23B-035 61 Locust Sub-Comp 2nd floor 2017-06-15Final Construction Control Document
To be submitted at completion of construction by a
Registered Design Professional
for work per the gth edition of the
Massachusetts State Building Code, 780 CMR, Section 107.6.4
Project Title: Wohl Family Dentistry Date: June 15,20 17 Permit No.
Property Address: 6 1 Locust St, Northampton, MA 0 10 1 60
Project: Check (x) one or both as applicable: New construction X Existing Construction
Project description: complete remodel of level 2, new electrical, HVAC, plumbing & fire sprinkler system, partial
remodel of Level 1, new staff break room
I Stephen Jablonski MA Registration Number: 6078 Expiration date: 0813 1 120 17 , am a registered design professional,
and hereby certify that I have prepared or directly supervised the preparation of all design plans, computations and
specifications concerning1:
Entire Project
X Fire Protection
X Architectural
Electrical
Structural
Other:
Mechanical
for the above named project. I certify that I, or my designee, have performed the necessary professional services and was
present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with
the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and
that I or my designee:
1. Have reviewed, 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. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the
Enter in the space to the right a "wet" or
electronic signature and seal:
progress and quality of the work and to determine ifthe amanner-consistent with the
construction documents and this code.
Phone number: 413 747 5285
Building Oficial Use Only
Building Official Name: Permit No.: Date: I
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.
Trial Version 10-09-201 2