31B-253 BP-2021-2104
33 ELM-ALUMNAE COMMONWEALTH OF MASSACHUSETTS
HOUSE
Map:Block:Lot: CITY OF NORTHAMPTON
31 B-253-00I
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2104 PERMISSION IS HEREBY GRANTED TO:
Project# SPRINKLER SYS Contractor: License:
Est.Cost: 217098 FIRE SERVICE GROUP LLC 145974
Const.Class: Exp.Date:07/04/2022
Use Group: Owner: SMITH COLLEGE XINH SPANGLER
Lot Size (sq.ft.)
Zoning: EU/URC Applicant: FIRE SERVICE GROUP LLC
Applicant Address Phone: Insurance:
1010 THORNDIKE STREET 14136689100 FI WC290917
PALMER, MA 01069
ISSUED ON:11/01/2021
TO PERFORM THE FOLLOWING WORK:
RETROFIT SPRINKLER SYSTEM
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.
Signature:
I� l
, 5 . 5177,,
Fees Paid: S 1,519.1111
212 Main Street, Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
TME-----t—e-- -----'--
F-------1-YEI) 1 .
OCT 2 7 2021 The Commonwealth of Massachusetts
rt. *w Office of Public Safety and Inspections
t: I�l f R Massachusetts State Building Code(780 CMR)
•',, !: r of E3UILo,N neon 3:v. • •rmi Application for any Building other than a One-or Two-Family Dwelling
�_ HA"DTon, r iA 010g0 N6
(This Section For Official Use Only)
Building Permit Numbe,,"'d 1. il'Ir Date Applied: Building Official:
SECTION 1:LOCATION
33 Elm Street Northampton MA 01060 Smith College Alumnae House
No.and Street City/Town Zip Code Name of Building(if applicable)
Assessors Map# Block#and/or Lot #
SECTION 2:PROPOSED WORK
Edition of MA State Code used If New Construction check here 0 or check all that apply in the two rows below
Existing Building® Repair 0 Alteration Cif Addition 0 Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes 0 No 0
Is an Independent Structural Engineering Peer Review required? Yes 0 No ❑
Brief Description of Proposed Work: Retrofit fire sprinkler system within existing
building being renovated
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 CMR 34) ❑
Existing Use Group(s): Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.)
Total Area(sq.ft.)and Total Height(ft.)
SECTION 5:USE GROUP(Check as applicable)
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0 E: Educational 0
F: Factory F-1❑ F2❑ H: High Hazard H-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3 0 I-4 0 M: Mercantile 0 R: Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1❑ S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description:
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB 0 IIIA ❑ IIIB ❑ IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Water Supply: Flood Zone Information: Sewage Disposal:
Trench Permit Debris Removal:
fEl
Public® Check if outside Flood Zone 13 Indicate municipal® A trench will not be Licensed Disposal Site
p required t8 or trench or specify: F S G
Private 0 or indentify Zone: or on site system 0
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 13 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 124 Yes 0 No 0
SECTION 8: CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space:
A City of Northampton
- �NMp e,,,,
s✓
fcMassachusetts 't{r •
1�rx� ` �3
?v° °f DEPARTMENT OF BUILDING INSPECTIONS 9k
9
`ip,,,°.; ' 212 Main Street • Municipal Building �%, .Cb
Northam ton, MA 01060 `^�ri�-=°l
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized agent.
2. One set of plans and specifications of proposed work (Digital & Hard copy).
3. Site Plan with location of proposed structure(s) and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy of CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit (if applicable).
10. Proof of Water and Sewer entry fees paid (if applicable).
11. Trench Permit (if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
13. Please provide the appropriate fee in the form of a check made payable to: The City of
Northampton
r �' SECTION 9: PROPERTY OWNER AUTHORIZATION
Name and Address of Property Owner
Smith College Office of the Treasurer 100 Elm St, Northampton, MA 01063
Name(Print) No.and Street City/Town Zip
Property Owner Contact Information:
Treasurer 413 585 .2639 _ _ ose@smith. edu
Title Telephone No. (business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
Fire Service Group 1010 Thorndike Street, Palmer MA 01069
Name Street Address City/Town State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
. If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control form--;(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals)
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip Discipline Expiration Date
10.2 General Contractor
Fire Service Group, LLC
Company Name rll
Daniel P Belanger SC-145974 q 0'-
Name of Person Responsible for Construction License No. and Type if Applicable
Fire Service Group 1010 Thorndike Street, Palmer MA 01069
Street Address City/Town State Zip
4136689100 - - brenna@fireservicegroup . com
Telephone No. (business) Telephone No. (cell) e-mail address
SECTION 11: WORKERS'COMPENSATION INSURANCE AFFIDAVIT (M.G.L.c.152.§ 25C(6))
- 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 issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes❑ No ❑
SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE
•
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ 217, 09 8
1.Building $ Building Permit Fee=To onstruction st x (Insert here
2.Electrical $ appropriate ;s cipal factor)=$ •
3.Plumbing $ "' 1 61�
4.Mechanical (HVAC) $ Note:Minimum ee=$ 1 o t municipality)
5.Mechanical (Other) $ Enclose check payable to
6.Total Cost $ 217, 098 . 00 (contact municipality)and write check number here 9-01
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 t be•t of my knowledge and understanding.
Brenna K Hanechak 0,4 tj,_Assistant Proj . Mgr . 413-6689100 10/5/21 V
Please print and sign name Title Telephone No. Date
1010 Thorndike Steet, Palmer, MA 01069 brenna@fireservicegroup . com
Street Address City/Town State Zip Email Address
Hviv_., �Municipal Inspector to fill out this section upon application approval: r (b �: i INa
Name ' Date
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
The Commonwealth of Massachusetts
li vv7=' c
Department of Industrial Accidents
cifilisiimil.=
1 Congress Street,Suite 100
Boston, MA 02114-2017
www.mass.gor/dia
1Voricers ('ompensation Insurance Affidavit: Builders/ContractorstElectricians/Plumbers.
TO Ili:IA LEI)WITH'111E:PEICVIITIING AUTHORITY,
Applicant Information Please Print 1,teittiv
Name tBusinessiOrban, izatiorondividualy Fire Service Group
Address: 1010 Thorndike Street
City/State/Zip: Palmer, MAO1069 Phone#:
k re yew an employee theek the appropriate ts,es: Type of project(required):
1 D I':1111 a viriployar with 43 , _employees(full andfor part-timer" 7. 0 New construction
L':...D I.an a sok propnetor or purtnaship and have no einployees working for me in 8. 0 Remodeling
any capacity.[No winters'comp.insurance required)
9. El Demolition
k.:11 I am a homeowner doing all wort myself.[No*miters'torrip.arbors rti.e roa aired]
I 0 0 Building addition
4 Ej 1 am a homeowner and will be hiring warm:lora to conduct all work on my property. I will
ensure that all contractina either h31,C workers'conmensatium insurance OF&It)101e 110 Electrical repairs or additions
proprietors with no employees.
I 2.E3 Plumbing repairs or additions
.SC:i I am a general contractor and I have hired the sub-contractors listed uri the attaithed sheet
1 10 Rixif repairs
These sub•contractors have employers and have workers'comp.insurance.;
14121 Other Fire Protection
ts.E]We ant a corporation and its officers have exercised their right of exemptice per MGL c.
152,§1{4),and we have no employees.[No workers'comp.insurance required]
'Any applicant that checks box 0.1 mast also till out the stection below showing their workers'compensation policy idorniation.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside centrac—tors worst salami a new affidavit nalicalan;soh.
tContractors that check this box mug attached an additional sheet showing the name of the sub-contractors and state whether or not dm:,entities lime
employees lithe sub-contractors have erriplir,ees.the-y must provide their v.vri.en'oorrqs pulley number..
..... ,_,...
I ant an employer that is providing warAers'compensation insurance for my enipioyeeN. Below is the policy and job'ate
information.
Amguard Insurance Company
Insurance Company Name:
Policy /or self4os.Lie.#:F I WC 2 9 0 917 ExpoilvionDmc9/1/2 022
Job Site Address: 33 Elm Street CityiState2ip:Northampton, MA
Attach a copy or 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 tine 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
Alit craue verification.
/do //17-1'bi cc, 'y a tiler the pains and penalties of perjury that the information provided above is awe and correct
phone#.: 413-668-9100
Official us t one. Do not write in this arra,to he completed by city or town oflicial_ 1
City or Town: Permit/Lieense it .......
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#:
..
City of Northampton
Massachusetts �{ _ 'iA.
4 '-4.1 DEPARTMENT OF BUILDING INSPECTIONS ..
^ 212 Main Street • Municipal Building Jti. ?;
v\ Northampton, MA 01060 41,..PP �N14
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance-of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal-facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: Fire Service Group Dumpster 1010 Thorndike St Palmer, MA
The debris will be transported by:
Name of Hauler:
4 Signature of Applicant: Date: 10/5/21