23B-046 (80) 1
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DEPARTMENT OF BUILDIN7G INSPECTIONS
INSPECTOR 212 Main Street • Municipal Building
Northampton, MA 01060
CONSTRUCTION CONTROL DOCUMENT
(for professional Engineers/Architects responsible for Entire Project)
Cooley Dickinson Hospital Date: 11/12/04
Project Title:0ffi� Reneyations
Project Location: 30 Locust St . Map: Parcel: Zone:
ScopeofProject: Renovation of 4 existing nfficps into 2offace.s
Li accordance with the sixth edition Massachusetts State Building Code, 780 CMR SECTION 116.0:
1, Kerry L. Dietz , Principal 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:
V,j 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 1 16.2.2:
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 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 occupancy.
Signature 1 of registered professional
/`6`[���
'` Fax 413-587-1272 - phone 413-587-1240
°E GThll cf �'Tc'rf(}a1)13j'Loll
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^^ a G_?A2-M_'?.7 O•' DUILA.-NC !NS?2CT10? S
2 2 Mara Strcc, ' Muc.icipa! DuiidinG
NortharnpLon, Mass. OIOGO
«VoruC:R'S C(D'YTENSAT-ION AF=1 AVLT
I — Rand R._Houle Construction Inc.
wILL, z prncipa1 place of business/residence at:
187 East St. South Hadely, MA 01075 (phone.') 413-532-9243
(Sa=uci tylsutc 12�p)
do hereby ccrzdi!, under dic pas aed penalties oL per)ury, iinr
( ar an employer provldi die followia)c % orkcr's compcnsc ion c for fny
ctuplovccs wor.,dng on'tttis job.
Arch Insurance Company IRWC100737 12/31/04
(•Las'1.-_^.= Co C`^=—. (PCLic-; C,} (.-:p1 do r, D? ^} -
O I-ate a sole proprrctor, genera? co, u-ac-Lor or hozeovwuer (c-.-c:e one) and have hired
Ule coou`aci0:� 1-57.°...'1 below b ve tht fo1.io%Vi,, worker's c0m:)tasazon pokles:
l.•"•SL Inc D.ac)
_- (N_a c of Coacacor) (E.vpiraon Duc)
(N=t o(Cocr•aclo;} (^Sl:�Z �c Co�j d I�!"t?OI;C j N:c ?i_1 (cxpiL zboa DSic)
of Coaa-actor) (^suranw Compacypoucf N=z;1 tc.\-pinrioa Da:-_)
(a h= .1,:�xx)c'x_iI o coej:ti•t�c•,�'�iJ°x-�i oe��;w..LI ooC-.�^) .
} I zn, z sole propneror and t_:ve no ore wore for me
( ) I azina ho_e owner per;o: - gig a< the work myst"IF.
NOT!:pies be er-Lx - c xc�a•x- w A��.c.p_ •w ca- o=
cx c x t-�c J it a�CL Sc '=Cr x L`_ z-r�^ -� `c^�<.ax�- '•,oc�.--d w c
.�=l_=• :.:5---1(5)1, =-
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arty of t.S,',�-, =..y�.rc.r-.<.�.`to t`..1;:�...-x o!Lo.•S n moo.e!(rt�rx cS
cueao.v^y�oca:.d.. ."' !`_rsx:- 23A 1SI=Ic'_whe pctocOfC- per-a
cYC `a o!a Drag W S I}CO.oG a�cJ'or ':'--r oCup W cot y-:' c�=J xci5a Sc form ora Scv w oe�G.'..c—J r
!Qc.V'G a d-.y
For dq.r —a%u,c airy
Lot "
Sit urt of i IPcrruucc _ e .. . - ... .J
Version l.7 Commercial Building Per,, it May I i, ')000
F ECTION db STRUCTURAL PPEER REVIEW 780 CMR 110 11)
ntependent Structural Engineering Structural Pear Review P,equired Yes......❑ No... 12
SECTION 3_1'...OWNER,AUTHORIZATION--TO.BE COMPLETED WHEN
OY{NERS AGENT_OR CONTRACTOR APPLIES FOR BUILDING PERMIT -.
!. S v 0 �7 nSO
. as Owner of the subject p-c:,
he-eby authorize Raymond R. Houle Construction Inc
r7l. b_ha `, in all mz,t s re(a wet work authorized by this builomg permit appl�cat�on. `- `-�
Siz nature of Owner Date
i, Timothy S. Pelletier as Owner/Authorized A e-:t
he-e :declare that the statements and information on the foregoing application are true and accurate, to the best of my
kncn,!edge and belie`.
S-,ed under the pans and penalties of perjury.
Timothy S. Pelletier
Prir: Name
L
S:g-ature o`Owner/A ent Date
SECTION..12 CONSTRUCTION SERVICES.,.
10.1 Licensed Construction Supervisor. Not Applicable ❑
Na.^e of License Holder: Timothy S. Pelletier 066227
License Number
187 East St. ou dley, MA 01075 07-07-2005
== _ Expiration Date
413-532-9243
S 3 afore Telephone
SECTION 13 -WORKERS' COMPENSATION-INSURANCE AFFIDAVIT(M.G t c 152, §_25C(6))�
V,:--:e-5 Co^n pens anon Insurance affidavit must be completed and submitted with this application. Failure to provide tris
in the denia! of the issuance of the building permit.
S _ _ 'davit At`_chet Yes....... 0 No. .. . ❑ — -
Version 1.7 Commercial Building Permit May 15,2000
SECTION_9 _PROFESSIONAL,DESIGN AND CONSTRUCTION SERVICES - FOR.6UILDINGS AND STRUCTURES SUBJECT-3 O
CONSTRUCTION CONTROL"P,URSUANT T0780.CP4iR..116''(CONTAINING MORE THAN
35;000:C F,•ENCLOSED:SPACEj
9.1 Registered Architect:
s4- . 1-14,-Al>
Not Applicable ❑
Name(Registrant): 5 2,1j y
Registration Number `
Address
Expiration Date
Signature Telephone
92 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
Signat- Telephone Expiration Date
Nar-e Area of Responsibility
Address Registration Number
Signature Telephone Expiration Dale
9.3 General Contractor !
I
Raymond R. Houle Construction Inc. Not Applicable ❑ I
Timothy S. Pelletier I
es� s _ie In Charge o' Construction
187 East
413-532-9243
�ignat - Telephone
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:
PubiicXX Private D Zone: Outside Flood Zone IRX Municipal V On site disposal system
8. i+i ORTHANfPTON ZON-LNG
Existing Proposed Required by Zoning
This column to be filled in by
Building Depa..-neat
Lot Size 969 427.8 969427.8
Frontage 2,658' 2,658'
Setbacks Front
102 102'
Side L:_$8i R: 42, L: SS, R: 42,
Rear 181 18'
Building Height
64.5' 64.5'
Bldg. Square Footage
%
402,861 402,861
Open Space Footage
(Lot area minus bldg&paved 40.6 40.6
arldn )
of Parking 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. X
IF YES, describe size, type and location:
Versioal.7 Co=ercial Buil. —Permit May 15, 2000
SECTION 4 t NSTRUCiZON-IERVIGES FDRPR07ECTS LESS THAN 35,fl00
CUBIC°FEET OF i`NCL�SEDSPAME -,
Interior rations Existing Wall Signs Existing Ground Signs Additions ❑ I
Roofing ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ) Other [ ]
❑ Accessory Building ( Repairs [
E? DESCRIPTION:
SECTION 5='.USE GROUP AND CONSTRUCT I0N TYPE
USE GROUP (Check as applicable) ( CONSTRUCTION TYPE
A I=sernbl/ 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A NX
A-4 ❑ A-5 ❑ 16 ❑
B B-,siness 10 2A ❑
E Educational ❑ 2B I ❑
F Fc_tory 10 F-1 ❑ F-2 ❑ 2C I ❑
H Koh Hazard ❑ 3A ❑
I Ins`itubonal ❑ I-1 ❑ I-2 I-3 ❑ 33 ❑
M f:°_;canule ❑ 4 ❑
R Residential Cl R-1 ❑ R-2 ❑ R-3 ❑ SA ❑
S S:
Versioal.7 Commercial Building Permit May 16, 2000
- u -
City of Northampton
Building Department
212 Main Street
Room 100 e
Northampton, MA 010050 a
phone 413-587-1240 Fax 413-587-1272
_
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, O MOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING \
SECTIONI_. SITEINFORMATION 4 � 4v Z, \
� 'onto omplet��y-fl e �.
1.1 Property Address: O �.�-' �t
" 3 x
N.
Cooley Dickinson Hospital EWA
30 Locust St.
d"a"l--"_FZ''�L�" a_..c.� -'8' r� ^tom-`--='4 -"`•..Ya'� :rx
=FJm St'`nistr�cts-4- �t _ -�`- <-CB�Dis�ct� _ --•'_.�.:�_<:-: °�-
SECTION:Z= PROPERTY..OWNERS HIP1AUTHORIZED AGENT -
2.1 Owner of Record:
Cooley Dickinson Hospital 30 Locust St.
Name(Print) Cu, ent Mailing Address:
413-582-2313
Signawre Telephone
2.2 Authorized Agent:
Raymond R. Houle Construction Inc. 187 East St. South Hadley, NIA 01075
Name(Print' ��-- rj _ Carr=_^t hailing Address:
413-532-9243
Signa^re Te!°_phone
SECTION 3-'ESTIMATED CONSTRUCTION COSTS ,
Item Estmated Cost(Dolls;) to be 05faf Use Only
Completed by permit aoo(icant I .
1. Building I 7{ 'W-Puilding`Perrnit Fee
2. Electrical L {o)�sumated Total Cost o`
;Construction from"(6)•-
3. Plumbing I Z Buildi�Permitfee_
4. MetPanicaf (HVr,C)
3. Fire Protec`aon / B'U
Ton-! = (I + 2 - 3 + 4 + 5) 3 I Ch kNur ter
_This Section For Official Use Only
FS ulcing Permit iJum- r -- — - Date Issued:
I
Signature:
Building Conmission&/Inspector of Buildings Date
File#BP-2005-0629
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
Fee Paid
Typeof Construction: 2ND FLR EAST WING-RECONFIGURE SEVERAL ROOMS TO CREATE NEW
OFFICE AREA
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 066227
3 sets of Plans/Plot Plan
THE F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFfilrRMATION 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 Commissio
L 2aO�
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.
30 LOCUST ST BP-2005-0629
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-046 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Cate or : BUILDING PERMIT
Permit# BP-2005-0629
Project# 35-2005-0840
Est.Cost: $34500.00
Fee:$172.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sgft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning:M Applicant: Raymond R. Houle Construction Inc
ri: 3)l: ;=0 C-
Applicant Address: Phone: Insurance:
187 East St (413) 532-9243 _ Workers Compensation
SOUTH HADLEYMA01075 ISSUED ON:1212104 0:00:00
TO PERFORM THE FOLLOWING WORK:2 NID FLR, EAST WING - RECONFIGURE SEVERAL
ROOMS TO CREATE NEW OFFICE AREA -
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough:/J�/�d$—��r House# Foundation:
DriN,eway Final:
Final: Final:,Z�3/pf
RoughFrame:(J1< l
Gas: Fire Department Fireplace/Chimney:
Rough: Oil. Insulation:
F
Final: Smoke: Final:
�
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION
Certificate of Occu anC Si nature:
Feel e: Receipt No: Date Paid: Check No: Amount:
Building 12/2/04 0:00:00 9917 $172.50
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo