38-050 DEMO PERMITS (3) BP-2006-1262
GIs#: COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category:demolition BUILDING PERMIT
Permit# BP-2006-1262
Project# JS-2006-1865
Est,Cost:
Fee: $15.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: S & R CORPORATION 061320
Lot Size(sg. ft.): 226512.00 Owner: HOSPITAL DVVELOPMENT LLC
Zoning: PV Applicant: S & R CORPORATION
AT: 1 PRINCE ST
Applicant Address: Phone: Insurance:
706 BROADWAY ST (978) 441-2000 WC
LOWELLMA01854 ISSUED ON:5125I2IN6 0:00:00
TO PERFORM THE FOLLOWING WORK.DEMOLITION - BLDG 12
POST THIS CARD SO IT IS VISIBLE FROM THF 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 I Signature:
FeeType: Date Paid: Amount:
Building 5/25/2006 0:00:00 $15.00773
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2006-1262
APPLICANT/CONTACT PERSON S&R CORPORATION
ADDRESS/PHONE 706 BROADWAY ST LOWELL (978)441-2000
PROPERTY LOCATION 1 PRINCE ST
MAP 38A PARCEL 050 001 ZONE PV
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: DEMOLITION-BLDG 12
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 061320
3 sets of Plans/Plot Plan
THE F30fLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 S Commission
Signature of Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning&Development for more information.
Version 1.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton, t �_,fPkirli
Building Department C rib C t/06vpway permit
212 Main Street Sewer/Septjc va labildy
Room 100 „ . r Ny llability
Northampton, MA 010610 '' j ' etsi nictural Plans
phone 413-587-1240 Fax 413-587-1272 PlotlSltefans
Etf31�C�eclfy�� ..
APPLICATION TO CONSTRUCT,REPAIR, RENOVATE,CHANGE THErUSE 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
1 Prince Street Map Lot Unit
Northampton, MA
Building#1 2 Zone Overlay District
Elm St.District CS District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
MassDevelopment 1 Prince St. , Haskell Build.
Name(Print) f Current Mailing Address:
✓�+- /vo,-- rr � /`J`p3ec� -�q� � (41 3 ) 587-6314
Signature / Telephone
2.2 Authorized Agent:
Name(Print) Current Mailing Address:
Signature
Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a)Building Permit Fee
2. Electrical (b)Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total= 0 +2+3+4+5)
Check Number
This Section For Official Use Only
Building Permit Number bate
/ Issued
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Pen-nit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition P Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here. Complete demolition of building
Of Proposed Work: including foundations
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 ❑
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 1 St
2nd 2nd
3 rd 3rd
4th 4t
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: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone Outside Flood Zone❑ j Municipal ❑ On site disposal system❑
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 Spaces
Fill:
(volume&Location
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:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON'T KNOW 0 YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW U YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained 0 , 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 0 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.
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:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Tighe & Bond Engineers
Name Area of Responsibility
53 Southampton Road. Westfield, MA 01085 '$`j4L- S+
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
S&R Corporation, Not Applicable ❑
Company Name:
Thomas Guerette
Responsible In Charge of Construction
706 Broadway St. , Lowell, MA 01854
Address
A!�— Q � (978 )441 -200T
Signature —1, Telephone
Version 1.7 Commercial Building Permit May 15,2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
"'T 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.
Sign re of Owner ' Date
I, 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
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Thomas Guerette CS 061320
License Number
gAve. , y, 3/19/2007
18 Longwood Ave. Londonderry, NH03053
Address Expiration Date
( 603 ) '488-5042
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No 0
- - - - 7
77 7
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Number: CS 061
320
Birthdate: 03/19/1967
Expires: 03/19/2007 Tr.no: 11076
Restricted: 00
THOMAS J GUERETTE
18 LONGWOOD AVE
LONDONDERRY, NH 03053
Commissioner
Tighe&Bond
Consulting Engineers
Environmental Specialists
W-3280-9A-14
May 12, 2006
Ms. Sara Northrup, P.E.
Project Engineer
MassDevelopment
Northampton State Hospital
Northampton, MA
Re: Abatement & Demolition of the Main
Building Complex at the former
Northampton State Hospital
Dear Sara:
Tighe & Bond has inspected Building 12 (Grounds Shop) at the Northampton State Hospital to
confirm completion of the specified abatement work. All asbestos containing materials and
hazardous materials that were identified in the specifications have been removed and abated
from the building. This letter serves as the final clearance of the building scheduled for
demolition. S&R Corporation is cleared to commence demolition of Building 12.
If any questions or comments arise please contact the undersigned at 508-754-2201, ext 123, with
any questions.
Very truly yours,
TIGHE & BOND, INC.
Daniel J. Dragon
Environmental Scientist
1:\W\W-3280\OLD MAIN AND BLDGS 3-14\BLDG CLEARANCE LETTERS\BLDG 12 CLEARANCE LETTER FOR DEMO.DOC
Copy: Alan Delaney, Director of Engineering
Tom Guerrette, S&R Corporation
Paul Darling, S&R Corporation
53 SOufhamptou Road• Westjietd. NIA 01035•Tei. 413-562-1600• Fay. 413-562-5317
Luwu1.Ughe�boad.com
FROM :S&R. CORP. NORTHR11TON FAX NO. :4135841568 Apr. 08 2006 12:22PM P1
�. way
A N/Sourm Company
2025 Roosevelt Ave
P,O.Box#2025
SpringlIeld,MA avo2
harsh 31, 2006
SSR CORP
706 BROADWAY ST
LOWELL KA 81854
Dear S&R CORP,
The addrea® listed belov he® had tho gas wervicela)
disconnected and 1s nov ready :for demolition.
ADDRESS: i PRINCS 6T
TOWN NORTHAMPTON HA
STATE Ma®eachueetts
Sincerely
Terri Miner
Workforce Plgnning
FROM :S&R. CORP. NORTHRMTON FAX NO. :4135841568 Apr. 02 2006 12:23Pf1 P2
MAR 32 260E 12, 1.1 PM FR MASS EL.EC CJST 6ERU 532 7521 TO 614135841566
Massa�eh etts Electr*
A;HaVe"GMd company
March 30,2006
S and R Corp
706 Broadway St.
Lowell MA 01854
To Whom It May.Concern,
This is to verify that National Grid has removed the electric servicc and meter's at 1
Prance St.,Northampton, -Massachusetts, for Building Demolition.
Ancerely,
t
Jim Niohols
Supervisor
Distribution Design
3N/okp
PO 6vx 507
Narinampmn,MA 02061-0507
413.U2.72oo
*t TOTAL ?AGE. r 1 .�
The Commonwealth of Massachusetts
Y Department of Industrial Accidents
' Office of Investigations
600 Washington Street
Boston, MA. 0211.1
Workers' Compensation Insurance Affidavit
Name f hc,7-e/neni j 2gm��i'
Job Location.1. J'/Z2"NG S r1aE E;7—
City
City /Vc)/e T/���/�77777iN rnf3 Phone (978)441-2000
❑ L am a homeowner performing all work myself_
Q I am a sole proprietor and have no one working in any capacity.
I am an employer providing workers'compensation for my employees wor rng on u to
Company Name: S&R Corp-or tion
Address 706 Broadway Street
City Lowell, MA 01854 Phone# (978)441-2000
Insurance Company L ih@LTA_ /It/7i/a/ Policy#WC 1111,25 7 8,390i`i'
rj I am a sole proprieto .general contractor or omeowner(circle one)and have hired the
contractors listed-below who have the following workers'compensation policies:
Company Name n/a
address
city Phone#
Insurance Comgatty Policy#
Failure to secure coverage as required under Section 25A of MGL'152 can lead to the imposition of
criminal penalties of.a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties
in the form of a S'L'OP WORK ORDER and a fine of$100.00 per day against me. I understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage
verification.
I do hereby certify der the pains an�_penalties of perjurv*at the information provided above is
true and correct.
Signature. . 2 1�icr Prt��eci rin r Date .S•lllr'f2fw)l
Print Name_7-�lG��y - ererre Phone # (978)441-2000
Official use only do not write in this area to be completed by city or town official
City or Town: Permithicense# Building Ocpt
Ucensing dd-
l�check if immediate response is required Selectmen
Contictcrxon I(Wth DcgL
P phone L Othcr
Tighe&Bond
C:msult:ngEngineers
Environmental Specialists
W-3280-9A-14
May 12, 2006
Ms. Sara Northrup, P.E.
Project Engineer
MassDevelopment
Northampton State Hospital
Northampton, MA
Re: Abatement & Demolition of the Main
Building Complex at the former
Northampton''State Hospital
j
Dear Sara:
Tighe & Bond has inspected Building 12 (Grounds Shop) at the !!Northampton State Hospital to
confirm completion of the specified abatement work. All asbestos containing materials and
hazardous materials that were identified in the specifications hl ve been removed and abated
from the building. This letter serves as the final clearance of the building scheduled for
demolition. S&R Corporation is cleared to commence demolition of Building 12.
If any questions or comments arise please contact the undersigned jat 508-754-2201, ext 123, with
any questions.
Very truly yours,
TIGHE & BOND, INC.
I-eL- Daniel J. Dragon
Environmental Scientist
1:AW1W-32W0LD MAIN AND BLDGS 3-14\BLDG CLEARANCE LETTERSIBLDG 12 CLEARANCE LETTER FOR DEMO.DOC
Copy: Alan Delaney, Director of Engineering
Tom Guerrette, S&R Corporation
Paul Darling, S&R Corporation
,r':;frrlr�ar,au l�,ar.1 ! ;Er_,,1�ilt. .tl.t U1tIN;) V. 41, Jtf -Io11U• t`'QV- 4/�i
u��ic.!ir�lrel;ond.conl