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31B-006 (3) Initial Construction Control Document N t To be submitted with the building permit application by a Registered Design Professional r for work per the 8th edition of the H 5� Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Selective Demolition—Rogers Hall Date:12.30.2013 Property Address: 47 Round Hill Road,Northampton,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Selective Demolition I WALTER R.McILVEEN of WALTER McILVEEN ASSOC. INC.MA Registration Number:47213 Expiration date: 6/30/14 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural X Mechanical X Fire Protection X Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 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 if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a`Final Construction Control ocLiment, . a f�c Enter in the space to the right a"wet"or / �1�` ' WALTER R. '. electronic signature and seal: _ MCILVEEN MECHANICAL No.47213 i Phone number: 860-678-0230 Email: wnncilveen @mcilveen.com �•, Z NA Eft► ��` ,'i,rN\ Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 • Phone number:1860)264-1014 Email:mwittmeraphasezerodesign.com Building OR'icial Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or directly super%ised.If'other'is chosen, provide a description. Version 06 11 2013 Initial Construction Control Document ' To be submitted with the building permit application by a Registered Design Professional for work per the 8"edition of the Massachusetts State Building Code,780 CMR,Section 107 Project Title:Selective Demolition—Rogers Hall Date:12.30.2013 Property Address: 41 Round Hill Road,Northampton,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description:Selective Demolition 1 Matthew D.Wittmer MA Registration Number:31926 Expiration date:8.22.2014,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge,information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: i. Review,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 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 if th8 work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'. "fit • Enter in the space to the right a"wet"or electronic signature and seal: �' s cF Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering StructuraL Peer Review Required Yes 0 No • SECTION 11-OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNER-S-AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby authorize Dan Dodge — � C to act on my-behalf,in all ers relative to y!rk autho f WIG this building permit application. C 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 pains and penalties of perjury. Print Na e _ Signat er/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Constructlon SuRgrylsor: Not Applicable ❑ Name of License Holder Ucense Number Address Expiration Date Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152,§25C(8)) 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 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) 9.1 Registered Architect: ����1►1�I�� � "v i ►`M'" � '' Not Applicable ❑ 31926 Name(Registrant): Registration Number Yh C,. g 1 (l.l-OTC. ('• �7`� GYOD 08/22/2014 Ad (860)264-1624 ? ' IO"Date Telephone 92 Registered Professional En ineer(s): Name Area of Responsibility Address Registration Number Stature Telephone ration Date Name Area of Responsibility Address Registration Number Signature Telephone ration 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 Selective Service,LLC Not Applicable C! Company Name: Joel Mrosek Responsible In Charge of Construction 206 Center Street, cheater,CT 06040 (860)649-5500 natu Telephone Versionl.7 Commercial Building Permit May 15,2000 S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be felled in by Building Department Lot Size Fronta e Setbacks Front L: R: L: R: &K Building Height Bldg.Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parkinit Spaces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW U YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW ® YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO a DONT KNOW O YES O 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 Q NO U IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property? YES o NO IF YES, describe size, type and location: E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTIOU 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations ❑ Existing Wall Signs ❑ Demolition W Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other❑ Brief Description Enter a brief description here. Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUvn N TYPE USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 113 ❑ B Business ❑ 2A ❑ E Educational ❑ 28 ❑ F Facto ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h Hazard ❑ 3A ❑ 1 institutional ❑ 1-1 ❑ 1-2 ❑ I-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ® R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 58 1 ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify. S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: E,R-2,B, Proposed Use Group: R-2 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(so 1st 1a 2n° 2nd 3`d 3 r 4r' 4t Total Area(so 63,915 Total Proposed New Construction(sf) 63,915 Total Height(ft) 51 Total Height ft 51 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Dispos*System: Public © Private❑ Zone Outside Flood Zone 0 Municipal ® On site disposal system[3 Versionl.7 Commercial Building Permit May 15 2000 Department use only wity of Northampton Status,of Permit: ilding Department Curb Cut113 iveway;Permit � 1 212 Main Street Sewer/Septic AveMbiiity G As�! — 014 Room 100 f E3 6 2 watnweil.Avaiq► I N6 ampton, MA 01060 Two Sets of stntctuml,Plans �cV F 'r:' hn!41 7-1240 Fax 413-587-1272 Pw'site pie" Elec Other$pec� ir'. in tLI"' Fir, Eo _ r. P—UCATION TO CONSTRUCT,RNPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office Rogers Hall Map Lot Unit 44 Round Hill Road zone Overlay District Northampton,MA Elm tat.District Ce District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2,1 Owner of Record: Historic Round Hill Summit LLC 47 Rond Hill Road Name(Print) Current Mailing Address: (413)726-9825 Signature _ c t r Telephone 2.2 Authorized Aaent: Dan Dodge 1 t t T, 'loo c t 1776 Main Street Springfield MA 01102 Name(Print) Current Mailing Address: (413)726-9809 Signature - Telephone L4 1 Item Estimated Cost(Dollars)to be Official Use Only completed by Pe it applicant 1. Building $107,124.00 (a)Building Permit Fee 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) 5.Fire Protection 6. Total= 1 +2+3+4+5 Check Number OL This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissionedlnspector of Buildings Date File#BP-2014-0854 APPLICANT/CONTACT PERSON SELECTIVE SERVICE LLC ADDRESS/PHONE 206 CENTER ST MANCHESTER (860)649-5500 PROPERTY LOCATION 49 ROUND HILL RD-ROGERS HALL MAP 31B PARCEL 006 001 ZONE URQI00)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid T,ypeof Construction: SELECTIVE NON-STRUCTURAL INTERIOR DEMOLITION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: 4'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 Commission Permit DPW Storm Water Management Demolition Delay 2- 1 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. 49 ROUND HILL RD-ROGERS HALL BP-2014-0854 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 3 1 B-006 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: INTERIOR DEMOLITION BUILDING PERMIT Permit# BP-2014-0854 Project# JS-2014-001498 Est. Cost: $107124.00 Fee: $642.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: SELECTIVE SERVICE LLC, Lot Size(sq. ft.): 101930.40 Owner: HISTORIC ROUND HILL SUMMITT Zoning_URC(100)/ Applicant: SELECTIVE SERVICE LLC AT. 49 ROUND HILL RD - ROGERS HALL Applicant Address: Phone: Insurance: 206 CENTER ST (860) 649-5500 MAN CHESTERCT06040 ISSUED ON.2/7/2014 0:00:00 TO PERFORM THE FOLLOWING WORK.-SELECTIVE NON-STRUCTURAL INTERIOR DEMOLITION 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• Date Paid: Amount: Building 2/7/2014 0:00:00 $642.00 212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner mmow