Loading...
25C-095 (39) 1.SYSTEM INSTALLATION TO WFOIN TO NFPA-13 9113 EDITION. 2 ONG 6 REM TO PAPAS HEAT 1Hi010WUT THE ENTIRE BLW111NG TO MAINTAIN MINIM 1 t t 1 71E OINT 610 EF Y�AIFD�1 ET FOR ALL AS AREAS PRO EC ED WITH S�� SYSTEM. -7YL 4-7.11 S MAN PIPING PIPING 6 DOS11NG TO REMAIN SOEDUE 10&a PIPING, E I E 1 E Qo-s o-t 114 Io l0 1 �E l BRALK3EINE PIPING 6 DISK TO ROW NEW THREW BWIpiNE WIND,ARMOYD6,AND DROPS/SPAKS TO NEW SPBIIDERS ARE BOO(SCHEDULE D WITH THEW ENDS AND BACK RTINGS ALL 'n 'olp xI� Ia 1 NEW PPIG TO HE S®PER THE COSTING BUM SCHEDULE S PIPING 5 10 BE SUPPORTED AS REWRED BY VA-13, HANGERS ARE TO BE FED LOCATED TO BEST SI PPORT THE PFE T —1'-714 �0-7Y� 3 t I Yo i C ESDDCDFDL LOA BFAReu ANALYSIS 6 NOT N0.WED wnWl Df SmPE OF THIS SPANaER `° 8 E yzl^ E I P y= 1. R^ ( 7.OW IS RWED TO SPRINGER WE ROM ON THIS GRAVING. ° a 1 Pl sPRIABFR SCtl'E 70 START AT 1N EASING MRII fWNG WIDWIL THIS SPACE 0-11Y1� 4 PENDENT MAO NE TO BE INSULLED VISUALLY SIRASIT AND ARE TO BE LOCATED N THE CENIFR Seal IM 4 x.o E 4 OF CEINC TIES+-1'. o4sCT-- y---r-- 9-611 --T -1th 24o7T —s4 t ____y___t�_ z 3 _ �v 1a NEYF PENDENT SPRIADEAS 10 W701 E10SING�INIaERs SYSTEM NOTES tP'�^^�, L BWDNG USE 6 cE1FR/1 OFFICE SP10E CPISiRUCTION 6 NONCOMBUSTIBLE. 1-1lyA� 0-BYI�J R �'•� R 2EA1STNG SISIETI IS DENG FOR LIGHT HAM OCCUPANCY PER NFPA-1S ALL 0 PANIC 6 OFF OF E I E I I N 11 C EASING OUTLETS AND OR EKING ALAN.WNITNI DEW SYSTEM PPE SCIEDUE 1 I 1 I I x1� xp �1° IF Nash cam Sim NOES I t 1 I 1 ALL COSTING PM CONTROL Wa1ES,ROW SYDM INSPECTORS TEST CONECIM DIVN CONNECTIONS,FIRE DEPARNENT 1" r-� P 2-� COHFCTOR&!NA N DEVICES SWll RYAN SCOPE 6 HWED TO MONOTNR6 INDICATED ON THIS DRANK 1 1 E 1 E 1?6 R 1?6 R 1 I I - I . il0 1 R !5 1^ d ISEE MMOVER PLAN) 1 i N 0 ao a in 1'X 11-2'NIPPLE I� 2' DROP (SEE PLAN) X10 I I G (1DUSTING ( OUTLET a CHANCE UegM R.I mNe an,In- I^ � t I PITTING IF REWIRED) -�1-X 1/2-R.G. 592 Dealer St—I- Po Bea 582 1 ludh.,Id 01056 2-0^�1 - ��PENDENT W/E9GT. AI}589-0672 I 3'-tE I TIE INTO EXISTING BRANCHLNE SUSPENDED muNC 11�pywlln e M ApGlf Or MGti R F.aFFCI014 MG AMr IH aE E i TYP. RETURN BEND ASSEMBLY Ilallilm.IIIGaT M IIPIESGO.'RIIDI COFltlMIF T91S ALL RGR9 E1a[kD i from EXISTING BRANCHLINE 1�1 D-9 Dale: 08-21-14 1 D S..).: 1/4'=1'-0' CENTER OF TILE 1/4 POINT CENTER OF TILE 1/2 POINT Contractor. SC-122479 o 711�-3--�� SOFFIT 9° BELOW CEILING I a o E E T P S TOO OO 1 k—z'-o" z'-D"—,I' o Io> 2 X 4 TILE OR 2 X 2 TILE o Q HEADS TO BE INSTALLED IN THE CENTER 1/4 POINT OR 1/2 POINT OF CEILING TILES AS INDICATED ABOVE. SPRINKLERS TO BE + - 1". L J FIRST FLOOR SPRINKLER PLAN TOP a GWP r9E111W RETANNG O SCALE: ° = I° A — I FLOOR ASSEMBLY NOT LESS THAN 2"NOMINAL WIOTH(1-1/21 o Z Z STW �IVZ Sprinkler Head Schedule WOOD JOISTS---_ Symbol ICount Thread K-Factor Sh Description Note Q. 6 1/2' 5.6 TYCO TM-8 S.6K 1/2 OR 155'CHROME RECESSED PENDENT an Drop Sheet iicle 8=Total Number of Heod.This Roar SPRINKLER PLAN J/8-AT.R FOR,--.-PPE _ 1/2'Ai.R FOR 8'-0'PPE ---- 'R NEW HEAD TO BE RELOCATED FROM IXISDNG OURfT _ ----�DENOTES DaSDNG PIPING AND HEAD TO R[IANN g CEILING SYSTEM FOR BR 2-1/Y FROM BOTTOM —NANCER RNC CE INSTALLED) SAMMY(CSI) FOR UM 2—DALES, O FROM DENOTES EXISTING SPRINKLER HEAD TO PLUG BOTTOM FOR MAINS. DENOTES CONNECT TO EXISTING � SDEWINDER(SWG) /— TOP BEAM LTN�A.T.R R RIND sh..1 I of I HANGER#1 SAMMY SUPER SCREW °GST" SAMMY "SWG" FP- 1 NaT TD 9naE WOOD JOIST WOOD JOIST 1011,11 11 MOOSED ^ IBC Chapter 7, section 704.2 "Column protection. Where columns are required to be fire-resistance rated, the entire column shall be provided individual encasement protection by protecting it on all sides for the full column length, including connections to other structural members, with materials having the required fire-resistance rating. Where the column extends through a ceiling,the encasement protection shall be continuous from the top of the foundation or floor/ceiling assembly below through the ceiling space to the top of the column." The column that is exposed will be encased in 5/8 in. type"X" gypsum wall board. From IBC table 1017.1, "Corridor Fire Resistance Rating,"the rating requirement for the walls in buildings classified as B with a sprinkler system is 0. IBC 1018.2 Corridor width. The minimum corridor width shall be as determined in Section 1005.1, but not less than 44 inches. Exception 2. Thirty-six inches with a required occupant capacity of less than 50. There