Loading...
23B-046 (97) of �dr#I�ant}ztatt - e � � Z e DEPARTMENT OF BUILDING; INSPECTIONS pal Building 212 Main Street • Munici = INSPECTOR b Northampton,MA 01060 SECONDARY CONSTRUCTION CONTROL DOCUMENT (for Professional Engineers/Architects responsible for only portion of a controlled project) New Closet Addition Project Title: Emergency Department Date: July 1, 2003 Cooley Dickinson Project Location: Hospital _Map: Parcel: Zone: Scope of Project: Limited interior renovations In accordance with the sixth edition Massachusetts State Building Code,780 CMR SECTION 116.0: I Edward L. Jendry,, A.I.A. Mass.Registration Number 4105 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 N Architectural [] Structural (J Mechanical (J Electrical [1 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 M_ assachusetts 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 a final report as to the satisfactory completion of the above- mentioned portion of the work. Signature and Seal of registered professional: cy cpi� IV C Fax 413-587-1272 -phone 413-587-1240 4.(ttMf PT - • _0 Gr of f���1111fIIti a e - g6 j?{ciaac(icrsctts' DEPARTMENT OF BUILDrNG INSPECTIONS 212 Main Street ' Municipal Building a Northampton, Mass. 01060 WORICER'S COMPENSATION INSURANCE AFFIDAVIT S7 «ith a principal place of business/residence at: S E S 7 .So c/7ii�i�.f�G e}� �'�4/D�(phonetr l�l3S�Z ?Z`t'� (&a-cc/city/sta&zip) do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the follo�ving workcr's compensation coverage for my eruployees working on this job: //.el,�sv i5'�f 4y�-vcy (Cnsurana Cornprny) (POT N u mbcr) (Expiration Dac^) ( ) 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: ,f n: (Name of Contractor) ans=cc Company/Policy Numbcr) (Expiradoa Date) (Name of Contractor) (lnsi=cc Compaay/Policy Nunber) (Expiradoa Date) (Name of Contractor) (Cnsuranc_- Campy /Policy Number) (Expiradon Date) (Name of Contractor) Jmura.ace Compa_^y/Policy Number) (E)qpiration Date,) (ems 26d�oO 51 tSOd ifc.= Iy to jD h ir�OC per't2 g to at!OCCtZ n) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:pt= rcpair work ea a d—JfL-ab of ant©orc U-n Lsx=Wj is uldi 6c mzi'w ar oe Ll c gv4ad:rr r'wys LS=tto a._oot C=avYy oocsrdcrs'.to be cplaycs=2 t5c :.a> c.�m Ar-I(01.152_=t(5)�&Pp1i_-aE=by a t:==W=rc a 6C==cc pm-ma m.ey cr.&axc the leynl eta is of as a�ploy�r uadac t.4o Worico�a Coa a:iac A.cL I undo cuad t4 a copy of t:.:t Ca,_=ay bo rorwwed d to tSo Dop1a�of L a sl Acadrs f t7f5oe of tauc+ma fa tbn eovrc-ta_vctilYC�:en a:.d ttut fiitt.-e to cazue co�ra�:ts�'.a soetioe 2 SA.et Md(,152 eaa lay'm t5d icr�ri�oa of aimicsl pr.-sl�a ooc.iG g of a Eoc of Lr to S1,500-00 anr'Jot k=;X�orup to ou yw and civil pcattia is the roc=or a stop Wcrk orlc"- a fm o(St00.00 a cry ay ia�c�c For dcp r U-octy �— permit Number _ /'o c'i 03 ivf apx Lot — Signaturc of Late ` Version 1.7 Commercial Building Permit May 15,2000 ti�l'+.'YiL"2rai-'��i,,'"* SECTION�10 TSTRUCTURAL PEER REVIEW,�(780 CMR 1 w11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......J0 -SECTION II ,,OWNER'AUTHORIZATION TO'BE.COMP.LETED1WHEN �y OYINERS'AGENT;,OR CONTRACTOR APPLIE,3'�FOR BUILDING PERMIT-- LJ C f')1'1 tS C�'� as Owner of the subject property hereby authorize //mil ����� Tr r to act on my behalf in aN rrpt�te'rs`rela ' t,& work i;�ythorized by this building permit ppplication Signature of Owner bate as Owner/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 Nam O Z A-,3 lSignature of Owner/Agent Date SECTION 12 CONSiRUCTION^SERVICES 10.1 Licensed Construction Sup ervisor:`/Y / p Not Applicable ❑ Name of License Holder: /� r�7 / < £ C�- e966 20 7 License Number T s i,e f i -5 c) vTi/�/ t c�lo ;s 7/�/2 003 Address Expiration Date gnature 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....... No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION =9 PROFESSIONAL DESIGN A _ ND4CONSTRUCTION SERVICES �FORBUILDINGS AND STRUCTURES SUBJECT:Tp' _ CONSTRUCTION CONTROL:'PURSUANTT0.-780;CMR 116,(CO.NTAININ6_ MO.RE;THAN 35,000 C FOF ENCLOSED;SPACE) 9.1 Registered Architect: Ot/VCL Not Applicable ❑ Name(Registrant): jr Ob ID Registration Number G /�," Expiration to S1 nay re Telephone `a! 92 Registered Prof es ion ngi r(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 Te!ephone Expiration Date 9.3 General Contractor —6i�2diV /vf/tc �rl�Tf'vcTtO�v �c° Not Applicable ❑ Company Nzme: Pbe P._sp)nsible In Cnarge of Construction -s F�.dress S!gnature Telephone ` Versionl.7 Commercial Building Permit May 15,7000 7. Water Supply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ 1 Zone: Outside Flood Zone ❑ Municipal 17 On site disposal system p S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size �� 4 a 7. 0 q 9 Frontage 2 2 �•� Setbacks Front Side' L: R: L: Rear Building Height Bldg.Square Footage % 395 8il 3 S1) Open Space Footage % (Lot area minus bldg&paved '7 parking) C) l:U' #of Parking Spaces ('i �• (�/ Z Fill: volume&Location /v A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW V YES IF YES, date issued: - J IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book �,4' Page V7 and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES St- 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 X 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 � IF YES, describe size, type and location: Versionl.7 Commercial Building Permit Nfay 15,2000 .1!-.- .-s. _ \..�:. .1 .'�- 3!•.•:C,`,-1.-' 1:-. �;�1.. mac.'..-. �t;E'�'"-itii .SECTION-4---CON TRUCTION SERVICES FOR,PROJECTS,LESS tTHANr35 b 000I LSDSPC CUBIC FEET � 162 .- --..t_e f.-t•� -t!k.e!'•'�.+.-C•'�:.�.1`:.rl:�h.....t-r..:...��t:'7/t+:w�'Lti4�.R..a�:�•%�.:li7eX:::i"r..::�:VA.�rT:iOf�/F+L%.-." -.r,.. -i: �w.er� �FY+•.r.'.1.a._�:fnYrY4'(1'r 'n-:�..�.•- •aav'�'t1:..�.. Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] Ce IVs reve ,q��cj 1IX_ 7*£ 9P19P-7AfNT SECTION*5 °USE GROUP.AND CON STRUCTION'TYPE'�%o; w USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational 13 2B El I F Factory ❑ F-1 ❑ F•2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ 1.1 19- 1-2 ❑ 1.3 ❑ 38 ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S'1 ❑ S•2 ❑ 5B I ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION I,F EXISTING BUILDING UNDERGOING RENOVATIONS oADDITIONS AND/OR,CHANGE IN USE Existing Use Group: Proposed Use Group: 2 Existing Hazard Index 780 CMR 34): 7 Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA "� V 1� /�j� �0 FICEUSEiONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION '�aX ` � . Floor Area per Floor(sf) 2 nd sfA.r�f�Y�_4 •+5`�. �La�c� w,i•crr'`�jy.sr�3x`�. 3 rd r 4th '-r t) ...- i-� a• a- Teta' Area (sf) Total Proposed New Construction (s ) Total Height(ft) Total Height ft Versionl.7 Commercial Building Permit N1ay 15,2000 Depa rr�e t se City of Northampton tat s o er, I ing Department GUr-b C3 Dr ve t N filj2 Main Street Se e l is .vaila t Room 100 a er el va labth , , ,mpton, MA 01060 Two ets f,,S c ra• an 1p toMi 8 •1240 Fax 413.537.1272 �P..f site Ians ° 0«. eci A'PPLICi161dS��'IT, RE AIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING. OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION iF4'SITE INFORMATION ' rr This section to be completed by.office 1 1.1 Property Address: ; Unit ' Zone ` Overlay Di trict " Sys locv5 -7 -57.- Q(L j/S/fJi✓I jv,c/ �/' ' O iD .E( 6 / m St Distract a CB Distract SEC 'JON2 PROPERTY;OWNERS HIP%AUTHORIZED_AGENT , - a. 2.1 Owner of Record: Name(Pr Current Mailing Address Signature Telephone 2.2 Authorized Agent: 25�3 76 7- So� i/��I�CC); 7S Name(Print) Current Mailing Address: - �� �'• % 72t3 Signature Telephone SECTION 3= ESW 'k TED`C64 YT ,UCTION COSTS Item Estimated Cost(Dollars) to be Official Use Only completed by permit applicant 1. Building (a) Building Permit Fee Z S '0- 2. Electrical (b) Estimated Total Cost of Construction from 6 _ 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (I + 2 + 3 + 4 + 51 ' •5-50 Check Number ''This`Sectiori For Official Use Only Building Permit N be fi .� Date Issued: y t }_+ Signature L Building Commissioner/Inspector of Buildings Date File#BP-2004-0063 APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc ADDRESS/PHONE 187 East St (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 7 Typeof Construction: CONSTRUCT CLOSET IN EMERGENCY DEPARTMENT 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 OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF 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 Co sion e 2 Z 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. 4opmrsT BP-2004-0063 GIs#: COMMONWEALTH OF MASSACHUSETTS CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2004-0063 Project# IS-2004-0098 Est. Cost: $4550.00 Fee: $50.00 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 Zoning:M 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.7122103 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT CLOSET IN EMERGENCY DEPARTMENT 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• Receipt No: Date Paid: Check No: Amount: Building 7/22/03 0:00:00 7880 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo