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31B-281 (16) 86 MASONIC ST BP-2018-1026 GIS 4: COMMONWEALTH OF MASSACHUSETTS Mao:Block:3 1 B-281 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-2018-1026 Project JS-2018-001860 Est Cost:$90947.00 Fee:$636.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: RAYMOND R HOULE CONST INC 109244 Lot Size(sp.&A 12196.80 Owner: CORLISS RUGGIERO LLC zoning: CB(100)/ Applicant: RAYMOND R HOULE CONST INC AT. 86 MASONIC ST ApplicantAddress: Phone: Insurance: 5 MILLER ST (413) 547-2500 O WC LUDLOWMA01056 ISSUED ON:4/25/2078 0:00:00 TO PERFORM THE FOLLOWING WORK.-RENOVATE INTERIOR OF BUILDING, MILLWORK, FURNITURE, PARTITIONS, COSMETIC FINISHES 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 Occuoancy Signature: FeeTvpe: Date Paid: Amount: Building 4/25/2018 0:00:00 $636.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner File N BP-2018-1026 APPLICANT/CONTACT PERSON RAYMOND R HOULE CONST INC ADDRESS/PHONE 5 MILLER ST LUDLOW (413)547-2500 Q PROPERTY LOCATION 86 MASONIC ST MAP 3 I B PARCEL 281 001 ZONE CB(100F THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid TvoeofConstruction: RENOVATE INTERIOR OF BUILDING MILLWORK FURNITURE PARTITIONS COSMETIC FINISHES New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 109244 3 sets of Plans/Plat Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: s� 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 Demolition Delay Q r �[ `E z 18 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. a pry The Commonwealth of Massachusetts Department of Public Safety Massachusetts State Budding Code(780 CMR) Building Permit Application for any Building other than a One-or Two-Family Dwelling (This Section For Official Use Only) Building Permit Number: Date Applied: Building Official: SECTION 1:LOCATION(Please indicate Block If and Lot 8 for locations for which a street address is not available) 86 Masonic St Northampton 01060 Northampton V'son Snacafsts �f/Q7 No.and Street City/Town Zip Code Name of Building(if applicable) Map and Paccel SECTION 2:PROPOSED WORK Edition of MA State Code used 8 If New Construction check here ❑ or check all that apply in the two rows below Existing Building ❑I Repair Alteration 0✓ Addition I Demolition[](Please fill out and submit Appendix l) Change of Use ❑ Change of Occupancy O[her Specify: Are building plans and/or construction documents being supplied as part of this permit application? Yes • No Is an Independent Structural Engineering Peer Review required? Yeao No Brief Description of Proposed Work: Renovate interior fbulding Millwork furniture partitions,cosmetic finishes SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR CHANGE IN USE OR OCCUPANCY Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CNBC 34) Existing Use Group(s):troy ness I Proposed Use Group(s):No charge SECTION 4:BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) as =arw sr a r no change no change Total Area(sq.R.)and Total Height(ft) 5755 1 24 FT I no change no Change SECHON 5:USE GROUP(Check as applivable) A: Assembly A-1LjA-2LJ Nightclub L] A-3A-4 A-5 B: Business 0 E: Educational F: Facto F-1 F2 H: High Haaard H-1 H-2 H-3 H4H-5 L Institutional 1-1 Lj1-2LJI-3LJ]-4 [_] I M: Mercantile I R: Residential R-1 Lj R-2 LjR-3 LJR4 Lj S: Storage Sl Lj S4 U: Utility U I Special Use ❑ and please describe below: Special Use: SECTION 6:CONSTRUCTION TYPE(Checkas a livable) IA L] IB IIA [:] IIB Q IIIA IIIB IV VA ❑ VB SECTION 7:SITE INFORMATION(refer to 780 CMR 111.0 fox details on each item) Water Supply: Flood Zone Information: Sewage Disposal: french Permit Debris Removal: Licensed Disposal Site Public Check ti outside Flood Zone Indicate municipal A trench will not be P Private or indentdv Zone: or on sirerequired or trench or specify: rysrem permit is enclosed MA Historic Commission Review Process Is their review completed? Yes O No O SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 8 Use Group(s): e Type of Construction: 8 e Occupant Load per Floor. 91 Does the building contain an Sprinkler System?: No Special Stipulations: Is your project within 100 feet of any wetland? Yes 0 No If yes you must contact the Conservation Commission PyH lj P@ �z oflo4L£,C O M R SECTIONS PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Theresa J Ruaa em 86 Masonic St NgMamoton 01075 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Theresa J.Ruggiero (413)586-5002 evetlr(dhotmal corn Signature Telephone No.(business) Telephone No. (cell) a-mail address If applicable,the property owner hereby authorizes Raymond R Houte Construction 5 M Ile,ST Ludlow MA 01056 Name Street Address City/Town State Zip to act on the property owner's behalf,in all matters relative to work authorized Iw this budding permit application. SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 2) If buddingis less than 35,"cu.ft,of enclosed s ace and/or not under Construction Control then check here and ski Section 10.1 10.1 Registered Professional Responsible for Construction Control JDho Landry 4135873050 J.1m@-out2bIaanbuld rum in9S7 Name(Registrant) Telephone No. E-mad address Registration Number 104 Elm Sl NortM1amotonMA 01060 Arch dedural 08/3112018 Street Address Ci Town State ZIP i Discipline Excavation Date 10.2 General Contractor Raymond R Houle Construction Company Name Ryan Pelletier fin'/T/ CS-109244 Name of Person Responsible for Construction Signature License No. and Type if Applicable 5 Miller ST Ludlow MA 01056 Street Address City/Town State Zip 41354)2500 Nano0 o yhoule com Telephone No.(business) Telephone No. cell a-mail address SECTION Il:WORKS 'COWI'ENSATION INSURANCE AFFIDAVITM.G.7..c.152.9 2506 A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the��'66suanc of the building permit. Is a signed Affidavit submitted with this a lira nl Yea Cue SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from been 6)=$ 90 947.00 1.Building $71,747.00 Building PermitFee=Total Construction Cost x 407 (Insert here 2.Electrical $Not under this cmiract appropriate municipal factor)=$ 3.Plumbing $19,200.00 //,^, /• 4.Mechanical (HVAC) $Nd underthls wmad Note:Minimum fee=$(/c3� (contact municipality) 5.Mechanical Other $Nomoder.a.traa Endow check payable to 6.Total Cost $90,947.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Ryan Pelletier Proed Manaus, 4135472500 01118121M Please print and sign name Title Telephone Na Date S Miller ST Ludlow MA 01056 Street Address Ci Town State Zi Municipal Inspector to fill out this section upon application approval: Name Date 1 Appendix 1 For the demolition of structures the building permit applicant shall attest that utility and other service connections are properly addressed to ensure public safety. Please fill in the information below and submit this appendix with the building permit application. The building permit applicant attests under the pains and penalties of perjury that the following is true and accurate. Property Location(Please indicate Map #and Lot# for locations for which a street address is not available) Theresa J Ruggiero 86 Masonic ST Property Owner No. and Street Map# Lot# For the above described property the following action was taken: Water Shut Off? Yes QNo (F) Provider notified, Release obtained? Yes0No0 Gas Shut Off? Yes QNo Q Provider notified,Release obtained? YesONoo Electricity Shut Off? Yes ONo Q Provider notified, Release obtained? YesONoo Yes0No0 Provider notified, Release obtained? YesONoo Yes 0No(j) Provider notified, Release obtained? YesONoo Yes 0NoO Provider notified,Release obtained? YesQNoo Others (if applicable) e Appendix 2 Construction Documents are required for structures that must comply with 780 CMR 107.The checklist below is a compilation of the documents that may be required for this.The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents"' Mark"x"where a liwble No. Item Submitted Inoma tete Not Re uimd 1 Architectural X 2 Foundation X 3 Structural I I I X 4 Fire Suppression 5 Fire Alarm(may require repeaters) X1 I I X 6 HVAC X I I X 7 Electrical X 8 Plumbing include local connections X1 X 9 Gas Natural,Pro ane,Medical or other X 10 Surveyed Site Plan Utilities,Wetland,etc. X 11 Specifications I X 12 Structural Peer Review I X 13 Structural Tests&Inspections Program X 14 Fire Protection Narrative Report X 15 Existing Budding Survey/Investigation, X 16 Ener Conservafim Report X 17 Architectural Access Review l521 CMR X 18 Workers Compensation Insurance X 19 Hazardous Material Mitigation Documentation X 20 Other(Specify) X 21 Other (Spec' X 22 Other(Specify) X "Areas of Design or Construction for which plan are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction.Work started prior to approval may be subjected to triple the origin/permit fee. Registered Professional Contact Information John4139873090 John mute9desi nbuildecon 30257 Landry 9 Registration Number Name(Registrant) Telephone No. a-mail address 104 Elm St Northampton MA— 01060 Architectural 0813112018 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Telephone No. e-mailaddress Registration Number Street Address Ci /Town State Zip Discipline Expiration Date Name(Registrant) Telephone Na e-mail address Registration Number Street Address Ci Town State ZipDiscipline Expiration Date 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 ajoint 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 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 ofthis 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-contractors)name(s),address(es)and phone numbers)along with their cenificate(a)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 ifyou 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(ifnecessary)and under`Job Site Address"the applicant should write"all locations in —» (cityor town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year. Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 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 k The Commonwealth ofMassaehusetts Department of IndustrialAccidents, 1 Congress Street,Suite 100 Boston,MA 0211 4-2 01 7 www.mass.gov/dia Markers'Compensation Insurance AffidaviC Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aoolicant Information Please Print Legibly Name(Business/Organization/Individual):Raymond R Houle Construction Address:5 Miller St City/State/Zip: Ludlow MA 01056 Phone#:413 547 2500 Are you an employer?check the appropriate box: Type of project(required): LQ I am a employer with 30 emplorees(full and/or pastime)` 7. ❑New construction 2.❑l an a sole onsricmr or partnership and have m employees working for me in g. ORemodeling y capacity.[No workerscamp.humane required.l 3 I am a homeowner doing all work myself[No workers'emial,commove required.l' 9. El Demolition 4.❑1 am a bomeownw and will A Lining connacmrs to conduct all work on my property. lain 10[]Building addition ensure that an convauors either have worke%eomomeation insurance or are sole Il.❑Electrical repairs or additions pmpremrs with nc employee, 12.Q Plumbing repairs or additions 501 amagcremlwnnacmrandIhave hired amwkcvntmdrr,[,smdontheirmuchedshea 3.�ROOfrepars These sub-oommms an ors have employeed have war rip p.Insurance: 6.0we art a ccommumn and its officers have exercised thea right ofexemption per MGL c. 14.❑Other 152,$1(4),and we have no employees[No worke%comp.insurance required.] 'Any applicam that checks too,kl must also fill out the section below showing their workers'compensation policy infrawrom Homeowners who submit this affidavit indicating they are doing all work and then hire outside eoonacmrs most submit a new affidavit indicating such. tCwarrwv ors that check this bur most shortest an additional sheet showing the name of the sub-contractors and scale whether or not those entities have employees. If the subcontredors have employees,fey must provide their waders'comp.policy number. 7 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:AIM Mutual Insurance Company Policy#or Self-ins.Lic.#:WMZ-800-8005579-2017A Expiration Date: 12/31/2018 Job Site Address:86 Masonic St City/State/Zip:Northampton MA01060 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$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 pains and penalties ofperjury that the informadon provided above is true and correct Signature- Date: 04/09/2018 Phone#:413 547 2500 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#: Massachusetts Department of public Safety Board of Building Regulations and Standards Ii License- CS-109244 Supervisor ConstructionnSupervisor RYAN PELLETIER 915 TINKHAM ROAD WILBRAHAM MA 01095 fir.—"JZ. LA_ Expiration: Commissioner 07/292019 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 9-edition of the 9th Ulf Massachusetts State Building Code,780 CMR, Section 107 Project Title: Renovation to Northampton Vision Date: 3/29/18 Property Address: 86 Masonic St. Northampton, MA Project: Check one or both as applicable: _ New construction XExisting Construction Project description: Interior renovations to Waiting, Reception, and Dispensary. New barrier-tree toilet rooms added. New optometry exam room artriPri other oxam rooms switeh pesition with therapy spaces. Associate plumbing, HVAC, and electrical. MA Registration Number: 30iitb 7 Expiration date: 8 3/ Da ,am a registered design professions, and 1 have prepared or directly supervised the preparation of all design plaris, computations and specifications concerning: [11 Architectural [ ] Structural [ ] Mechanical [ I Fire Protection [ ] 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 1(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,1 shall submit to the building official a `Final Construction Control Document Enter in the space to the right a"wet'or N 02 electronic signature and seal: a LA._ Phone number: 7/3- j7-305<> Email: �,,, .:�. „v. •,•♦� Building Official Use Only Building Official N. Permit No.: Date: Verson 06 11 2013 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: —�; The debris will be transported by: J SA T,a SA The debris will be received by: U SA- T H 2Q „ 1 Building permit number: Name of Permit Applicant 9YAQ PC(LCTSL2 Date Signature of Permit Applicant BASE BID ALT 1 AS DRAWN Core Work Core Work ceMO max STUOSISREEIROCN DIRSHE IR OCUSL BIN mXWV/S 6NO&SXEETRCLN Blxp w n DDpga Axomxppws FLU......qou h BING pnlM BIXG nbM1 MxMC MxVAC ELECTRICAL PLELECIRICAL $ 92,976 a 11,719 aom in Iwuonemamrl onpen Mwapnpm pn,poanyy. Adw vane mlioneellvwna meMea en Olea wvNarpl Nl�mm emaamaNana u WpheM Paul newaexeper^piena yvr ma paveSAM S.I.,penope u00NeM YMIISYrana9L'an9 pnewae pi s Finishes VERxEM COS] ExER4 ccXOmpxawvERxE%D cont ALL6 }EMPORARYWALLS DTOTAL WpcO BASEBOARD TOTALMflOLNFECnON CONTROLG0.0DRIX0 PAIMIXD i 99}11 IF 21,540 "Ll dl wMe ae.a SASH na mouuvaum..emuae.gaana9n nafewu "A�,na ADO'l—1 All�Axanad lnee.en. P.A Office Equipment Of ENEExERAL coce COST REUSED AND NEW OFFICE WORK SV RMCE&ETOMGeFURNRU RE gEUSEO AND XEW OFFICE WORN SVRFACESRTORAGEhVRHINRE MISC FURNISHINGS I A CESSORIM MISC FURNISHINGS I ACCESSORIES a 79602 f 2SM2 E9uwaedwlId rt wA1 uxnxece..v1-1 ei overs seen ma ea'»u eeuromml eeoda tte —dl pIyA, mnaxo • vS Ra airs Repal e GEXEML CONDITIOXSIOYEN.—COST GENERAL COXDmo"N' RNEAO COST SUB FLOOR REPAIR WORK SUB FLOOR REPAIR WORK E%ISPXO DOOR REPAIR ElG MOq REPAIR WORK NMC ELECTRICAL ELECTRICAL $ M 1 $ Bp All AAI RN,dI AIM Il nexroaewee aamaunn d d. um9euraI'd IN— uWw�dortcew omem.mEKK eewlnamn.w�eSAow Parowows am wmmremawpe Solo omm�mevawx LUuae—pwh-nMme ro m TOTAL BASE BID: $ 297,320 P TOTAL ALT i AS DRAWN $ 86,007