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18D-047 (2) City of Northampton Massachusetts A. :, = x DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building ° j �� ; f' Northampton, MA 01060 Bill Hellman State Permits, Inc. 319 Elaines Court Dodgeville, WI 53533 Re 366 King St 18D -047 December 6, 2012 Dear Mr. Hellman, I have reviewed the building permit application submitted for renovations to the CVS store at 366 King Street in Northampton. have approved the permit on the condition that you submit sprinkler relocation plans to the fire department and obtain a sprinkler permit from them. The fire department must inspect the work and sign off prior to the building department's final inspection. Feel free to contact me if you have any questions. Respectfully, Louis Hasbrouck Building Commissioner City of Northampton (413) 587 -1240 lhasbrouck@city.northampton.ma.us q Letter of Transmittal RESTEv SWE PERMITS, INC. NOV 262 031120412 Stan DEr N( Rf n4MPro N 0�{S !, If 319 Elaines Ct. - Dodgeville, WI 53533 -31 608/319 -2096 * fax: 608/319 -2011 www.st8.com Date: 11/20/2012 To: City of Northampton 212 Main St Rm 100 Northampton, MA 01060 Phone: (413) 587 -1240 Attn: Louis Hasbrouck Re: CVS #447 Street Location 366 King St Northampton, MA Proj: 331331 We Transmit - VIA FED -EX ITEMS : 1 app 1 cca 1 set of plans and CD in pdf 1 CS license & work comp 1 check These Are Transmitted : Remarks : Mr. Hasbrouck, permit submittal package for he project we've discussed - let me know if you need anything else Signed: Bill Hellmann x106 Page 1 of 1 319 Elaines Ct. - Dodgeville, WI 53533 - 608/319 -2096 - Fax:608/319-2011 - www.st8.com City of Northampton G Massachusetts r' � 11- 1 / ' : �+ DEPARTMENT OF BUILDING INSPECTIONS so'•. 1 ; f 212 Main Street • Municipal Building Northampton, tat 01060 r _ � . c 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: CVS Phacy #0447 Date: 11/15/12 Project Location: 366 Kim Street Map: Parcel: Zone: Scope of Project: Gxstzucti ii of two cffioas aryl ao ibility Made;;. In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6: 1, Willian C. Star& Mass. Registration # 3843 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: V] 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 I 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. f A, 9tA Signature and Seal of Re • 1 - d P • ess onal • \ " c 61 �.6 15th Day of NJventer 20 12 '' .k The Commonwealth of Massachusetts Department of Iudaslrial Accidents 4 = Office of Investigations ; ` n3 = 600 Washington Street Boston, MA 02111 www.mass.gat/dia Workers' Compensation Insurance Affidavit: Builders / Contractors /Electricians/Plumbers Atsnlicant lnformati ©u Please Print l.eglbly Name t Business/Orbaniaytionrtndivtdual): --r-,..--' 6' (1ti + . Ca ., .. 0 LLC . Address: - p. D • E)0 7. 5 I3 City /Statc/Zip:) /it'1e!•US©CJc i i 1 t t 1T Phone #: '/01 - - 7t ?-- `,t'/d- $ r" Arripar an employer? Check the appropriate box: Type or project (required): 1.014' l em a employer with f S 4. 0 lam a general contractor and 1 6. © Nciv constntctitm employees (full and/or part-time).* have hired the subcontractors 2.E3 t am a sok proprietor or partner= listed on the attached sheet.: 7 . Mentodeiing Ship and have no employees These subcontractors have 8. ❑ Dctttotkiott working for me in any capacity. workers' comp. insurance. q, 0 Building addition (No workers' comp. insurance 5. 0 w are a corporation and its required.' lacers have exercised their 10.0 Electrical repairs or additions 3.0 t am a homeowner doing all work right of excmption per MGI. 11.0 Plumbing repairs or additions myself. (No workers' comp. c.1 S3. §1(4), and we have no 11.0 Roof repairs insurance required.) ' employees. (No workers' comp. insurance required) l3.Q Other 'my ertimnr that ducks bus 01 mint also 111* out the section below yt�+fng stair uuestss' annum:ntica p uney Woman= ' t lunncnstera uhv submit this affidavit indgeating they au degas all end. atut then hire cm* contras must sut nit a nc►e atlittait indicating snth, t Cansectoas that dtcde this boa um miadttd at Wilmot sheet shunting the scum urett sutscostoustuts and Unit minims comp. putt* inti meat un ! am an employer Mot lrproviding workerr'compensaation huviaaceformy employees Below lrt the policy and job s/tr information. BE 9(C441 / 41 - Insurance Company Name: &U 11-14L Policy M or Self -ins. t.ic. II: .- � S / S Expiration Date: c a / A- Job Site Address: — `t' D JK l 41 ) ` City/Stale/Zip: f�! ,C JL .. ti . LJ r ' 4 C Attach a copy al the workers' compensation policy declaration page (showing the policy number and e . level . n date). Failure to secure coverage as required under Section 25A of MGI. c. 152 can lend to the imposition of criminal penalties of a tine up to 51.500.00 and/or one -year Imprisonment, as well as civil penalties in the form ore STOP WORK ORDER and a liar of up to S2S0.00 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 dry hrrrbc• rrrrifj• u she pains• rl cnuiuics of p:rjnrr dun the information prodded •.. , re 7r true and correct. i . • Phone #: '/O /- 76,9 — Id• $S Official use ate(. Do not write In this area, to be completed by city or lawn official City or Town: Permit/Uctase it issuing Authority (etrek one): 1. Board of Health S. Building Deportment 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6.Other Contact Perna: Phone 11: : \•'o,`o| ' t. ..xv,czu| kmiJ',; Puom \b` 15. ] SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11) | ~—� _ /�,;!":,!:m Sv�o/a| EnV^o*hngGtmc«r�p�r_Rc`� 0 ) Yes No k� SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN - ---� i OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT | �--- --- �--------� --- --- --- - ----- -----------' l . �� «�! /� � / \ w*�2— �� • ^ / 42L ^` unnv,n/ mr ^v^r(.: pnrr/ ■ I! to .1,/po ,- r.?,'tchn|[ in nUnsxen nrfaV,c 10 v...0! ovY`co;,i:o hy 1)1, |v"k8og wnox ,wJimoon. � ��/�� / --- / /l J ------ ' -- i �a"" m,..mo°r~, /'3 / v� ' �� � �� gavKVl0yt�,�_��� vsn=.,/mm.""ou ",,''; he" *s|^■ h,at the statements 01 u mIu,vuo.v' .,` x /"wn,i/m xmx^aom` xm mc and vcc"rxte to Inc: best of wyknoyr:c: ,:'ho .,m.x the m*vs am.: ouvx|ooso/ vcn . | IE>t~t~y *` | ',"r'u �c ^�~�~-�~' ~~~' ( ���� � �� _— �_�_ � | _� � �� »�'~ ^ SECTION o ' CONSTRUCTION SERVICES 1 m.| Licensed Construction Supervisor: Not xvp'caNe O ���' �^ N n��� / u °~� c""o"o"/u", A461,- V61-1 | �y cl ��. - - - — — i tOBI ����� @� 8�-� 67-20‘ 4 j_ *-70 , _qt,,, . -�--- �-- - --- - - ----- --- --' ---- - - ! -- --- ---- sECr0w 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.s.L c. 152. § 25C(6)) ! ! - `'/",,u,`xy`,non/ }n,x*'c /swxv|y"./ .ox. ~oiw`:/.,`mx/ o":;x FoUo^.m provide this amdx,' nNsn^/ v, ^`. .x,'m| :/ the |ssy.,x� of Oil:: nuiWv,g r:;:!111111. ! -- -- 2r ---- �- ��- --- - - -- - ---------'' No 0 ( L (k • 'v,; , £ , SECTION 8 - PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35000 C.F. OF ENCLOSED SPACE) 8.1 Re stered Architect: Area of Responsibility: Name (Registrant): (Please Print) �{ f GP _ %ME. t NIA Registration Number Address (Please Print) zip code 1TiLG 3i 1 ac�1.7 r STS. J Expiration Date EMail T ephon Vii,. yog471 -77 33 - , e 8.2 Registered Professional Engineer(s) and Design /Install Professionals: Area of Responsibility: i ! Name (Registrant): (Please Print) Address: (Please Print) : Registration #: zip code Or License #: I , EMail Telephone ' Expiration Date: Signature Not Required 1 1 Area of Responsibility: Name (Registrant): (Please Print) Address: (Please Print) Registration #: zip code Or License #: 1 1 . EMail Telephone Expiration Date: Not Required 1 i Signature 1 Area of Responsibility: Name (Registrant): (Please Print) Registration #: Address: (Please Print) ! 1 zip code Or License #: t EMail Telephone Expiration Date: Signature Not Required ( i Attach additional sheets if necessary. Include Professional Engineer /Design /Install Professional's name, address, email, telephone #, area of responsibility, license #, expiration date and signature. 8.3 General Contractor _ _ _ Company Name: (Please Print) C i1 Alb. "11 Not Required ( ] Responsible Person in Charge of Construction: (Please Print) () License q Address: 6 gL LQrc� 7 A 7)d. M l I ;1, % ' ff,� /Z,/ (Please Print) zip code Expiration Date 1 L k/ 1 74,42 - L/ 1 1 :: -2---------- - Telephone Job Site Telephone # 1 1 Versionl .7 Commercial Building Permit May 15, 2000 SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE 1 Interior Alterations El Existing Wall Signs ❑ Demolition ❑ Repairs'/) Additions ❑ Accessory Building ❑ Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing ❑ Change of Use ❑ Other ❑ Brief Description ; Enter a bri f description here. 'l)' C�1LQ I a O FC`Cre- A ' } IDDC$I. O QJ Of Proposed Work: �lV'Sl/1 , �( �-c�nOS ' t"` *- t* ri » ) tit( . a. . 5A1 __ . ' NW t°A.4. C talPar �1► _ lam SECTION 5 - USE GROUP AND CONSTRUCTION TYPE 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 I 0 / , F Factory ❑ F -1 ❑ F -2 ❑ 2C (Lij H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1 -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑ M Mercantile E 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: 1w1 Proposed Use Group: ti lik 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) 2nd 2 nd 3rd 3 4th 4`n Total Area (sf) tQy Total Proposed New Con uction (sf) Total Height (ft) Total Height ft 7. Wate ply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information 7.3 Sewage Disposal System: Public S Private ❑ Zone Outside Flood ZoneD Municipal II- On site disposal system . - - - \ Department use only ‘ „..., ,---- Cii of Northampton shitw, cf Permit \ \ ri b %O2 Btli ding D:part.m(:!)t ; (.. I, !-,l,rD11',.•.'." ...._,_,,.. ___I 2 2 l',Iniri Strt::, -::: ,,,, 1 sK)11 ,, 0 - , - t a_-,N. ,- -;a c - 16 ° 0 Room IOU ' sA',Itt.riWeli A\, \...............„---- : Northampton, id,A, 0 I ONO T :;(qs of sttm.turdi i n t4 05T1* p hone 13-587-12. F;-"ix 41:i-Wr*-1:,',./:.' I , - I i-lot -,ir., , , l Otlwr Specify 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 This section to be completed by office 1.1 Property Address ,j)(4) Ai < y i 1■1044Narkpka 044ciapa Niap 1 z p Lot 091 tits'. 00 i i Zone Overlay District 1 Eim St. District CB District SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 1 ;? 1 a:PIC! of Record: 6 40 , &EA St /1 A A)-AGt12. C/o - k-r_Ai y ASS( , fY - 6 (1 C 0 AJr . %I.i.111•1 6224j4-4____ co I .S6 Ptil-i3 671 1.-INE .J 0 /4, L iVi; 2 Atithori/A!cl Aq_clil: (Ornanin St ,,...,....,,,:...,.,,,..„,-, la Ci 1 viAtAX , 3ss I „ Ain) : .',- III ; ' ' ; ; - ' (.9 ZXA_I SECTION :3 . ESTIMATED CONSTRUCTION COSTS I 1 , f:stiimitoil i',:) 313,d1.1!• lc 3),, Olfical ti:o..! Only ( hi, n•rr'' .:1,1•1::::1") , . :::..,. • I : : : F3•1:1:: P•An1;!1: .: - N 1 010 ; 1 Elewrii .il 05 Estiiii,iti Total Cost of (0 c at.) CO•1:•!rt:,:t101! fr:rri 161 : r .- : • ; Building Permit Fee Ce4._ 1 c11,1,111 ,i1 il-IVACI I I 4 1 q 4C1 - ) , , , ...,d ' • 2 -- '','z. - •1 • :;. ' qcigoo 1 ,:•,,„.,.:mit'....r jaaq I 1/41,4,) / Lb' ...- y ieyekfLOL____ This Section For Offici;i1 Use Only -1 I , I 13 I :::rIti., File # BP- 2013 -0582 APPLICANT /CONTACT PERSON STATE PERMITS INC ADDRESS/PHONE 319 ELAINES CT DODGEVILLE (608) 319 -2096 PROPERTY LOCATION 366 KING ST MAP 18D PARCEL 047 001 ZONE HB(100) /WP(16)/URB(0)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out / 07 �j6- —7 Fee Paid ` jU� tv Typeof Construction: REMODEL 1NTERIOR,NEW OFFICE AREAS,FLOOR & WALL CHANGES,NEW EQUIP/FIX, RELOCATE SPRINKLERS,CMR521 IMPROVEMENTS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/ Statement or License 56874 3 sets of Plans / Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: /Approved 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 / 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. 366 KING ST BP- 2013 -0582 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 18D - 047 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- 2013 -0582 Project # JS- 2013 - 000943 Est. Cost: $95500.00 Fee: $576.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TED'S CONSTRUCTION CO INC 56874 Lot Size(sq. ft.): 93915.36 Owner: SCP 2002E -34 LLC C/O CVS CORP #447 -02 OCCUPANCY EXPENSE DEPT Zoning HB(100) /WP(16)/URB(0)/ Applicant: STATE PERMITS INC AT: 366 KING ST Applicant Address: Phone: Insurance: 319 ELAINES CT (608) 319 -2096 WC DODGEVILLEWI53533 ISSUED ON:12/31/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: REMODEL INTERIOR,NEW OFFICE AREAS,FLOOR & WALL CHANGES,NEW EQUIP /FIX, RELOCATE SPRINKLERS,CMR521 IMPROVEMENTS 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 12/6/2012 0:00:00 $576.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner