23B-046 (117) OgSlt/ulplO
V 4R4 _
c Ti
flt� of 'Wart4alnvton D.
DEPARTMENT OF BUILDrNG INSPECTIONS
INSPECTOR 212 Main Street • MunicipaI Building
Northampton,MA 010f0
CONSTRUCTION CONTROL DOCUMENT
(for professional Engineers/Architects responsible for Entire Project)
Cooley Dickinson Hospital
Project Title: 5th Floor Renovations Date: June 19, 2002
30 Locust Street
Project Location: Northampton, MA Map: Parcel: Zone:
Scope of Project: Renovations tr, thn Fifth Fl nor Psychi atri r ITni t
In accordance with the sixth edition Massachusetts State Building Code,780 CMR SECTION 116.0:
1, Kerry L. Dietz Mass.Registration Number 5264
Being a registered professional Engineer/Architect hereby CERTIFY that I have prcpared or directly
supervised the preparation of all design plans, computations and specifications concerning:
X]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 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 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 and Seal of registered professional: � LR,
No. 5264 to
�p,jnf��fle1C,
/MASS.
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Df i•
Fax 413-587-127 -ph ne 413 587-1240
4 ttvarPT
k�o ���•°�`E �,ii�l of �l�cl�fl�all�}1tcl�t
=^cam DEPARTMENT OF DurLDINC INSPeCT10t:S —
212 Ma n Strcct ' N'iunicipal I3uildin
NorlhnmPton, ATass. 01060
V''OR10EJ`S CO�II'tiNSA ION MSUn.0 CE AFTLD�%M'
\),Ith 2 principal place 0fb11Sl13tSS/FcSldc11Gc at.
-2(, 2- 0(� " 26
(so- 1Jci ty/sta>_c/n p)
do :'lereby ccr-df;, under Lhc ppls and penalties of perjury, dial
( ) I Jul all employer providin` the follo\vimi \";orkc.r's collin ns:: 'ion cove;2^.c iar illy
cFUployccs woli'_111 g, On tills)Ob
T ?ouzz�3viZCla -
(Lana Cora wry) CQe1sc; ?vu��cr) (r;oiruor: L�21_j
I un r: sole proonetos, general c00=10r or 1lomeovy�ner (c cic o?e) zno 'ild 'e hired
Lhe coda acio-i 1ls e-d be-iO I WL0 `,nave_ tale 'loDowifIg ',vol-ke s G0::iJ;.i1 non pchcleS:
([�l�nlc o;Co �c;osl
(111Fur-ancc Coiuoan)ii ouc, umc•_;)
,r
(Name of C0otT2e1o;) (lnssranc:. CD1CDanV/POI1je,' ;; ) C ' )
. Lr�csr L��u-:,on Die
(T,':1mc of C0mnClo;) C�n�rranc ComPan;lPol c� lyumb�) t�spiruo� Dntc)
",_
(i ,auc Of Contrlctcl) (Insurance Comt,>?m;lPolicr i�umL,:�) (I>�i�: ion Dom:=;
f C.LlpC_C�A. to e.-'u�±-Fa(cXrsiiee 1*=tz a {,
( ) I am sole propnetor and Dave no one worl,d.ng for 111e.
( ) I am a hole owner performing all Lbc -work mystl
NOTE:plcsc tK cc. rc Li u�_jc bc<r,=0,n wi:ro car, loy tr_ OT to c;o r. -, �c x�>>c fr au cri_� C..cL_�of
aoc 2�oct Lti_^,t_`xr_ter,,in«Wc':tb_ raid-=ox co the(To' � z,- _ftc-c-r_iJ�-^:o�T rx �_lly n_�-:d--.�ro L.:
ciployc u1 =LS: Act(GL!52-=1(5)� _{pL boa try ,hoz c ,a _fcr c Lc=_.:a Pz rmn r>v c i.sx
1 --n e—d.o ". _
f undc ria..od >coFY of thi,- �m.y be for--arnni,od to Ll—pn- --z of ln�ic.rieJ/,cvGa-..f OfLoe o!L�-uw�z for ttx
cova-,_E�c vmL c>too and th_t Liltac Lo s Cja c coy-FtV-uc-'S s=ati=n 2 5 A of MG 152 can tcd to 11.i_.,>ataioa of c,Mia_1 p.--'iu-
oo¢zi mg of n C r of up to S I}PJ.O��r Sr ioon�—x oC uP w on=5�-a d a.il Pm Y�o L n (o m of n Stop Work Od cad e
(im o(SIPJ.(x) ,d. ,cti n„me
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$i�nahrrc of l.icc��r cl�'crr' airier
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW,(780 MR 110.11)
idependent Structural Engineering Structural Peer Review Required Yes......❑ No......IINX
SECTION 11- OWNERAAUTHDRIZATION -ITD BE.COMPLETED WHEN'
OWNERS AGENT 0111 CONTRACTOR APPLIES FOR:BUILDING°PERMITI
GEORGE NOLAN, DIRECTOR OF FACILITIES, CDH as Owner of the subject property
hereby authorize MAROIS CONSTRUCTION CO. INC. (THOMAS P.LUCIA) to act on
I b half, in all m tters lative to work authorized by this building permit application.
7. o
102-
ignature of ner Date
GEORGE NOLAN, DIRECTOR OF FACILITIES. CDH 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.
GEORGE NOLAN
Print Name
AI& Z
Signa ure of 0 r/Agent Dat
z;ECTlON.12 :CO.NST RUCTION SERVICES,
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : THOMAS P. LUCIA 016370
License Number
60 IN STRE , BLANDFORD MA 01008 7/28/03
Address Expiration Date
(413) 531-4002
Si re Telephone
SECTION 13 =W0 KERS'".,CO.MPENSATION:,.I:NSURANCE��AFiF
(DAVITIM.AG.�.
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...... ❑
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9- PROFESS IONALDESIGN°AND CONSTRUCTION SERVICES - FOR BUILDINGS:AND STRUCTURES."SUBJECT TO
CONSTRUCTION CONTROL''PURS'AN, 'TO 7SD CMR 1'16(CONTAINI'NG""MORE THAN.35000 C:F. OF ENCLOS°ED SPACE)
9.1 Registered Architect:
DIETZ & COMPANY ARCHITECTS,
Not Applicable ❑
Name(Registrant):
17 HAMPDEN STR T, SPRINGFIELD, MA 01103 Registration Number
Ad ss
(413) 733-6798 Expiration Date
igna re Telephone
92 4 is rofessional 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
MAROIS CONSTRUCTIUON CO.INC. — Not Applicable ❑
Company Name:
THOMAS P. LUCIA _
Responsible In Charge of Construction
26 LD LYMANJkOAD SOUTH HADLEY, MA 01075
?ddre
(413) 533-1320
nature Telephone
Versionl.7 Commercial Building Permit May 15,2000
7.Water Supply(M.G.L. c.40, § 54) 17.1 Flood Zone Information: 17.3 Sewage Disposal System:
Public Private ❑ Zone: Outside Flood Zone ❑ l Municipal N On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 969,427 .8
Frontage 2658
Setbacks Front
Side L: 88 R: 42 L: R:
Rear
Building Height
64.5
Bldg. Square Footage 402,861 41. 6%
Open Space Footage %
(Lot area minus bldg&paved
parking) 566,567 5 8.4
#of Parking Spaces 761
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES XX
IF YES, date issued: 8/1996
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES XX
IF YES: enter Book 4981 Page 47 and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES XX ELM STREET BROOK
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: ENTRY SIGN & EMERGENCY ROOM
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:
Version 1.7 Commercial Building Permit May 15,2000
SECTION 4-.CONSTRUCTION SER;I/ICES FOR<PROJECTS:LESS THAN.35,000'
CUBIC FEET.Of ENCLOS.ED',-SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
XX ❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
(-400.c-mS / 0 Cvoor.,. . � NJvgt� 5t#-1 pp
+t� F100 V FCh
CatneCS New 04 t 3 e+ Li-9" Fi4_lIO- S.
�noUtki
SECTION 5 •U.$E-GROUP A.ND.COINSTRUCTION'TY,PE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 113 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
1 Institutional IN 1.1 ❑ 1.2 XI 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THlS SECTIO"N.11 :EXISTING BUILD.I:N.G UNDERGOING RENOVPTIONS, ADD.4Ti ON"S QNDIC)R CHANGE 1N 11SE ,
Existing Use Group: I-2 Proposed Use Group: I-2
Existing Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 4
SECTION 6 BUtLDiNGHEI'GMT AND AREA,
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
3FI IOE USE31�11�Y
Floor Area per Floor(sf)
St ac b 3t
s �. ."r,�
2nd r t
1st 4 j
2 3rd
nd
3
4th
rd
� 5
4th a
Total Area (sf) 393,899 Total Proposed New Construction (sf) r 4
Aal Height (ft)
Total Height ft --------------------
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department
212 Main Street
om 100
ton, MA 010602
40 Fax 413.587.1272 Eli � u
II a�i., iS
tF.re'��'�=h Tt3x S •�y.
APPLiCA710 cg NST T, I , RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
HER THAN A ONE OR TWO FAMILY DWELLING
G_� o
SECTION 1-SITE"INFORMATION
Thistionflhe�co ►�ieed by office
1.1 Property Address: sk
30 LOCUST STREET Lt Uttt
OVe,,le A str�ck�s
NORTHAMPTON, MA 01060 Y
E�rn�tDistr�ct CB D�str�tt e
._�.
"SECTI( N 2-.:PROPERTY OINNERSF6IPIA117 HOR=IZED AGENT
2.1 Owner of Record:
COOLEY DICKINSON HOSPITAL 30 LOCUST STREET
Name(Print) Current Mailing Address:
<4:13) 582-2313
.gnature Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature Telephone
SECTl�N"t 3 -"EST.IMATEO CONSTRUCTION"COSTS ;
Item Estimated Cost(Dollars)to be Ofificial Use Qnly
completed by ermit applicant
1. Building (0) Building"Permit'Fee
82,300 .00
2. Electrical Estimated Total Cost of" "
24,000.00 Constructionfrorri"`6"
3. Plumbing wild Perrn�t'Fee
3,300.00
4. Mechanical (HVAC)
5. Fire Protection 400.00
6. Total =(1 + 2 + 3 +4 + 5) 110,000.00 Check<.Number ;`p"
This,"Section F.or'Official'Use'Onl
Building Permit Number: Date"Issued,-
-nature: _
Building Commissioner/Inspector of Buildings Date
File 4 BP-2003-0086
APPLICANT/CONTACT PERSON Marois Construction Co Inc
ADDRESS/PHONE 262 OLD LYMAN RD (413)533-1320
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 •Sy
Typeof Construction: INTERIOR RENOVATIONS 5TH FLOOR PSYCH UNIT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 016370
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
pproved 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 ommission
0/e/zzco
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.
Ol
tj
30 LOCUST ST BP-2003.0086
GIS#: COMMONWEALTH OF MASSACHUSETTS
MV:Block: 23B-046 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category BUILDING PERMIT
s
Permit# BP-2003-0086
Project# JS-2003-0176
Est.Cost: $110000.00
Fee: $413.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class:4 Contractor: License:
Use Group: 12 Marois Construction Cc Inc 016370
Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M Applicant: Marois Construction Co Inc
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
262 OLD LYMAN RD (413) 533-1320 Workers
Compensation
SOUTH HADLEYMA01075.2653 ISSUED ON:818102 0:00:00
TO PERFORM THE FOLLOWING WORK.-INTERIOR RENOVATIONS 5TH FLOOR PSYCH
UNIT
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: I ��� Y Rough: ���. t�l y; ,/ House# Foundation:
Driveway Final:
r _ z
Final: Final:-0ji�{% - y.�,�i . . G�/1
Rough Fr
;�n
3
Fj2'w� S `
Gas: Fire Department �r��. ,, y Fireplace/Chimney:
Rough: Oil: 'I �k..>c � '' �j Insulation:
Final: Smoke: Final: d,k�—
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS/4
Certificate of Occu anc 0�r --� si nature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 8/8/02 0:00:00 1763 $413.50
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo