HALL 18 (333) r ma 13R HR MANAGER 63 62 DIR ADMIN VP CB VP HR VP OP (331) (329) (327) (325) (323) n n J u� I 4 Ir u r� City of Northampton Massachusetts - s DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Northampton, MA 01060 ,A INSPECTOR Louis Hasbrouck Fax: 413 - 587 -1272 Chuck Miller Building Commissioner Phone: 413 - 587 -1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Engineers /Architects responsible for Entire Project) Project Title: C /Ni Cif 5 (.1/."- % /✓Coate: 4 5 - Z -/ 2 Project Location: /f T/N4 20 f '2 , 2 , 3 , = i / OC22S Map: Parcel: Zone: Scope of Project: /Vi A i-ir 5u/ G D OUT - In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: I, `JA /✓ '5' i3/Z ii'l Mass. Registration # 4 5'7 © , Being a registered professional Engineer /Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: yl- ENTIRE PROJECT For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable Laws for the proposed project. Furthermore, I understand and AGREE that 1 shall perform the necessary professional services to determine that the above mentioned portions of the work proceed in accordance with the documents approved for the building permit and shall be responsible for the following as specified in Section 10.7.6.2.2: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction documents as submitted for the building permit, and approval for the conformance to the design concept. 2. Review and approval of the quality control procedures for all code - required controlled materials. 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, in general, if the work is being performed In a matter consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress report together with pertinent comments. Upon completion of the work, I shall submit to the building official a final report as to the satisfactory completion and readiness of the project for occupancy. P sb.AAA ®. AHC, Signature and Seal of Registered Professional j * No.59Q �' ` o LONGti1FAD04V. � g o y ow ® : 2-3 Day of 0 20 12 , ►� OF M PSyP 1 .1 (seal) 1�t Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supers isur License: CS - 020404 tier r\ TERRENCE &RIPPS 60 SILVER LAKE DR AGAWAM NSA 01001 o-72 , A rr Expiration Commissioner 12/15/2013 NOTICE _ NOTICE TO ��► TO fit � � EMPLOYEES _- _ _ ,.. / j EMPLOYEES 7 %% i 0 = Sv The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617- 727 -4900 — http: / /www.mass.gov /dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE TRAVELERS INSURANCE COMPANIES NAME OF INSURANCE COMPANY P.O. BOX 1450 MIDDLEBORO, MA 02344 -1450 ADDRESS OF INSURANCE COMPANY (IEUB - 8771 W83 - 7 - 1 2) 04 TO 04 POLICY NUMBER EFFECTIVE DATES JAMES J DOWD & SONS INC 14 BOBALA RD ° ° HOLYOKE MA 010402879 NAME OF INSURANCE AGENT ADDRESS PHONE # 0 ° DEVELOPMENT ASSOCIATES 630 SILVER STREET, UNIT 3C AGAWAM MA 01 001 EMPLOYER ADDRESS 0= EMPLOYER'S WORKERS COMPENSATION OFFICER (IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services <= provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER 000003 W20P1G02 The Commonwealth ofMassachusetts 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 Legibly Name ( Business /Organization/Individual): t ' .... /LI /L/ /Ld_id .I Address: 630 i City /State /Zip: 11,.102/ Phone #:_18 / i9 379-0' Are you an employer. Check the appropriate box: Type of project (required): 1.J I am a employer with e 4. 0 I am a general contractor and I 6. New construction employees (full and/or part- time).* have hired the sub- contractors listed on the attached sheet. 7. 0 Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub- contractors have 8. E Demolition working for me in any capacity. employees and have workers' 9. 0 Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11.0 Plumbing repairs or additions 3. E] I am a homeowner doing all work 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.E 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: / / ��yy Policy # or Self -ins. Lic. #: / Ui3 - S7o/G(f D3 ' ~ J • 2■ Expiration Date: 1 7 (— /3 - 13 Job Site Address: 2 44,z(J&(J City /State /Zip:7/411 ft. 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 co py of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under the pains • ndpenalties of perjury that the information provided above is true and correct. Si • nature: ■ �// // n g Date: Phone #: 4/3 7+ g9- 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 I,A /4RD C. , Orl Z , as Owner of the subject property hereby authorize / .� !f 1 rriv<t E CR 1 p ? act on my beht matters relaf ,+ rk authorized by this building permit application. __ ______ _ ....._..µ._,., _. Signatuc :f r er A y.' Date l�� . _. _�.._ ___ __._...,_._____.._____ _ _.__._ , as OVI r /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 u the pains and nal ' of _pe ury. ,. _ ... Print Na A _..__...._.._ .__ 27rifrArreer ck-,,, _ -R.9 -12 Signature of Owner /Agent Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder . :14471',.641 . �.� 1*....1191_,1,.........,.___ __-. �� •- -.a� .- License Number Add ss Expiration Date Signs ure Telephone I / SECTION 13 = WORKERS' COMPENSATION INSURANCE AFFIDAVIT (MG.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 •Et LOSE© SPACE) 9.1 Registered Architect: yy� ; Not Applicable Name (Registrant) a ( I cl i raw C ' r ! ` L.-- � �� ® � Registration Number Addre j.5 - 6 — ZFj Expirati Date Signature Telephone v — i — ( Z 9.2 Registered Professional Engineer(s): - Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: µ. M... ag Responsi. e n Charge Constructi n Address _ / 4/.(_ 11 ..., Z.Ol 'J3 390F? ' 77 d Signature Telephone • Version1.7 Commercial Building Permit May 15, 2000 8. NORTHAMPTON ZONING Existing Proposed Required by Toning This column ter; filled in by Building Department Lot Size Frontage Setbacks Front Side L._ _.._ R.i._. _ 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 *14 IF. YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ( YES +44 IF YES: enter Book '/ Page /03 and /or Document # B. Does the site contain a brook, body of water or wetlands? NO i DONT 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 (3 , Date Issued: C. Do any signs exist on the property? YES 0 NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES NO 0 IF YES, describe size, type and location: , ✓,o " �i1.W iv fjLn .J 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 NO 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 0 Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 0 Accessory Building 0 Exterior Alteration 0 Existing Ground Sign 0 New Signs 0 Roofing 0 Change of Use 0 Other 0 r+4 Brief Descriptio titer a b 'et" description here. .4 #, g lid 74 3 - x _ ,...._ SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly A-1 0 A-2 0 A-3 0 1A 1 0 0 A-4 0 A-5 0 1B 0 B Business 0 2A 0 E Educational 0 2B - r 0 F Factory 0 F-1 0 F-2 0 2C 0 H High Hazard 0 3A 0 1 Institutional 0 1-1 0 1-2 0 1-3 0 3B 0 M Mercantile 0 4 0 R Residential 0 R-1 0 R-2 0 R-3 0 5A 0 S Storage 0 S-1 0 S-2 0 5B I 0 U Utility 0 Specify: ..„. __ _ , _._ • _______ ________ ........., ..„....______ ,_ _____ _ _ M Mixed Use 0 . Specify: l S Special Use 0 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) i 1 st I 4 St 2d 2 n ,,,---_ ._ 3'4 3 41" , 4 _A/A , , Total Area (sf) Total Proposed New Construction fsf) , / e 000 sr . , Total Height (ft) Total Height ft . 7. Water Supply (M.G.L. c. 40, § 54) 7.1 FloodZone,Information: 7.3 Sewage Disposal System: Public 0 Private 0 Zone Outside Flood Zone0 Municipal 0 On site disposal system 0 4 Version1.7 Commercial Building Permit May 15, 2000 g ; Department use,only City of Northampton stat s'of eFmit, � y.g , , i RE1„s R V � Building Department Cirrb-Cuf/Dnueway Permit �, f ei , 212 Main Street Sewr /SepflcAlailabtlity �r�1 [wc Room 100 ul�ate�eH R�rallabiltty s � , Northampton, MA 01060 Fwo ets of Striactnrat Plans � 1 r, _ ne 413- 587 -1240 Fax 413 - 587 -1272 PloUU Plans DEPT. OF BUIL; , k�ECT I 6 N NORTHAMEi , MA01060 ' Other SpeCrfy, T 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 g'-- 0� Map Lot Unit 9 1021144 / 7 4/ 97/4. 01060 .. Zone Overlay District SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT 2.1 Owner of Record: 0 Name (Print) / f" /�"� " >1.) Current Mailing Address: 6 , 76' Signature " iJ „ _ , ,r�� Telephone 2.2 Authorized A ent Name (Print) Current Matting Address ' '', 4/ 81 _Atq.A 11. ' 7.101 4747 , Sign re 0741 Telephone SECTION 3-- 'ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee ..-» /'Q 2. Electrical (b) Estimated Total Cost of /' 6 Construction from (6) . 9O& _. 3. Plumbing - .. 00 D Building Permit Fee `0 1 4. Mechanical (HVAC 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 5'.( ©• 700, Check Number , `! r 80 This Section For Official Use Only , Building Permit Number Date °issued . Signature: Building Commissioner /Inspector of Buildings Date 4 File # BP- 2012 -1052 APPLICANT /CONTACT PERSON DEVELOPMENT ASSOCIATES ADDRESS /PHONE P 0 BOX 528 AGAWAM (413) 789 -3720 PROPERTY LOCATION 8 ATWOOD DR MAP 39 PARCEL 063 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid /d V cP 0 )i6 `f' Typeof Construction: INTERIOR OFFICE FIT UP 2ND & 3RD FLOOR METAL STUDS & DRYWALL New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 20404 3 sets of Plans / Plot Plan T F 9LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 , / ell 9/1 - z_ 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. 8 ATWOOD DR BP- 2012 -1052 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 39 - 063 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 -2012 -1052 Project # JS-2012-001110 Est. Cost: $560800.00 Fee: $400.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: DEVELOPMENT ASSOCIATES 20404 Lot Size(sq. ft.): 64381 .68 Owner: ATWOOD DRIVE LLC Zoning: Applicant: DEVELOPMENT ASSOCIATES AT: 8 ATWOOD DR Applicant Address: Phone: Insurance: P 0 BOX 528 (413) 789 -3720 WC AGAWAMMA01001 ISSUED ON:6/20/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: INTERIOR OFFICE FIT UP 2ND & 3RD FLOOR METAL STUDS & DRYWALL 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 6/20/2012 0:00:00 $400.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner