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23B-046 (278)
30 LOCUST ST BP-2020-0906 GIS#: COMMONWEALTH OF MASSACHUSETTS Maa:Block:23B-046 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 P E RM I T Permit# BP-2020-0906 Project# JS-2020-001541 Est.Cost: $2276958.00 Fee: $15400.00 PERMISSION IS HEREBY GRANTED TO: Const.Class! Contractor: License: Use Group: RAYMOND R HOULE CONST INC 066227 Lot Size(sa. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M(99)/WP(21)/URB(,l)/ Applicant: RAYMOND R HOULE CONST INC AT: 30 LOCUST ST Applicant Address: Phone: Insurance: 5 MILLER ST (413) 547-2500 0 WC LUDLOWMA01056 ISSUED.ON:2/14/2020 0:00:00 TO PERFORM THE FOLLOWING WORK RENOVATIONS TO CHILDBIRTH CENTER 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 2/14/2020 0:00:00 $15400.00 212 Main Street, Phone(413)587-1240, Fax:(413)587-1272 Louis Hasbrouck—Building Commissioner Versionl.7 Commercial Building Permit May 15, 2000 Department use only City of Northampton Status of Permit: y Building Department Curb Cut/Driveway Permit 200 _ nFuT 5F ,2 Main Street Sewer/Septic Availability ' `t TyV��Di Room 100 Water/Well Availability q l4<1 r NC'/nlc Ch!4y44PECr'/CN NO hampton, MA 01060 Two Sets of Structural Plans �' es413 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 46—W& �) 1.1 Property Address: This section to be completed by office Cooley Dickinson Hospital Map J Lot OC/6 Unit 30 Locust St v,- Northampton, MA 01060 Zone Overlay District Elm St. District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Cooley Dickinson Hospital 30 Locust St. P.O. Box 5001 Name(Print) Current Mailing Address: 413-582-2313 Signature Telephone 2.2 Authorized Agent: Raymond R. Houle Construction Inc. 5 Miller St. Ludlow, MA 01056 Name(Print) Current Mailing Address: 413-547-2500 Signature Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by permit applicant 1. Building 1,080,802.00 (a)Building Permit Fee J 2. Electrical 325,037.00 (b)Estimated Total Cost of Construction from 6 3. Plumbing 312539.00 Building Permit Fee /r 4. Mechanical (HVAC) 558580.00 5. Fire Protection !� 6. Total = (1 + 2+ 3 +4 + 5) o a -7 &V s Check Number This Section For Official Use Only Building Permit Number Date Issued SignatWre: TAt /),/� Buildinr/Ins ector of Buildvio Date uIr / Versionl.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 0 Demolition 0 Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑ Enter a brief description here. Renovations to the Childbirth Center To include: Cabinetry, Flooring, Painting, minor Brief Description wall modifications, plumbing, medical gasses, HVAC and electrical Of Proposed Work: SECTION 5-USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ 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 ❑ 1-2 El 1-3 ❑ 3B M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: i 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: 12 Existing Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 4 SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 s` 15200 1 st 15200 2nd 2nd 3 rd 3rd 4n, 4m Total Area(sf) 15200 Total Proposed New Construction (sf) 15200 Total Height(ft) Total Height ft 7.Water Supply(M.G.L.c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public E] Private E] Zone Outside Flood Zone E] Municipal E] On site disposal system E] Version 1.7 Commercial Building Permit May 15,2000 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 969,427.8 969,427.8 Frontage 2658' 2658' Setbacks Front 102' 102' Side L: 88 R:42' L:88' R:42' Rear 18' 18' Building Height 64.5' 64.5' Bldg.Square Footage 40286 % 40286 Open Space Footage % (Lot area minus bldg&paved 40.6 40.6 parking) #of Parking Spaces 761 761 Fill: volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO O DONT KNOW O YES O IF YES, date issued: Dec 13,2001 IF YES: Was the permit recorded at the Registry of Deeds? NO O DONT KNOW © YES e IF YES: enter Book 6504 Page 239 and/or Document#. B. Does the site contain a brook, body of water or wetlands? NO O DON'T KNOW O YES O IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained © Obtained O , Date Issued: C. Do any signs exist on the property? YES e NO IF YES, describe size, type and location: Various D. Are there any proposed changes to or additions of signs intended for the property? YES O NO e 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 O IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial h, "ng 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 35,000 C.F.OF ENCLOSED SPACE) 9.1 Registered Architect: Isgenuity LLC 500 Harrison Avenue, Suite 5F Boston, MA 02118 Not Applicable ❑ Name(Registrant): See Affadavit Isgenuity LLC 500 Harrison Avenue, Suite 5F Boston, MA 02118 Registration Number Address 617-419-4660 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): BVH Integrated Services HVAC, Electrical and Plumbing Name Area of Responsibility One Gateway Center, Suite 701 Newton, MA 02159 See Affadavit Address Registration Number 1-617-658-9008 Signature Telephone Expiration Date _—J Name Area of Responsibility Address Registration Number i Signature Telephone Expiration Date l J Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date l Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Raymond R. Houle Construction Inc. Not Applicable ❑ Company Name: Timothy S. Pelletier Responsible In Charge of Construction 5 Miller St. Ludlow, MA 01056 Address 413-537-8657 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 O No O SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Cooley Dickinson Hospital as Owner of the subject property hereby authorize Raymond R. Houle Construction Inc to act on my behalf, in all matters relative to work authorized by this building permit application. 01-31-2020 Signature of Owner Date 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 If Print Name 01-31-2020 Signature of Own /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 413-537-8657 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 denial of the issuance of the building permit. Signed Affidavit Attached Yes Q No 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: '36 Lo c vs 1-S 1 The debris will be transported by: f/YA /,*-/7 61 The debris will be received by: V'5/4 /1A V///,/ (— Building permit number: Name of Permit Applicant �A%Mv�lb �. Hydr COW'..-5- A-31- ?o 2 iWlS3/- ?o2 Date Signature of Permit Applicant ZThe Commonwealth of Massachusetts Department of IndushWAccidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 ` Y www massgov/dia Workers'Compensation Insurance Affidavit: Buffders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Otganizationandividual): Raymond R. Houle Construction, Inc. Address: 5 Miller Street City/State/Zip: Ludlow, MA 01056 Phone#: 413-547-2500 Are you an employer?Check the appropriate box: Type of project(required): 1.X I am a employer with 30 _ 4• ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet_ 7. Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp. insurance comp•insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.E]Other employees. [No workers' comp.insurance required.] *Any applicant that ehecioz 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 contractors must submit a new affidavit indicating such. :Contractors 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. If the sub-contractors have employees,they must provide their workers'comp.policy number, lam 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 Policy#or Self-ins. Lic.#: MCC-200-2000566-2019A Expiration Date. 12/31/2020 Job Site Address:_3d ZV C t'/,$T S7_ City/State/Zip&e 7'��-�i¢ Q/060 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify ander th painsapftpenaftiesof erjury that the information provided above is true and correct 7; Si mature: 2Date: —Z-0 Phone#: 4/1�—Ty7— 2_<ou OJjrcial 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 S.Plumbing Inspector 6.Other Contact Person: Phone#: RAYMRHO-01 ANGE A�ORO' CERTIFICATE OF LIABILITY INSURANCE DAT1/2/2 DIYYYY) 1/2/2020 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(ies)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 c CT Angela DWugustino Phillips Insurance Agency,Inc. P"�"N ;(413 594-5984 FAX 413 592-8499 97 Center Street Chicopee,MA 01013 14p%ss.angela@phillipsinsumnce.com INSURERS)AFFORDING COVERAGE NAIC/ NSURER A:S911111 a Insurance 12572 INSURED INSURER B:A.I.M.Mutual Ins.Co. 33758 Raymond R.Houle Construction Inc NSURERC: 5 Miller St INSURER D: Ludlow,MA 01056 NSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. I"T TYPE OF INSURANCE ADDL�� POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �1 OCCUR S2395590 12131/2019 12/31/2020 DAME 500,000 occurrence)PREM, ESIE. $ MED EXP An one $ 15,000 PERSONAL b ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY❑X JEC7 F—]LOC PRODUCTS-COMP/OP A 112,000,000 OTHER: A AUTOMOBILE Lwam COMBINED SINGLE LIMIT 1,000,000 ANY AUTO 9107499 12/31/2019 12/31/2020 BODILY INJURY Per arson $ OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY BRORDILY INJURY Per accident X ATOS ONLY X ALJTOR ONLY PPeOra dent AMAGE A X UMBRELLA LJA' X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLJAe CLAIMS-MADE 2395590 12/31/2019 12/31/2020 AGGREGATE $ 5,000,000 DED I X I RETENTION$ 1000 B WORKERS COMPENSATION �( PER 1FRTH- AND EMPLOYERS'LIABILITY MCC-200-2000566-2019A 12/31/2019 12/31/2020TUTE 1,000,000 ANY�PR�ROPREIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT Windar4gnM R EXCLUDED' NIA 1 j0'000 lM wt I Nf1) E.L.DISEASE-EA EMPLOYE K es,describe under 1,000,000 ES RIPTION F RAT/ N below E.L.DISEASE- LI LIMIT A Leased/Rented Equip S2395590 1213112019112/31/2020 Limit 100,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addldonal Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof Of Coverage THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25(2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 Hospital Childbirth Center Renovation Date:2/3/20 Property Address: 30 Locust Street,Northampton, MA 01060 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description:Multi-phased renovation of the existing birthing center in the P2000 building. I, Martin 1. Batt, MA Registration Number: 11098 Expiration date: 8/31/20 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. 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'. Enter in the space to the right a"wet" or klIN J. electronic signature and seal: Phone number: 617419-4662 Email:mbatt®isgenuity.com 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. Version 01 01 2018 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 0 edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: Cooley Dickinson Hospital Child Birth Center Renovations Date: February 4, 2020 Property Address: 30 Locust Street,Northampton,MA 01060 Project: Check(x)one or both as applicable: New construction I X Existing Construction Project description: Multi-phased renovation of the existing birthing center in the P2000 building. 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 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,I shall submit to the building official a `Final Construction Control Document'. N �S Enter in the space to the right a"wet"or electronic signature and seal: HO KI Phone number: 860-286-9171 Email:jeffc@bvhis.com U No. e4 Q 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. Version 06 11 2013