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18D-070 BP-2023-1720 971 BRIDGE RD COMMONWEALTH OF MASSACHUSETTS Map:Block:Lot: 18D-070-001 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-2023-1720 PERMISSION IS HEREBY GRANTED TO: Project# GOODWILL RENO 2023 Contractor: License: Est. Cost: 245874 KEVIN PERRIER QK 3Jc/ Const.Class: Exp.Date: Use Group: Owner: ELLENDAVE LLC Lot Size (sq.ft.) Zoning: HB/WP Applicant: FIVE STAR BUILDING CORP Applicant Address Phone: Insurance: 123 UNION ST (413)527-4060 WMZ80080077052020 EASTHAMPTON, MA 01027 ISSUED ON: 12/26/2023 TO PERFORM THE FOLLOWING WORK: INTERIOR RENOVATION 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: 11 I 1 Fees Paid: $1,721.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Office of the Building Commissioner 20 °Fa r 4� The Commonwealth of . .esto �N Office of Public Safety and Inspectio A'4'TO,y lNSpFC • Massachusetts State Building Code(780 CMR) Mq O10 0N3 Building Permit Application for any Building other than a One-or Two-Fami -1 ' g (This Section For Official Use Only) Building PermitNumberr,3• 17a 0 Date Applied: Building Official: SECTION 1:LOCATION 971 Bridge S Northampton, MA 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 9th If New Construction check here 0 or check all that apply in the two rows below Existing Building ff Repair 0 Alteration ftl 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 fg No 0 Is an Independent Structural Engineering Peer Review required? Yes 0 No M Brief Description of Proposed Work: The scope of work consists of minor demolition and renovation of an existing Goodwill Store consisting of new walls, 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) Cl Existing Use Group(s): M Proposed Use Group(s): M SECTION 4 BUILDING HEIGHT AND AREA Existing Proposed No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft.) 1 6940 1 6940 Total Area(sq.ft.)and Total Height(ft) 6940 20' 6940 20' 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 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❑ I-4❑ M: Mercantile® 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 0 IB 0 IIA 0 IIB 0 IHA 0 IIIB 0 IV 0 VA ❑ 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 CM Public DI Check if outside Flood Zone IN Indicate municipal f7 A trench will not be P Private 0 or indentify Zone: or on site system 0 required El or trench or specify: permit is enclosed 0 Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process: Not Applicable® Is Structure within airport approach area? Is their review completed? or Consent to Build enclosed 0 Yes 0 or No El Yes 0 No DI SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY Edition of Code: 9th Use Group(s): M Type of Construction: VB Does the building contain an Sprinkler System?: No Special Stipulations: Design Occupant Load per Floor and Assembly space: 164 SECTION 9: PROPERTY OWNER AUTHORIZATION Name and Address of Property Owner Morgan Memorial Goodwill Industries 1010 Harris Ave Boston MA 02119 Name(Print) No.and Street City/Town Zip Property Owner Contact Information: Glenn Pierce 617.541 _1249 617_438. 7562 gpierce@goodwillmass.org Title Telephone No.(business) Telephone No. (cell) e-mail address If applicable,the property owner hereby authorizes: Five Star Building Corp 123 Union Street, Suite 200 Easthampton MA 01027 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 0. 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) Gregory Sullivan 857.719 _3147 greg@slatebluedesign.com 8190 Name(Registrant) Telephone No. e-mail address Registration Number 7 E Main Street Hopkinton MA 01748 Architecture 8/31/24 Street Address City/Town State Zip Discipline Expiration Date 10.2 General Contractor Five Star Building Corp • Company Name Kevin Perrier CS-085319 Name of Person Responsible for Construction License No. and Type if Applicable 123 Union Street, Suite 200 Easthampton MA 01027 Street Address City/Town State Zip 413.527_4060 413. 246.9845 kperrier@fivestarcorp.net 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 El No D SECTION 12:CONSTRUCTION COSTS AND PERMIT FEE Item Estimated Costs:(Labor and Materials) Total Construction Cost(from Item 6)=$ 1.Building $ Building Permit Fee=Total Construction Cost x (Insert here 2.Electrical $ appropriate municipal fact r(=$ 3.Plumbing $ 4.Mechanical (HVAC) $ Note:Minimum fee=$ U (contact municipality) 5.Mechanical (Other) $ Enclose check payable to 6.Total Cost $245,874.00 (contact municipality)and write check number here SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT By entering my name belo ,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and r e to the est of my knowledge and understanding. Kevin Perrier / President 413 -246-9845 Please print and sign e Title Telephone No. Date 123 Union Street, uite 2 0 Easthampton MA 01027 kperrieri fivestarcorp.net Street Address City/Town State Zip Email Address • Municipal Inspector to fill out this section upon application approval: • I' a� Name Dat CITY OF NORTHAMPTON SETBACK PLAN MAP: LOT: LOT SIZE: REAR LOT DIMENSION: REAR YARD 0\ SIDE YARD SIDE YARD FRONT SETBACK FRONTAGE City of Northampton OQ'',AMP O i# . h S�5 '' Massachusetts ?it !I A yy c 1I l \ ,� DEPARTMENT OF BUILDING INSPECTIONS a. 4 '� 212 Main Street • Municipal Building .)j Northampton, MA 01060 sklY .. `�4 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: 295 Forest St, Peabody MA 01960 The debris will be transported by: Name of Hauler: Cassella Waste Management Signature of Applicant: Date: /Zl Z 3 Appendix 1 Construction Documents are required for structures that must comply with 780 CMR 107. The checklist below is a compilation of the documents that may be required. The applicant shall fill out the checklist and provide the contact information of the registered professionals responsible for the documents. This appendix is to be submitted with the building permit application. Checklist for Construction Documents* Mark"x"where applicable No. Item Submitted Incomplete Not Required 1 Architectural X 2 Foundation X 3 Structural 4 Fire Suppression jC 5 Fire Alarm(may require repeaters) 6 HVAC 7 Electrical 8 Plumbing(include local connections) 9 Gas(Natural,Propane,Medical or other) 10 Surveyed Site Plan(Utilities,Wetland,etc.) sC 11 Specifications X 12 Structural Peer Review 13 Structural Tests&Inspections Program K 14 Fire Protection Narrative Report 15 Existing Building Survey/Investigation Kj 16 Energy Conservation Report 17 Architectural Access Review(521 CMR) �( 18 Workers Compensation Insurance X 19 Hazardous Material Mitigation Documentation ,o 20 Other(Specify) 21 Other(Specify) 22 Other(Specify) *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 Gregory Sullivan8190 857- 719-3147 gregQslatebluedesign.com Registration Number Name(Registrant) Telephone No. e-mail address 7 E Main Street Hopkinton MA 01748 Architecture 8/31/24 Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Tel-ephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Name(Registrant) Tel-ephone No. e-mail address Registration Number Street Address City/Town State Zip Discipline Expiration Date Please follow this link for construction control forms to be used by Registered Design Professionals. _ \ The Commonwealth of Massachusetts 1, Department of Industrial Accidents _' 1 1 Congress Street,Suite 100 "� Boston,MA 02114-2017 =i www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Five Star Building Corp Address: 123 Union Street; Suite 200 City/State/Zip:Easthampton, MA 01027 Phone#: 413-527-4060 Are you an employer?Check the appropriate box: Type of project(required): 1.El I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. ❑Demolition 10 E Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.1K1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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: AIM Policy#or Self-ins.Lic.#: WMZ8008007705202A Expiration Date: 5/9/24 Job Site Address: Logan Intl A/P 500 Terminal Rd city/state/zip: East Boston, MA 02028 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 n r the pains and nalties of perjury that the information provided above' true and correct. Signature: Date: f Z I 1.-3 Phone#: 413-527-4060 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#: A`R o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/D DIWYY) 06/20/2023 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 CONTACT Michelle Lastowski NAME: Alera Group,Inc. PHONE (413)586-0111 FAX (413)586-6481 (A/C,No,Ext): (A/C,No): Webber&Grinnell Division E-MAIL mlastowski@webberandgrinnell.com ADDRESS: 8 North King Street INSURER(S)AFFORDING COVERAGE NAIC# Northampton MA 01060 INSURERA: Citizens Ins America/Hanover 31534 INSURED INSURER B: Allmerica Financial Benefit/Han 41840 Five Star Building Corp. INSURER C: Hanover Insurance Group Attn:Kevin Perrier INSURER D: AIM 123 Union Street,Suite 200 INSURER E: Easthampton MA 01027 INSURER F: COVERAGES CERTIFICATE NUMBER: Exp 5/2024 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 CLAIMS-MADE X OCCUR PREMISES(Ea occurrence) $ MED EXP(Any one person) $ 10,000 A ZBND23859306 05/09/2023 05/09/2024 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OPAGG $ 2,000,000 _ JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) i ANY AUTO BODILY INJURY(Per person) $ B - OWNED X W SCHEDULED AND23888206 05/09/2023 05/09/2024 BODILY INJURY(Per accident) $ _ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) Medical payments $ 5,000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 9,000,000 C - EXCESS LIAB CLAIMS-MADEUNHD23859406 05/09/2023 05/09/2024 AGGREGATE $ 9,000,000 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER Y/N 1 D ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WMZ80080077052023A 05/09/2023 05/09/2024 E.L.EACH ACCIDENT $ , , OFFICER/MEMBER EXCLUDED? 1000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ , If yes,describe under 1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , Leased/Rented $99,752 Inland Marine A ZBND23859306 05/09/2023 05/09/2024 Deductible $500 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 liti . rr ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r Commonwealth of Massachusetts Division of Occupational Licensure Board of Building R,ee Cations and Standards Cons ttontc� $ isor CS-085319 • „ ,%pires: 01f13J2025 KEVIN A PEI$IER ° . 123 UNION Si STE E' EASTHAMPYtfI MA I, • "01.LV&133 >e a f vi Construction Supervisor Unrestricted -Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information ybo t this. Call(617)727-3200 or visit www.mass-gov/dpl Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 9th edition of the ' Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Goodwill Northampton Date: 11/22/23 Property Address:971 Bridge Road,Northampton,MA Project: Check(x)one or both as applicable: New construction (X)Existing Construction Project description: Ths scope of work consists of minor demolition and renovation of an existing Goodwill Store consisting of new walls,and finishes. The scope also includes minor electrical work and HVAC work related to the erection of new walls. I,Gregory Sullivan,MA Registration Number: 8190 Expiration date: 8/31/24 ,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 oAED ` electronic signature and seal: 4i��pPY SG i, &-47.47 C(1 :514.11‘4"a"66. <;1k 'i11'• ', 0\441Phone number: 857-719-3147 Email:greg@slatebluedesign.com - BuildingOfficial Use Only Y 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 Initial Construction Control Document To be submitted with the building permit application by a v�l Registered Design Professional I S' P for workper the 8th edition of the C t ��,� Massachusetts State Building Code, 780 CMR, Section 107.6.2 Project Title: /d o irrr14' P (j( D uAL L Date: t a / id3 Property Address: $ OG RO /1/4-1O 11V f P O (, 4 S Project: Check one or both as applicable: New construction 8 Existing Construction Project description: a.) 5114'U— MAO im.4734c1.1.-71. -L-)O M.(/ &JA L j fI r- 1 .oc.,4-71- 5 mi16 A NT S I 5M161xl C"L Q MA Registration Number: 3 54?). Expiration date: 7 a o ,am a registered design professional, and hereby certify that I have prepared or directly supervised the prep tion of all design plans,computations and specifications concerning: [ ] Entire Project [ ] Architectural [ ] Structural [ ] Mechanical [ ] Fire Protection [A Electrical [ ] Other for the above named project and that 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. 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 *elk a ui�electronic signature and sea1. Phone number: `P3 777-04`2 Email: $ G43/W4 -i 1 g I&Oltl Building Official Use Only Building Official Name: Permit No.: Date: Trial Version 10 09 2012 Initial Construction Control Document , To be submitted with the building permit application by a Registered Design Professional • for work per the 9th edition of the •�`�' Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Morgan Memorial Goodwill Date: 12.5.2023 Property Address: 96 Bridge Street,Northampton Ma, Project: Check(x)one or both as applicable:_New Construction_X Existing Construction Project description: Renovations to existing HVAC systems I,James P Stroke PE,MA Registration Number: 20068 Expiration date: June 31, 2024, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerningt: Architectural Structural X 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 will 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 will submit to the building official a `Final Construction Control Document'. 41pytkk OF M,,,,tfc S JANFS P �GP STROKE 5 JNO Nods i • • A. eSSIOM al' Enter in the space to the right a"wet"or electronic signature and seal: Phone number:413-626-8752 Email: ddangelo@tjconway.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.