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23B-046 (229) mornswAswitzer environments for health June 5, 2014 Comm. No. 201031 Mr. Louis Hasbrouck Building Commissioner City of Northampton RE: Cooley Dickinson Hospital —Pharmacy Renovation Dear Mr. Hasbrouck, This letter is to confirm that the proposed pharmacy renovation at Cooley Dickinson Hospital is intended to fall under a Level 2 Alteration per the IEBC section 404. The work to be performed meets the requirements of chapter 7 of the IEBC for Level 2 alterations. Drawing sheet A2 (First Floor Reference Plan and Ground Floor Plan) which was previously submitted to the building dept for the permit application, lists additional code review information for the project.This sheet can be amended if needed to include that the project is a Level 2 Alteration per the IEBC. We hope that this letter meets with your satisfaction. Please do not hesitate to contact me at 617.807.1881 should you have any questions or require additional information. Very truly yours, Morri Switzer-Environments for Health z/1 Kirk McIntosh Sr Staff Architect Cc: planning • architecture - i n t P r I o r s 11 drydcck avenue, ste. 2060, 6oston, ma ' 617.772.4260 617.772.0261 www.morrIsswIIzer.com From 9175346271 1.917.534.6271 Tue May 20 19:48:58 2014 MST Page 4 of 4 v DATE(MMIDD,YYYY) AC� � CERTIFICATE OF LIABILITY INSURANCE {.0;26,2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BYTHE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Turner Surety and insurance Brokerage,Inc. PHONE FAX 300 Tice Boulevard-Suite 250 ArC No.Ext:201-644-2500 A/C.No): Woodcliff Lake.NJ 07677 E-MAIL ADDRESS: I NSURER(S)AFFORDING COVERAGE NAIC# INSURER A;Liberty Mutual Fire Insurance Company 23035 INSURED INSURER B:Liberty Insurance Corporation 42404 Turner Corporation Turner Construction Company INSURER C 3 Paragon Drive MOnlVale,NJ(17645 INSURER D INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER:V84B7385 REVISION NUMBER: THIS IS FO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY Err POLICY EXP LIMITS LTR I R V POLICY NUMBER MM1DD/YYY iYYYY MM1Dl A GENERAL LIABILITY TB2-625-092815-043:Ea.Occ.Dam 11i01i2013 11101/2014 EACH OCCURRENCE $ 2,000,000 to Rent Prem, Pers&Adv Inj:$250k. DAMAGE 10 RENTED X COMMERCIAL GENERAL LIABILITY TL2.625-092815.083:Ea.Oce,Pers& PREMISES Ea occurrence $ 2,000,000 Adv Inj,Dam to Prom:$1.75mm.Total CLAIMS-MADE �OCCUR Aggs at right MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMITAPPLIESPER: PRODUCTS-COMR,0PAGG $ 12,500,000 POLICY FRI PRO-JECT LOG $ A AUTOMOBILE LIABILITY AS2-625-092815-013 11/01;2013 11%01/2014 COa MBINED SINGLE LIMIT 2,000,000 E accident ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ALL TOS AUTOS NON-OWNED PROPERTYDAMAGE $ X HIRED AUTOS X AUTOS iPer accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 11 i0112013 11i0112014 WCSTATU- OTH- AND EMPLOYERS'LIABILITY Y r N Employers Cab.'Siop-Gap X TORY LIMITS ER ANY PROPRIFTOR'F19RTNER;EXECUTIVE F7 OH,ND,WA,WV.WY E.L.EACH ACCIDENT $ 2,000,000 OFFICERIMEMBER EXCLIJDED� N i A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 2,400,000 If yes,describe under 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ A Follow-form Excess General Liability TL2-625-093906.493 11;01;2013 11;01%2014 Pei OCCUrenCe 3,000,000 above Primary limits Per Project Limits Aggregate $ 5,000,000 ProductsiComp Dos Agg. $ 0 $ DESCRIPTION OF OPERATIONS i LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule;if more space is required) FOR EVIDENCE PURPOSES ONLY CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATETHEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE EVIDENCE ONLY + Page 1 of 1 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD From 9175346271 1.917.534.6271 Tue May 20 19:48:58 2014 MST Page 2 of 4 The Commonwealth of Massachusetts Department of Industrial Accidents tl i -= —� '' Office o f Investigations { l E, w1� ,r v °:y 600 Washington Street - Boston, ,VlA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelsibly Name(i3usi ties s%or,ani7arion/lndividiml): Turner Construction Company Address: 50 Waterview Drive City/State,Zip: Shelton, CT 06484 Phone#: 203-712-6070 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑X I am a general contractor and I 6 ❑ New construction employees(full andorpart-time).* TBD have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working forme in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.: ❑ required.] 5. We are acorporation and its 10.E] Electrical repairs or additions 3.❑ 1 am a homeowner doing al I work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Roof repairs insurance required]t c. 152, §1(4),and we have no employees. [No workers' 137 Other Renovation comp.instu•ance required.] *Any applicant that checks hox!'l mull also fill out[lie section helow showing their workers'cotnpensutiun policy information- 1 IIotneowners who submit this affidavit indicating they are doing all work and then hire outside contractors n1U5t submit a new affidavit indicating Such. 'Contractors that check this box roust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If time sub-cortLractors have employees.they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Liberty Mutual Policy#or Self-ins. Lic. 4: WC7-625-092815-033 Expiration Date: 11/01/2014 Job Site Address: 30 Locust Street city.;State%zip:Northampton, MA 01061 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a Tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a line of up to$250.01)a day against the violator. Be advised that a copy of this statement may he forwarded to the Office of Investigations ofthe DIA for insurance coverage verification. i do hereby cerrttifi�under the pains and penalties ofperjury that the information provided above is trite and correct. Sip_iature; IlUit-1 Date; 5/20/2014 Phone#: 860-883-6630 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: From 9175346271 1.917.534.6271 Tue May 20 19:48:58 2014 MST Page 1 of 4 F x r Vv To: Louis Hasbrouck I�vate,. 5/20/14 Fax= 14135871272 subject: WC insurance affidavit From: Reginald Tolliver Email: rtolliver30 @hotmaii.com Phone: 8609137950 Pages: 4 IzUrgent El Please Reply El For Review 1:1 Please Recycle El Please Comment Comments: a m AOL IrA crowd�r �3 i.c� ►gin Q��c .�� �. .�:-z. �. �, f �� � •' > +°l i �C�6 �t .: ! ..i`` .�itF.ii` +J� t` f �. ��tl r Initial Construction Control Document u To be submitted with the building permit application by a r d Registered Design Professional for work per the 8th edition of the Y•�' Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Cooley Dickinson Hospital Pharmacy Renovation Date: 519114 Property Address: 30 Locust Street, Northampton Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovation of various existing spaces. I,Jeffrey S. Cichonski, MA Registration Number: 49384 Expiration date: 6/30/2014, am a registered design professional, and hereby certify,to the best of my knowledge, information and belief,that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Entire Project Architectural Structural X_ Mechanical X Fire Protection Electrical Other: for the above named project and that 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 in accordance with the Professional Standard of Care, 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. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 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. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means, methods, sequences and procedures, and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. 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 C t of Document'. ,ZH OF V4 Enter in the space to the right a"wet"or FREY electronic signature and seal: 3 co 49 Phone number: (860) 286-9171 Email:jeffc @bvhis.com T �Q At 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 10_09_2012—Draft modified by AIA MA City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS ?y i� 212 Main Street • Municipal Building Jpf� Z Northampton, MA 01060 Sp11 INSPECTOR Louis Hasbrouck Fax:413-587-1272 Chuck Miller Building Commissioner Phone:413-587-1240 Assistant Commissioner CONSTRUCTION CONTROL DOCUMENT (For professional Englneers/Architects responsible for Entire Project) Project Title: ��� �, LS1 •r2k\Co Dater Project Location: 1�� �cM�C Map: Parcel: Zone: Scope of Project: �k�l -�.t� In accordance with the Eighth edition Massachusetts State Building Code,780 CMR Section 107.6: I Mass. Registration# 1 Being a registered professional Engineer/Architect hereby CERTIFIES that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: [ ] 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 10.7.6.2.2: 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 matter 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. MFR DA Signature and Sealpf liegistered Professional P r, No.31405 WILL ON, _Day of I�AAzl 20 k4 . . c (seal) OF ��� �F� z, �`�,'�'�y '`1�-�� F '� y r4 A S 3 � t y j}�c } '�? Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Y• Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Cooley Dickinson Hospital Pharmacy Renovation Date: 5/9/14 Property Address: 30 Locust Street,Northampton Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Renovation of various existing spaces. I, Alan K. Vanags, MA Registration Number: 49981 Expiration date: 6/30/2014,am a registered design professional, and hereby certify,to the best of my knowledge, information and belief,that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning`: Entire Project Architectural Structural Mechanical Fire Protection X Electrical Other: for the above named project and that 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 in accordance with the Professional Standard of Care, 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. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 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. The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods, sequences and procedures,and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the Code. 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'. Enter in the space to the right a"wet"or OF MAS�cG electronic signature and seal: C Phone number: (860) 286-9171 Email: alanv @bvhis.com +� .0�9, 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 10 09 2012—Draft modified by AIA MA Version 1.7 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 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT PA Q6 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 rO L L(VE �0 7�t �E- �U1�1 '�'-�1i��1►J as Own Authoriz gen ereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge an elief. Signed under the pains and penalties of perjury. Req y,~t,, 7-o)/ ve r Print�me Signatur of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: License Number Address Expiration Date Signature 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 0 No 0 Versionl.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: Not Applicable 0 Name(Registrant): ------- 4 00L- Registration Number Address -, Expiration Date Signs re Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility ---------------- 413e4 Address Registration Number —i g n Telephone Expiration Date Signet i A/ I Name Area of Responsibility sav Address Re Istration Number Signature Telephone Expiration Date Area of Responsibility Name ...... Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor n. W (04 Not Applicable I 6JI-Af ❑ Company Name: --------------- -------- Responsible In Charge of Construction ........... W4ef-v-LLW r"y Address Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: L: R: . Rear Building Height Bldg. Square Footage % Open Space Footage /o (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained 0 Obtained 0 , Date Issued: C. Do any signs exist on the property? YES NO 0 IF YES, describe size, type and location: D, Are there any proposed changes to or additions of signs intended for the property? YES 0 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 Q NO WIN IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSED SPACE Interior Alterations lj,/Existing Wall Signs ❑ Demolition❑ 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: A C F f NoVAT 1 v SECTION 5-USE GROUP AND CONSTRUCTION TYPE _7 USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 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 ❑ I Institutional 1-1 ❑ 1-2 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: 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: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING HEIGHT AND AREA OFFICE USE ONLY BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) 1 St 1St _ ,,., 2na-. 2"° 3rd y 3rd 4m Total Area(sf)_ _ Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: [Municipal 3 Sewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ ❑ On site disposal system E] Versionl.7 Commercial Building Permit May 15,2000 Department use only City of Northampton Status of Permit: Building Department Curb Cut/Driveway Permit - j 212 Main Street Sewer/Septic Availability [MAMA Y 16 2014 i?�I Room 100 Water/Well Availability iJ Northampton, MA 01060 Two Sets of Structural Plans E ctric,Rumbin ne 13-587-1240 Fax 413-587-1272 Plot/Site Plans NorthamptonMq 0 nspections 060 Other Spegfy 1 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 !.!Property Address- This section to be completed by office C L t>C TZ zM� Map Lot Unit N 'L T ��( M 4P'�' 0 °V )r ► � O(G Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: CSC L C V- N \� 5 t' L 3 Lo c i ,t- Name(Print) Current Mailing Address: JoWrr �— �y ,q2' 1 �i¢ �rFAC1 -1 =fZ5 x{ 13 ; a2. — ?-3 Signature Telephone 2.2 Authori d Agent: Name(Print) 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 I 9� (a)Building Permit Fee yO.� 2. Electrical (b)Estimated Total Cost of / 65• Construction from 6 3. Plumbing w 1HVAC Building Pennit Fee 4. Mechanical(HVAC) I cc 5.Fire Protection 1 / ,J-� 6. Total=0 +2+3+4+5) 7 Check Number .111 13 V This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date re;�•�P (� File#BP-2014-1231 APPLICANT/CONTACT PERSON TURNER CONSTRUCTION COMPANY ADDRESS/PHONE 50 WATERVIEW DR SUITE 220 SHELTON (203)712-6070 PROPERTY LOCATION 30 LOCUST ST � L 5`� MAP 23B PARCEL 046 001 ZONE M(99)/WP(21)/URB(l)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out � l Fee Paid Typeof Construction: RENOVATE PHARMACY New Construction Non Structural interior renovations Addition to Existing AccessM Structure Buildinp-Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFQItMATION 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 Commission Permit DPW Storm Water Management Demolition Delay Iq I 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. 30 LOCUST ST BP-2014-1231 GIs#: COMMONWEALTH OF MASSACHUSETTS MU:Block:23B-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Buildinq DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2014-1231 Project# JS-2014-002072 Est. Cost: $672742.00 Fee: $4038.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: TURNER CONSTRUCTION COMPANY_ Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M(99)/WP(21)/URB(l) Applicant: TURNER CONSTRUCTION COMPANY AT. 30 LOCUST ST Applicant Address: Phone: Insurance: 50 WATERVIEW DR SUITE 220 (203) 712-6070 SHELTONCT06484 ISSUED ON.61512014 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE PHARMACY 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 6/5/2014 0:00:00 $4038.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner