39-063 (13) 8 ATWOOD DR BP-2016-1190
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 39-063 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-2016-1190
Project# JS-2016-002052
Est.Cost: $28000.00
Fee: $196.00 PERMISSION IS HEREB Y GRANTED TO:
Const. Class: Contractor: License:
Use Group: DEVELOPMENT ASSOCIATES 075752
Lot Size(sq. ft.): 64381.68 Owner: ATWOOD D VE LLC
Zoning. Applicant. DEVEL PMENT ASSOCIATES
AT. 8 ATWOOD D
Applicant Address: Phone: Insurance:
P O BOX 528 (413) 789-3720 WC
AGAWAMMA01001 ISSUED ON:4/13/2016 0:00:00
TO PERFORM THE FOLLOWING WORK;RENOVATE ROOMS 248, 318 & 314
POST THIS CARD SO IT IS VISIBLE FROM THg STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: Hous@# 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 §ignature:
FeeType: Date Paid: Amount
Building 4/13/2016 0:00:00 $196.00
212 Main Street,Phone(413)1587-1240,Fax: (413)587-1272
Louis Hasbrouck—Building Commissioner
File#BP-2016-1190
APPLICANT/CONTACT PERSON DEVELOPMENT ASSOCIATES
ADDRESS/PHONE P O BOX 528 AGAWAMO1001 (41J)789-3720
PROPERTY LOCATION 8 ATWOOD DR
MAP 39 PARCEL 063 001 ZONE
THIS SECTION FOR OFf ICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: RENOVATE ROOMS 248, 318&314
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 075752
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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 CommissionPermitDPW Storm Water Management
Demolition Delay
L1 / o2 161
Sig e o Building 6Mcial 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.
Versionl.7 Commercial Building Permit Ma 15,2000
City of Northampton
Building Department
212 Main Street
Room 100
2 2W Northampton, MA 01060
jhne 13-587-1240 Fax 413-587-1272
y I
DEPT Fjroo 6UIl ING INSPECTIONS
APPLICA CT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR'TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION
This section to b6 com leted b office
1.1 Property Address: � y
8 Atwood Drive f Lll Map cJ Lot, lQ Unit
Northampton, MA 01060
i Zone Overlay District
Elm St.,District: CB Dlstrlct
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Pr Oxbow Pr e sional Park, LLC Current Mailing Address: 200 Silver St., Suite 201
nn Agawam, MA 01001
Signature 1'. Mr fir2!!t�elephone (413) 789-3720
2.2 Authorized Agent:
Name(Print)Travis P. d, velopment Associates Current Mailing Address: 200 Silver St., Suite 201
Agawam, MA 01001
Signature Telephone 413 789-3720
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be '', Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
28 000.00
2. Electrical (b) Estimated Total Cost of
Construction from 6
3. Plumbing Building Permit fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+3+4+5) $ 28 000.00 Check Number 10
This Section For'Official Use Only
Building Permit Number Date
sued
Signature:
Building Commissioner/Inspector of Buildings Date
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❑ Change of Use❑ Other ❑
Brief Description Enter a brief description here.
Of Proposed Work:
q -31`Z 1
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 Ea
E Educational ❑ 26 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: g Proposed Use Group: g
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTIONOFFICE USE ONLY
Floor Area per Floor(sf)
1 St
St
2nd 2nd
d 3rd
3
4th 4m
Total Area(so Total Proposed New Construction (so
Total O
Height ft
9
Total of 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❑
Version 1.7 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 Q DON'T KNOW Q YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW Q YES Q
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 0 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 Q 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 O NO V
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 SE.!,�VICES F,OR.BUILOINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO led CMR 116(CONTIAINING MORE THAN'35,000 C.f OF ENCLOSER SPAC
9.1 Registered Architect:
.Tortes Whitsett Architects - J. Kristian Whitsetrt, Architect Not Applicable 0
Name(Registrant): 50231
308 Main S deenf Feld 1301 ReglstWon Number
Addres
8/31/16
(413)773-555,
413)773-5551 Expiration Date
Sig re Telephone
9.2 Reglatered 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 I Expiration Date
9.3 General Contractor
Lk%w-1 a=nt A-.swiates Not Applicable ❑
Company Name:
Travis P. Ward
Responsitte in Charge of Construction
200 Silver S 01, Agawam, MA 01001
Address
;;A (413)789-3720
Signature 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
I, Oxbow Professional Park, LLC as Owner of the subject property
hereby authorize Travis P. Ward to
act on my behalf, in all matters relative to work authorized by this building permit application.
4/11/16
Signature of Owner Date
I, Travis P. Ward 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.
Travis P. Ward
Print Name--------
4/11/16
am4/11/16
Signature o w er/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Travis P. Ward CS-075752
License Number
200 Silver Street S 'te 201 , Agawam, MA 01001 5/19/17
Address Expiration Date
(413)789-3720
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 0
. �. The Commonwealth oflfassachusetts
Department of Industrial Accidents
Office of Investigations
600 lEashington Street
Boston,Mass. 02111
wjvmniass.gov/dia
Workers' Compensation Insurance Affldavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): Development Associates
Address: 200 Silver Street, Suite 201
City/State/Zip: Agawam, MA 01001 pllone#: (413) 789-3720
Are you an employer?Check the appropriate box: Type of project(required):
1.XX I am an employer with 5 4.0 I am a general contractor and I 6. 0 I�few construction
employees(full and/or part time).* have hired the sub-contractors 7, D Remodeling
2.0 I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub-contractors have 8. 0 Demolition
working for me in any capacity. employees and have workers' 9, ❑Building addition
[No workers'comp.insurance comp.insurance.1
required] 5.D We are a corporation and its 10. 0 Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 11. 0 Plumbing repairs or additions
myself [No workers' comp. right of exemption perm MGL
insurance required]t c. 152, § ](4),and we have no 12. 0 Roof repairs
employees. [no workers' 13. 0 Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers,compensation policy Information.
tHomeowners who submit this affidavit indicating they are doing ail work and then hire outside Contractors must submit a new affidavit indicatin.-such.
*Contactors that check this box must attacb au 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'coma•policy number.
lam an employer that-isproviding workers'compensation insurance for my employees.Beloit,is thepolicy and job site
information.
Insurance Company Name: The Travelers Insurance Companies
Policy#or Self-ins.Lic.#: IEUB-8771 W83-7-15 Expiration Date: 4/13/16
Job Site Address:_ 8 Atwood-Drive, Suite 101 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 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
$250.00 a day against violator.Be-advised that a copy of this statement maybe forwarded to the Office of Investigations of the
DIA for coverage verificatio .
I do herby c to pal anti penalties ofperjury that the information provided above is true and correct
Signature: � Date: November 24, 2015
Print Name• Travis P Ward as agent for owner Phone 4: (413) 789-3720
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):
I.Board of Heath 2. Building Department 3.Citytrown Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
contact person: Phone ti:
City of Northampton
GO
Massachusetts
p IY+
DEPARTMENT OF BUILDING INSPECTIONS 7 �
212 Main Street • Municipal Building C1
Northampton, MA 01060
INSPECTOR
Louis Hasbrouck Fax: 413-587-1272 Chuck Miller
Building Commissioner Phone: 413-587-1240 Assistant Commissioner
SECONDARY CONSTRUCTION CONTROL DOCUMENT
(For professional Engineers/Architects responsible fora portion of a controlled project)
Project Title:Clinical&Support Options-2nd& 3rd Flr. Tenant Imp. Date: April 11, 2016
Project Location: 8 Atwood Drive, Northampton, MA Ma
p: Parcel: Zone:
Scope of Project: Tenant Improvements to three office spaces at 2nd & 3rd Floors of 8 Atwood Drive
In accordance with the Eighth edition Massachusetts State Building Code, 780 CMR Section 107.6:
I, Mass. Registration#
being a registered professional Engineer/Architect hereby CERTIFY that I have prepared or directly supervised
the preparation of all design plans, computations and specifications concerning:
[ ] Fire Protection [)(]Architectural [ ] Structural [ ] Mechanical [ ] Electrical
[ ] Other(specify)
for the above named project and that to the best of my knowledge, such plans, computations and specifications
meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices
and all applicable Laws for the proposed project.
Furthermore, I understand and AGREE that I shall perform the necessary professional services to determine that
the above mentioned portions of the work proceed in accordance with the documents approved for the building
permit.
Upon completion of the work, I shall submit to the building official a final report as to the satisfactory
Completion of the above mentioned work.
R@Q ARCy,,T
Signature an ea of Regist d essional
..; 50231
0
SHELBU�A FALLS C�j
t LDay of 20 6 ��
o-H C*
(seal)