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23B-046 (129) Grits of Nazt4aniptart � � Ali:ssachosetts "3�? " AUG 2 8 20 c9 DEPARTMENT OF BUILDING INSPECTION INSPECTOR 212 Main Street • Municipal Building S'E OF k r f Northampton, MA 01060 CONSTRUCTION CONTROL DOCUMENT (for professional Engineers/Architects responsible for Entire Project) Renovations For: Rehabilitation De Rn rtm August ust 28, 2000 Project Title: (-,,,,l P�7 ni rkinl_nn gP;ra i Date: 23B— Project Location: 30 Locust Street Map: 046 Parcel: _Zone: Scope of Project: 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: [A 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 neceGsary 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 peimit,and approval for the conformance to t'he 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 o=-.pancy. Signature and Seal of registered professional: Lo Ai�cl �( A '� �714 of �`'SPG Fax 413-587-1272 -phone 413-587-1240 O fi �k q Q+ b C7 p Z ---4 pr O C) rn p.!► O rn -. `+ O O r+ � N fp w� � � A z wC _ CD m A D O v 0 RAI z ..� m � o 0 ya M � D y � Z � 0 v _ z O m DO Z R, m col' c z- m b 4 � r n• a, to A f0 Cb z 0.StlnJrn1, _ �.o oy R `E Crii� of Tortlialllptoil : g E t}t - asaechncrt(e _ DEPART ME11T or DUfLDP\'G fNSPECfIOI s — 212 Main Street ' Municipal Building Northampton, Mass. 01060 WOMCER'S COiY[PENSATION tNSURANCE AFFMAVIT i (lj ccnse rlperntj(tcc) — \119th a principal place of business residence at- (phone ') (sn�t/ci tyls[a1c/a P) do hereby certify, under the pains aad penalties of pc,3ury, tha( ( I am an employer providing the following worker's compens_Lo . cove m-e for Ind etuployccs worlang on Lhis job 51=1 C vVV5cs Y�e d _ `aasw=cz- Cocic;.n.•) (PeL c-. Numir_r) ----- (r,piraon Dace) ( ) I am a sole proprietor, general contractor or homeowner (curie Oae) and have hired the coauac ors listed below v,,ho have the following •worker's pokles: (Name 0. C0.^.�mczo-) (IrJRJmricc Coinoany/PGUC( Nl1tIlI-Y:-) (!.?:)l;lUO Dmc) .c (Name of Coarractor) -- (lns-,franc;, ComoaayiPolicr NwDn.rr) (Expu lion Date) (Name of Conn-acto.-) Rasuranc; CompaDy/PoLc-y Nu mb�r) (E\p raoo Date) (Name of Connector) (Insurance Compauy/Pohcy Nu1nI}:f)� (ExT.raluon Date) (a u �d?i ocil r:kd Ioc ei. cn ucL nfo(a,ioo p sttvinE o.L oea--__r_On) ( ) I am z sole propnetor and have no one worinng for me. ( ) I am a home oNviter perfoirniug all the work myself. NOTE:pl=-:be c -zr,(t :"L-AC bCQKA"n-T'I wbo cmplay pLSOC3 to 63 m>=ca, repa r orx oo k d%. U &of OD(nrxc t;+:n l.`7cr v^ii'j in ubica ax ksocnool+ver rtiido a o0 the D-a.rndr zt p:.ztc-n-r^tlrao LT ox - ::fly Occr:d to be cnploycs uric.,ttx Riffs ccMPamz6oa Act(GL152-=1(5)�nppLcajjoo try a bomcow=fnr c lic=-_v a per=m:y c.idX)cc the IcSIJ rtnau or an er:ployer under din Woekcic cooap,�t_;oa rid I und-t�d the x copy of thi,ct>j� _y bo r__,ded to tbo D?V_I_xzL or l�ss;al Modest OfLioo or k_,000 for tbse covens,verve-1100 n.'td ttu C_il sc to coal,,eov-rase under section 25 A of 1.{oL 152 no teal to he urg i-of crir l peaaW- 000'u: of a fiat orup to S 1,500.00 anNoc im�scri of up to rnx y,ar end civil pmahia in tx form of a Slop Work Ordcr end a run 0(5100.00 a d y a Eaia t Mx For&putn­--j ur_oily permit Num(xl Si�tt:tUut n!LicoJSCC11'cnnittcc -----T7�e --- Version 1.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) "'idependent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION 11-OWNER AUTHORIZATION -TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT �IJ�C�'C1MSC�^l� ©5' o �-A ( , as Owner of the subject property hereby authorize l r yxe;,+ )a& 1,\A-2 '-�J 1 W A to act on my-"half, in all matters relative to work authorized by this building permit application. E ► - Signature of Owner Date I, Y 0 F,f- VY�_�L �J'�t S�- , as Owner/Authorized Agent hereby declare that the statements aWd 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. VV\. VV\-AV--Cj y d'y� Print e or ,�• - vv� �� C' �G� LAK Signature of Owner/Agent Date Q .ECTION 12 -CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Jp Not Applicar le y❑ c� Name of License Holder: �& /(.�� C_5 License Number Olvmbrcyxb(, ZA' 571►tiwylali lea. 019.2 S-/q - -GUS-- Address `J Expiration Date r' -S-601 Signa re 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 o e building permit. Signed Affidavit Attached Yes....... No...... ❑ e Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE) .1 Registered Architect: d, jS,.�•�. Not Applicable ❑ Name( e istrant): �1-,J � 4105 � ' Registration Number s Expiratio Date 4zX413 5�6- l5(� ure Telephone 9 Registered Profess'„nal ngineer(s): 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 y` Co C9 l t' ° 04 F Ci � a d� 't , V � Not Applicable ❑ Company Na e: CI)P P,21C�L(J-t-el- Responsible In Charge of Constru ion ,ddrpVA 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 Wsposal System: 'ublic Private ❑ Zone: Outside Flood Zone MunicipaA On site disposal system ❑ 1°* 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front fps Riga / i / Side L: R:� L: R: Rear Building Height Bldg. Square Footage / 9 % Open Space Footage (Lot area minus bldg&paved parking) Z- #of Parking Spaces Fill: � volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: wtc--�-� 13 0ck pat C ' Z IF YES: Was the permit recorded at the Registry of DUeds? NO DON'T KNOW YES IF YES: enter Book 4 c 1 Page 2qll- and/or Document # B. Doe the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? N o Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location:_`Ir� � 0 l r. � �c1<� � J�)E7 � ` C ✓i t E' D. Are there any proposed changes to or additions of signs intended for the property ?YES No , IF YES, describe size, type and location: Version 1.7 Commercial Building Permit May 15,2000 ';FSTION+CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 UBIC FEET OF ENCLOSED SPACE nterior Al tions Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs [ ] SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1.1 ❑ I2 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: 5 Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE Existing Use Group: �' Proposed Use Group: �- Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ?' OFFICE USE ONLY Floor Area per Floor(sf) St _ Yt f©too 2nd 1st F 3`d .. 2nd "? tn 3'd 4 4th Total Area (sf) Total Proposed New Construction (sf) .................................... wi `al Height(ft) Total Height ft .................... ,, � �r Version 1.7 Commercial Building Permit May 15,2000 71�71 thampton epartment I FPIII n Street AUG 10 0 , MA 01060 €1FP T{���n 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 SECTION 1 -SITE INFORMATION This section to be ca ftgx eted +� ff 1.1 Property ert Address: ' x � .�f� �c'u> Map io ,�/ /� OrYstrictk Elm St-DFstrict �IDistrict ;f SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: y � "10 L C' !ame(Print) Current Mailing Address: X13°- 5$ Signa,'ure Telephone 2.2 Authorized Agent: +� fi=r r C-6f ym vvl 2 r J w y) &0 X t) �, s /krl N {Print) v Current Mailing Address: Signature Telephone SECTION 3 = ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit Fee 2. Electrical (b) Estimated Total Cost of 0 (}c9 0 Construction from 6 3. P .!mbing 00 Building Permit Fee 4. Mechanical (HVAC) f y 0 5. Fire Protection 7 �C) 6. Total = (1 + 2 + 3 +4 + 5) ` ( Check_Number d is Section For Official Use Only Building Permit Number: Date Issued: Signature: Building Commissioner/Inspector of Buildings Date August 15, 2000 i AUG 2 5 2000 , O Narrative for Fire Protection Systemsfr -` `' - Pedi-Rehab Area Cooley Dickinson Hospital 30 Locust Street Northampton, MA 01060 Fire Protection Narrative I. Fire Alarm System This area will have a new fire alarm system that will receive a new fire alarm system that will connect into the hospital's relatively new Notifier Fire Alarm System. New smoke detectors,pull stations, visual alarms, audio alarms and wiring will be installed in this area. 2. Sprinkler System The entire project area is currently protected by a wet sprinkler system in accordance with N.F.P.A. There will be minimal relocation of sprinkler heads in this project to accommodate a few changes in the room layouts. e File#BP-2001-0218 APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL ADDRESS/PHONE 30 LOCUST ST (413)582-2313 PROPERTY LOCATION 30 LOCUST ST MAP 23B PARCEL 046 ZONE M THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildina Permit Filled out Fee Paid s lypeof Construction: INTERIOR PEDIATRICS RENOVATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building,Plans Included: Owner/Statement or License 0745 3 sets of Plans/Plot Plan TH�LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: G 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 Commission Permit from CB Architecture Committee g' 1�d Sig4aa Buildi 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. 4 s J Y ;� .. a-„.^ .",,,�-a.�yry•s.._ rv�* T«.,.R.,....�+.w—^„ys..n.^w«, ..m-.nyn Y-..w._...�,,,s....,. „ r ....>,.ww�.....^� k�"'>rv-*,...v"�” ^+......",t°' r""'.«, m »? z 77" r 30 LOCUST ST BP-2001-0218 COMMONWEALTRIOFMASSACHUSETTS Matral gk:23-B-046 'CM Off+N'ORTHA1 PTQI Emit owl dhi I G29MIT kroio# 4S- Qj-%347 Est CPA L95ca.00 �45p, PERMISSION IS HEREW Y ORANTE1D TO: wa,Chas.IA Con actor: License: I 13se.Ciry p, 477 'CO L Y DICKINSON Ht?SPITAL 7-4 y Iat57 ,�4 F ,� C1L13 11SC?IV HC?SPITAL Il�fiC l•v 61 t A ,4anl�ca�tt Addr hon : fns L© ;` ."'1 41� �8 -231 Workers Ccjm.��sc�n NORTRAMPTO A011 E}BQ - &0:QQ ?'Q " "'T 'f .* NTEAIOI1.PE,0,IATRICS IIENOVATION DUST ', ET Inmpec#ar 4f riumbin g of >flr p.'W. Inspector of Buildings Underground. me ter. Footingr. Ram:fa oa House* Foundation: Rough Frame: Gas Fire 9010ts►eaat# Firepla+celChimney: Rough: _ Vic, _ si►laoa:_ Final: * Finat: 1k !j- c+ TIC PST 81 �Y+ �Y T +NRTA�'TUN UPf3► i LATIUN 4F ANY OF 100E Cf 4S. AM a, ►: Building 8/29100 0:00:00 4938#13 $450.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner Anthony Patillo