23B-046 (19) M. Response to 903.1.1-14—Fire Extinguishing System:
1. There are local fire extinguishers located at periodic intervals throughout the corridors on all
floor levels.
N. Response to 903.1.1-15—Fire Extinguishing Control:
1. The local fire extinguishers (hand held) are manual.
O. Response to 903.1.1-16—Fire Protection System Equipment Room:
1. The existing wet sprinkler service entrance and alarm valve assemblies are located in the
basement level.
2. The existing dry sprinkler service entrance and alarm valve assemblies are located in Mechanical
Room B-34D.
P. Response to 903.1.1-17 Fire Protection System Equipment Identification and Signs:
1. The sprinkler system shall incorporate all signage as required by NFPA,as well as indicated in the
specification.
Q. Response to 903.1.1-18—Fire Protection System Alarm Supervisory Transmission Method
and Locations:
1. The System monitors and reports all flow and trouble supervisory signals from the building fire
suppression system. Any trouble or alarms that are activated shall send a signal to the 24/7 on-
site security office for action by staff..
Should you have any questions regarding this project,please feel free to call.
Sincerely yours,
CONSULTING ENGINEERING SERVICES,INCORPORATED
Steven R. Collins
Principal
p:\28528.00\riarratives\fpnarrative.doc
Cc: FILE
3
E. Response to 903.1.1-3 Fire Hydrant Data.
1. The flow test at the site resulted in a static of 120 psi and a residual of 110 psi with a flow of
1100 gpm. The results of the flow test indicated that the existing city main shall support the
required system flow.
F. Response to 903.1.1-4—Sprinkler System Info:
1. The sprinkler system consists of a wet pipe type with sprinklers attached to piping system
containing water under constant pressure,building alarm valve,zone control valves and backflow
preventer.
2. The sprinkler system consists of a dry pipe type with sprinklers attached to piping system
containing compressed air,water under constant pressure behind dry system zone control valves,
building alarm valve,and backflow preventer.
G. Response to 903.1.1-5—Sprinkler System Control Location:
1. The entire fire protection system is equipped with isolation valves at the backflow preventor,
each building alarm valve and zone control valve. Each isolation valve is equipped with a
supervised tamper switch. In addition,the alarm valve and zone control valve stations are
equipped with flow switch.
H. Response to 90311-6 &7—Standpipe System In
1. The existing standpipe system designed to NFPA 14 is installed through the building and
shall remain.
I. Response to 903.1.1-8—Fire Department Connection.
1. The Fire Department connection consists of an existing two port Siamese with two (2) 2-1/2"
connections to match Fire Department hose threads. The location of the siamese is at the
entrance into the building,this device&location shall remain.
J. Response to 903.1.1-9&10—Fire Protection Signaling System:
1. The existing sprinkler system alarms and trouble signals are wired to the existing building fire
alarm system control panel. The signals are sent to the central fire alarm annunciator panel and
to on-site 24/7 security office for action by staff.
K Response to 903.1.1-11&12—Smoke Control System:
1. The renovated portion of this building has smoke detectors being installed within corridors and
patient areas.
L. Response to 903.1.1-13—Life Safety Features:
1. The building is equipped with horns,strobes and pull stations. Upon activation of any duct
smoke detector or pull station the building will go into alarm with all strobes flashing and horns
sounding.A signal will be sent thru the fire alarm control panel to the Fire Department. Existing
area smoke detectors while not required,shall be maintained in service as supplemental
equipment.
2
f
Consulting Engineering Services , Inc.
January 29,2009 1
Mr.Duane Nichols V�
Assistant Chief
City of Northampton JAN ., 9
2009
26 Carlon Dr `
Northampton,Ma 01060 STANDARD BUILDERS,INC.
Re: Cooley Dickinson Hospital-28528.00
Dear Mr.Nichols,
A. Response to 903.1.1-1a—Basis of Design:
1. The design is based on a building Use Group I-2,consisting of a 5,500 sq. ft interior renovation
and modification to the existing wet and dry pipe sprinkler system.
2. The entire building is protected by an existing wet pipe sprinkler system,in accordance with
NFPA-13 2002 edition.
B. Response to 903.1.1-lb—Sequence of Operation:
1. The wet pipe sprinkler system is attached to a piping system,which is always charged with water.
Upon the opening of a sprinkler head or hose valve,the water will flow to suppress the fire,
which in turn will activate alarm system caused by the sprinkler flow.
2. The dry pipe sprinkler system is attached to a piping system,which is filled with compressed air
and controlled by a dry system control panel. Upon the opening of a sprinkler head or hose
valve,the air pressure in the line will drop,causing the control panel to open the valve to allow
water flow to suppress the fire and activate the alarm system.
3. The space is equipped with existing alarm valves,and existing zone control valves. Upon
activation of any sprinkler,an alarm is sent to the central fire alarm annunciator panel and to on-
site 24/7 security office for action by staff
C. Response to 903.1.1-1c—Testing Criteria:
1. Along with review of shop drawings,hydraulic calculations, etc.,acceptance shall be confirmed
through routine project inspection,punch list inspections, system pressure test, flow test, for
compliance with all related NFPA codes will be performed.
D. Response to 903.1.1-2—Building and Site Access:
1. The building is accessible from the Locust St. and Hospital Rd.;the building is also accessible
from the paved parking lots,which will accommodate the fire fighting equipment.
81 1 Middle Street,Middletown,CT 06457 T 860.632.1682 F.860.632.1768 ces @cesct.com cesct.com
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: DATE: January 29, 2009
PROJECT TITLE: New Linear Accelerator- Basement
PROJECT LOCATION: Locust St, Northampton, MA
NAME OF BUILDING: Cooley Dickinson Hospital
SCOPE OF PROJECT: Interior renovation for new linear accelerator
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING
CODE, 6TH EDITION, I, DELBERT B. SMITH, MASS. REGISTRATION NO. 41215, BEING A
REGISTERED PROFESSIONAL ARCHITECT/ENGINEER HEREBY CERTIFY THAT I HAVE
PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL STRUCTURAL X MECHANICAL
FIRE PROTECTION ELECTRICAL OTHER (specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE
ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED
PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND
PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE
WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE
RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2:
1. Review of shop drawings, samples and other submittals of the contractor as required by the
construction contract documents as submitted for building permit, and approval for
conformance to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled
materials.
3. Special architectural or engineering professional inspection of critical construction
components requiring controlled materials or construction specified in the accepted
engineering practice standards listed in Appendix B.
PURSUANT TO SECTION 116.2.3, 1 SHALL SUBMIT PERIODICALLY, A PRO ..�
REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INS ass,�cy
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT o E&T B
SATISFACTORY COMPLETION AND READINE F THE PROJECT FOR OCC ITN,JR, co
U MECHANICAL
41215 O ��
Ir Signs re ��O,c F-ISTEP������
On this IRI day of ' A )I jj A A I 1 20 09, before me, the undersigned nota �� I..
personally appeared h�krfff_ (name of document signer), proved to me throtT�Ti
satisfactory evidence of identification, which was personal knowledge of the identity of the principal, to be
the person whose name is signed on the preceding or attached document in my presence.
)1114 ` Q -
(Offic tsig nature and seal of notary)
My commission expires q,13Q,P'6q
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: DATE: January 29,2009
PROJECT TITLE: New Linear Accelerator- Basement
PROJECT LOCATION: Locust St, Northampton, MA
NAME OF BUILDING: Cooley Dickinson Hospital
SCOPE OF PROJECT: Interior renovation for new linear accelerator
IN ACCORDANCE WITH SECTION 116.0 OF THE MASSACHUSETTS STATE BUILDING
CODE, 6T" EDITION, I, DOUGLAS S. LAJOIE, MASS. REGISTRATION NO. 42533, BEING A
REGISTERED PROFESSIONAL ARCHITECT/ENGINEER HEREBY CERTIFY THAT I HAVE
PREPARED OR DIRECTLY SUPERVISED THE PREPARATION OF ALL DESIGN PLANS,
COMPUTATIONS AND SPECIFICATIONS CONCERNING:
ENTIRE PROJECT ARCHITECTURAL STRUCTURAL MECHANICAL
FIRE PROTECTION X ELECTRICAL OTHER (specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE
ENGINEERING PRACTICES AND ALL APPLICABLE LAWS FOR THE PROPOSED
PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR AND
PERIODIC BASIS TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE
WITH THE DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE
RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2:
1. Review of shop drawings, samples and other submittals of the contractor as required by the
construction contract documents as submitted for building permit, and approval for
conformance to the design concept.
2. Review and approval of the quality control procedures for all code-required controlled
materials.
3. Special architectural or engineering professional inspection of critical construction
components requiring controlled materials or construction specified in the accepted
engineering practice standards listed in Appendix B.
PURSUANT TO SECTION 116.2.3, 1 SHALL SUBMIT PERIODICALLY, A P
REPORT TOGETHER WITH PERTINENT COMMEINTS TO THE BUILDING �y
UPON COMPLETION OF THE WORK, I SHAL S BMIT FI AL REPOR oTCQlG 6_
SATISFACTORY COMPLETION AND READINE O T E T FOR O Af4WIE
ELEVRICAL
,42833 Q
ignafure O�
�q NAL��
On this A day 20 09, before me, the undersigned nota
personally appeared (name of document signer), proved to me through
satisfactory evidence of id (cation, whicb4as personal knowledge of the identity of the principal, to be
the person whose name is signed on the preceding or attached document in my presence.
. 13Y:::Il -
(Officia signature and seal of notary)) 21 q
My commission expires /�"x)��
CITY OF NORTHAMPTON, MASSACHUSETTS
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: HAI-07-77A DATE: January 21, 2009
PROJECT TITLE: Renovations for New Linear Accelerator
PROJECT LOCATION: 30 Locust Street, Ground Floor
NAME OF BUILDING: Cooley Dickinson Hospital
SCOPE OF PROJECT: Addition and Interior Renovations
IN ACCORDANCE WITH THE MASSACHUSETTS STATE BUILDING CODE, 780 CMR,
CHAPTER, SECTION 116, I, RICHARD E. KATSANOS , MASS. REG.
NO. 8355 , BEING A REGISTERED PROFESSIONAL ARCHITECT/ENGINEER,
HERBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE
PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS
CONCERNING:
ENTIRE PROJECT ARCHITECTURAL STRUCTURAL
FIRE PROTECTION ELECTRICAL MECHANICAL
OTHER(specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE
ENGINEERING PRACTICE AND ALL APPLICABLE LAWS FOR THE PROPOSED
PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR BASIS
TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE
DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE
RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2:
1. Review of shop drawings, samples,and other submittals of the Contractor as required by the construction contract
documents as submitted for building permit,and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required controlled materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in appendix B.
PURSUANT TO SECTIONS 116.2.3, I SHALL SUBMIT PERIODICALLY, A PROGRESS
REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR.
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AND AN
AFFIDAVIT OF COMPLETION AS TO THE SATISFACTORY COMPLETION AND
READINESS OF THE PROJECT FOR OCCUPANCY.
Subscribed and sworn to before me
,4 ��E�A f>� this �day of ywx 20 09 FtLY q
��`•'��'�g EIR N F��'jr
ti v � �,c,Q`�M �2�o,9m•2
c
NN
�S thy;P1 Notary Public ��
I�,ic r atsanos,AIA My Commission expires on `1 p`�.SA
1pHOF _ S� TgRY'PV0
Standard
Builders
Since 1949
January 26.,2009
Cooley Dickinson Hospital
30 Locust Street
Northampton, MA
New Linear Accelerator-Basement
List of Sub Contractors for Permit information
Floor Finish Ayotte& King for Tile Inc.
165 Trilby Ave.
Chicopee, MA 01020
P(413)532-9463
Drywall/Acoustical Ceilings Professional Drywall
706 Prospect Ave.
West Springfield, MA 01089
(413)478-6370
Paint Berger Painting
90 Sargeant Street
Holyoke, MA 01040
(413)532-4891
HVAC/Plumbing M.J. Moran
4 South Main Street
Haydenville, MA
Phone: (413)268-7251
Fire Suppression Allied Fire Protection
I 1 East Fisk Ave.
Springfield, MA 01 107
Phone: (413)788-9038
Electrical Renaud Electric&Communications
Providence Place
Sutton, MA 01590
Phone: (508) 865-1300
Serving Connecticut and Massachusetts
The Commonwealth of Massachusetts
Department of Industrial Accidents
1'1 Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (13usiness/()rganiration/Individualj: f>TA.Ap t-f's �ot u0GVs 1j%j L _
Address: 52. klOcme& �uPs-lam
City/State/Zip: C,vV-3-D,3 Phone #: C040) sq4--71`f 3
Are you an employer? Check the appropriate box: Type of project (required):
1.❑ I am a employer with 4. X I am a general contractor and I 6. ❑ New construction
employees (full and/or part-time).* have hired the sub-contractors
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 9. ❑ Demolition
working for me in any capacity. employees and have workers' 9 F-] 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.El 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
employees. [No workers' 13.F1 Other
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.
tContractors 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 empk�vees. Below is the policy and job site
information.
Insurance Company Name:
Vtw� (,- �NSt� La"
Policy #or Self-ins. Lie. #: 7 Z!7.,A Expiration Date: 10` o l LZoOq
Job Site Address: 3o I.a OCT- ST City/State/Zip:/"(}�TN/}Mem a AA oloG o
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.
I do hereby cert d he airs and enalttes of perjury that the information provided above is true and correct.
Signature:
Date:
Phone#: o
Official use only. Do not write in this area, to be completed by city or town official.
Citv 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#:
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 Q No
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
hereby authorize Steven Glanzrock to
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date a
Steven Glanzrock
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.
Print Name � q
f'
Signature of Owner/Agent I Date
SECTION 12 -CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder: Ed Ackley CS051113
License Number
52 Homes Road, Newington, CT 06111 p 09/10/2010
Address Expiration Date
(860) 982-1895
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 � No 0
Versionl.7 Commercial Building 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:
H6-AtT4LA14-t fV—C-W .Z—S VV Not Applicable ❑
Name(Registrant):
G VUI�-ktLs� .SU► NU�Iu!'�`M�1�3 f )A 010(*0 Registration Number
Address
Expiration Date
C�t1,).q 1SI2
Signature Telephone
9.2 Registered Professional Engineer(s):
Consulting Engineering Services MEP p
Name Area of Responsibility
811 Middle St. Middletown, CT 06457
Address Registration Number
(860) 632-1682
Signature Telephone Expiration Date
Barry Engineering Structural p
Name Area of Responsibility
176 Churchill St. Pittsfield, MA 01201
Address Registration Number
(413) 443-6591
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Standard Builders,Inc. Not Applicable ❑
Company Name:
Steve Glanzrock
Responsible In Charge of Construction
52 Holnfs Road, Newington, CT 06111 p
Address
(860) 594-7143
Signature Telephone
Versionl.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
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(Lot area minus bldg&paved
parking)
# of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW t--,\ YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (�) YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained 0 , Date Issued:
C. Do any signs exist on the property? YES Q NO 0
IF YES, describe size, type and location:
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 0 NO Q
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
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 ❑ Demolition❑ Repairs❑ Additions ❑✓ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other ❑
Brief Description Enter a brief description here. Renovation of interior space for new Linear accelerator, includes structural
Of Proposed Work: concrete work, all new interior finishes, redistribution MEP(s)., construct above grade mechanical room.
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 0 1-1 ❑ 1-2 ✓❑ 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:
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: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
1 St
1St
2nd 2nd
3rd 3rd
4tn
4 m
Total Area (sf) Total Proposed New Construction(sf)
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 ❑ Private ❑ Zone Outside Flood Zone E] Municipal ❑ On site disposal system E]
r
Version 1.7 Commercial Building Permit May 15,2000
Department use only
City of Northampton Status of Permit:'
Building Department curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
J L�+ g Room 100 WaterNllell'Availability
No MA 01060 Two Sets of Structural Plans
phone 418-587'1240 Fax 413-587-1272 Plot/Site Plans
'S 1 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
1.1 Property Address: This section to be completed by office
Cooley Dickinson Hospital Map Lot Unit
30 Locust Street
Zone Overlay District
Ground Floor
91 Elm St.District CB District
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Cooley Dickinson Hospital 0 30 Locust St Northampton, MA
Name(Print) Current Mailing Address:
Signature Telephone
2.2 Authoriz Agent:
Steven Glanzrock 52 Holmes Road Newington, CT 06111 0
Name(Print) Current Mailing Address:
(860) 594-7143
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
com leted by ermit applicant
1. Building $1,061,000.00 (a) Building Permit Fee
2. Electrical $96,400.00 (b)Estimated Total Cost of $1,401,163.00
Construction from(6
3. Plumbing $52,750.00 Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection $191,013.00
6. Total = (1 +2+3+4+5) Check Number t7 �oZ This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2009-0674
APPLICANT/CONTACT PERSON STANDARD BUILDERS
ADDRESS/PHONE 52 HOLMES RD NEWINGTON (860) 594-7143
PROPERTY LOCATION 30 LOCUST ST-NEW LINEAR ACCELERATOR
MAP 23B PARCEL 046 001 ZONE M(99)/URB(1 /Z/WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid /
Tyneof Construction•_RENOVATION OF INTERIOR SPACE FOR NEW LINEAR ACCELERATOR
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 051113
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO)RMATION PRESENTED:
,/Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR Special Permit With Site Plan
Major Project: Site Plan AND/OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
02-1Ito9
Signature of Bum ilding 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.
� t It✓ELiTt BP-2009-0674
GIs#: COMMONWEALTH OF MASSACHUSETTS
* _ CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildincl DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: renovation BUILDING PERMIT
Permit# BP-2009-0674
Project# JS-2009-000796
Est. Cost: $1401163.00
Fee: $8412.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: IA Contractor: License:
Use Group: 12 STANDARD BUILDERS 051113
Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning:M(99)/URB(1)//WP Applicant: STANDARD BUILDERS
AT. 30 LOCUST ST - NEW LINEAR ACCELERATOR
Applicant Address: Phone: Insurance:
52 HOLMES RD (860) 594-7143 WC
NEWINGTONCT06111-1708 ISSUED ON:211212009 0:00:00
TO PERFORM THE FOLLOWING WORK.-RENOVATION OF INTERIOR SPACE FOR NEW
LINEAR ACCELERATOR
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 2/12/2009 0:00:00 $8412.0050936
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo