23B-046 (128) •
No nt ra cto rs
JTRACTORS--DESIGN BUILDERS
Fire Narrative
17 Jan., 2001
Building Department
City of Northampton, MA. 01060
Re: Cooley Dickinson Hospital
30 Locust St., Northampton
New Employee Wellness Center
The building permit application for the above is to be built within the P2000 Addition in
the space formerly designated as Ambulatory Care—Room B 259. It was left framed out
in rough steel stud construction as part of the original construction. It will be finished as
per the plans attached.
The building construction is type & fully protected by fire sprinklers. Further,
the space is monitored by a fully compliant fire protection/notification system w/photo
electric type detectors.
P.O. BOX 1145-NORTHAMPTON,MA.01061
VOICE:413-586-5491 FAX:413-527-5099
Div.Pi Con,Inc.
.09010 dW'N01dWVH1WN
04 T SN011036NI 9N1011f19 3D 1d30
ii� DM11t�7IIlt M of
9 JAN 18 ' �lassacflasctts'
D ENT OF BUILDING INSPECTIONS
f 2 ain Street ' Municipal Building '
U u orthampton, Mass. 01060
WORICER'S CONTENSATTON INSURANCE AFFIDA rr
PT ('np/PinnPer r'nni-rg nr.
(lioenseelpermittee)
with a principal place of business/residence at:
P.O. Box 1145 Northampton,. MA. 01061 (phone#) 413-586-5491
(sil-�ei/city/stairJap)
do hereby certify, under the pains and penalties of perJury, that:
I am an employer providing the following worker's compensation coverage for my
X)
employees worlang on this job:
I ihar♦•v Midjinl Ins Co WP1-499R22-039R ___ 6/30/01
(Insurance Company) (Policy Number) (Expiration Date)
( ) 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:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach=kWooal sheet if neo=sxy to inehsdo kdannation patkiming to an oowractors)
( ) I am a sole proprietor and have no one worldng for me.
( ) I am a home owner performing all the work myself.
NOTE:pl=at be aware that vibilo homeowners who employ pc==to do mamtenance�coostn=on'or mpotir work on a dwelling of
not mocn than throe units is which the homeowner resides or on the V=n&appurtena&thecceo an not generally 000sidemd to be
employers under tba%vrkces compensation Act(GL1524s 1(5)),applimdon by a homeowner fora lionise or permit may evidwoe the
Iegal atatua of en employer uudertbe Wodreea Compeos&uon Ace.
I underwAnd that a copy aftbia uatemras uuy be forwarded to the Depuuwcd of la&utrial Aoeidoz&office of Invowioa for the
covezur verification and that failure to eecure coverage under section.25A of MOL 152 can lead to the iatpasiti-of aimioal penalties
comistiog of a fine of up to$1,500.00 and/or imprisonmeal of up to one year and civil penalties in the form of a Stop Work Order and a
fwo of 5100.00 a day against mc.
For dgsatmerml anly
Permit Number
lq e o icensee a rni ee *��*� Tnt
Version 1.7 Commercial Building Permit May 15,2000
= ECTlO1Q STRUCTURAL 1?EER REVIEW(7$tl CMR 1101)
ndependent Structural Engineering Structural Peer Review Required Yes......❑ No......
p`
WNEW, 5F,�dR12AT�UN F BE COMPLETED 1NI�EN
1j�f1: r11 N "+DRiAPPLI1rF0U1L>�ILG PERMIT
as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
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 pai and pen ies "f erj
Z'k5e(l /X
Print Name
David A. Claxton/Pioneer Contractors
Signature of Owner/Agent Date
�$fixl` , 12 Ct3NSTRl) ER1l ICES.
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: David A. Claxton/Pioneer Contractors 017890
License Number
P.O. box 1145 Northampton, MA. 01061 1/19/02
Address 1 Expiration Date
(y' 586-5491
Signifture Telephone
� TI(t? 13 YYf�RKERS'COlN1?1"1�SAT1O1,111�SURANC AFF1DAVIT.{M;G L c. 152,§25((6))' "
uPo,
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
SECTIf lV 9 PRf3FESSIQ tAI.DEStG1 ANA t NS"TRUI,,Tt�OR 2 1 ES t R BUt�D1NGS AND"STRUfTU E B ECTI
E�l+]CI jTIQN„CC}htTFit71. ORSl1N `TO $0 CNIR”llfrCpl1AtNll . M1F THAr ;pgQ :E.
'U Registered Architect:
Not Applicable ❑
Edward L. Jendry/healthcare Architects, Inc.
Name(Registrant): 4105
64 Gothic St. rthampton, HA. 01060 Registration Number
Ad dces t74
C41� "U5-��jty 584-7224 Expira ' n Date
Signature Telephone
92 Registered Professi6nal En me *):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
'ignature 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
Not Applicable ❑
Company Name:
Responsible In Charge of Construction
'ddress
Signature Telephone
Version 1.7 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:
Public ❑ Private ❑ I Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
volume&Location
v A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW L' YES
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook, .body of water or wetlands? NO DON'T KNOW l/
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 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 V
IF YES, describe size, type and location:
` Version l.7 Commercial Building Permit May 15,2000
C COISTRUGTtON SERVICES FOR�'ROJEGTS.t,tSS.THAN35ib40."
f=NCLbSN:b SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
10 ❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
r
�,E�'��� "\�����P�►i�iD rr±DNSTRU�TtiI!N TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly Io A-1 ❑ A-2 ❑ A-3 ❑ lA
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A
Institutional ❑ 1.1 ❑ 1.2 ❑ 1-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential 10 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S 'Storage
10 S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
Mixed Use ❑ Specify:
S Special Use ❑ Specify:
CO IPLETS Tl it ,a ECT I JrIF EXISTING BUlLt71NG U;NDI✓RG ING RENC}1/ATIONS;`ADam NS AND/O.R CHANGE IN;l1SE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
5E`LION 61t.C5INGIEtl;HT f�IA6
A 3
�".,.n
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
e
Floor Area per Floor(sf) 1St ~
2nd �-
1st �a`yv � v� �\3
3rd
2nd
3rd 4th
th
4y
IS
Total Area(sf) Total Proposed New Construction(sf) 111111
- �i
i otal Height(ft)
Total Height ft .................... �
Versionl.7 Commercial Building Permit May 15,2000
SN011036NI JN1011119 301430 ty o Northampton
B 'I g Department
,IAN 1 8 20 1 Main Street
om 100
ton, MA 01060
h 240 Fax 413-587-1272
:APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECT ON 1 �lTE INI~ ,RIYIA'fION
1.1 Property Address;
30 Locust St. .�� �
Northampton, MA. 01060
Per
6
n., h. .,v ye Y . ..,,s, ,, .,yk.Er '✓,..GAF rd,..... b\�.._e.. ... ,.
2.1 Owner of Record:
Cooley Dickinson Hospital 30 Locust St. , Nnrth2m.ptnn, MA. 01060
Name(Print) Current Mailing Address:
Facilities/Engineering 413-582-2313
Signature Telephone
2.2 Authorized Agent:
Pi aneer Cantrartrt_rg P D Box 1145 Nnz!L @�tQP, M4 91961
Name(Print) I Current Mailing Address:
; 413-586-5491
Signatl5re Telephone
Mi3+TS Rt1C�'f10N�t I S
x� .
Item Estimated Cost(Dollars)to beOffircial Ube Only
completed by ermit applicant
1. Building (a)Btl�ld►ng Permit Fee
2. Electrical (okk" '1rrt tsd Iota!Cost of
3. Plumbing �1i3i �� rmi!°Fee
4. Mechanical(HVAC) ��
5. Fire Protection
6. Total =(1 +2 + 3+4+ 5) 15 000.00 Check,l c ,ber
,..
7N ect on For 4,fficial Use On
Buil�l�r�g=Permit Numtasr
Oate issued
( Signature .
' R�mmiiiioner/ins0e6t6r of Buildi rgs Date
I
File#BP-2001-0641
APPLICANT/CONTACT PERSON Pioneer Contractors
ADDRESS/PHONE PO Box 1145 (413)586-5491
PROPERTY LOCATION 30 LOCUST ST-EMPLOYEE WELLNESS CENTER
MAP 23B PARCEL 046 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
Tyueof Construction: INTERIOR RENOVATION TO EXISTING SPACE-EMPLOYEE WELLNESS CENTER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets o Plans/Plot Plan
TH LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § _w/ZONING BOARD OF APPEALS
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 ission Permit from CB Architecture Committee
dole
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.
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30 LOCUST ST-EMPLME WELLNESS CENM / BP-2001-4641
GISI: COMMONWEALTH OF MASSACHUSETTS
M 238- CITY OF NORTHAMPTON ;r
of -001
Cateaslr:renavatio» � 1
BI~' 2441-13641
A. 4S-2Ct11-1'!54
Est QWt
PERMISRON IS HEREBY G.,RAN7ND
Cow Class: Contractor. License.
eta. Pioneer Contractors 01759b
Lot T#bg.tv), 66"7'47? $$ CQE�LE�'I? KINS IN HOSPITAL INC
.Aw�t. P't,gp er Controctorl
A ' . T
.. -
.�+ rrt, ¢idress. e: t Burr e.
PQ Box 1145 413 leers
` Cc>mns�ion
NORTNARIIPTONVI .01001 « /2 #:
T PERT ( i klE F`OLLOWVVG *6"*ANTERIOR RENOVATION TO EXISTING SPACE -
EMPLOYEE WELLNESS CENTER
PCfST AAA &TR T
Inspector otPlumiing Ira for t' Viring D.I'.W ` Inspector of Buildings
Underground."' service. Meter:
t�I 40* Footings.
Roush:, lr Rough:, !, House# Foundation:
Final: si Finai:, 1� t1�
• Rough Frame: j9lf ,.- =SI
GasFire 1?euar#megt Fireplace/Chimney:
Rd : _ Insulations
Final: I� lE'inata 3 dG
TF PRR�IT I V B REV01=JOY TWO, OF NORTHAM'TON IPDX VIOLA71ON OF
ANY OF M RUES A"00VLA NS.
irei oo
Fee e; R ' ? 14,0* ll 'd P Check Ng: t;
Building 1/22!010:00:00 6396 $75,00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo