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38A-110 (4) Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-042190 ` THOMAS RANDEJLL 392 ROCHDALE ST AUBURN MA 017501 Expiration commissioner 0313112016 Initial Construction Control Document H To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the V Massachusetts State Building Code, 780 CMR, Section 107 Project Title: The Residences at Christopher Heights Date: 8-26-14 Property Address: Village Hill,Northampton, MA 01060 Project: Check (x)one or both as applicable:New construction X Existing Construction Project description: Building Renovations I Robert McClanaghan MA Registration Number: 34457 Expiration date: 6-30-16 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection X Electric X Other:Fire Alarm 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 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 Document'. Enter in the space to the right a"wet"or �'�SM OF electronic signature and seal: a M Phone number:401-739-2224 Email: rwm @rwmengineering.comFQt S1tiP4 '�ONAt E� 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 Initial Construction Control Document W To be submitted with the building permit application by a W Registered Design Professional A< for work per the 8th edition of the °�M SYe�e Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Christopher Heights Date:September 2,2014 Property Address: Northampton,Ma. Project: Check(x) one or both as applicable: x New construction Existing Construction Project description: HVAC I Richard R. Faella MA Registration Number: 27449M Expiration date: June 30,2016 , 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 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 '•ofessional 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 Document'. Enter in the space to the right a"wet"or �,� Crw p Q electronic signature and seal: RICHARD C3 R. i-ALU A r �� to No. 274!!9 Phone number: 1-508-757-7429 Email: RFAELLA @JJBAFARO.COM 0 a<s AL 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 •► 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 °r Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title:Residence at Christopher Heights Date:9/1/14 Property Address: The Residence at Christopher Heights,Northampton,MA Project: Check(x)one or both as applicable:X New construction X Existing Construction Project description: Instalation of Automatic Sprinklers I Scott Henderson MA Registration Number:46553 Expiration date:6/30/16 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Entire Project Architectural Structural 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 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. 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'. Scott D. Henderson p F � Enter in the space to the right a"wet"or s c, electronic signature and seal: 201 4.09.02 Legacy Fire Protection '00'04- 11 :14:25 Phone number:(413)221-3399 Email: scott_henderson @charter.net 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. Trial Version 10 09 2012 Initial Construction Control Document To be submitted with the building permit application by a OW Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: The Residences at Christopher Heights Date:9/2/14 Property Address: Village Hill Drive,Northampton,MA 01060 Project: Check(x)one or both as applicable: X New construction Existing Construction Project description: Non-separated mixed use assisted living facility. I, Thomas E. Lamb, MA Registration Number: 49045 Expiration date: 06/30/16,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural X 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: 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 Document'. OF iygss Enter in the space to the right a"wet"or ��� THOMAS 9cti electronic signature and seal: E. R, IJIMB O STRUCTURAL co No.49045 Phone number: 603 472-4488 Email: tlamb@tfmoran.com FSO`S Ea�� number: (603) @ S�ONAL Building Official Use Only Building Official Name: Permit No.: Date: ,Vote 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 Initial Construction Control Document To be submitted with the building permit application by a T � 2 A Registered Design Professional r for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: The Residences at Christopher Heights Date:9/2/14 Property Address: Village Hill Drive,Northampton, Massachusetts Project: Check(x)one or both as applicable: x New construction Existing Construction Project description: 83 Bed Assisted Living Facility I Clay B. Smook MA Registration Number: 7976 Expiration date: 8/31/15 ,am a registered design professional, and 1 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: 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 Document'. Enter in the space to the right a"wet" or electronic signature and seal: tn No, i`it Phone number: 617-423-3040 Email: clay @smookarchitecture.c )'h OF 0�Sg� Building Official Use Only ilding 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 I 1 2013 ® CERTIFICATE OF LIABILITY INSURANCE 112/212013 DATE DIYYYY) ACORO 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 PRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. PORTANT: 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 CONTAC — NAME: Christina Alliant Insurance Services, Inc., ni"N :617-53 -720 FAX No: 17- -72 131 Oliver Street,4th Floor E-MAIL. :c'ae er alliant.com Boston MA 02110 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Z rich American In ur n m 1 INSURED INSURERB:Indlarl Harbor Insurance Corn an 6940 Cutler Associates, Inc. INSURERC:National Union Fire Ins Co Pittsbur 19445 43 Harvard Street INSURER D: Worcester, MA 01609 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER:774057728 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 ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY GL09805130-02 12/1/2013 2/1/2014 EACH OCCURRENCE $2,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $300,000 CLAIMS-MADE � OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4,000,000 POLICY X PRO- X LOC $COMBINED SINGLE LIMI I UTOMOBILE LIABILITY BAP9805131-02 12/1/2013 2/1/2014 Ea accident $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE JE X HIRED AUTOS X NON-OWNED Per accident $ C X I UMBRELLA LIAR X OCCUR BE 013829236 12/1/2013 2/1/2014 EACH OCCURRENCE $25,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $25,000,000 —TIED I X I RETENTION$0 1 $ A WORKERS COMPENSATION C9805132-02 12/1/2013 2/1/2014 X WC STATU- ER AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED9 E.L.DISEASE-EA EMPLOYE $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below B Pollution&Professional PECO039315 12/1/2013 2/1/2014 Each Occurrence $3,000,000 Aggregate $3,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cutler Associates, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 43 Harvard Street Worcester, MA 01609 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1 ne uommonweatrn of ivlassacnuserrs Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 T Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Inc. Name (Business/Organization/Individual): Cutler Associates, _ Address: 43 Harvard St. City/State/Zip:Worcester, MA 01609 Phone #: 508-757-7500 Are you an employer? Check the appropriate box: Type of project (required): 1.Q I am a employer with 80 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 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 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 10.0 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' 13T] Other comp. insurance required.] * "'pplicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. fi I-, ieewners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 ani an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Zurich American Ins. Co. Policy# or Self-ins. Lie. #:WC980513202 Expiration Date: 12-1-14 Job Site Address: Village Hill Drive City/State/Zip: Northampton, MA 01060 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 certify under lie a'ns and penalties of perjury that the information provided above is true and correct. Si nature: Date:08/21/2014 Phone#: 508757-7500 Official use only. Do not write in this area, to be completed by city or town official. uity 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 0 No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, _,..W,y� n�►!1 _ ..... _...... _... ..... ... ..... . as Owner of the subject property Cutler Associates,Inc hereby authorize ...,. ._.. _._._.. _.. to act y be f, in all matters relative to work authorized by this building permit application. Signature o er Date Scott Garon I, L _ _11 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 Name, � _ ._ �., - ..; /vA(� 09/03/2014 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Thomas Randeel CSO42190 Name of License Holder . License e Number 392 Rochdale Street,Auburn, MA 01501 £03/21/2016 Addres Expiration Date 508 �( ) 509-2534 Signature Telephone SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6)) _T 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 Q Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO ONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 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): R U C- VZ \' c, i` r TG H 1 p t-�,b I"t ✓3 M G Name Area of Responsibility l I LA E zt. K <.-r. us r ,.,c C—.1 l�--t,o Z $1 g S6 Address Registration Number 1,11-$16�1coo) (. • O - ZGl (� 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 .LAddress OWN- Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO ONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Not Applicable ❑ ;Smook Architecture&Urban Design, Inc. .�. ._ . _w, �w.____ .w _ ; 7976 Name(Registrant) Smook Architec &Urban Design, Inc. Address _..,__.... (617)423-3040 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): 1F Moran Inc. Structural ....._ . _..,._... .a, _ �_... . _. .... .. Name Area of Responsibility '48 Constitution Drive,Bedford,NH 03110 'i49045 Address Registration Number ,(603)472-4488 , ;06/30/2016 Sign ure Telephone Expiration Date :Beals+Thomas Civil Name Area of Responsibility 144 Turnpike Road, Southborough,MA 01772 49337 Address Registration Number (508) 366-0560 ,06/30/2016 Signature Telephone Expiration Date .Legacy Fire Protection, Inc 'Fire Protection Name Area of Responsibility 592 Center Street, Ludlow,MA 01506 46553 Address Registration Number `(413) 589-0672 Signature Telephone Expiration Date J. J. Bafaro Inc. HVAC Name Area of Responsibility, :P.O. Box 943,Worcester,MA 01613 27449M { Address Registration Number (508) 757-7429 06/30/2016 Signature Telephone Expiration Date 9.3 General Contractor Cutler Associates,Inc. Not Applicable ❑ Company Name: ,Scott Garon Responsible In Charge of Construction 43 Harvard Street,Worcester,MA 01609 dress (508)757-7500 Signature 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 1„11,,700.SF,.• 111,,701„SF__....••. Frontage 553.07' : .120.0'. ....... _. . _.... Setbacks Front N/A_ry L. N/A' R N%A Side L. .. ..-. .l._ �.__. R..13,1'. 77 Rear _.2' _.._. . Building Height N/A_111 3,std �.. Bldg.Square Footage % o 0 .54 (6 48 Open Space Footage _, (Lot area minus bldg&paved N/A NSA, parking) #of Parking Spaces Fill: volume&Location __.._5,6Q6t CY p:.__.___.. ..._._...... r A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued 03/06/2009 IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book 9957 Page; 56 and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW Q YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained Q , Date Issued C. Do any signs exist on the property? YES Q NO 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 Q IF YES, describe size, type and location: New Site Entrance Sign 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 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 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 Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing Change of Use❑ Other❑ Brief Description Enter a brief description here. S t, avo S�" ass;s���� L,�;rJ �� << 1 Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑0 A-1 El A-2 ❑ A-3 1A ED A-4 ❑ A-5 ❑ 1B ❑ B Business 0 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ 1-2 ❑ 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential R-1 ❑ R-2 R1 R-3 ❑ 5A ❑ S Storage S-1 ❑Q S-2 ❑ 5B ❑ U Utility ❑ Specify: Mixed use pj Specify: Non-separated mixed use assisted living_facility a S Special Use E3 Specify. COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE Existing Use Group: _,,. .. .-__._._. .. ..... ._ i Proposed Use Group: Existing Hazard Index 780 CMR 34) . ..... .. ....... Proposed Hazard Index 780 CMR SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) St St 5,069- 2nd 17,486 2nd _._ 3rd 17,062 3rd ------ 4th 179062 4th Total Area(sf) Total Proposed New Construction(sf) _.. 56,679 Total Height(ft) 43 Total Height ft „ 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone,Information: 7.3 Sewage Disposal System: Public ❑✓ Private ❑ Zone, Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Ci y of Northampton Stable f�rni `k - SEp — Q 2014 L ilding Department 3 12 Main Street •,' A Electric, Plumbing&G N.ctions Room 100 1Nat ttl b A ii� Northampton. rt�� ,��� ampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 t� E� 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 5 Village Hill Hriwe Map ' Lot p Q unit Northampton,MA 01060 Zone Overlay District _, ____. .....__.,,...... ___._.. Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Northampton Heights ALF LP ;C/O The Grantham Group, LLC Name(Pmt) Q` Current Mailing Address ,( 08) 281-8001 eLS ignature Telephone 2.2 Authorized Agent: Scott Garon 43 Harvard Street,Worcester, MA 01609 Name(Print) Current Mailing Address 508)e 757-7500 Signature Telephone . _ ._ ..... _.__....... ... .. . .. ....._ SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $5,628 126.00: (a) Building Permit Fee 2. Electrical $929,000.001 (b)Estimated Total Cost of Construction from 6 3. Plumbing $780,730.001' Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection $1,011,629.00: 6. Total=(1 +2+3+4+5) )11 1 Lit,i3 Check Number v This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0262 APPLICANT/CONTACT PERSON CUTLER ASSOCIATES INC ADDRESS/PHONE 43 HARVARD ST WORCESTER (508)757-7500 or— PROPERTY LOCATION 50 VILLAGE HILL RD MAP 38A PARCEL 110 001 ZONE PV000)/SG b(100) THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 99t F Building Permit Filled out Fee Paid Typeof Construction: CONSTRUCT 3 STORY 56,000 SO FT ASSISTED LIVING FACILITY New Construction Pti6S_4_a E2!A1JDA EIVrI 28 ND 5fJFL-L. Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 042190 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: V 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 Signatu of Building Officla 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. 50 VILLAGE HILL RD BP-2015-0262 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 38A- 110 CITY OF NORTHAMPTON Lot:-001 Permit: BUi[g lM Category:NEW COMMERCIAL BUILDING BUILDING PERMIT Permit# BP-2015-0262 Project# JS-2015-000499 Est.Cost: $8349485.00 Fee:$16543.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: CUTLER ASSOCIATES INC 042190 Lot Size(sq.ft.): 14810.40 Owner: NORTHAMPTON HEIGHTS ALF LP Zoning: PV000)/SG b(I00)/ Applicant: CUTLER ASSOCIATES INC AT. 50 VILLAGE HILL RD Applicant Address: Phone: Insurance: 43 HARVARD ST (508)757-7500 WC WORCESTERMA01609 ISSUED ON.911912014 0:00:00 TO PERFORM THE FOLLOWING WORK. CONSTRUCT 3 STORY 56,000 SQ FT ASSISTED LIVING FACILITY Phased Approval Foundation and shell 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 9/19/2014 0:00:00 $16543.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 - Louis Hasbrouck-Building Commissioner