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1 " 9 { . , ! DEPARTMENT OF BUILDING INSPECTIONS j ,
"+ 212 Main Street • Municipal Building J�
Northampton, MA 01060 ssNy... �1��C
INSPECTOR
Louis Hasbrouck Fax 413-587-1272 Chuck Miller
Building Commissioner Phone: 413-587-1240 Assistant Commissioner
SECONDARY CONSTRUCTION CONTROL DOCUMENT
(For professional Engineers/Architects responsible for a portion of a controlled project)
Project Title: ,4i f(EV) AM/ So►?e A o1-0190/ Date: 2-to SVI%-( Zo I3
Project Location: C,q ST 'r Map: Parcel: Zone:
Scope of Project: /4e-fry Ito TE(--
In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6:
I, CttR t Sra Pea. S. V-44 CT_ Mass. Registration # 2-0 O 37 7 ,
being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised
the preparation of all design plans, computations and specifications concerning:
[ ] Fire Protection Architectural [ ] Structural [ ] Mechanical [ ] Electrical
[ ]Other(specify)
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.
Upon completion of the work, I shall submit to the building official a final report as to the satisfactory
Completion of the above mentioned work.
GORED
Signature and Seal of Registered Professional A `��OpHERg4 ,
✓✓�`'' 66(6701--•- " No.20377 r+
Up BOSTON
U Day of SV l."( 20 1 3 ‘4114.-0/
141OP1.04
(seal)
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Silasstutusrits
DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street Municipal Building
Northampton,MA 01060
Fax: 413-587-1272
Phone 413-587-1240
CONSTRUCTION CONTROL DOCUMENT
PROJECT TITLE: Fairfield Inn & Suites by Marriot DATE: July 26, 2013
PROJECT LOCATION: Conz Street Northampton, Massachusetts
SCOPE OF PROJECT: Construct a new 4-story wood framed structure.
In accordance with 780 CMR Section 107.6.2 of the 8`h Edition of the Massachusetts State Building Code,
I,Andrew J. Pavlica, Jr., P.E., Massachusetts Registration No. 32486 being a Registered Professional Engineer
hereby CERTIFY' that I have prepared or directly supervised the preparation of all design plans, computations, and
specifications concerning:
[ ] Entire Project [ ] Architectural [X] Structural [ ] Mechanical
[ ] 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 applicable provisions of the Massachusetts State Building Code, acceptable engineering practices and the
applicable laws and ordinances for the proposed use and occupancy.
Furthermore, I understand and AGREE 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 the following as specified in section 116.2.2:
1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract
documents as submitted for building permit, and approval for general 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 manner 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
compl-tion and - • es the project for occupancy:
= ew J. Pavli•:, J , P.E., SECB
Structural Engin,er of 'ecord (SER)
SUBSCRIBED AND SWORN TO BEFORE THIS 26'4 DAY OF pedef 20 13
MY COMMISSION EXPIRES ON , EBREO,JR.
ary • blic Notary Public
COMMONWEALTH OF MASSACHUSETTS
My Commission Expires
June 11.2015
1 certify:a statement of the Structural Engineer of Record's(SER's)opinion,based on his observation of conditions,to the best of the SER's
professional knowledge,information and belief.Such a statement of opinion does not constitute a warranty,either expressed or implied.It is
understood that the SER's certification shall not relieve the Client or the Client's contractors of any responsibility or obligation they may have by
industry custom or under any contract.
WC Subcontractor List
Fairfield Inn Project
115 A Conz St
Northampton mA 01060
Pioneer Valley Concrete
66 N. Chicopee St., Chicopee, MA 01020
EMC Ins Co -WC POL#4X45442 CT AS A 3A STAT
• The Commonwealth of Massachusetts
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): Five Star Buildina Corn
-
Address: 123 Union Street, Ste 200
City/State/Zip: Easthampton, MA 01027 Phone#: 413.527.4060
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. New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. D Remodeling
ship and have no employees These sub-contractors have 8. El Demolition
working for me in any capacity. employees and have workers'
g Y P h # 9. El Building addition
[No workers' comp.insurance comp.insurance.
required.] 5. [l We are a corporation and its 10.[]Electrical repairs or additions
3.El 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' 13.0 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.
tContractors 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: General Casualty of WI
Policy#or Self-ins.Lic. #: CWC 0820373 Expiration Date: 5/9/2014
115 A Conz St. Northampton, MA 01060
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 certify under the pains and penalties of perjury that the information provided above is true and correct.
Signature: Date:
413.527.4060
Phone#:
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 it:
Version I,7(-ominerciai Bui)djnn Permit May I5,20t0
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110:11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No j
SECTION 11 -OWNER AUTHORIZATION.TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES.FOR BUILDING PERMIT
Tala Hotels IX NutA ;h3, LLe-
,x, i)trt r f the subject property
Five Star Building Corp.
hereby authorize _ __,_.to
net on my behalf, in an matters relative to work authorized by this building permit application.
Sign lure of():ner _ .."'"-
• ' • :..... a ': . :,, ,, ;�.,..�,y: ma..,,te•.--g'----���71 7),0 a
tite \ \ .p\ \ : : ; 4g $ * at2 mvmagyst
i,
TIQiif r ...L il --- ✓_� ._____ as Owr . uthociz-e
Agent hereby declare that the statements and information on the fc regoi it pplication are true and accurate, to the best of my knowledge
and belief.
Signed under the pains a d penalties of perjury'.
f j'>aL)t✓1 : .: l`1-6
r'rrnt:Yti. ?/i /1 3
_Signatt '-of ne Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed.Canstrt. tIonn Supervisor: Not Applicable C7
Name of license Holder.
Kevin Perrier CS 085319
t
--- ------ --- ----- ,..�...,__,,...._.._._.. License Number
123 Union Street,, Ste 2011, Easthampton,.MA 01027 01133/201.5
Address_,..._. �xpi:afion Bali;.
(413)527-4060
Signatur Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M,G 1.c.152,§25C(6)) j
Workers Compensation Insurance affidavit must be completed and submitted with this application.Faiii re to provide this affidavit will result
in The denial of the issuance of the building permit:
Signed Affidavit Aitached Yes \`J Ne 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 35,000C..F OF ENCLOSED SPACE)
9.1 Registered Architect:
Stefflan Bradley Architects - Chris Waltz Not Applicable ❑
..... 20377
Name(Registrant):
Steitian Bradley Architects -Chris Waltz I Registration Number
08/31/2014
(860)627-1920 Expiration Date
•
Signattito w `�r Telephone
9.2 Registered Professional Engineer(s):
Engineering Design Associates-Andrew Paviica Structural
Name Area of responsibility
ctrCer;. al Ste 1W-s p lt lr h
A 0_1089 32486
:/ Registration on Number
i
(413)788-0182 06/30/2014
tryst d :: ?_ Telephone Lxplialion Date
Nape Area of Responsibility
{ i
Address Registration Number ...�
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Sr nature Telephone Expiration Date
Name . Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Five Star Building Corp Not Applicable 0
Company Name:
Kevin Perrier
Responsible In Charge of Construction
123 Union Street, Ste 200, Easthampton, MA 01027
1 (413) 527-4060
Sionure ,� ..- _ _ ................ . .. Telephone _ .,.,,.. ...,.
•
Version 1.7 Commercial Building Permit May IS,2(100
K fNOR']HHAMP]ONZON)N(,
ft
Existing Proposed. egi;irat]by Zoning
This coturnrt to he filled in by
Building Dental imett:
2.3 acres(100.282s al
r rontar e
Setbacks Trent
Side L: 12'. t.:. . R:
Rear
13 a i•leighi 42
Bldg.Square Footage.
Open Space Footage
e !;
r1.9i orea n:inns
;1 of Perking:Spaces 1 09
Fill'
1�rluute AL Location} —_
A, Has a Speciat Permit/Variance/Finding;ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued: 2/15/2013
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 PONT KNOW 0 YES
IF YES: enter Book 11271 Page 52, 55 and/or Document/t
B. Does the site contain a brook, body of water or wetlands? NO e PONT KNOW 0 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , Date Issued:
C, Do any signs exist on the property? YES NO
i{'.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:
E. Will the construction activity disturb(clearing,grading,excavation,or fining)over 1 acre Of is it par of a common plan
that will disturb over 1 acre`? YES (S NO 0
IF YES,then a Northampton Storni Water Management Permit from the DPW is required
Previously issued
Ve sionl,7 Commercial Building Permit May i5,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing.Wall Signs ❑ Demolition❑ Repairs 0 Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign 0 New Signs❑ Roofing 0 Change of Use❑ Other Cl
Brief Description FOunkdatiOn hisall
Of Proposed Work:
SECTION 5-USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) I CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 0 A-3 0 w._ €.._ 1A ( — ❑
A-4 0 A-5 ❑ 's 'I B ❑
B Business ❑ 2A C]
EEducationa( ❑ 26 0
F Factory ❑ F-1 ❑ F-2 0 2C
H High Hazard ❑ 3A i ❑
,L Institutional ❑ 1-1. ❑ I2 ❑ I-3 ❑ ; 363
NI Mercantile ❑ # 9 ❑
—
R Residential Q R-1 ® ;-2 0 R-3 ❑ 5P
S Storage ❑ S-1 ❑ S-2 0 3 5F3 ❑
_.._�.. ____ __.__._ w..___.___. -----•--_..._._.___ _.......• _...... _ 4
U Utility [) Specify;
Ah Mixed Use ❑ Specify::
.S..SpECial il39__._�_._..............._.._......._Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING. t'IDLR.GOiNG 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.,,
w .. 13,458
gnu: 13,948
z`�
3t<i 13,948
G i, 4''' 11948
Total Area(sf) Total Proposed New Construction(sf)
55,303
Total Height(ft) !
