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23B-046 (275)
30 LOCUST ST BP-2020-0366 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-046 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY IFUND (MGL c.142A) Category: ELECTRICAL BUILDING PERMIT Permit# BP-2020-0366 Proiect# JS-2020-000565 Est.Cost:$50000.00 Fee: $350.00 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 INCI Zoning: M(99)/WP(21)/URB(1)/ Applicant: RAYMOND R HOULE CONST INC AT: 30 LOCUST ST . Applicant Address: Phone: I Insurance: 5 MILLER ST (413) 547-2500 () WC LUDLOWMA01056 ISSUED ON.9/30/2019 0:00:00 TO PERFORM THE FOLLOWING WORK:LINEAR ACCELERATOR RENO POST THIS'CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector'of Wiring D.P.W. Building Inspector Underground: Service: Meter: Fooltings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: I i Rough: Oil: Insiulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. i Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 9/30/2019 0:00:00 $350.00 212 Main Street,Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner File#BP-2020-0366 APPLICANT/CONTACT PERSON RAYMOND R HOULE CONST INC ADDRESS/PHONE 5 MILLER ST LUDLOW (413) 547-2500 () PROPERTY LOCATION 30 LOCUST ST MAP 23B PARCEL 046 001 ZONE M(99)/WP(21)/URB(l) I THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKL'IST P<LOSM REQUIRED DATE ZONING FORM FILLED OUT ; Fee Paid Building Permit Filled out Fee Paid Tvveof Construction: LINEAR ACCELERATOR RE New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 066227 . 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 Wiih Site Plan / Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § I Finding ' Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from.DPW Water Availability Sewer Availability ' I Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee i i Permit from Elm,Street Commission Permit DPW Storm W ter Management Demolition Delay i Sign re 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. Versi6n1.7 Co it May 15,2000 Department use only City of Northampt n ja."Yb Building Depai nt Curb Cull Permit - 212 Main 8tre SEP 1 8 Mr/SDepartment Room 100 Water/Wility Northampton, MA 10 aT OF Setstural Plans LDINGIphone 413-587-1240Fax I � r'TONr A��ot2� 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.sectionito be completed by office Cooley Dickinson Hospital T T_ Map.: Lot Unit 30 Locust St. Northampton, MA 01060 Zone Overlay District : . SM St._District CBbistrict SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cooley Dickinson Hospital ^� 30 Locust St. P.O. Box,5001 Name(Print)]�, l -� Current Mailing Address: 413-582-2313 _ Signature Telephone 2.2 Aut zed A ent: R ymond R. Houle Construction Inc. -� — (5`Miller St. Ludlow, MA 01056 Name Print Current M.9.iling Address:. i 413-547-2500 Signature. Telephone SECTION 3-ESTIMATED.CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only con leted by permit applicant 1. Building (a)Building Permit Fee I 2. Electrical (b)Estimated Totai Cost of � Construction from 6 3. Plumbing UlN� Building Permit Fee /4. Mechanical(HVAC) 7%00 I►gype SGO-00 5. Fire Protection, Z 6. Total=(1 +2+3+4+5)• a V U Check Number �. This Section For Official Use Only. Building Permit:Number Date Issued Signat re: BuildiM Conimissionel/Inspector of Buildin Date i Versioril.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 0 Repairs❑ Addition's ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing[] Change of Use❑ Other❑ Brief Description Enter a brief description here. Remove and replace a raaar Acce erl .ato Cabinetry replacement and minor non Li Of Proposed Work: structural wall modifications. F� SECTION S. USE GROUP AND CONSTRUCTION TYPE USE GROUP.(Check as applicable), . CONSTRUCTION TYPE A Assemblya A-1 ❑ A-21 ❑ A-3 ❑ 1A A-4 ❑ A-5 ❑ - 1B ❑ B Business ❑ 2A ❑ E. Educational. ❑ 2B I ❑ .F Factory _ ❑ F=1, . ❑ F-2 2C. ❑ H High Hazard ❑ 3A ❑ ,Institutional ❑ 1-1 ❑ k2. 0 I.3 ❑ 3B. ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage S-1 ❑ S-2 E) 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: 12 ___ - __ Proposed.Use Group: Existing Hazard Index 780 CMR 34): �� . Proposed Hazard Index 780 CMR 34): I`* T^Y� SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE_ONLY. Floor Area per Floor(sf) 1 S` 51 2nd 2nd P .. . 3rd th 4th 4 i J Total Area(sf) �9��j Total Proposed New Construction s. Total Height(ft) Total Height ft j i 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone Outside Flood ZonegQ Mdnicipalo On site disposal system❑ i Versionl.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING . Existing Proposed Required by Zoning This'column to befilled in by Building Department Lot Size. x969,427.8 ] 1969,427.8 Frontage 2658 [2658' Setbacks Front 102' 102'� Side L:88' R:42' ] L:88'l_] R:42' L J Rear Building Height 64.5' Bldg;Square_Footage 40286 Open Space Footage % (Lot area minus bldg&paved 40,6 40U 0 parking) #of Parking Spaces. 761V. 761 0 Fill: volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on,the site? NO 0 DONT KNOW 0 YES IF YES, date issued: (Dec 13,2001 IF YES: Was,the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES IF YES: enter Book _6504 Pagel 239 _ al d/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DON7 KNOW 0 YES 0 IF YES; has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued:C C. Do any signs exist on the property? YES @ NO IF YES, describe size, type and location: VariousA D. Are there any proposed changes to or additions of signs intended for the�property? YES 0 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 ® NO IF YES,then a Northampton Storm Water Management Permit from the DPW iso required. i i Versionl.7 Commercial Building Permit May 15,2000 i SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: H/AI Architecture 64 Gothic St. Northampton, MA 01060 Not Applicable ❑ Name(Registrant): See Affadavit FH--/Al Architecture 64 Gothic St. Northampton, MA 01060 I Registration Number Address `—� 413-585-1512 Expiration Date Signature Telephone 1 9.2 Registered Professional Engineer(s): Ill Integrated Services HVAC, Electrical and Plumbing* l Name Area of Responsibility 1 206 Newbury St. Bloomfield, CT 06002 See Affadavit Address Registration Number 11-860-286-K7] Signature Telephone, Expiration Date i Name Area lof Responsibility I Address Regi stration Number l Signature Telephone Expiration Date Name Areal of Responsibility Address ReFgijstration Number Signature Telephone Expiration Date Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date h 9.3 General Contractor Raymond R. HouleConstruction Inc. Not-Applicable ❑ Company Name: Timothy S. Pelletier _V Responsible In Charge of Construction15 _ Miller St. Ludlow, MA 01056 � � Address _ 413-537-8657 Signature Telephone i 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 1 No 0 SECTION 11 OWNER AUTHORIZATION-TO BE,COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT ,I Cooley Dickinson Hospital { ,as Owner of the subject property hereby authorize Fgay mond R. Houle Construction Inc to I act on m alf,in all matters relative to work authorized by this building permit application. 9-11-2019 Sifnature of Owner Date I i Raymond R. Houle Construction Inc. ,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. (Timothy S. Pelletier Print Name � C F77 Signature of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Timothy S .. Pelletier _ 066227 License Number 5 Miller St. Ludlow, MA 01056 07-07-2021 Address Expiration Date F413-537-8657 1 Signature Telephone I I 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 (D No 0 i City of Northampton 212 Main Street, Nor ihampton, MA 01060 i 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 LOCUS i S /. The debris will be transported b : r y �1 The debris will be received by: ( AW ;Al i Building permit number: Name of Permit Applicant S Date Signature of Permit Applicant The Commonwealth of Massachusetts. Department of Industrial Accidents Office qInvestigations 1 Congress Street,Suite 100 Boston,MA:02114-2017 www.massgov/dia J. Workers':Compensation Insurance Affidavit: Builders%ContractorslElectricianslPlumbers Auuficant.Information. I Please Print Legibly Raymond Name (Business/Organization/Individual): R'. Houle Construction,: Inc. Address: 5 Mller.Street. CitylState%Zip: :Ludlow;MA.01056 Phone#: . 413-547-250.0*. ' Are you an.employer? Check the appropriate box: Type of project(required): 1. am a employer with 4:.Q I am a general contractor and.I 1 employees(fitll and/or part-time);* have hired the sub-'contractors 6. Q N cons • construction 2:❑ I am;a sole proprietor or partner-. listed attached sheet. 7. D Remodeling ship and have.no employees. . These sub=contractors have g,• Q Demolition working for me in any,capacity: employees and have:workers' 19:. Building addition. [No workers' comp. insurance comp: insurance:I , required.] IP 5: oration.and its : .10.0 Electrical,repairs_or additions • .. 0 We are a co officers:have exercised their 3.ElI:am.a homeowner doing all work : 11:0 Plumbing repairs of additions m .self. o workers'. . . . right of exemption per MGL y . .. p. 12.0 Roof repairs T. c..152 1: 4 and we have no. �: . insurance required:] § (.)� .'. .. Other employees: [No workers :13: 0 . c inp:insurance required.]_. I. . . . "Any applicant that checksboz A must also fill out the section below showing their.workers'compensation policy information. t Homeowners who subi iit this affidavit:indicating they are doing all work and then hire outside contractors m>�st submit a new affidavit;indicating such. tContraotors 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. :ff the sub-contractors have employees,they must provide their.workers'comp:policy number: I ant an employer that is.providing.workers'compensation insurance foY my:employees.'Below is:t/:e.policy and job site . . Insurance.Company.Name: CITIZENS INSURANCE-COMPANY.OF AMERICA Policy#or Self-ins:.Zic.:#: : WBN-D733095-00 Expiration Date: _ 1.2/31/2019 Job Site.Address: City/State/Zip:. . Attach a co of the workers'.com ensation olic .declaration. a e' showin the ohc number. and,ex iration date FY P F. Y - P g (.. g P . YP�. ) Failure to secure coverage.as re.quired.under Seetion.25A of MGL c..152 can lead.to the imposition of eriniinal penalties of a fine up.to'$1;500'00 and/or one-year imprisonment,_as:well-as.civil-penalties in the form hof a STOP WORK ORDER and a fine of up to.1250,00z day against the violator. Be.advised that a copy of this•statementmay.be forwarded to-the Office of Investigations of the DIA.for insurance:coverage verification: I do hereby certify:under.the pains d e es of perjury that the.information.providedpabove:is true and correct Si attire-:. Date: / Phone#: Official use onl•. Do.not write. area,-to be com.leted-b ci or official, ff. Y . . �. P Y . tY .. City or Town: Permit/License. Issuing authority(circle one): : .'Board of health, 2.Bitilding Department 1,City/Town Clerk. 4.Electrical Inspector &TIunibing Inspector. 6:Other. 1 Contact Person: Phoifle#: .. A�® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1 01/11/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME:NTACT Michelle Arsenault USI Insurance Services LLC ac No e><t: (413)750-4407 tFAIX C No): (413)543-4153 711 E Main Street E-MAIL michelle.arsenault@usf.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Chicopee MA 01020 INSURERA: Citizens Ins.Co.of America 31534 INSURED INSURERB: Allmerica Financial Benefit 41840 Raymond R.Houle Construction,Inc. INSURERC: Hanover Insurance Company 22292 5 Miller Street INSURER D: INSURER E: Ludlow MA 01056 INSURER F: COVERAGES CERTIFICATE NUMBER: 2018 Cert REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED(ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1�7RR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS (NSD WVD POLICY NUMBER MM/DD/YYl'Y MM/DD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 100,000 MED EXP(Any oneperson) $ 5,000 A ZBND446685 12/31/2018 12/31/20191 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATELIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑PRO- JECT LOC PRODUCTS-COMP/OPAGG $ 2000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea aident $ 1,000,000 a ANY AUTO BODILY INJURY(Per person) $ BOWNED X SCHEDULED AWN D446731 12/31/2018 12/31/2019 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ Ix AUTOS ONLY X AUTOS ONLY Per accident [AND UMBRELLA UAB X OCCUR i EACH OCCURRENCE $ 5,000,000 CEXCESSLIAB CLAIMS-MADE UHN D446693 12/31/2018 12/31/2019( AGGREGATE $ 5,000,000 DED X RETENTION$ NIL $ RKERS COMPENSATION PER OTH- X STATUTE X ER EMPLOYERS'LIABILITY Y I N PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 C ICERIMEMBEREXCLUDED7 N NIA WBN-D733095 12/31/2018 12/31/2019 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached H more space Is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN EVIDENCE OF INSURANCE ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WtR-��IVGGi.�/ ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I H I Al Architecture TRANSMITTAL DATE: September 19, 2019 PROJECT: 19-031 Renovations for Linear Accelerator Replacement Cooley Dickinson Hospital 30 Locust Street Northampton, MA 01060 TO: City of Northampton Building Department Pulchalski Municipal Building 212 Main Street Northampton, MA 01060 Attn: Louis Hasbrouck, Building Commissioner FROM: Don Hafner HAI Architecture 64 Gothic Street, Suite 1 Northampton, Massachusetts 01060 ITEMS: Copies Date Description 1 09/17/2019 Permit Set, 24x361stamped/signed prints 1 09/17/2019 Permit Set, electronic copy 1 09/17/2019 Initial Constr. Control Affidavit (Arch) 1 09/17/2019 Initial Constr. Control Affidavit(M/E/P/FP) REMARKS: Attached please find the Permit Set for Renovations for Linear Accelerator Replacement at Cooley Dickinson Hospital. Please contact me if you have any questions concerning the submission. cc: Jonathan K. Slater, CDH, Director of Facilities Management Tim Pelletier, Raymond R. Houle Construction Jeff Cichonski, BVH Integrated Services h4 Gothic street;suite 1,Nortlianipton,MA 01060 1 4'13.585.1512 1 W413.586.7945 I wivw hAiarc6itecture.cam i I Initial Construction Control Document Z W To be submitted with the building permit application by a d Registered Design Professional ,w for work per the ninth edition of the, Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Renovations for Linear Accelerator Replacement Date:09/17/2019 Property Address: Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060 Project: Check (x) one or both as applicable: New construction X Existing Construction Project description: Replacement of existing linear accelerator and minor renovations to a limited area of Radiation Oncology— Basement Floor Level. i I Donald J. Hafner, MA Registration Number: 8951 Expiration date: August 31, 2020 , 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 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. 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. I 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. EDAR c Upon completion of the work,I shall submit to the building official a'Final C ity' Document'. Enter in the space to the right a"wet" or MaslhU electronic signature and seal: �o setts o Phone number: 413.585.1512 Email: don.hafner@haiarch itectu e. 41 of MP55P Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an'x'project design plans,computations and specifications that you pr(pared or directly supervised.If'other'is chosen,provide a description. Version 01_01 2018 I Initial Construction Control Document _ To be submitted with the building permit application by a N _ d Registered Design Professional for work per the 9a'edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Cooley Dickinson Hospital Linear Accelerator Replacement Date: September 18,2019 Property Address: 30 Locust Street,Northampton,MA Project: Check(x)one or both.as applicable: New construction I X Existing Construction Project description: Replacement of existing linear accelerator and associated equipment include room finish upgrades. I, Jeffrey S. Cichonski,MA Registration Number: 49384,Expiration date: 6/30/2020, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural Structural X Mechanical X Fire Protection X 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 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. 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 m er 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,I shall submit to the building official a `Final Construction Control Document'. H Mq� Enter in the space to the right a"wet"or N electronic signature and seal: 8 Ki No. 84 y Phone number: 860-286-9171 Email:jeffc@bvhis.com I i Building Official Use Only Building Official Name: Permit No.: Date: 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. i Version 06 11 2013 HAI Ambitecture 64 GOTHIC STREET.SUITE 1 . ' '_' •) ..` '. ..'' NORTHAMPTON.MA ')1Or.0 Tata 5.65.1512 F41,16PS.7945 NEW CONCRETE SLAB(4000 PSI) CONSULTANT: O d LL PLA w 'PLA EXISTING CONCRETE SLAB TO REMAIN `•i, SEAL: PLAN NEW CONCRETE SLAB(4000 PSI) EXISTING ALIGN NEW 5/6"x 16"MINIMUM STEEL DOWEL(#5 CONCRETE SLAB BAR)ANCHORED INTO EXISTING&NEW PROGRESS SET CONCRETE SLABS ALL SIDES AS SHOWN NOT FOR CONSTRUC TION .-m DRILL EXISTING CONCRETE SLAB FOR NEW STEEL DOWEL ".� :;r'.' '•-> "`'' CONTRACTOR TO PROVIDE 10-MIL VAPOR BARRIER BELOW PROPOSED CONCRETE WORK AND OVERLAP EXISTING VAPOR BARRIER(12"MINIMUM) TAPE ALL EDGES 7. Y= 2"MIN.COVER SAND OR STONE DUST @ PIPE AND/OR CONDUIT;SIMILAR WATTS° bF� :" ;' ; , CONDITION FOR RECESSED ELECTRICAL" (TYPICAL) :`' BOX-SEE MECHANICAL AND/OR SECTION ELECTRICAL DRAWINGS FOR ADDITIONAL MARK DATE ISSUE INFORMATION 18 SLAB PATCH DETAIL A101 SCALE: N.T.S. . - - PROJECT: Renovation for: Replacement Linear Accelerator Basement Floor Level Cooley Dickinson Hospital 30 Locust Street Northampton,MA 01060 PndEm"o: 1931 anwscru,o�cr: OH v"aecr"awDen DH GS mre 09/17/2019 ro%w" Ii JAI Ard-itecture.Inc. SHEET TITLE SLAB PATCH DETAIL A501