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23A-291 (6) _ City of Northampton Massachusetts DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street • Municipal Buildingk. a Northampton, MA 01060 INSPECTOR Keith Modestow January 29, 2015 36 Burleigh Road Hampden, MA 01036 Subject Location: 190 Nonotuck Street Map Block: 23A-291 Mr. Keith Modestow, Your building permit application and plans dated 08-28-14 have been approved as drawn and per this memo. All work must meet all applicable codes whether noted or not included within this memo. The issuance of this permit is conditional based on the following items: 1. Work excluding plumbing may proceed. 2. The builder or plumbing contractor must provide the plumbing inspector with the fixture counts of the existing facilities and total building occupancy to determine what if any upgrades are required in conjunction with the proposed building modifications.Section 710 of the Existing Building Code with MA amendments appears to be in conflict with 248 CMR. 3. Alternate#1 drawing is not approved. Upon completion close out documents must be submitted to the building department before a Certificate of Occupancy can be issued. Feel free to call if you have any questions. My telephone number is 587-1240 and office hours are Monday through Friday, 8:30 am to 4:30 pm, excepting we close for walk-ins at 12:00 noon on Wednesdays. My email address is: cmiller(c-northamptonma.gov Thank you for your cooperation on these matters. husk PMVillerA City of Northampton Assistant Commissioner and Zoning Enforcement BATE(WeDD/YYYY) ACORd CERTIFICATE OF LIABILITY INSURANCE 1/15/2015 TH13 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: N the cwti caW holdw is an ADDITIONAL INSURED,the polley(bo)must be andorsed. If SUBROGATION IS WAIVED,subject to the terra and condlloM of the poky,certaln pollcles may require an andamement A statement on this certUleale does not tanfar rights tD the cartilicats holder In Ileu of oath end s PRODUCER NAME: Meyer Insurance) PHIONE 413-203-5180 ArcNe13-2035183 186 Northampton St Suite E ADORESS:m& era en @farm-famil .con Easthampton, MA 01027 INSUaEacsl APFOMWA COVIDU a ISM INSURER A-Farn Family Casualty INSURED Modestow, Keith INSURER B Modestow Construction Inc. INSURER C 36 Burleigh Rd INSURER D Hampden, MA 01036 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAW, POLICY EFF 6 TYPE OF INSURANCE POLICY NUMBER MMVD I IYYYY LIMITS X QSMUIAL LMSOLn EACH OCCURRENCE S 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ee aaxursrlce $ 50 000 MED EXP(My om person) S 5,000 2008X0202 01/01/15 01/01/16 PERSONALaAOVINJuRY s 1,000,000 GEN'L AGGREGATE LIWT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY❑JECT F LOC PRODUCTS-COMP10P AGG S 2,000,000 OTHER. S AUTOMOBILE LIABILITY Pry f ANYAUTO 01/14/15 01/14/16 BODILY INAAZY(Perperson) S 1,000,000 AALL Os NED X AUTOS ED 200IC3499 BODILY INJURY(PeracadeM) s 1,000,000 X HIRED AVTDS X AUTOASYfNED $ 100,600 S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR L i CLAPAS4AOE AGGREGATE E DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOWRS'LIABILITY Viso STATUTE R ANY PROPRIETOMPARTHEPAXECUTIYE 20017805 11/13`14 10/01/15 E I.EACH ACCIDENT S 500,000 . OPft=OUMeMMR EMUDEEP 7 N!A (Mm"M M NIS E L DISEASE-EA EMPLOYE S 500,000 If yyesaa deribe La du DESC7lcRIPTION OF OPERATIONS bWM E L.DISEASE-POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101,Addd**Rewaft SdrduN,may be aftoW d mare Waco 4 required) This workers compensation policy does not provide coverage for Keith Modestow. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Modestow, Keith THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ' Modestow Construction Inc. ACCORDANCE WITH THE POLICY PROMS 36 Burleigh Rd Hampden, MA 01036 AUTHORIZED RE SE AT 19 13 A RD RPORATK3N. All rights reserved. ACORD25(2013104) The ACORD name and logo are registered marks D ACORD M:�SSACH I�_ETTS DRIVER'S LICENSE K? "^h.'7' ISS 1.END 4d MN.IBEit a 2011:1.NONE s 561766115 Asa X16 12 68 9 CU458 t3 REST 15 SEX t 68 DM, NONE M©DESTOW 3 KEITH E AOk e 36 BURLEIGH RD HAMP�N,MA 01036.9661 5 W 12-07.3011 RevOMS-000 1 Mass r:cf^usetts -7jerartment of Puolic Safety 3oard cf 3uilding Rcgu!at;ons and Standards Gino ruction Superlisur License: CS-058467 KEITH E MODES"W 36 BURLEIGH RD ' HAMPDEN MA 81036 ` Expiration Commissioner 12/0612015 Uonarnon vea''_h u1 saach asetts Oepar,ment of Public Safet,, lloktink En_,ineer License, HE-072073 KEITH-9 MODFBTOW W 36 BURLEIGH RD HAMPDEN MA 0103 h E-: ration Commissioner 12/06/2015 Section 711 Energy Conservation 711.1 Minimum requirements Level 2 Alterations to existing buildings or structures are permitted without requiring the entire building or structure to comply with the energy requirements of the international Energy Conservation Code or international Residential Code. The alterations do not affect any components related to energy requirements of the International Energy Conservation Code. END OF EXISTING CONDITIONS REVIEW REPORT 64 Gothic Street,Smite 1, Northampton, 11A01060 1 413.5,85.1512 1 fax 413.5ib.7945 I Fvr�e.haiarclutecttne.a�m The scope of this project work area does not affect any existing structural systems, nor does it affect applied loads on existing structural systems. Section 708 Electrical 708.1 New Installations Convenience outlet wiring and data wiring are included in the project and shall comply with the requirements of the Massachusetts Electrical Code 708.2 Existing Installations B-Business occupancy does not apply 708.3 Residential occupancies B-Business occupancy does not apply Section 709 Mechanical 709.1 Reconfigured or converted spaces Existing HVAC ductwork and diffusers shall be relocated and rebalanced at renovated areas 709.2 Altered existing systems n/a 709.3 Local exhaust The project scope does not include new equipment requiring local exhaust. Section 710 Plumbing 710.1 Minimum fixtures Because the occupant load of the project work area story shall not be increased more than 20 percent, existing plumbing fixture quantities are not required to be modified. 64 Gothic Street,Suite 1,Northampton,MA01060 1 411585.1512 1 fax 413 586.7945 1 Nrivw.haiarchitecture.coni 705.5.5.2 Transoms This section only applies to 1-1, R-1, and R-2 occupancies. 705.5.5.3 Other corridor openings There are no other openings in corridor walls within the project work area. 705.6 Dead end corridors There are no dead end corridors within the project work area. 705.7 means of egress lighting Existing, compliant, and unchanged 705.8 Exit signs Existing compliant fixtures remain unchanged. Several new internally illuminated exit signs shall be installed as part of this project indicating egress. 705.9 Handrails Not applicable 705.10 Guards Not applicable Section 706 Accessibility In accordance with Massachusetts Architectural Access Board 521 CMR, because the project construction cost exceeds $100,000.00 but is less than 30% of the replacement cost for the entire building, all new work within the project work area is required to conform to the requirements of Massachusetts Building Code 780 CMR 8th Edition Section 605 and 706 and Massachusetts Architectural Access Board 521 CMR. All newly built components of the project shall be in compliance with Massachusetts Building Code 780 CMR 8th Edition Section 605 and 706 Massachusetts Architectural Access Board 521 CMR. Section 707 Structural 64 Gothic Street,SUite 1, Northampton, MA01060 1 413.5851512 I tax 413.586.794', I vvvvw.haiarchitecttare.com n/a 704.3 Standpipes n/a 704.4 Fire alarm and detection A fire alarm system, compliant with the International Fire Code, exists within the common egress corridor serving this suite Notification consists of horn and strobe devices. The project does not include any fire alarm scope. Section 705 Means of Egress The existing and new egress requirements within the project work area are compliant with Massachusetts Building Code 780 CMR 8th Edition and NFPA Life Safety Code 101. 705.3 Number of Exits: Unchanged. 705.4.1 Egress doorways —two egress doorways required Unchanged. 705.4.2 Egress doorways - door swing New doors in the suite corridor and egress from the waiting room shall swing in the direction of travel. 705.4.3 Egress doorways - door closing The new door from the main building corridor shall have a door closer. 705.4.4 Panic hardware n/a 705.5.5.1 Corridor doors Corridor doors are not part of this project. 64 Gothic Street,S614e 1,Northampton, N1.N01060 1 413.555.1512 1 fax 413.586.7945 1 tir«xi-.haiarchitecture.corri ALTERATIONS LEVEL 2 Section 701 General This project work area will comply with all requirements for Alteration Level 1 as specified in Chapter 6 and all requirements of Level 2 as specified in Chapter 7. No portion of the proposed project work area alters the existing conditions such that the building will become less safe than its existing condition. Requirements regarding flood hazard areas are not applicable to this project Section 702 Special Use and Occupancy Not applicable. Section 703 Building Elements and Materials 703.2 Vertical Openings No new or existing vertical floor openings are within the project work area. 703.3 Smoke barriers This section applies to 1-2 occupancies and therefore does not apply to this project. 703.4 Interior finishes All new interior finishes, including wall, ceiling, floor, and trim materials to be installed under this project work area will comply with Massachusetts Building Code 780 CMR 8th Edition. 703.5 Guards There are no existing non-compliant guards within the project work area or in the means of egress from the project work area to exit discharge and no new guards in the project scope. Section 704 Fire Protection 704.2 Automatic sprinkler systems 64 Gothic Street,SUitC 1,Northampton, h9.AC11000 1 473.585.1512 1 fax 413.580.7945 1 witi•ta.haiarchitecture.rni7i CLASSIFICATION OF WORK The proposed project work area is classified as Alteration - Level 2 per IEBC Section 404 and therefore complies with the provisions of Chapter 6 and Chapter 7 for the following reasons: - The project is not a repair, therefore IEBC Section 402 does not apply - The project exceeds the limitations defined under Level 1 Alterations as specified in IEBC Section 403: Level 1 alterations include the removal and replacement or the covering of existing materials, elements, equipment, or fixtures using new materials, elements, equipment, or fixtures that serve the same purpose. - The project meets the limitations defined under Level 2 Alterations as specified in IEBC Section 404: Level 2 alterations include the reconfiguration of space, the addition or elimination of any door or window, the reconfiguration or extension of any system, or the installation of any additional equipment. - The project is below the threshold triggering Level 3 Alterations as specified in IEBC Section 404: Level 3 alterations apply where the work area exceeds 50 percent of the aggregate area of the building. - The project does not involve a change of occupancy, therefore IEBC Section 406 does not apply. - The project does not involve an addition, therefore IEBC Section 407 does not apply. - The project does not impact the exterior or substantial interior configuration of a historic building, therefore IEBC Section 408 does not apply. - The project does not involve a relocated building, therefore IEBC Section 409 does not apply. 64 Gothic Strut,Suite 1,Northampton,h1A 01060 1 413.535.1512 I fax 41 536.7945 I www.haiarchitecture.com GENERAL EXISTING PROPERTY INFORMATION A. PROPERTY NAME: Florence Medical Center B. ADDRESS: 190 Nonotuck Street, Florence, MA 01062 C. BUILDING USE: The building is currently a B (Business) occupancy . D. BUILDING USE GROUP: B- Business as defined by the Massachusetts Building Code, 780 CMR 8th Edition. E. CONSTRUCTION CLASSIFICATION: Type 313 Foundation: concrete slab on grade Exterior Walls: split face CMU masonry Int. Load Bearing: CMU Roof: flat membrane roofing on steel framing and deck F. HAZARD INDEX: Existing and proposed Hazard Index is 4 as defined by the Massachusetts Building Code, 780 CMR, 8th Edition (IEBC Table 912.4) 64 Gothic Street,SUite 1,Northampton, N1 01060 1 413.585.1512 1 fax 413.586.7945 1 w,cvw.haiarchitecture.com Massachusetts Building Code 780 CMR 8th Edition International Existing Building Code 2009 Interior Renovations to Modestow Family Dentistry 190 Nonotuck Street Florence, Massachusetts 01062 Purpose This Report is in conformance with Massachusetts Building Code 780 CMR 8th Edition and the International Existing Building Code 2009 regarding alterations to an existing building located at 190 Nonotuck Street, Florence, Massachusetts. Visual Observation Only The extent of this review is limited to visual inspection of existing facilities and/or as-built documentation only. No destructive testing was performed as part of this analysis. Project Description The project consists of the limited interior renovations to the waiting area, front office reception area, and business office. Some finishes upgrades at existing dental rooms are included. New acoustical ceilings and lighting will be provided, some new doors and interior windows are also included. No load bearing or structural systems are modified by this project. This project renovates less than half of an existing 3,800 square foot suite. 64 Gothic Street,Saute 1,Northampton,MA 01060 1 413.585.3512 1 fax 473.586.7945 1 rw .haiarchitecture.axn Existing Conditions Evaluation Report Massachusetts Building Code 780 CMR 8t" Edition International Existing Building Code 2009 Interior Renovations to Modestow Family Dentistry 190 Nonotuck Street Florence, Massachusetts 01062 January 16, 2015 S���ATS�'�/�c� 'r No,8355 N H N O� 0 N1a''P S i hard E. Katsanos, AIA, Principal H I Al Architecture 64 Gothic Street,SuitE 7,(Northampton,N7 A 01060 1 413.585.1512 1 fax 4115€i6.7945 1 i%,�v%i,.haiarchitecttire.com Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Renovations to Modestow Family Dentistry Date: 16 January 2015 Property Address: 190 Nonotuck Street,Florence,MA 01062 Project: Check(x)one or both as applicable: New construction X Existing Construction Project description: limited interior renovations,new partitions,doors,electrical and lighting I Richard E.Katsanos MA Registration Number: 8355 Expiration date: 08/31/2015 , 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 X Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control EPED Aqcy�T Q``' KATS11 Enter in the space to the right a"wet"or No.8355 °cn electronic signature and seal: v.ESTHAMPTON z ASSACH ETTS �J A MPSSp� Phone number: 413-585-512 Email: Richard.Katsanos @HAIArchitecture.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an `x'project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen, provide a description. Version 06 11 2013 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 1 Congress Street, Suite 100 Y Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ModestoW Construction, Inc. Address:36 Burleigh Road City/State/Zip: Hampden, MA 01036 Phone #:413-566-0286 Are you an employer? Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. FEJ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' insurance.: 9. � Building addition [No workers comp.comp. insurance required.] 5. [:] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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:Meyer Insurance, Farm Family Casualty Policy#or Self-ins. Lic. #:2001w7805 Expiration Date: 10/1/2015 Job site Address: 190 Nonotuck Street, Florence, MA City/State/Zip: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 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 cl 7rtrfj and r t e pain alties of perjury that the information provided above is true and correct. Si ature: ts� n? Date:1/22/2015 Phone#: 413-5660286 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permi"icense# 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 O No SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT Ian Modestow as Owner of the ro subject J property Keith Modestow, Modestow Construction, Inc. hereby authc e to act on my b6� n all m ers relative to work authorized by this building permit application. 01/22/2015 Signature of O*n Date Keith Modestow, Modestow Construction, Inc. President I, , 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. Keith Modestow Print anT� 01/22/2015 Signat a of Owner/Agent Date SECTION 12-CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder: Keith E Modestow CS-058467 License Number 36 Burleigh Road,Hampden, MA 01036 12/06/2015 Address Expiration Date Y—'J- �' (413) 566-0286 Sign ure 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 0 No 0 9.1 RegisteredArchitect: Richard E. Katsanos 64 Gothic Street Ste I,Northampton, MA,01060 Not Applicable ❑ Name(Registrant): 8355 Richard E. Katsanos 64 Gothic Street Stel, Northampton, MA,01060 Registration Number Address 08/31/2015 5-60- ��' (413) 585-1512 Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number 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 Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Modestow Construction, Inc. Not Applicable ❑ Company Name: Keith Modestow Responsible In Charge of Construction 36 Burleigh Road, Hampden,MA 01036 Add (413) 531-5179 Signs re Telephone Version].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 0 DONT KNOW Q YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW 0 YES Q IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW @ YES Q IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Q Obtained © , Date Issued: C. Do any signs exist on the property? YES Q NO Q 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 Q 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 Q 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 Interior Improvements-Installation of new ceiling tile and lights,painting of walls,Construct and demo 2 Of Proposed Work: new walls to refit reception area,and install new carpeting through out front offices.Replace noted doors. 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 Hi h Hazard ❑ 3A ❑ I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 ❑ 313 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: 313 Medical offices Proposed Use Group: 313 Medical offices Existing Hazard Index 780 CMR 34):'4 Proposed Hazard Index 780 CMR 34): 4 SECTION 6 BUILDING HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY Floor Area per Floor(sf) 1 S` 2,000 1 St 2,000 2nd 2nd 3rd 3rd 4"' 4"' Total Area(sf) 2,000 Total Proposed New Construction(sf) 2,000 Total Height(ft) 9 Total Height ft 9 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public 0 Private ❑ I Zone Outside Flood ZoneEj Municipal [Z] On site disposal system[] - — Version 1.7 Commercial Building Permit May 15,2000 Lity of Northampton Status of Permit Department use only. Building De Department cut � 9 P b�ulrr'13i iyev�y Ptrnit 2220 '� - 212 Main Street SS, Aveilebity _.= 1 Room 100 Waterl"I Avaftbilitl Electric,P t48 hampton, MA 01060 Two Sets of I Puns Nor'.hu" '` ' ` ne 413-587-1240 Fax 413-587-1272 PlotlS,lte Plans Other specify- APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1 -SITE INFORMATION 1.1 Property Address: This section to be completed by office 190 Nonotuck Street Map Lot Unit Florence,MA 01060 Zone Overlay District Elm St District CB District SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: Ian ichelle Modestow 15 New Street, Florence,MA 01062 Name(Print) , Current Mailing Address: (413) 374-8608 Signature Telephone 2.2 Authorize A nt: Keith Modestow Modestow Const. Inc. 36 Burleigh Road,Hampden,MA 01036 Name(Print) Current Mailing Address: (413) 531-5179 Signature X, Telephone SECTION 3-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building $189,560.00 (a)Building Permit Fee 2. Electrical I (b)Estimated Total Cost of $30,570.00 Construction from 6 3. Plumbing $6,800.00 Building Permit Fee 4. Mechanical(HVAC) 5. Fire Protection $3,000.00 _ 6. Total=(1 +2+3+4+5) Check Number 77 9Y This Section For Official Use Only Building Permit Number Date Issued Signature: Building Commissioner/Inspector of Buildings Date File#BP-2015-0754 APPLICANT/CONTACT PERSON KEITH MODESTOW ADDRESS/PHONE 36 BURLEIGH RD HAMPDEN01036(413)566-0286 PROPERTY LOCATION 190 NONOTUCK ST-MODESTOW FAMILY DENTISTRY MAP 23A PARCEL 291 000 ZONE GI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Tvneof Construction: CONSTRUCT&DEMO 2 WALLS&INTERIOR RENOVATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 58467 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF42AMATION PRESENTED: pproved 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 e elay ature of BdffiQ ial 00 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. 190 NONOTUCK ST-MODESTOW FAMILY DENTISTRY BP-2015-0754 GIs#: COMMONWEALTH OF MASSACHUSETTS Ma:Block: 23A-291 CITY OF NORTHAMPTON Lot: -000 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit# BP-2015-0754 Project# JS-2015-001459 Est.Cost: $229930.00 Fee: $1379.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: KEITH MODESTOW 58467 Lot Size(sa. ft.): Owner: MODESTOW IAN E&MICHELLE M KERSBERGEN Zoning: GI(100)/ Applicant: KEITH MODESTOW AT.• 190 NONOTUCK ST - MODESTOW FAMILY DENTISTRY Applicant Address: Phone: Insurance: 36 BURLEIGH RD (413) 566-0286 WC HAMPDENMA01036 ISSUED ON:112912015 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT & DEMO 2 WALLS & 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: 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 1/29/2015 0:00:00 $1379.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Louis Hasbrouck—Building Commissioner