23B-046 (70) t
� ti -
A e C11 its of 'Nortllailytell - -
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y
DEPARTMENT OF BUILDING INSPECT IONS 'a
INSPECTOR 212 Main Street 1 Municipal ;
icipal Buildin
Northampton, MA 01060
CONSTRUCTION CONTROL DOCUMENT
(for professional Engineers/Architects responsible for Entire Project)
Renovation
ProiectTitic: Cancer Care Program Date: 4/25/05
Cooley Dickinson Hospital
Project Location: 30 Locust S t . Map: Parcel: Zone:
Scope of Project: Renovation to Reception/Waiting & Changing Room
w inis pgra es to rogram Space
In accordance with the sixth edition Massachusetts State Building Code, 780 CMR SECTION 116.0.
I, Kerry L Dietz Mass. Registration Number 5264
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:
�] 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 profsssional 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 116.2.2:
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 ail code-required controlled
materials.
3. Be present at intervals appropriate to the stage of constniction 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 completion and readiness of the project for occu
0 ARCy`
Signature and Seal of registered professional: ����P•1 L. Q�! �
cz
No. 526" �
,. �l
Fax 413-587-1272 -pho e 413- 87-124
Glill of
All AChr.ZCUS'
EN T 017 DVIILO.�G ws?�CTIO?,s
2 2 Main Strccll
A1ass. 01060
CG.N`TZPiSATION CiSU-IRA-NCE AFFDDAVIT
Houle Construction Inc.
187 East St. South Ha-.Iely, MA 01075 (phone:;) 413-532-9243
G'0 hereby Qby CCr �7, rider LhC p�--L -0d p� 121 -5 O'pC,3Ur Y
U-1a;
1 --,:, rrq employer prov'd' - Llic f0 !!0,,y,*nQ %yo,-I cr'S cot, -'I -njorl. Covcrz-
Cl-Upto-vCC5 wc)r.�jn -)'011S Job:
Dv
I.zm, a so!e propriccor. gtctrall C-0,-N:7-2e�Or Or (C;-.-C;e or2c) 274 hz\,c hired
Ule c o Ln u-?-c-t O-. U sT below Tv h a v c Lh-- fo U o%Vin�z w o r e r's Co 0 p ru-a U o n p 0 c I C S:
(N'zra-, r,,-'Ccn,.=C�of) 1'*n-Cu,:--,rIC:-- Co'n gale)
0 L.,C 0 Q f--Z C(0 C)
(N or C 0 C-r.7a n 0.-) DaLc)
01! (Expin.-joc D*ai--).
azd L--vt- no o-ne for M-1
a-ma hoznt ownntr per o: 'D
,—,g 2-1'- Lt-t work myst-l',
:,v C<cc V--:.:'- --v k-, Or= t4
a=,:cc rnldd 't-:
—;rf Or LtL *r U-Z x r-L'--
0C A C:m.C-5: I t=-e'-Z LIA=Pa:�=CdCr:=L--'
o!+ y or up to 0,%p-,.z C-, Z.Z-' -: .-=
�4 tx rom or.T%Cp W.-I"0a
For
P
S;
:e J
Versionl.? Commercial Building Perm it May IS,2000
SECTION 10 STRUCTURAL PEER REVIEW(780 CNI- 110.1
Inceoendent Structure! Engineering Structural Peer P.eviev/ Required Yes......❑
SECTION 31 -'OWNER„AUTHORIZATION TO_BE,COMPLETED..WHEN.,_
OWNERS AGENT.-OP, CONTRACTOR APPLIES,FOR-BUILDING PERMIT
\ 25 Owner of the subject p--__-
h= -by a ; orize Raymond R. Houle Construction Inc.
beh in al terss refat ve ,o work a:jthonzed by this building permit application.
Lr'
$i�-zture of w. r Date
I Timothy S. Pelletier as Owner/Authorized Ag-_
h:-_b-declare that the statements and information on the foregoing application are true and accurate, to the best of my
kn_,v!°dge and belief.
S!_',ed under the pains and penalties of perjury.
Timothy S..,Peljat4er
F1
$it-.=lure o`OYrner/:+;ent Dzt>_
SECTION 12 CONSTRUCTION_SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Na^e cf License Holder : Timothy S. Pelletier 066227
License Number
187 East St.Sou adley, MA 01075 07-07-2005
��-e- Expiration Date
413-532-9243
g,R-at,,re Telephone
SECTION 13 -WORKERS-' COMPENSATION INSURANCE AFFIDAVIT,LM G.L c-152, §25 �
` ' r? :e ..Ida let° :?d hr„I ed w;th 1I de i
/, 'S 'vOrrla_nSc.�O�” !i^SJ �__ a•ii�...V mUS; b_ CO�'�1� �.,j a. �. SU., ti_ � t,"is ap�!ICdtIO,'1. Fai!Ur,. i0 prQV��, t'��S
jr-, the Venial of the issUanCe c, the bullring perm:;'. _._--
I
Yes....... Z tic...... ❑
Version 1.7 Commercial Building Pe mit Lfay 15,2000
SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS AND STRUCTURES SUEJECT_To .
CONSTRUCTION CONTROL"P_URSUANT T0780:CMR.116 KCONTAINING MORE THAN 35;000 CT. 0 -ENC.LOSEP�SPACEj'
9.1 Registered Architect:
Not Applicable ❑
a,rne(Registrant):
P.egistrat on Nunbe
i
Expiration Date I
S:gnatura Telephone
92 Registered Professional Engineer(s):
a.,-.I a Area of Fesponsibility
A.Jdress p
'3istratior, Number
Signature Telephone Expiration Date
f'am, e Area of Responsibility
Adtress Registration Number
Sra'"ztu Telephone Expiration Date
e Area of Responsibility
A�cress Fegistration Number
i
Teieonon? Expiration Date
f'-rn- Area of Responsibility �
P.egistrati or, Nunber f
I
S:g-a:cre Telephone Expiration Dale
9.3 General Contractor
i
Raymond R. Houle Construction Inc. Not Applicable ❑ I
Corr" Na-ne
I
Timothy S. Pelletier
i
i
.°s_:-s :ie In Charge o` Constru_;ion F
187 East St. SOU h Hadley', MA 01D75
-'L
413-532-9243
D'S'°—
Versionl.7 Commercial Building Permit May 15, 2000
7.Water Supply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
PublicXX Private O Zone: Outside Flood Zone IRX Municipal 0 On site disposal Stem ❑
S. itiORTELAMPTO\ZON-L G
Existing Proposed Required by Zoning
This col=m to be f lice'in by
Building Dcpa.-rnc:t
Lot Size 969 427.8 I 969427.8 I
Frontage 2,658' I 2,658'
Setbacks Front
102 102'
Side L: RR, R: 42, L: RR, R: 42,
Rear 18' 18'
Building Height
64.5' 64.5'
Bldg. Square Footage %
402,861 402,861
Open Space Footage %
(Lot azea minus bldg&paced 40.6 40.6
arldng)
r of Parlana Spaces 761 761
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES XX
IF YES, date issued: December 13,2001
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES XX
IF YES: enter Book 6504 Page 239 and/or Document
B. Does the site contain a brook, body of water or wetlands? NO XX DONT KNOW
YES
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 XX NO
IF YES, describe size, type and location: Various Locations on Site
D. Are there any proposed changes to or additions of signs intended for the property ?YES—
No_XX
IF YES, describe size, type and location:
vcisio:1.J commerclat Pith l._a Pew':May 1-5, 7000 �
1=— DE-SCRIPTION ONSTRUCION-�E_RVICfSFDRPROJECfSLESS THAN 35jQO
d- CL�SEDSPACE-=t
ations Existing Wall Signs Existing Ground Signs Additions❑ I Roofing ❑
❑ ❑
ations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
Accessory Building [ ] -y'.P4 airs /
RIPTIONI: �ITL���^ Wj..�'�if_ � 'L
SECTION 5 =:USE iGROUP.1lND'CONSTRUCTION TYPE
'.:r
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A mbfy ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A �{
A-4 ❑ A-5 ❑ 18 ❑
ess ❑ 2A ( ❑
tional ❑ 23 ❑
❑ F-1 ❑ F-2 ❑ I 2C , ❑
H Hioh Hazard 10 11 3A ❑
I Ins`.itufionai ❑ I-1 ❑ I-2 I-3 ❑ 33 ❑
M t:=_rand!e Cl 4 ` ❑
R R=si Benda! ❑ P.-1 ❑ R-2 ❑ R-3 ❑ 5A I ❑
S Sxzg I❑ S-1 ❑ S-2 ❑ 53 I ❑
F U U_,!ity 01 Specify:
M X xed Use ❑ Specify:
S sp-C:12!Use Cl I SP ify:
-.,COi%1?LETE THIS SECTION Ir EGSTING T3UP,DING UNDrRGOING�2ctvOVA3I0N5,ADDMONS.i~ND%OR.CH`ANGE IN USE
Use Group: 1-2 Proposed Use Group:
I-2
Ha'a-d index 780 Ch1R 3 4): 4 P;opcsed Hazard Index 780 CMP 34): 4
SECTION 6 BUILDING HEIGHT AND'AREA--
SUILDING AREA EKISTING PROPOS D NEM CONSTRUCT N t: x0 1 =
.,.�"-�:'�•-
� /, 'j,/y/�1� // /� ����•3 toy-•j` r - ^ �
_._ De Ficci���� 7 C//V If• I DS•' ..P�ti
4 -�• Zr__tJ .C_ - G
7:6a P;�,-:)se� Nev; t:CJr)'- (Si� i,. z Lam.,•..- ^t„ - "'
-- --"^_-------- `�.?�::.e�•�•'T�•a�;Ta._fir-.�;7a_=d.�'��:T�;;.•.?:_:
R
Vcnionl.7 Co=ercial Buac'-^z Pcamr Nfa L, 2000
9 �pp5 City, of Northampton
Bungling Department
212 Main Street Y
Room 100
Northampton, MA 01060 rat Ja
phone 413-587-1240 Fax 413-587-1272 - _ -
..........
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY SUILDIt,
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTIONI=SITEZNF_ORMATI_ON -
1.1 Property Address: =Flsor>; oeVcompletecIj,Ag{ce
Cooley Dickinson Hospital
Zoner �—� -Overlay�ist�ict -
30 Locust St.
�s�c
BrJ Stbi stnt Disl��ct
SECTION:2;;PROPERTYOWNERSHIP JAUTH_ORIZED_AGENT -
2.1 Owner of Record:
Cooley Dick' son Hospital 30 Locust St.
Na.'n°(PI-4,t � Cu.�ens Railing Address:
�Cr 413-582-2313
S Telephone
gnz:ure
2.2 Authorized Agent:
Raymond R. Houle Construction Inc. 187 East St. South Hadley, NIA 01075
F+ me(Print) 01 Our-,-,en,,1?i1:ng Address:
413-532-9243
Signa^ re Te!e,,hone
SECTION 3 --ESTIMATED CONSTRUCTION COSTS_ =1
Item Estimated Cost(Dolla„) to be Of. ciai Use Only
om leted by w_rmit aoo(icant
1. Building G � (a)'_Building Perml;_Fe:
2. El—e-trical / �f�,� r {o}Estimated Total Cost o`
'.Gonstvcuon from-(o) -
13. Plunbing I �rG;� _Building-Permit fee
4. Myhariical (HV,C) 7 1? .
. Fire Protecton , S 3aj.
o--' (1 2 3 + 4 + 5) G, I Cn= li��i�;,�:
This Section For Official Use Only
F__clifng pe-nit Date Fes.�:
i
5'c"a:Ur e:
Building Conmissioner)Insp r ctor of Buildings 0=•'-
File#BP-2005-1063
APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc
ADDRESS/PHONE 187 East St SOUTH HADLEY (413)532-9243
PROPERTY LOCATION 30 LOCUST ST
MAP 23B PARCEL 046 001 ZONE M
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out go* 012046
Fee Paid
Typeof Construction: RENOVATE INTERIOR BASEMENT/GROUND FLOOR(CANCER CARE PROGRAM)
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Buildinp,Plans Included:
Owner/Statement or License 066227
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION 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
Signature of Building Official Dat
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.
30 LOCUST ST BP-2005-1063
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category_ BUILDING PERMIT
Permit# BP-2005-1063
Project# JS-2005-1451
Est. Cost: $434000.00
Fee: $1815.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq.ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoniag:: i Applicant: Raymond R. Houle Construction Inc
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
187 East St (413) 532-9243 Workers Compensation
SOUTH HADLEYMA01075 ISSUED ON.617105 0:00:00
TO PERFORM THE FOLLOWING WORK:RENOVATE INTERIOR BASEMENT/GROUND
FLOOR (CANCER CARE PROGRAM)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P. V. Building Inspector
Underground: Service: Meter:
�/J� Footings:
Rough: PkjgSE .I el< Rou h: V/ House# Foundation:
/-3 /��G Driveway Final:
Final ! -��a ..�,�� Final:
pGS� 1 o-/< G-;7 l
Rough Frame: 4
ire Department Fireplace/Chimney:
af lac
Final: Smoke: x fy-�N Final: << d I1' C' -'3
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATTJO
IN OF [9A S
ANY OF ITS RULES AND REGULA ONS. r
Certificate of Occu anc / Si nature:
FeeT pe:_ Date Paid: Amount:
Building 6/7/05 0:00:00 $1815.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo