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31B-079 BP-2023-0857 12 PROSPECT ST COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 31B-179-001 CITY OF NORTHAMPTON Permit: Alts Renovations Repair PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) BUILDING PERMIT Permit # BP-2023-0857 PERMISSION IS HEREBY GRANTED TO: MECH CONVERSION DAVIS Project# CENTER Contractor: License: Est. Cost: 1228498 MIKE SPOEK C S- oa479 Const.Class: Exp.Date: Use Group: Owner: COLLEGE SMITH Lot Size (sq.ft.) Zoning: EU/URC Applicant: BOND BUILDING CONSTRUCTION INC Applicant Address Phone: Insurance: 10 CABOT RD SUITE 300 (617)387-3400 WA7-61D-B9P93B-010 MEDFORD, MA 02155 ISSUED ON: 06/30/2023 TO PERFORM THE FOLLOWING WORK: MECHANICAL SYSTEMS CONVERSION 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: Final: Final: Final: Rough Frame: Gas: Fire Department Driveway Final: Fireplace/Chimney: Rough: Oil: Insulation: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Signature: dj17 Fees Paid: $8,599.50 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Office of the Building Commissioner RECEIVED 61/19�`/ _ G7 JUN 2 9 2023 The Commonwealth of Massachusetts Office of Public Safety and Inspections �.�g Massachusetts State Building Code(780 CMR) DEPN of NORTH*. • '' ••- .�cppliiation for any Building other than a One-or Two-Family Dwelling _ (This Section For Official Use Only) Building Permit Number:O1.^ lb I Date Applied: Building Official: SECTION 1:LOCATION 12 Prospect Street Northampton, MA 01060 Davis Center No.and Street eet City/ vpi Zip Code Name of Building(if applicable) B Ags9s9113Map# Block#/and/or Lot # SECTION 2:PROPOSED WORK Edition of MA State Code used 9`h If New Construction check here❑or check all that apply in the two rows below Existing Building® Repair 0 Alteration ® Addition 0 Demolition 0 (Please fill out and submit Appendix 2) Change of Use 0 Change of Occupancy 0 Other 0 Specify: Mechanical Systems Conversion Are building plans and/or construction documents being supplied as part of this permit application? Yes ® No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No Brief Description of Proposed Work: Install new fan coil units this requires minor demolition Rough Carpentry, Gypsum Board, Acoustical Ceilings, Painting, HVAC Building Conversions, Electrical, Flooring 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) El 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.) 4 Floors 5,155 Ft.'4 Floors 5,155 Ft.' Total Area(sq.ft.)and Total Height(ft.) 20,620 Ft.2 36 Ft. 20,620 Ft.' 36 Ft. SECTION 5:USE GROUP(Check as applicable) A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 ® A-4 0 A-5 0 B: Business a E: Educational 0 F: Factory F-1 0 F2 0 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 0 S-2 0 U: Utility 0 Special Use 0 and please describe below: Special Use Description: SECTION 6:CONSTRUCTION TYPE(Check as applicable) IA El IBO HA El IIB0 IIIA ❑ IIIB ❑ IV CI VAD VB ® SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item) Trench Permit Debris Removal: Water Supply: Flood Zone Information: Sewage Disposal: Licensed Disposal Site Public 1& Check if outside Flood Zone 0 Indicate municipal 1ffi A trench will not be P Private 0 or indentify Zone: or on site system 0 required®or trench or specify: USA permit is enclosed 0 Waste & Recycling Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable IN Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No 2r Yes❑ No 0 N/A SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code:9th Edition Use Group(s):A-3 & B Type of Construction: Does the building contain an Sprinkler System?:Yes Special Stipulations: Design Occupant Load per Floor and Assembly space:a.First Floor: 173 b.Second Floor: 300 c.Third Floor:35 Ballroom Assembly space has a capacity of 300 people SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Smith College Board of Trustees 10 Elm Street Northampton, MA 01060 Name(Print) No.and Street City/Town Zip Property Owner Contact Information:Gary Hartwell Project Manager - - 413 - 320- 9763 ghartwell@smith.edu Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Bond Building Inc. 10 Cabot Road, Suite 300 Medford MA 02155 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 O. Otherwise provide construction control forms(see section 107 in the code)as required. 10.1 Registered Professional Responsible for Construction Control (the professional coordinating document submittals) Jim Keay 617- 908 4902 jkeay(a)bond-building.co CS-102479 Name(Registrant) Telephone No. m e-mail address Registration Number 7 Loudville Road Easthampton MA 01027 Construction_ 01-07-2025 Street Address City/Town State Zip Discipline Expiration Date Supervisor 10.2 General Contractor Bond Building Construction Inc. Company Name Mike Spodek / Jim Keay Name of Person Responsible for Construction License No. and Type if Applicable 10 Cabot Road, Suite 300 Medford MA 02155 Street Address City/Town State Zip 617- 394 0694 mspodek(aibond-building.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 4enial of the issuance of the building permit. Is a signed Affidavit submitted with this application? Yes® No CI SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$1,228,498.20 1.Building $112,006 Building Permit Fee=Total Construction Cost x0.007(Insert here 2.Electrical $94,873.00 appropriate municipal factor)=$8.599.50 3.Plumbing $ 4.Mechanical (HVAC) $1,021,619.20 Note:Minimum fee=$100 (contact municipality) 5.Mechanical (Other) $ Enclose check payable to City of Northampton, MA 6.Total Cost $1,228,498.20 (contact municipality)and write check number here 1009016 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 the best of my knowledge and understanding. Ximena Cruz de Brown Project Manager 857-321-9983 6/14/2023 Please print and sign name Title Telephone No. Date 10 Cabot Road. Suite 300 Medford MA 02155 xcruznbond-building.com Street Address City/Town State Zip Email Address Municipal Inspector to fill out this section upon application approval: Ii fQk, i . r 6 20 Name Da e CITY OF NORTHAMPTON SETBACK PLAN MAP: 31B LOT: 179-001 LOT SIZE: 0.172 Acres REAR LOT DIMENSION: 0.172 Acres REAR YARD 0' (According to:EU Educational Use Overlay Zoning District,there are 0'setbacks all sides.) -- 1233 3113-299-001 ac ry 167 37. a 47 29 31B-298-001 0 101 318-17ti-0O7 - - . 75 024 19 31 B-177-001 .11 B-296-001 0 261 0.316 L1.7 33 3 Z l r r / `C t 31 8-1 7 9-0 01 r` CURT J 29 a SIDICYARL).._._..._._0' SIDE YARD 0 _- J C(/ 7 31B-179-001 L - Ill �� 0.172 25 CO 0 G 31 0.3 T-0o1 0, 01 acu , / a 21 �Q- 01� , 4 S� 2 Q 0 315204 / / 0 / / -- 31B-202.001 ,` 0.841 `'{G f0 ^,/ 10-201.001 318-207-001 ,`f' 0115 2.69 C? 79 4G �Q FRONT SETBACK 0' FRONTAGE None' City of Northampton ARK_MGM Massachusetts �4?` DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Building Jti, �•e' Northampton, MA 01060 ssy .. P� 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: Valley Recycling Location of Facility: 234 Easthampton Rd, Northampton MA 01060 The debris will be transported by: Name of Hauler: USA Waste & Recycling Signature of Applicant: Date: 6/14/2023 <\ The Commonwealth of Massachusetts -L, 1= 1. Department of Industrial Accidents ?/j�= 1 Congress Street, Suite 100 't�— Boston, MA 02114-2017 wwwmass.gov/dia Rat Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Legibly Name (Business/Organization/lndividualy Bond Building Construction, Inc. Address: 10 Cabot Rd City/State/Zip: Medford, MA 02155 Phone #: 617-387-3400 Are you an employer?Check the appropriate box: Type of project(required): ID I am a employer with 800+employees(full and/or part-time).' 7. ❑New construction am a sole proprietor or partnership and have no employees working for me in ' 8. EI Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]f 9. El Demolition 4.0 lam a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 1.0 Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.C1 1 am a general contractor and(have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 14.DOther 6.0 We arc a corporation and its officers have exercised their right of exemption per MGL c. — 152,§1(4),and we have no employees.[No workers'comp.insurance required.] I "Any applicant that checks 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: XL Specialty Insurance Company Policy#or Self-ins.Lie. #: CWG740963605 Expiration Date: 10/31/2023 Job Site Address: 12 Prospect Street - Davis Center City/State/Zip:Northampton, MA 01060 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 I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: 6'28:'2023 Phone#:617-394-6222 Official 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 5.Plumbing Inspector 6.Other Contact Person: Phone#: enri f,4ir e4 J`.1.1` ' '_ '` i • i Commonwealth of Massachusetts I fit Division of Occupational Licensure Board of Building Regulations and Standards Lt Const .'l�n I{t Srvisor CS-102479 f Tres: 01/07/2025 JAMES D KEAY 7 LOUDV ILLliSROA e , EASTHAMPTgN MA A mr, issioner 0 r-� E. »cam._ • Construction Supervisor Unrestricted -Buildings of any use group which contain less tha.t 35,000 cubic feet (991 cubic meters) of enclosed space. Failure to possess a current edition of the Massachusetts ;!R-ix- iluildng Code is cause for revocation of this license. For information about this license 317) 727-3200 or visit www.mass.govldpl i s Page 1 of 2 ,REP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 10/25/2022 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 CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Northeast, Inc. PHONE 1-877-945-7378 FAX 1-888-467-2378 c/o 26 Century Blvd A'C,Not: P.O. Box 305191 E•MAII ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER(S)AFFORDING COVERAGE NAIC4 INSURER A: Greenwich Insurance Company 22322 INSURED INSURER B; XL Specialty Insurance Company 37885 Bond Building Construction, Inc. XL Insurance America Inc 10 Cabot Road INSURER C: 24554 Medford, MA 02155 INSURERD: ACE Property & Casualty Insurance Company 20699 INSURERS: Ohio Casualty Insurance Company 24074 INSURERF; Indian Harbor Insurance Company 36940 COVERAGES CERTIFICATE NUMBER:W26402868 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. INSR TYPE OF INSURANCE ADDL SUeR POLICY EFF POLICY EXP -LTR INSO WVD POLICY NUMBER (MM/10D/YYYYI_1MM!DD/YYYY)_ LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 DAMAGE TO REN-ED CLAIMS-MADE X I OCCUR PREMISES(Ea occurrence) $ 500,000 A _____ _ MED EXP(Any one person) $ 10,000 CGG740963705 10/31/2022 10/31/2023 PERSONAL&ADVINJURY $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 6,000,000 POLICY PRO- JECT LOC IPRODUCTS-COMP/OPAGG $ 6,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X ANY AUTO BODILY INJURY(Per person) $ - A ^ OWNED SCHEDULED CAH740963805 10/31/2022 10/31/2023 BODILY INJURY(Peraccbenl) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ B X UMBRELLALIAO X OCCUR EACH OCCURRENCE $ 7,000,000 EXCESSLIAB CLAIMS-MADE US00066004LI22A 10/31/2022 10/31/2023 AGGREGATE $ 7,000,000 OLD I RETENTIONS $ WORKERS COMPENSATION • X STATUTE OTH- ER AND EMPLOYERS'LIABILITY C ANYPROPRIETOR/PARTNER/EXECUTIVE YIN EL.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDE09 No N/A CWG740963605 10/31/2022 10/31/2023 (Mandatory In NH) E.L,DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ D Excess Liability XCQ G72545990 002 10/31/2022 10/31/2023 Per Occurrence $8,000,000 Aggregate $8,000,000 i I DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mars space Is required) SEE ATTACHED CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Evidence Only - V te9 — ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD SR IS 23230406 BATCH: 2717728 Initial Construction Control Document ��_r= _ ). To be submitted with the building permit application by a w I� Registered Design Professional for work per the ninth edition of the '4 _ b•°,., Massachusetts State Building Code, 780 CMR,Section 107 Project Title:Smith College GEP-Davis Center Building Conversion Date:06/23/23 Property Address: 12 Prospect Ave,Northampton,MA 01603 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description:Hot water building conversions, replacement of existing steam heating systems with hydronic dual temperature (heating&cooling) systems I Charles Roberts MA Registration Number: 10107 Expiration date:08/31/2023,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: X Architectural Structural Mechanical Fire Protection Electrical Other:Plumbing 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 ,-,s5kED electronic signature and seal: , c ' s w•R�4.'. e• l U �iP u o10107 1 Phone number:413-259-1630 Email:CRoberts@kuhnriddle.com ' c. A>MHERST ') MASS \ .: Building Official Use Only \\ L�" G OFUAk, . 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_0I_2018 Initial Construction Control Document )r, To be submitted with the building permit application by a ' Registered Design Professional for work per the ninth edition of the "mo' Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Smith College GEP- Davis Center Building Conversion Date:06/23/23 Property Address: 12 Prospect Ave,Northampton,MA 01603 Project: Check(x) one or both as applicable: New construction X Existing Construction Project description:Hot water building conversions,replacement of existing steam heating systems with hydronic dual temperature (heating&cooling) systems I,Darren Dickenson,MA Registration Number: 56592 Expiration date: 06/30/2024,am a registered design professional,and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural Mechanical Fire Protection X Electrical Other:Plumbing 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'. 16. r r DAf'J / , . l 1, �AL � a6'(2!ST£ '1 V Phone number:651.404.4007 Email:darren.dickenson@salasobrien.com Initial Construction Control Document }' `i To be submitted with the building permit application by a • ill . Registered Design Professional . �IU for work per the ninth edition of the '`'•,„.., Massachusetts State Building Code, 780 CMR,Section 107 Project Title:Smith College GEP-Davis Center Building Conversion Date:06/23/23 Property Address: 12 Prospect Ave,Northampton,MA 01603 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description:Hot water building conversions,replacement of existing steam heating systems with hydronic dual temperature(heating&cooling)systems I,Jeff Urlaub,MA Registration Number:53643 Expiration date:06/30/2024,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications • concerning1: Architectural Structural X Mechanical Fire Protection Electrical Other:Plumbing 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'. 01 Ili : . f \\Ak.�FQrs'ref. \ ° o►ow i Phone number:715-832-8680 Email:jeff.urlaub@salasobrien.com f Appendix 1 Construction Documents are required for structures that must omply with 780 CMR 107. The checklist below is a compilation of the documents that may be equired. The applicant shall fill out the checklist and provide the contact information of the regist red professionals responsible for the documents. This appendix is to be submitted with the buildin permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural X 2 Foundation X 3 Structural X 4 Fire Suppression X 5 Fire Alarm(may require repeaters) X 6 HVAC X 7 Electrical X 8 Plumbing(include local connections) X 9 Gas(Natural,Propane,Medical or other) X 10 Surveyed Site Plan(Utilities,Wetland,etc.) X 11 Specifications X 12 Structural Peer Review 13 Structural Tests&Inspections Program 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) 18 Workers Compensation Insurance X 19 Hazardous Material Mitigation Documentation 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) I *Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the authority having jurisdiction. Registered Professional Contact Information Charles W.Roberts 413=259-1630 crobertsakuhnriddle.com No. 10107 Name(Registrant) Telephone No. e-mail address Registration Number Architect 8/31/2023 Kuhn Riddle Architects,28 Amity Street,Suite 2B,Amherst, MA 01002 Discipline Expiration Date Street Address City/Town State Zip No. 53643 Jeff Urlaub 715 -832 -5680 jeff.urlaub@sala8obrien.com Name(Registrant) Telephone No. e-mail address Registration Number Mechanical 6/30/2024 Salas O'brien,One Gateway Ctr,#701, Newton, MA 02458 Street Address City/Town State Zip Discipline Expiration Date Darren Dickenson 651_-404_-4007 darren.dickenson@salasobrien.com No. 56592 Name(Registrant) Telephone No. e-mail address Registration Number Salas O'brien,One Gateway Ctr,#701, Newton, MA 02458 Electrical 6/30/2024 Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered esign Professionals.