Total Height II. 42
'---•'t
7.Water Supply(NM.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public E Private 0 Zone Outside Flood Zone[} i Municipal X On site disposal system C3
RECEIVED
Aug 62013
7
i
DEPT or Eita 1.1Z y Ft i-7''Nz
^ Version] 7Conmercial Bvtidmi Permit A! . 15 2000
ON MA 01 060
beparimtmeri use gn3Y
City of Northampton
tpartlptan
3liCing Department Suf ta s oxent
Ctvf Cvtil:lnveway 1 amiit`
1 212 Main.Street S..-4 Seotrr'Avarlabittty
Room 100 aYerglslelEvt#t} baltiy
Northampton, lU A 01060 ?Cwo Seis of S4ri cturat Plans ,.
phone 413-587-1240 Fax 41a-587-1272 r�totrelte`Plans <'.
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMVMOUSH ANY BUILDINGMV:
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
. This section to be catnp3eted by ofiee
E.1 Pra Ad teSs
� Map Lot: •llrtis
115 A C0in7.Street Mp
Zones Overtax.District
_ •
Elm St:Dtst.rict CB District
SECTION 2-PROPERTY:OWNERS3 IP!AUTHORIZEb AGENT
2.1 Owner of Record:
.1:A1a.Hmels.DisC 14 0111 iKoff , LL-c. 36.Kin'St.,Northampton, MA 01060
Name(Print) AN A Ns d u 14 -- G H A L.r t3A F- Curren:Mailing Address:
(413)584-3100
� ...-moo
S;yrw"".rte � 'y�` telephone
,2.Authorized Anent:
�
F�u��Sfi a:� �U.x�c�i6-t t ? 193 i Sr, Ste 2I . s4luoupkn 1 71
Name(Print) Current Ma ling Address:
1 .-1 i3 5(97 - 0C)
Snature -__- FIepvme-_ -___ ______
.—._.______- __ __-
SECTION 3-ESTIM ED CONSTRUCTION COSTS
JY-- Estimated Cost(Dollars)to be Official Use Only Item ly
--
completed by permit applicant
1. Building 220,000.00 (a) Building Petmrt Fee
2 Electrical (b)Estimated Total Cost of
Construction from feij
3. Plumbing Butidtng Permit Fee
4. Mechanical(HVAC)
5. Fire Protection _ .
6. To; - (1 a-2 3+4.t.5) 2z b t ocx) , Check Number ,! 1; �/
} /411. This Section-For Official Use Only--_...... ........
Building Permit Number Date
Issued
Signature.
Building Commissioner/Inspector of Buildings Date 1
File#BP-2014-0145
APPLICANT/CONTACT PERSON FIVE STAR BUILDING CORP
ADDRESS/PHONE 17 EAST ST EASTHAMPTON (413)587-4060 0
PROPERTY LOCATION 115 A CONZ ST-FAIRFIELD INN
MAP 39A PARCEL 034 001 ZONE GB(100)/URC(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
0/3 i-01, 01
Typeof Construction: CONSTRUCT FOUNDATION ONLY FOR HOTEL 13,458 SO FT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 085319
3 sets of Plans/Plot Plan
THE FF LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I ION PRESENTED:
�V 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
7/2-9 1I3
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.
115 A CONZ ST-FAIRFIELD INN BP-2014-0145
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39A-034 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category:FOUNDATION BUILDING PERMIT
Permit# BP-2014-0145
Project# JS-2013-000826
Est. Cost: $220000.00
Fee:$2691.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: FIVE STAR BUILDING CORP 085319
Lot Size(sq. ft.): 126759.60 Owner: H S GERE&SONS INC
Zoning: GB(100)/URC(0)/ Applicant: FIVE STAR BUILDING CORP
AT: 115 A CONZ ST - FAIRFIELD INN
Applicant Address: Phone: Insurance:
17 EAST ST (413) 587-4060 () WC
EASTHAMPTONMA01027 ISSUED ON:8/9/2013 0:00:00
TO PERFORM THE FOLLOWING WORK:CONSTRUCT FOUNDATION ONLY FOR HOTEL
13,458 SQ FT
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 8/9/2013 0:00:00 $2691.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner