Loading...
23B-046 (258) The project scope does not include new equipment requiring local exhaust. Section 710 Plumbing 710.1 Minimum fixtures Because the occupant load of the project work area story shall not be increased more than 20 percent, existing plumbing fixture quantities are not required to be modified. Section 711 Energy Conservation 711.1 Minimum requirements Level 2 Alterations to existing buildings or structures are permitted without requiring the entire building or structure to comply with the energy requirements of the International Energy Conservation Code or international Residential Code. The alterations do not affect any components related to energy requirements of the International Energy Conservation Code, with the exception of new energy efficient light fixtures,. END OF EXISTING CONDITIONS REVIEW REPORT Uothic`trf.o'Suite 1,Nort;3.:nIptol1, 0 ii6O +_.E � .3 ( t.a�•11:,.ti,,.;'�� of Massachusetts Building Code 780 CMR 8th Edition Section 605 and 706 and Massachusetts Architectural Access Board 521 CMR. All newly built components of the project shall be in compliance with Massachusetts Architectural Access Board 521 CMR. Section 707 Structural The existing structural system consists of concrete and steel floor decking and steel beams supported by steel columns. The scope of this project work area does not affect any existing structural systems, nor does it affect applied loads on existing structural systems. Section 708 Electrical 708.1 New Installations New electrical work is limited to several new convenience outlets in new partitions connected to existing distribution circuits 708.2 Existing Installations A2-Assembly occupancy does not apply 708.3 Residential occupancies A2-Assembly occupancy does not apply Section 709 Mechanical 709.1 Reconfigured or converted spaces The existing HVAC ductwork serving the spaces will be rebalanced based on the new configuration. 709.2 Altered existing systems The existing HVAC ductwork serving the spaces will be rebalanced based on the new configuration. 709.3 Local exhaust t14 c;o iic Stmt,Suitt., I, MA11io,gI �,.-�.�h;��.l=i�' ta5•l 1. MW 705.4.4 Panic hardware Existing exit doors have panic hardware and remain unchanged by this project. 705.5.5.1 Corridor doors There are no new corridor doors in the project area. 705.5.5.2 Transoms This section only applies to 1-1, R-1, and R-2 occupancies. 705.5.5.3 Other corridor openings There are no other openings in corridor walls within the project work area. 705.6 Dead end corridors There are no dead end corridors within the project work area. 705.7 means of egress lighting Existing, compliant, and unchanged. 705.8 Exit signs The existing exit signs remain unchanged by this project. 705.9 Handrails Not applicable 705.10 Guards Not applicable Section 706 Accessibility In accordance with Massachusetts Architectural Access Board 521 CMR, because the project construction cost is less than $100,000.00 and is less than 30% of the replacement cost for the entire building, only new work within the project work area is not required to conform to the requirements u3ittrzl'i: t _ ',. An approved automatic fire protection system exists throughout the story on which the project work area is located therefore corridor wall ratings are allowed to be reduced to zero. 704.2 Automatic sprinkler systems An approved automatic fire protection system exists throughout the story on which the project work area is located. There is no fire protection work in the project scope. 704.3 Standpipes Because the project work area is not on a level more than 50 feet above or below the lowest level of fire department access, this section does not apply. 704.4 Fire alarm and detection A fire alarm system, compliant with the International Fire Code, exists within the building. The detection consists of sprinkler flow sensors, space smoke detectors, space heat detectors, and duct smoke detectors. Notification consists of horn and strobe devices. The project does not include any fire alarm scope. Section 705 Means of Egress The existing and new egress requirements within the project work area are compliant with Massachusetts Building Code 780 CMR 8th Edition and NFPA Life Safety Code 101. 705.3 Number of Exits: Two exits exist serving the project area and shall remain unchanged by this project. 705.4.2 Egress doorways - door swing Existing exit doors swing in the direction of travel and remain unchanged by this project. 705.4.3 Egress doorways - door closing The existing exit doors have door closers and remain unchanged by this project. t,{il�ic stait,.> I,A t.3.a not„n,MA 0,114 O ::'.�� .I�i= ,�ati 4 13,5 45 1 ALTERATIONS LEVEL 2 Section 701 General This project work area will comply with all requirements for Alteration Level 1 as specified in Chapter 6 and all requirements of Level 2 as specified in Chapter 7. No portion of the proposed project work area alters the existing conditions such that the building will become less safe than its existing condition. Requirements regarding flood hazard areas are not applicable to this project Section 702 Special Use and Occupancy Not applicable. Section 703 Building Elements and Materials 703.2 Vertical Openings No new or existing vertical floor openings are within the project work area. 703.3 Smoke barriers This section applies to 1-2 occupancies on stories used for sleeping rooms and therefore does not apply to this project. 703.4 Interior finishes All new interior finishes, including wall, ceiling, floor, and trim materials to be installed under this project work area will comply with Massachusetts Building Code 780 CMR 8th Edition. 703.5 Guards There are no existing non-compliant guards within the project work area or in the means of egress from the project work area to exit discharge and no new guards in the project scope. Section 704 Fire Protection 704.1.1 Corridor ratings CLASSIFICATION OF WORK The proposed project work area is classified as Alteration - Level 2 per IEBC Section 404 and therefore complies with the provisions of Chapter 6 and Chapter 7 for the following reasons: - The project is not a repair, therefore IEBC Section 402 does not apply - The project exceeds the limitations defined under Level 1 Alterations as specified in IEBC Section 403: Level 1 alterations include the removal and replacement or the covering of existing materials, elements, equipment, or fixtures using new materials, elements, equipment, or fixtures that serve the same purpose. - The project meets the limitations defined under Level 2 Alterations as specified in IEBC Section 404: Level 2 alterations include the reconfiguration of space, the addition or elimination of any door or window, the reconfiguration or extension of any system, or the installation of any additional equipment. - The project is below the threshold triggering Level 3 Alterations as specified in IEBC Section 404: Level 3 alterations apply where the work area exceeds 50 percent of the aggregate area of the building. - The project does not involve a change of occupancy, therefore IEBC Section 406 does not apply. - The project does not involve an addition, therefore IEBC Section 407 does not apply. - The project does not impact the exterior or substantial interior configuration of a historic building, therefore IEBC Section 408 does not apply. - The project does not involve a relocated building, therefore IEBC Section 409 does not apply. E,4 Gothi(`�trwt,.4a.itx, 1, Lr'4'1:3. i '14 i tits..-i .ft.airrc`}3�e:.t:cc:.rr?;a GENERAL EXISTING PROPERTY INFORMATION A. PROPERTY NAME: Cooley Dickinson Hospital B. ADDRESS: 30 Locust Street, Northampton, MA 01060 C. BUILDING USE: The building is currently a mixed use occupancy with A2-Assembly, 13- Business and 12- Institutional (Hospital) use. D. BUILDING USE GROUP: Mixed Use A2-Assembly, B-Business and 12-Institutional (Hospital) as defined by the Massachusetts Building Code, 780 CMR 8th Edition. This project area falls within the A2-Assembly Occupancy. E. CONSTRUCTION CLASSIFICATION: Type 2B Foundation: concrete basement slab and foundation walls Exterior Walls: brick masonry on steel backup Int. Load Bearing: steel columns / steel floor decking Roof: pitched asphalt shingles F. HAZARD INDEX: Existing and proposed Hazard Index is 4 as defined by the Massachusetts Building Code, 780 CMR, 8th Edition (IEBC Table 114 r,..,> .1_I fa� 17 .�, .. ... 1 y, a.,.l�i.. °1 . ,s•.crt Massachusetts Building Code 780 CMR 8th Edition International Existing Building Code 2009 Renovations to Cafeteria Cooley Dickinson Hospital 30 Locust Street Northampton, MA 01060 Purpose This Report is in conformance with Massachusetts Building Code 780 CMR 8th Edition and the International Existing Building Code 2009 regarding alterations to an existing building, Cooley Dickinson Hospital, located at 30 Locust Street, Northampton, Massachusetts. Visual Observation Only The extent of this review is limited to visual inspection of existing facilities and/or as-built documentation only. No destructive testing was performed as part of this analysis. Project Description The project consists of an interior renovation to reconfigure the cash register and salad bar area of the serving line in the existing cafeteria, as well as new finishes and lighting. i1 U'othic Stroet.Saito. 1,North nIrtoti, 41:\0 1 Or,tt A y ; .Iro1 t, 11 Existing Conditions Evaluation Report Massachusetts Building Code 780 CMR 8t" Edition International Existing Building Code 2009 Renovations to Cafeteria Cooley Dickinson Hospital 30 Locust Street Northampton, MA 01060 January 08, 2016 Revised January 21, 2016 P�0\IECr s° �kp NO& s :. d 5 , 00, Richard E. Katsanos As prepared by Richard E. Katsanos, AIA, Principal H I A.1 Architecture e 1 t,adFiC faca s,Santa 1,.No t?:ampton,MA OWN! � :3.171 = t.ix 413,586,71-'4? 1 ti,;i .lt<s=srcti_..t;rs°.cnt Initial Construction Control Document To be submitted with the building permit application by a b d Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Renovations to Cafeteria Date: 08 January 2016 Property Address: Cooley Dickinson Hospital 30 Locust Street,Northampton,MA Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: Limited interior renovations to existing cafeteria serving line and dining area I Richard E. Katsanos MA Registration Number: 8355 Expiration date: 08/31/2016 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical Fire Protection X Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 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 Doc t . P,l SA iy Enter in the space to the right a"wet"or �`' w� 55 0 V electronic signature and seal: S1 1! Phone number: 413-585-5H Email: Richard.Katsanos @HAIArchitecture.com ISIZ 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 H I AI Architecture TRANSMITTAL PROJECT: Renovations to Cafeteria Cooley Dickinson Hospital 30 Locust Street Northampton, MA 01061 Project No. 15-053 DATE: January 8, 2016 TO: Mr. Ryan Pelletier Raymond R. Houle Construction 5 Miller Street Ludlow, MA 01056 FROM: HAI Architecture 64 Gothic Street, Suite 1 Northampton, Massachusetts 01060 Richard E. Katsanos, AIA ITEMS: # Date Description 2 01/08/2015 Stamped Permit Sets 1 01/08/2016 Stamped Construction Control Affidavit 1 01/08/2016 Stamped Existing Conditions Evaluation Report 1 01/08/2016 CD with all documents above in pdf REMARKS: 04 Gothic Street,Suite 1,Northampton,MA 01060 1 413.585.1512 1 fax 413.586.7945 I www.haiarchitecture.com Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and,if necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachus tts Department of Industrial Acciden s �1, 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston,MA 02114-2017 �•`t www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information Please Print Le6bly Name (Business/Organization/Individual): RAYMOND R. HOULE CONSTRUCTION Address:5 MILLER STREET City/State/Zip:LUDLOW, MA 01056 Phone#:(413)-547-2500 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with J(�!) employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.E]I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10E] Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.[:]Plumbing repairs or additions 5.[3 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]ROOf repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'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:A.I.M. MUTUAL INSURANCE CO. Policy#or Self-ins.Lic.4:WMZ-800-8005579-2015A Expiration Date:12/31/2016 Job Site Address: .C; C.-.s 4— 54- City/State/Zip: AJ f7h_ .A,._o Ayn M 4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expi atr, ion date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 the is and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone# 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 I C -C It,n N+aS r as Owner of the subject property hereby authorize 6 tat IC. A'.1 C to ad n my I if in all matter relative to work authorized by this building permit application. cr- CP—<LI LD�+ I ' I I I'Z0 ( Si ure of ner Date I, �av�"wd�t4l )je%a ' ( Q0►S4r0-C40 07 as Own r/A thorized hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge am—belief. Signed under the pains and penalties of periurv. ?IV 01�D 10 1•t♦- Print Name 2-614- Sig wne g nt Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: n { e+( C-5 — /C-j9 2 4q License Number r^�ka,� �d �lbrgkaM /o 0 ;r - 2� • 2v �� 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 build' permit. Signed Affidavit Attached Yes No Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: k<j.*,oj ka4 Not Applicable ❑ Name(Registrant): 23 3 e— Registration Number Address S—31— 2-0 t(� 9 t3 3.pS lS/Z Expiration Date Sign re Telephone 9. a istered Professional Engineer(s): 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor 'Al-tItAVond On lie- fOnr `aE ��� Not Applicable ❑ Company Nam - j Responsible In Charge of Construction Address Signature ' Telephone _8. NORTHAMPTON ZON Version 1.7 Commercial Building Permit May 15,2000 ING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 9 G Z $ Frontage ` 2& r$ Setbacks Front Side L. R:' `I Z L:'1$_ R: 4 Z Rear !4 1 Q Building Height q Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved (�b IJA parking) #of Parking Spaces tG Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/o a site? NO 0 DON'T KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON'T KNOW © YES IF YES: enter Book (pro L-1 Page 2-3c? and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW YES Q IF YES, has a permit been or need to be obtained from t onservation Commission? Needs to be obtained Q Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Hp5 i rulkag f, 14*r)G4..'s 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, exca ion,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES Q NO 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 SE ICES FOR PROJECTS LESS THAN 35,000 CUBIC FEET OF ENCLOSPAWACE 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. 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 F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H Hi h 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: _ �S, ne SJ / Proposed Use Group: Hess Existing Hazard Index 780 CMR 34):. _L[ 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 3 .5 O o S-F 1 St 2"d 2"d 3rd 3rd -fir 4th , 4th Total Area (sf) Total Proposed New Construction(sf) Total Height(ft) L Total Height ft i 7.Water S ply(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[] Version l.7 Commercial Building Permit May 15,2000 RQ r -.-.. io rimeM use p f City of Northampton �' } � A JAN ! f �' ! Building Department # �, 'i. 212 Main Street Room 100 oFI iN<-;r EONS orthampton, MA 01060 NANIPIMi FAAni p on 3-587-1240 Fax 413-587-1272 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 30 Locus,4 S Map Lot Unit 0 or ft emp 40 r M O 1 V (. I Zone Overlay District Elm St.District CB District SECTION 2-PROPERTY OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Coo le. D, khst-n 1-�o,�P �« 30 Loc,,st" 0 Nort�.aM�o4e,y MA Name(Print) Current Mailing Address: Y i 3 s-s z Signature Telephone 2.2 Authorized Agent: _ Name(Print) Current Mailing Address: ks3 OV2.- moo Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building lS--s u I,� (a)Building Permit Fee 2. Electrical 'Y (b)Estimated Total Cost of Q SD Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total= (1 +2+3+4+5) Check Number 6 This Section For Official Use Only Building Permit Number Date a Issued I i AN Signature: 3 e i rvD_. ._ Building Commissioner/Inspector of Buildings Date s `__ File#BP-2016-0891 APPLICANT/CONTACT PERSON RAYMOND R HOULE CONST INC ADDRESS/PHONE 5 MILLER ST LUDLOW01056(413)547-2500 Q 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 Typeof Construction: RENOVATE CAFETERIA New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 109244 3 sets of Plans/Plot Plan lce��d/G✓ �% 1 THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION 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 Demol' ion elay Signa ure of Buil ing lcial 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-2016-0891 cis#: 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-2016-0891 Project# JS-2016-001508 Est. Cost: $170267.00 Fee: $1197.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: RAYMOND R HOULE CONST INC 109244 Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M(99)/WP(21)/URB(1)/ Applicant: RAYMOND R HOULE CONST INC AT. 30 LOCUST ST Applicant Address: Phone: Insurance: 5 MILLER ST (413) 547-2500 () WC LUDLOWMA01056 ISSUED ON:112112016 0:00:00 TO PERFORM THE FOLLOWING WORK.RENOVATE CAFETERIA 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 1/21/2016 0:00:00 $1197.00 212 Main Street, Phone(413)587-1240, Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner