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23B-046 (248) City of Northampton Mail-RE: CDH Emergency Department fire sprin... https://mail.google.corn/mailiu'O/?ui=2&i1--3921 1afc3d&view=pt&se... City j Bi Of Charles Miller<cmiller northam tonma. ov> r RE: CDH Emergency Department fire sprinkler shop drawing 1 message Larry Therrien<Itherrien @northamptonma.gov> Thu, Jul 16, 2015 at 7:40 AM To: Charles Miller<cmiller @northamptonma.gov> I don't see any issues. Larry From:Charles Miller[mailto:cmiller @northamptonma.gov] Sent:Thursday,July 09, 2015 4:27 PM To:Fire Prevention Cc: Louis Hasbrouck Subject:Fwd:CDH Emergency Department fire sprinkler shop drawing Hi Larry, These are sprinkler drawing for the CDH ER could you review and let me know? Thanks, Chuck Miller ----------Forwarded message---------- From:Joseph Misterka<jmisterka @hampshirefirellc.com> Date:Thu,Jul 9,2015 at 3:58 PM Subject: CDH Emergency Department fire sprinkler shop drawing To: "cmiller @northamptonma.gov"<cmiller @northamptonma.gov> Cc: Eric Hockenberry<EHockenberry @hampshi ref i relic.com> Mr. Miller, Per your request I have attached a copy of sprinkler shop drawings for a renovation in the Cooley Dickinson Emergency Department. Regards, Joseph Misterka Designer Hampshire Fire Protection LLC 507 Southampton Rd Westfield, MA 01085 0:413-642-3287 F:413-642-3792 www.hampshirefirellc.com 1 of 7/17/2015 10:23 AM D E "'91 2015 Fire Protection LLC Plum! ,c z "-1 AElectric, th .i QI s QI Hampshire Fire Protection LLC Date: 5/27/15 507 Southampton Rd Westfield,MAO 108 5 Tele: (413)642-3287 Fax: (413)642-3792 Job Number: 0197CMA Job Name: Cooley Dickinson-ED Send to: Northampton Building Dept. 212 Main St Northampton, MA Attention: Building Dept. Transmitted via: ❑US Mail ❑UPS ❑FedEx ❑Next Day ®Hand ❑Via separate cover ❑Fax: The following items: ❑ Shop drawings ❑Prints ❑ Calculations ❑Change Order❑ Samples ❑ Specifications ❑Copy of letter ❑Eq. Submittal ❑ Quantity Date Description 3 6/25/15 FP Shop Drawings—FP 1 1 7/1/15 Sprinkler Permit Application 1 7/1/15 WC Affidavit 1 7/1/15 Permit Fee Check-$35.00 Transmitted for: ®Approval ❑Your use ❑As requested ❑Review&comment ®Permit ❑Record ❑ Coordination ❑ Quotation Notes: Copy to: VJ J. U�. President If enclosures are not as noted,kindly notify us at once. ® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12/23/2014 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). CONT PRODUCER NAMEACT Renee Skillings THE ROWLEY AGENCY INC. PHONE (603)224-2562 FAX N : (603)224-6012 139 Loudon Road ADDRIE :rskillings @rowleyagency.com P.O. BOX 511 INSURERS AFFORDING COVERAGE NAIC# Concord NH 03302-0511 INSURER AAmTrust Int'1 Underwriters Ltd 0010 INSURED INSURERB:Allmerica Financial Benefits 41840 Hampshire Fire Protection, LLC INSURERCA.I.M. Mutual Insurance Co. 507 Southampton Rd. INSURERD:Hanover Insurance Co. 22292 INSURERE:Wesco Insurance Co. Westfield MA 01085 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 Master 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 POLICY NUMBER MMIDDIYYYY (M GENERAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence $ A CLAIMS-MADE ❑X OCCUR PAL104190802 1/1/2015 1/1/2016 MED EXP(Any one person) $ 5,000 X Contractual per CG0001 PERSONAL&ADV INJURY $ 1,000,000 X $2,500 BI/PD Ded - OCc GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,0001 POLICY X PRO LOC $ AUTOMOBILE LIABILITY EE .d.",SINGLELIMIT 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED WV 9412142 03 1/1/2015 1/1/2016 BODILYINJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS I AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 E EXCESS LIAB CLAIMS-MADE B01012015 1/1/2015 1/1/2016 AGGREGATE $ 5,000,000 DED X RETENTION$ 10,00 $ C WORKERS COMPENSATION X WC STATU- O FIR CRY AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 001012015 E.I_.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? NIA 3A: MA/CT 1/1/2015 1/1/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D LEASED/RENTED EQUIPMENT RHV 9412144 03 1/1/2015 1/1/2016 LIMIT 50,000 INSTALLATION FLOATER LIMIT 50,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. For Permit purposes only AUTHORIZED REPRESENTATIVE C Holman, CPCU, CIC/H ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INSn25/,)mnnFlni Tho Ar r1Rr1 nmmn and Inn^arc ranicfornrl marts^f ACr1Rr1 1111( The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Nye(Business/Organization/Individual):H��t/l N) (r "M (2v? Q'jaG 1 L OIJ L�—G Address: r✓'07 soz�Tl-1�4 yy�Ir7TaJ �O City/State/Zip: rr4f ( Phone #: �(3 • t`s2�2 3287 Are you an employer?Check the appropriate box: Type of project(required): 1.( , I am a employer with__lb 4. E) I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling ship and have no employees These sub-contractors have g. []Demolition working or me in an capacity. employees and have workers' g Y P tY• # 9. []Building addition [No workers'comp. insurance comp. insurance. required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12T0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also fill 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: Y1n . (�'f(�p,(_ DNS. Policy#or Self-ins.Lic.#: /`a ���Eu C,o.T_ Expiration Date:_ 11nnAA Job Site Address: 'So LDGc)-sq- �� City/State/Zip:` Yrl 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 D A for insurance coverage verification. I do hereby certify un er t pains and penke f p a ry that the information provided above is true and correct. Si natu 1A Date: Phone#: �3 ' (P q2— 32.8q Official use only. Do not write in this area,to be completed by city or town official City or Town: PITTSFIELD Permit/License# Issuing Authority: Building Department Contact Person: Phone#: (413)499-9440 COLt E9f�B ko,id 2 P s WesMet-d SO. �•..y��♦�TC/yy�lsis��C3 y��°T. 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 0 SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT _, 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 William J. Rhodes 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 penury. Print N e TA 07/01/2015 Signa a of wner/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 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 35,000 C.F. OF ENCLOSED SPACE) 9.1 Registered Architect: Boston, MA Not Applicable ❑ Name(Registrant): Boston, MA Registration Number Address (617) 772-0260 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Hampshire Fire Protection LLC Name Area of Responsibility 507 Sout am ton Rd Westfiel MA 01085 SC 105360 Addres Registration Number (413) 642-3287 05/10/2016 —Sign Kure- 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 Raymond R Houle Construction Inc. Not Applicable ❑ Company Name: Ryan Pelletier Responsible In Charge of Construction 5 Miller St Ludlow, MA 01056 Address (413) 547-2500 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 Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved parking) #of Parking S aces Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DON'T KNOW YES 0 IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO ® DON'T KNOW 0 YES 0 IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO � DON'T KNOW Q YES 0 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 0 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 Q NO 0 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 0 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 Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing El Change of Use❑ Other ❑ Brief Description Renovations to the existing wet sprinkler system as per HFP drawing FP I, dated 6/25/15 Of Proposed Work: 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 Hi h Hazard ❑ 3A ❑ 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 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1st 1st 2nd 2nd 3 rd 3rd 4th 4 m 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: 7 ewage Disposal System: Public ❑ Private ❑ Zone Outside Flood Zone❑ Municipal ❑ On site disposal system❑ Versionl.7 Commercial Building Permit May 15,2000 Department use only Ity of Northampton Status of Permit: uilding Department Curb Cut/Driveway Permit lg)g L� j 212 Main Street Sewer/Septic AvailabilitRoom 100 Water/Well Availability ampton, MA 01060 Two Sets of Stru ctural Plans 7-1240 Fax 413-587-1272 Plot/Site Plans Other Specify AP 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 Cooley Dickinson Hospital Map Lot Unit ED Renovations Zone Overlay District 30 Locust St Elm St.District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: unknown Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: William J. Rhodes 507 Southampton Rd Westfield, MAO 1085 Name(Print) Current Mailing Address: (413) 642-3287 Signature Tel SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee $35.00 2. Electrical (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical(HVAC) $35.00 5. Fire Protection $5,300.00 6. Total =0 +2+3+4+5) Check Number SCr3 This Section For Official Use Only Building Permit Number Date Issued J 1 Signature: Building Commissioner/Inspector of Buildings Date File#BP-2016-0046 APPLICANT/CONTACT PERSON HAMPSHIRE FIRE PROTECTION LLC ADDRESS/PHONE 507 SOUTHAMPTON RD WESTFIELD01085(413)642-3287 PROPERTY LOCATION 30 LOCUST ST MAP 23B PARCEL 046 001 ZONE M(99)/WP(21)/URB(1)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tyueof Construction: RENOVATE SPRINKLER SYSTEM-EMERGENCY ROOM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildinp,Plans Included: Owner/Statement or License 105360 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFOIJRMATION 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 De y Si ature 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-2016-0046 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.Block: 23B-046 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category:renovation BUILDING PERMIT Permit# BP-2016-0046 Proiect# JS-2015-001973 Est. Cost: $5300.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: HAMPSHIRE FIRE PROTECTION LLC 105360 Lot Size(sg. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M(99)/WP(21)/URB(1)/ Applicant. HAMPSHIRE FIRE PROTECTION LLC AT. 30 LOCUST ST Applicant Address: Phone: Insurance: 507 SOUTHAMPTON RD (413) 642-3287 WC WESTFIELDMA01085 ISSUED ON 711712015 0:00:00 TO PERFORM THE FOLLOWING WORK:RENOVATE SPRINKLER SYSTEM - EMERGENCY ROOM 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 7/17/2015 0:00:00 $100.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner