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39-041 (11) 23 ATWOOD DR BP-2019-0516 GIS# COMMONWEALTH OF MASSACHUSETTS Map,Bl : 39-041 CITY OF NORTHAMPTON Lot -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: Building BUILDING PERMIT Permit# BP-2019-0516 Proiect# JS-2017-001642 Est Cost:$13000.00 Fee $800.00 PERMISSION IS HEREBY GRANTED TO: Const Class: Contractor: License: Use Group: DEVELOPMENT ASSOCIATES 075752 Lot Size(so.ft.): 217800.00 Owner: ATWOOD DRIVE LLC Zuni=GB Applicant: DEVELOPMENT ASSOCIATES AT: 23 ATWOOD OR Aypticant Address: Phone: Insurance: P O BOX 528 (413)789-3720 WC AGAWAMMA01001 ISSUED ON.•1 013 012 018 0:00:00 TO PERFORM THE FOLLOWING WORK:DEMISING WALL FOR TENANT FIT OUT , BUILD OUT OF MEDICAL OFFICE SPACE IN EXISTING BUILDING 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: Insulation: Final: oke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: Fee1WDe: Date Paid: Amount: Building 10/30/2018 0:00:00 $800.00 212 Main Street,Phone(413)587.1240,Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner 051thd. o1a4,,3_ i Version1.7 Commercial Buildin Permit May 15,2000 j 'Mint, .i.. p�paMintt�seanly Ci of Northampton S,ptu of henynd NAY Budding Department 7 ?019 , 12 Main Street Room 100 1rPl7 OF UoLmc ;TI`S 'Nort mpton, MA 01060 orfe�T3Bg7-1240 Fax 413587-1272 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 Property Address: This section to be completed by office D-AtwwU Linve Map Lot Unit Northampton,MA 01060 Zone Overlay District Elm SL District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: o wo eve opmen , ox gawam, Name(Print) Current Mailing Atltlress: Signature Telephone 2.2 Authorized Agent: rayls ar ,as agentwn or oox , gawam, Name(Pont) Current Mailin Atltlress'. Signature z j Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Oficial Use Only completed by permit applicant 1. Building I 750,000 (a)Building Permit Fee r 2. Electrical !— _ - (b)Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee re 4. Mechanical(HVAC) p.7�� �D I i` 4gan, ob 5. Fire Protection T 6. Total=(1 +2+3+4+5) 1 Check Number This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commisslonerlinspector of Buildings Date ` 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 ❑ Existing Wall Signs ❑ Demolition Repairs Additions ❑ Accessory Building Exterior Alteration ❑ Existing Ground Sign❑ New Signs ❑ Roofing Change of Use❑ Other ❑ -71 w outo medical o cespace m ems-mg ru mg Brief Description Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly11A-1 ❑ A-2 11A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business 0 2A ❑ E Educational ❑ 2B 0 F Factory ❑ F-i ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ 5-2 ❑ 5B ❑ U Utility ❑ Specify: l— _ 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: L 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) 1., 2rer 3 mf— m _. __... L _J Total Area(sf) Total Proposed New Construction(sQ___ Total Height(fl) Total Height K Public Private Zone -_ Information: 7.3 Sewage Disposal System: 7.Water Supply(M.G.L.c.40,g 54) 7.1 Flood Zone ❑ ❑ [, Outside Flood Zone[] 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 L _ Lot Size Frontage Setbacks Front i I I Lt1 R:Si F Rear Building Height r �_ __ _J L_. --_J _ Bldg.Square Footage �. i_— % Open Space Footage .. _ % - (lotareaminusbldg&paved arkin ) #ofParkmg Spaces vdume&location) L -- -- --- --- --- -�' A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO © DONT KNOW O YES Q IF YES, date issued: li IF YES: Was the permit recorded at the Registry of Deeds? NO © DONT KNOW O YES 0 IF YES: enter Book - Page and/or Document Ni B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW © YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained © , Date Issued: C. Do any signs exist on the property? YES O NO O IF YES, describe size, type and location: xis Ing and previous y approv D. Are there any proposed changes to or additions of signs intended for the property? YES O NO Q 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 Othat will disturb over t acre? YES NO • IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.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) 9.1 Registered!Architect: Charles W. Roberts Not Applicable I7 Nene Ami bwm: 10107 26 Street, Suite 2B, Amherst, MA 01002 Registration Number Address /� - Au USt 31, 2019 413-259-1630 FxPiretlan Deb signature Telephone BZ Registered Prolecabnal ftkwe sg Name Ales of Respm1bloty Address Registration Number signature Tebphane 6piretlon Dew Name Area of Responsibglty Address istretlun Number L� signature Telephone Expiration Dab Name Area of Responsibility Addieaa Registration Number Slpnebre Tebphone Erpiratlon Data Name Area of Responsibility Addreaa Ragbtralbn Number Signature Telephone Expiration Dab 9.3 General Contractor Development Associates Not Applicable 0 Company Name: Travis P.Ward Resp nol*In Charge of Construction , 200 Silver Street, Suite 201 . O. Bm 528,Agawam, MA 01001 Address Z.- 413-789-3720 T.W.synaftwo Veraionl7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTNIN SERVICES-FON BUILDINGS AND STRICTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Reglelered Architect: Not Appgceble ❑ Mme Mn Repbfntlon Number Md. Expheuon Dery slonewn, L TNap-hone J 9.2 Islared Profeaeloml I c): RocC-l2-r C H&CS-4R Ad PE None Ara of Reeporabl3Y 39.8' .yvalrulzsr 77g. e.GoM6�yetmw Met o Address Ragbtratbn Number =&I-"o9 1 2-4'7s? r �T slpMhee Telephoto Eepnllon Data 06 ao Zo None Ane of Respon0b" Parent laVagm Number Signature Telephone Fxpinr n Data Name Ane of ReepoMbaity Mdms Regiatretbn Number SipneNre Telephone Expinibwn Dab Name Pna of RoapoMiNAy Address Ragistnson Number Signabire TebphoN, I EiPMbon Dab 9.3 General Contractor Not Applicable❑ Company Mme: RaeponsiNe In CMW of Conebutlbn Address Sgnabn TebpMne Versionl.7 Commercial Building Permit May l5,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT JfNorthwoodeve opment, as Owner of the subject property avis ar hereby authorize to act on my behalf,in a a ers relative t work authorized by this building permit application. IA ay , Signature of caner ��` Date ravlS F. Ward 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. Si ned under the ains and enalti of unit. rayls ar ,as agen row r Pant Name ay 6,2019 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 101 Licensed Construction Supervisor: Not Applicable ❑ avis ar Name of License Holder: License Number Liz o um t nve, a mg Hills,MA UIIJay , Address Expiration Date 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 tlenial of the issuance of the building permit. No © Signed Affidavit Attachetl Ves Q 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: 15 Atwood Drive, Northampton, MA 01060 The debris will be transported by: USA Hauling The debris will be received by: USA Hauling Building permit number: Name of Permit Applicant Northwood Development, LLC May 6,2019 �� �' �]C 0A47 f Date Signature of Permit Applicant The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Ww.rkers'Compensation Insurance Affidavit:Builders/Contractors/Electricions/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant If r tion Please Print Legibly Nagle (BusinesslOrganizalioNlvdlvidual): Development Associates Address:200 Silver St., Suite 201, P. O. Box 528 City/State/Zip:Agawam, MA 01001 Phone #:413-789-3720 Are you an employer?Check the appropriate box: Type of project(required): I.Qlamaemoloyerwnit 5 employees(run und/orpurt-hme) 7. ❑✓ New construction 2.❑1 am a sole proprietor or partnership and have no employees working forme in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3711 am a homeowner doing all work myself(No workers'comp.insurance required.)' 4.❑I an a homeowner and will be hiring cnionactors to conduct all work on my property. 1 will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 sm a general conlmelor and I have hired the sub-contractors[larder the couched sheet 13.[]Roof repairs These sub-examontors have employees and have workers'comp.inswence.t 6.❑Weare a corporation and its officers have exercised their right of exemption per MGL c 14.❑Other 152,§I(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant Nm checks box 41 most also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicazing they are doing all work and then hire outside contractors must submit a new afidmit including such. IContractors that check this box must attached an additional sheet showing the time of the sub-contractors and slate whether or not Nose entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensmion insurance for my employees. Below is the policy and job site information. Insurance Company Name:Great American Insurance Company Policy N or Self-ins. Lie. N:WC1130018-03 Expiration Date:04/13/20 Job Site Address:15 Atwood Drive City/State/Zip:Northampton, MA 0106 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. lzzzmml I do hereby certify und¢r the ' s and p shies of perjury that the information provided above is true and correct. Signature: Da[ - May 6,2019 Phone N:413-7t9-3720 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License N Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityfown Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone N: Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the ninth edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Cooley Dickinson Healthcare Date:04/30/19 Property Address: 15 Atwood Dr.,Suite 201,Northmapton,MA Project: Check(x) one or both as applicable:X New construction X Existing Construction(Core & Shell) Project description:This project is a 7,720 SF fit-out of existing open space on the second Boor of a recently constructed and occupied building. The project will include new doors and partition walk as well as new Boor,wall,and ceiling finishes. New HVAC work,as well as modifications to the existing sprinkler system will be part of this work. (MEP/FP drawings,specifications,and code compliance documents are to be submitted under separate cover). The new office space,and the entire building,will be fully sprinklered. I Charles W. Roberts MA Registration Number: 10107 Expiration date: August 31, 2019 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': X Architectural Structural Mechanical 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 I(or my designee)shall perform the necessary professional services in accordance with the Professional Standard of Care,and be present on the construction site on a regular and periodic basis to: 1. 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.Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 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.The contractor shall be responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods,sequences and procedures,and for construction safety. 4. The performance of the services shall not require any special testing or inspections unless specifically stated in the 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,I shall submit to the building official a Tinal Construction Control Document'. ytEA gRCy Enter in the space to the right a"wet"or electronic signature and seal t 7 9� Phone number: (413)259-1630 Email:CRoberts®kuhnriddle.com A S. Building Official Use Only OF MP`'SpG� Building Official Name: Permit No: Date: Note 1.Indicate with an'i project design plans,computa tons and specifications that you prepared or directly supervised. If'other'is chosen,provide a description. Versioa 01_01 2018