23B-046 (261) 30 LOCUST ST BP-2017-0234
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map-Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category REMODEL BUILDING PERMIT
Perrnit# BP-2017-0234
Project 4 JS-2017-000393
Est.Cost: $108826.00
Fee:$763.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: RAYMOND R HOULE CONST INC 066227
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) 547-25001)
LUDLOW MA01056 ISSUED ON:9/7/2016 0:00:00
TO PERFORM THE FOLLOWING WORK: Create mens and womens locker rooms
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 9/720160:00:00 $763.00
212 Main Street. Phone(413)587-1240, Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
Version l.7 Commercial Building Permit May I5.2000
r RECEIVED Department use only
City of Northampton Stews of Permit:
Building Department cow Cut/Driveway Permit
AUG2 2 2016
i 212 Main Street Sewer/Septic AvailabElly
Room 100 Water/Well Availability
ora r c n� pus Northampton,NtA 01060 Two Sets of Structural Pians
phone 413-587-1240 Fax 413.587-1272 Plot/Site Plans
Other Specify
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 Monody Aachen: This section to be completed by office
30 Locust SI Map Lot Unit
Northampton. MA (11060 Zone Overlay District
Elm St District Ca District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
3.1 Owner of Record:
Cooley Dickinson Hospital 30 t ocust Si. P.0 Box 5001
Name(Pere)-Tu N .•M 3 wL..3 1 'I7i Of FA I t I'71 CS Curren Mailing Address:
``\J j ' -h f) 1-413-582-2313
Signature `` {�j t_ Telephone
tar
Nrnothy S Pellebel 5 Miller St Ludlow. MA 01056
Name(Print) Current Mailing Addrass:
1-413-547-2500
Signature Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by Peened apWicant
1. Building $66,146.00 (a)Building Permit Fee
2. Electrical $13,680.00 (b)Estimated Total Cost of
Construction from(6)
a. Plumbing $24,000.00 Building PennitFee 173
4. Mechanical(HVAC)
5.Fire Protection $5,000.00
6. Tow=(1+2+3+4+5} $108,826.00 Check Number 2t7/( .-
This Section For Official Use Only
Building Permit Nugmber '1 G/ Date
AD/ 7- bP ( Issued
Signature.
Sodding Commissioner/Inspeclor of Buildings Date
J
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 0 Existing Well Signs 0 Demolition❑ Repairs Additions 0 Accessory Building
Exterior Alteration 0 Existing Ground Sign 0 New Signe 0 Roofing❑ Change of Use❑ Other 0
Brief Description Enter a brief description� here. / //
Of Proposed Wort C'rrec ✓l fts 06 eas L a�;Ilgr? (/( o oMes,
SECTION 5 W USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 0 A-2 0 A-3 0 IA 0
A-4 0 A-5 0 1B 0
B Business ❑ 2A 0
E Educational 0 28 0
F Factory 0 F-1 0 F-2 0 2C
0
H High Hazard ❑ 3A 0
IInssamonal 0 I-1 ❑ 12 0 I-3 0 38 0
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S1 0 S-2 0 5B ❑
U Utility 0 Specify
M Mixed Use 0 Spetlty:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDMONs AND/OR CHANGE IN USE
Existing Use Group: 1-2 Proposed Use Group: 1-2
Existing Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 4
SECTIONS BUILDING HEIGHT MID AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf) p
1a 600 in 6UQ
2"" 2
3r°
4a 4n
Total Area tet) Total Proposed New Construction(sf)
Total Height(It)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public 0 Private 0 Zone Outside Flood Zone❑ Municipal 0 On site disposal system❑
Version!.7 Commercial Building Pemut May 15,2000
8, NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column I be filled in by
Bulling Department
Lot Size 969,427.8 969,427.8
Frontage 2658' 2658'
Setbacks Front 102' 102'
Side L: 88' R. 422' L: 88' R: 42'
18' 18'
Building Height 64.5' 64.5'
Bid&Square Footage 402M61 % 402,861
Open Space Footage e/
(fol area minus bkigapavd 40.6 40.6
nutinu
B of Parting Spaces 761 761
Fill: N/A N/A
(volute&tormion)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW 0 YES 0
IF YES,date issued: Dee 13,2001
iF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book 6504 Page 239 and/or Document it
B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW O YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained U Obtained O , Date issued:
C. Do any signs exist on the property? YES 0 NO O
IF YES,describe size, type and location: Various
I), Are there any proposed changes to or additions of signs intended for the property? YES O NO
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
IF YES,then a Northampton Shinn Water Management Permit from the DPW is required.
Version1.7 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 36.000 C.F.OF ENCLOSED SPACE)
ILI Registered Architect:
Not Applicable 0
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Exlarotian Date
Name Area of Responsibility
Address Regieealbn Number
Signature Telephone Expiration Date
Name Mee of Responsibility
Address Registration Number
Signature Telephone Expaatlon Date
Name Mn of Responsitbfty
Address Registration Number
Signature Telephone Expiration Dale
Si General Contractor
Raymond R. Houle Construction Inc. Not Applicable❑
Company Name:
Timothy S. Pelletier
Responsible In Charge of Conateuclion
5 Miller St. Ludlow, MA 01056
Address
1-413-547-2500
Signature Telephone
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 Q No e
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
Coolly Dickinson Hospital •as Owner of the subject property
hereby authorize to
R. Houle Construction Inc m
act my benai in at matters relative work authorized by this building permit application.
5/1‘42
of
d bme
Raymond Ft Houle Construction Inc. ,as Owner/Authorized
Apert hereby declare that the statements and irdoonailan on the foregoing application are true and accurate.to the best of my knowledge
and bidet.
Signed under the pains and penalties of perjury,
Timothy S. Pelletier
Pam
r- ?3-/.6
Signature Signature. Own- ire Date
SECTION 12'CONSTRUCTION SERVICES
10.1 Llcsneed Construction Supervisor: Not Applicable 0
moms of 4lcepse Holder:`Timot by S. Pelletier 066227
License Number
5 Millet St. Ludlow, tv r 01056 07 07-2017
Address
101i— -ript
1-413.54 i-2500 Eapirnion Date
...
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 162,§26C(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 �:.Y
City of Northampton 212 Main Street, Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150A.
Address of the work: 30 Locust St. Northampton, MA
The debris will be transported by: USA Hauling
The debris will be received by: USA Hauling
Building permit number Pending
Name of Permit Applicant Raymond R. Houle Construction Inc.
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
P Department of Industrial Accidents
f odic] - I Congress Street,Suite 100
E =pt:�t_—
='.ipl-. . Boston,MA 021144017
a � www mass.gov/dia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO RE FILED WITH THE PERMITTING AUTHORITY.
Applicant information Please Print Legibly
Name (Business/Organization/Individual): RAYMOND R. HOULE CONSTRUCTION, INC.
Address:5 MILLER STREET
City/State/Zip:LUDLOW, MA 01056 Phone#:(413)-547-2500
Are yon an employer?Check the appropriate box: Type of project(required):
1.01 sin*empioyerWith 30 employees(full and/orpart4imt).' 7. Q New construction
3.0 I am a sole proprietor or partnership and have no employees working for me in 8. Q Remodeling
any capacity.[No workers comp.insurance required.]
).0I am a homeowner doingall work self.[No workers' nncc required.] 9. Demolition
mY' comp.heron rcq .]'
4.0 I ant a homeowner and will be hiring contractors to conduct all work on my Property. I will 10 Q Building addition
ensure that all cmmactorseither have workers'compensation insurance man sok 11.0 Electrical repairs or additions
proprietors with no employees.
12,0 Plumbing repairs or additions
5. 1 am a general contactor and I have hired the sub-contractors listed on the attached sheet.
These subcontractors have employees and have workers'comp.insurance' 13.0Roof repairs
G❑we area corporation and its officers have exercised their right of exemption per MGL c. 14.QOtber
152,{I(4),and we have no employees.(No workers'corp.insurance required.]
*My applicant that checks box#1 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 cunnctos most submit a new affidavit indicating such.
:Corundum 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. lithe sub-contractors have employees,they must provide their workers comp.pokey number.
1 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.Lir.#:WMZ-800.6005579-2015A Expiration Date:12/31/2016
lob Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to 51,500.00
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 pal and pe of perjury that the information provided above is true and correct.
f
/ c
Shen tgaand �"C_[/c< Date: P'"/y,A'
Phone 4; 1 Y/5 X% 7 2 S60
Official use only. Do net write in this area,to be completed by tint or town official
City or Town: Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.Cily(fown Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone it:
Houma
CONSTRUCTION, INC.
COMMERCIAL SOUSTR,A�.
5]Idler Sircec Wdlnw,MA 01056
I request that you grant a modification to waive the requirement for control construction for
the Cooley Dickinson Hospital New Locker Room at 30 Locust Street, in Northampton because
the work is of a minor nature,will not affect health, accessibility, life and fire safety, or
structural requirements and is impractical in that the cost of control construction is
considerable when compared to the cost of the proposed work. Thank you for your
consideration. "Mass Amendments, sections 107.1 allows for an exclusion from control
construction for this project"
Respectfully,
Timothy S. Pelletier
Raymond R. Houle Construction, Inc.
5 Miller Street
Ludlow, MA 01056
A // 1 Northampton
����&/Q // a 50-a�✓L( 16" narhnent
O�- - � rIl�� �t�:,,aw
zfr // / 212 pto n Street
/�(/Ji Northampton, MA 01060
50 33 134 35 136 137138139 40 ^ 35 136 37 38 139 1
/\ T. Warrens �— —
rocker Mens locker room 2
room
3\ 20 3
31 21 �—
4 . 1 4
IWomens Toilet z 32 22 5 N.22 5
Shower —.\ —
V� 33 236 \_^ 23 .. 6
j AA 49 34 24 7 \.4
e
// 48 35 25 8 A255 8
3fi 26 9 \
N __ \)-f-°/ 4] 9 \ 26 9
—by—
3] 27
46 Accessible 10 10
45 aisle 38 28 1288 —
11
44 39 29 12\ 29 12
40 30 ^i —
Ii 43 133 � 30 13
Mens Toilet
42 14 ` 31 14
Shower N/ 41 15 32
j 15
�s
/N 16 ` 33 16
20119 18 1V \:‘‘,...-341---
3y 17
t .
. '. T T
,a, _
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ree
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in } ,
\ Raymond R.Houle Consbvction Inc.
5 Miller 9.
Ludlow,MA01056
Phone:413.547.2500 Fax:413.547.2544
email:mailanyhoule.com
Date. 06-23-2016 'Rome 1# 01
Prgecc CDH New Locker Room
I Draining Al