are no changes to the number of exits planned as part of the project. The egress routes are essentially unchanged. Access. The offices fall under the Commercial Building section, Chapter 11. The first floor is generally accessible, except for the areas in the northwest corner designated as New Office #1, New Office#2, and New Corridor on drawing S2. These offices are used by staff members only and are not accessible to the public. Energy. There are no alterations to the exterior walls, doors, windows, etc. planned as part of this project. There are plans to alter the heating/cooling system, which will be addressed by others. Sincerely, Michael Rainville, P.E. Structural Support& Design Services c 236 S. Shirkshire Rd. Conway, MA 01341 � �ti�� 413-522-7771 r Page 3 The following codes are referenced herein: The International Building Code, IBC The International Existing Building Code, IEBC The Massachusetts Amendments to the above codes CMR 521 Architectural Access Board Rules The Massachusetts amendments eliminate Chapter 34 of the IBC and refer to the IEBC. This review excludes the requirements of the MA plumbing, electrical, and mechanical codes. The building is classified in Use Group B, Business. The building is of Type III B construction. The building is two stories and consists of approx. 4530 sq. ft. per floor. From IBC table 1004.1.1,the Occupancy Load is 100 sq. ft. per person (Business Areas),therefore, 46 persons. The building has an existing sprinkler system. The work is classified as Alterations. The Prescriptive Compliance Method was used for this review. The prescriptive Compliance Method requires that all new work complies with the IBC (303.1). "...Alterations shall be such that the existing building or structure is no less conforming to the provisions of the International Building Code than the existing building or structure was prior to the alteration." IEBC 303.3 "Existing structural elements carrying gravity load. Any existing gravity load-carrying structural element for which an alteration causes an increase in design gravity load of more than 5 percent shall be strengthened, supplemented, replaced or otherwise altered as needed to carry the increased gravity load required by the International Building Code for new structures.Any existing gravity load-carrying structural element whose gravity load-carrying capacity is decreased as part of the alteration shall be shown to have the capacity to resist the applicable design gravity loads required by the International Building Code for new structures." There are no additional loads gravity or lateral loads placed on the structure. The lintel over the new masonry wall opening was designed to meet the current code. IEBC 303.6 "Means of egress capacity factors. Alterations to any existing building or structure shall not be subject to the egress width factors in Section 1005.1 of the International Building Code for new construction in determining the minimum egress widths or the minimum number of exits in an existing building or structure. The minimum egress widths for the components of the means of egress shall be based on the means of egress width factors in the building code under which the building was constructed, and shall be considered as complying means of egress for any alteration if, in the opinion of the code official, they do not constitute a distinct hazard to life." The new layout complies with the egress width requirements of the IBC. From the IBC, Chapter 6, table 601 for Type III B construction interior non-bearing partition walls have a fire resistive rating requirement of 0 hours. Bearing interior partition walls are also have a required rating of 0 hours. Primary structural frame members' required rating is 0. Page 2 STRUCT02AL SUPP02T_. 0 0 ti & nCSf N SCQVICCS 236 S. SHIRSH12C RD. CONWAY, MR. 01341 413-522-7771 August 18, 2014 Mr. Jeff Dome Jeff Dome Design/Build 2 Fiske Mill Rd. Shelburne Falls,MA 01370 Subject: Chapter 34 Review Office Renovation Project 21 North St. Unit B Northampton, MA Dear Mr. Dome, I have reviewed the Massachusetts State Building Code for items relevant to the project that you are planning at the address listed above. The project consists of the following alterations to the existing building: 1. Demolition of several interior non-bearing partition walls (approx. 58 ft.) 2. Construction of several new interior non-bearing partition walls (approx. 40 ft.). 3. Create a new opening in an existing interior non-bearing partition wall (approx. 3.5 ft.) 4. Enclose two existing openings in interior non-bearing walls (approx. 7 ft.) 5. New masonry work to include the following: a. Remove existing transom window, saw-cut brick wall at sides of opening, and remove portion of wall beneath existing transom window. b. Saw-cut opening in existing brick wall, install lintel over opening, install new door frame in opening. 6. Two existing transom windows are to be re-located in interior non-bearing walls. 7. Four existing doors to be re-used in interior non-bearing partition walls. 8. Remove existing ramp, install a step to access corridor and offices. 9. New doors to be installed in non-bearing partition walls. 10. Modify existing drop ceiling to accommodate new layout. 11. Modifications to the existing electrical system. 12. Modifications to the existing Plumbing system. 13. Modifications to the existing Heating, Cooling and Ventilation systems. 14. Modifications to the existing Fire Suppression System. Page 1 City of Northampton mass achusetta A ' 1EPARZ211i:NT OF BUILDING INSPWTIONS f ' 212 Main Street a Municipal Building r \ Northampton, MA 01060 cyrr �•:i� INSPECTOR Louis Hasbrouck Fax:413-587-1272 Chuck Miller Building Commissioner Phone:413-587-1240 Assistant Commissioner SECONDARY CONSTRUCTION CONTROL DOCUMENT (For professional Enginsers/Architects responsible for a portion of a controlled project), Project Title: O'FJR LC- Q a o u FMas5 Date: -7- 2- &- /L/ Project Location: 2. 1 Q o d-Tu4 S-r Un-m -P N err A7 Map: Parcel: Zone: Scope of Project: /- AE/Tn �z r o.a-�A�r i o�s i2o o,a-s t %�Dw�o.+ W W,ilu'.)s In accordance with the Eighth edition Massachusetts State Building Code,780 CMR Section 107.6: I, M t CA+A 95 L�A 0 0, U'tj� Mass.Registration# N S 6&s- 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: [ ]Fire Protection [r]'Architectural [vfStructural [ ]Mechanical [ ]Electrical [ ]Other(specify) 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. Upon completion of the work,I shall submit to the building official a final report as to the satisfactory Completion of the above mentioned work. 1A OF Signature and Seal of Regist a Professional g° A41C o RAINW E cn -2741 C u N CIVIL 459195 9 _Day of_ vL _201_y '7/0NAt (Saw) City of Northampton 212 Main Street, Northampton, MA 01060 Solid Waste Disposal Affidavit In accordance of the provisions of MGL c 40, S54, I acknowledge that as a condition of the building permit all debris resulting from the construction activity governed by this Building Permit shall be disposed of in a properly licensed solid waste disposal facility, as defined by MGL c 111, S 150A. Address of the work: z o kb&TH ST . K) o2T fl o4 M P i o N The debris will be transported by: 1,..11 C K( CS i K UC </ The debris will be received by: F -b- G • t-J! A.)ASo/Z . C'T, Building permit number: Name of Permit Applicant t�j•'t_= �/ �c1 M cf Date Signature of Permit Applicant LEGAFIR-01 KWOOD ACORO �� CERTIFICATE OF LIABILITY INSURANCE DATE(MMroD1YYY1� 7/29/2014 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 BY THE 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: Mason&Mason Insurance Agency,Inc. PHONE 781 447-5531 aC,No: 781 447-7230 458 South Ave. AIC No Ext: Whitman,MA 02382 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Admiral 000074 INSURED INSURER B:Safety Indemnity 33618 Legacy Fire Protection,Inc. INSURER C:Star Insurance Company 000063 592 Center Street PO BOX 582 INSURER D Ludlow,MA 01056 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO 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 MAY BE 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 POLICY EFF POLI Y EXP LIMITS LTR IN SD WVD POLICY NUMBER MM/DDIYYYY MWDD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE FO R CLAIMS-MADE a OCCUR X CA00001654303 03/23/2014 03/2312015 PREMISES Ea occurrence $ 100,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- POLICY Fx]ECT 7 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B ANY AUTO 6222727 04/28/2014 04/2812015 BODILY INJURY(Per person) Is X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A X EXCESS LIAB CLAIMS-MADE EX00001412501 03/23/2014 03/23/2015 AGGREGATE $ 5,000,000 DED I I RETENTION$ Is PER FT WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER Y C ANY PROPRIETOR/PARTNER/EXECUTIVE a N/A WC0632089 0610312014 0610312015 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000, DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Project:211 North Street,Northampton,MA When required by written contract,Jeff Dome Design Build is an Additional Insured as respects general liability insurance for the ongoing and completed operations of the insured on behalf of the additional insured. Automatic additional insured status is only granted to the person or organization for whom the insured is performing work. In addition,there must be a written contract or agreement between the insured and the person or organization in which the insured agrees to name them as an additional insured. This SEE ATTACHED ACORD 101 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Jeff Dome Design Build ACCORDANCE WITH THE POLICY PROVISIONS. 2 Fiske Mill Road Shelburne,MA 01370 AUTHORIZED REPRESENTATIVE 2-, ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 0 DATE(MMIDDIYYYY) ,4coRO CERTIFICATE OF LIABILITY INSURANCE 07/21/2014 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 BY THE 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 03046-001 NAME CT Patrick M Shippee P.vc°NNO.Ell): (413)626-9437 nfc.No.: PO BOX 375 EMAIL Shelburne Falls,MA 01370 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 26158 INSURED Timothy Ballard INSURER B: INSURER C: 60 Glenbrook Drive Greenfield,MA 01301 INSURER D: INSURER E: I INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO 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 MAY BE 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 SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MMIDDIYYYY) (MMIDDIYYYY) GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea occurrence CLAIMS-MADE ❑OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ �EN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ POLICY ECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ '.fEa accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS �.NON-OVMIED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ T $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEC RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANNyy PRRppPRIETORIPgqRTNER/EXECUTIVE Y I N % E.L.EACH ACCIDENT $ 1,000,000,00 A OFFICER/MEMBER EXC U D? 7 N 1A AWC-400-7029744-2013A � 9/24/2013 9124/2014 ' - --- --- - - -- (Mandatory in NH) E .DISEASE-EA EMPLOYEE $_ 1,000,000.00 If es describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION Jeff Dome Dome Design&Build SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2 Fiske Mill Rd THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Shelburne,MA 01370 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents u W Office of Investigations w I Congress Street, Suite 100 Boston, MA 02114-2017 ^M S•� www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 7—EJcFR Ic y DOME 'D DA/ �OMF pF51 GN�I3y I C D Address: a F►Sl<e M l( t- g D SNf 8uaA)E City/State/Zip: 5 r 8 u/1 N .MP ,, o13 e) Phone #: Are you an employer? Check the appropriate bqx: Type of project(required): 1.❑ I am a employer with 4. ERrl am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6• F1 New construction 2.El 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 for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ 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' 131-1 Other comp. insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: 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 fine 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 fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy under the pains andpenalties ofperjury that the information provided above is true and correct. Si ature: �`r.� Date: Phone# 7 8 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#: 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 ® No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT V 4 C%�a_YUgheA t C E ) -�O W vl&orse (vie. as Owner of the subject property hereby authorize J�'� -TDOM:E to act on myybbehalf, inq all matters relative to work authorized by this building permit application. �- Signature of Owner Date I, ��r FR��� 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 th ains a penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: _-ITFFRFy d Mt License Number 2 F)Sl�t l ►� cc /2f� -5WEI ILA A)&, MAQ 01370 C q3)0 -�q Addre Expiration Date Signa ure Telephone L__T 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 No 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 36,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): M CNAC-L A101jLU- ST 2uG-rujz6 Name Area of Responsibility Z3(w S. St•+le.t-s0tZ6 (2-0. C11a..jA7, IM A Z-/ 5-6 85' Address /} Registration Number =A'r.� ��u.. i�-S zz-7'1 71 b - 3 a -1 6 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 T,>orrlC-- p cs/wy d v i c D Not Applicable❑ Company Name: TEFFRC)l 12orlc Responsible In Charge f Construction Lion F/S k C Add C> 3vN�a 12 0 Sig re Telephone Versionl.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 0.7 Ac lei 4 92 Frontage Z s z 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) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO ® DONT KNOW & YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DONT KNOW ® YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 9 DONT KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained ® Obtained O , 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 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 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 ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Build Exterior Alteration E3 Existing Ground Sign El New Signs❑ Roofing El Change of Use El Other❑ Brief Description Enter a brief description here. FLOo/t #444N !9 t,TFiQ4TtoN.S/ rivC4 bDI Of Proposed Work: tj j,=-C NRN f C4 j, -b 4 1 FC SAF FT y c"ANGES -ro su; PoAT rc ao q Pc ij SECTION 5-USE GROUP AND CONSTRUCTION TYPE 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 Nr 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 St If-950 1 St 2nd 2nd 3rd 3rd 4 t 4th Total Area(sf) Total Proposed New Construction(sf) Total Height(ft) Total Height ft 7.Water jupply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage isposal System: Public ® Private ❑ Zone Outside Flood Zone❑ Municipal Eg On site disposal system[-] \ 'e . Versionl.7 Commercial Buildin Permit May 15,2000 Department use only City of Northampton Status of Permit: f building Department Curb Cut/Driveway Permit - \`, " ` o \212 Main Street Sewer/Septic Availability Room 100 Water/Well Availability Northampton, MA 01060 Two Sets of Structural Plans phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans �. Other Specify 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 1.1 Property Address: This section to be completed by office g I I o/�T f- S 1 Map Lot Unit K6 R,T H j M f'�Tjv A), kj A Zone Overlay District �� -" ""' )q 4 `� Elm St.District CB District X SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: 1N Mhayse- I MN i lv c' ell NO<YA AAA Name(Print) Current Mailing Address: ,- (-13) '`✓?6-0207 'X kC)G OV k1O"Z Signature ceo Telephone 2.2 Authorized Aaent: 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 C7 2 J (a)Building Permit Fee 2. Electrical �S C, (b)Estimated Total Cost of Construction from 6 3. Plumbing /q Building Permit Fee 4. Mechanical(HVAC) $ g I 5. Fire Protection coo 6. Tot -(1 +2+3+4+5) 71, `&-5- 1 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0138 APPLICANT/CONTACT PERSON JEFFREY DOME ADDRESS/PHONE 2 Fiske Mill Rd SHELBURNE (413)834-2278 Q PROPERTY LOCATION 211 NORTH ST-UNIT A&B MAP 25C PARCEL 095 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvpeof Construction: RENOVATE OFFICES-UNIT A&B New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 043099 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOORIMM*nON 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 Commission Permit DPW Storm Water Management 0 ­ elay Signature of Building OfficiaF 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. 211 NORTH ST-UNIT A&B BP-2015-0138 GIS#: COMMONWEALTH OF MASSACHUSETTS Map-Block:25C-095 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Categorv: renovation BUILDING PERMIT Permit# BP-2015-0138 Project# JS-2015-000245 Est. Cost: $67985.00 Fee: $407.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: JEFFREY DOME 043099 Lot Size(sa. ft.): 8189.28 Owner: WINDHORSE ASSOCIATES Zoning: URB Applicant: JEFFREY DOME AT. 211 NORTH ST - UNIT A & B Applicant Address: Phone: Insurance: 2 Fiske Mill Rd (413) 834-2278 () SHELBURNEMA01370 ISSUED ON.812-112014 0:00:00 T TO PERFORM THE FOLLOWING WORK.-RENOVATE OFFICES - UNIT A & B 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 8/21/2014 0:00:00 $407.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner