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51-009 (2) Initial Construction Control Document , To be submitted with the building permit application by a l Registered Design Professional Ifor work per the 8th edition of the < Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: sww- 5 ' !ti C k. AZ Ct'-� Date: 675/2 0 t 3 Property Address: 5-S-7 E to /vim,. .� O�ew, •vi it- Project: Check one or both as applicable: ^1 New construction. iExisting Construction Project description: cn `6 ■#4 -r.vr� A�� S+i t'5i1e I �.x,,i e._ v�1 le, '�L cr nal dM�c- fi , ,Ir'a — �(,�✓MId I.�e t-J�+�J �t rJ -.1.l rY"� PQ.n�' C �'f O qcc R7i,b(.G, 1 "IGTJ . 1 f-]Dp ..s POVS`AJ MA Registration Number: g 9 A}di Expiration date: hV .,- 2013 , am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: peel Entire Project [ ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [ ] Electrical [ ] Other for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a Final Constructs Vgi*s D ocumeh y, ��,_, Enter in the space to the right a"wet"or ; electronic signature and seal: Phone number: 41 58,c 064 Email: 00 v5(aJ C T D v � a C 1 e� r Carol Building Official Use Only Building Official Name: Permit No.: Date: Trial Version 10 09 2012 p�S tln�t pT0 a �. 1$ GZtg •at NCTZ'tIj&1II�Jtan *`L 9 !� ` 4 • -_ DEPARTMENT OP BUILDING INSPECTIONS • = 212 Main Street Municipal Building —` Northampton, Mass. 01060 IMO' WORKER'S COMPENSATION INSURANCE AFFIDAVTT I, Pioneer Contractors (licenstdpermi tt.ee) with a principal place of business/residence at: • P.O. Box 114c _Northampton, MA 01061 _(phoned) 586 5491 (sticcUcity/stal zip) do hereby certify, under the pains and penalties of perjury, that: (V) I am an employer providing the following worker's compensation coverage for my employees working on this job: • Wcc 50059570120012 Assc)ri ated F ip1oyers Insttrance Co —_�_ _ / 1n/I.' (Insurana: Company) (Policy Number) (FaTiratioa Date.) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) •r • • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (attach additional shed ifnexaary to include infuniatioa pertaining to all oocructors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. • NOTE:pica=be aware that while homeowner who anploy persons to do m+io-o•0o-,aocsavction or repair work on a dweiting of not mode then throe units in winch the homeowner resides or on the grounds appurtenant thereto are not wally eccuid red to be employers under the worker's compensation Act(GL152,ss 1(5)),application by a homeowner for a license or permit may evidence the legal rtatw of an employee wader the Worker's Compomation Act_ I understand that a Dopy of this etxtocac t may be forwurdud to the Department of Industrial Accidents'Ofsoe of loau.oce for the coveragc vcrificectioo and that failutt to secure coverago uadcr scctioa 25A of h(C IL 152 can Iced to the imposition of gimbal'pcaathct consisting of a fax of up to S1,500.00 and/or iccoprisoccalcat anti to one year and avr7 pcoattics is doe form of a Stop Work order and a fine of 5100.00 a day against tnc I Fa-departmcdsl u,e aaly j Permit Number Ai W G�'' /3 ivfap# Lot# Sip• tare of Liccr eciPemii• t: e Versionl.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 O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Smith Childcare Center,Inc. as Owner of the subject property hereby authorize Pioneer Contractors--David Claxton to act on my behalf, in all matters relative to work authorized by this building permit application. , i nee4z5-7 06/11/2013 Signs ure of Owner Date Pioneer Contractors--David Claxton as-9wner/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 of perjury. Print Name /f 06/11/2013 Signature o Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: David Claxton CS-017890 License Number P.O. Box 1145 Northampton, Ma. 01061 01/19/2014 Address Expiration Date/0 zuoy (413) 626-7267 Signature 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 0 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: Thomas Douglas 196 Pleasant St. Northampton,MA. 01060 Not Applicable ❑ Name(Registrant): Thomas Douglas 196 Pleasant St. Northampton, MA. 01060 Registration Number Address 08/31/2013 Expiration Date 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 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 Pioneer Contractors Not Applicable ❑ Company Name: David Claxton Responsible In Charge of Construction P.O. Box 1145 Northampton, MA. 01061 Address , (413) 586-5491 Signatur: Telephone Version1.7 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 O YES 0 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 Q DONT KNOW O YES O 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 Q 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: 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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 Buijding❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other Brief Description Enter a brief description here. New roof& interior renovations per plan. Of Proposed Wofk: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 El A-3 ❑ 1A I ❑ ❑ A-4 ❑ A-5 El 1B ❑ B Business ❑ 2A ❑ E Educational p 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional . ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B IN 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: Business Proposed Use Group: Educational--I4 Day Care Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 1 1" 51 2 2nd nd 3 ro 3rd 4tn 4t" 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 p Private El Zone Outside Flood Zone p Municipal Is On site disposal system Version1.7 Commercial Building Permit May 15,2000 Department use only y of Northampton Status of Permit RECEIVEry D B ilding Department Curb Cut/Driveway Permit - ,12 Main Street Sewer/Septic Availability 2013 JUN I I Room 100 Water/Well Availability Nort ampton, MA 01060 Two Sets of Structural Plans 3--:7-1240 Fax 413-587-1272 Plot/Site Plans DEPT.OF BUILDING SPECTIONS NORTHAMPTON,MA 01060 Other 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: 557 Easthampton road Map Lot Unit Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Smith Childcare Center, Inc. 557 Easthampton Rd. Northampton,MA 01060 Name(Print) •-5t4Sti vi .J e eme' JAf"Qc - Current Mailing Address: (413) 585-2293 Signature Lf ■ '1�f. ��� ' Telephone 2.2 Authorized Agent:, Pioneer Contractors P.O. Box 1145 Northampton,MA. 01061 Name(Print) Current Mailing Address: (413) 586-5491 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building $123,800.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from(6) 3. Plumbing $23,000.00 Building Permit Fee 4. Mechanical(HVAC) $3,500.00 5. Fire Protection 6. Total=(1 +2+3 4+5 , . (1D Check Number /Q O/ $146 g /145)*IV This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date • File#BP-2013-1189 APPLICANT/CONTACT PERSON PIONEER CONTRACTORS ADDRESS/PHONE PO Box 1145 NORTHAMPTON (413)586-5491 PROPERTY LOCATION 557 EASTHAMPTON RD MAP 51 PARCEL 009 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Op� Fee Paid /COI J Typeof Construction: NEW ROOF&INTERIOR RENOVATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 017890 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION 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 /is/io 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. 557 EASTHAMPTON RD BP-2013-1189 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 51 -009 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-2013-1189 Project# JS-2013-001960 Est.Cost: $168000.00 Fee: $1008.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: PIONEER CONTRACTORS 017890 Lot Size(sq. ft.): 56192.40 Owner: SMITH CHILD CARE CENTER INC Zoning: Applicant: PIONEER CONTRACTORS AT: 557 EASTHAMPTON RD Applicant Address: Phone: Insurance: PO Box 1145 (413) 586-5491 Workers Compensation NORTHAMPTONMA01061 ISSUED ON:6/14/2013 0:00:00 TO PERFORM THE FOLLOWING WORK:NEW ROOF & INTERIOR RENOVATION 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 6/14/2013 0:00:00 $1008.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner •