23B-011 (2)ALLAN A VOGEL
SO-- ROOK 1 I72, PACE 146
PROPOSED 5'-]" X
C,,ST1011's GLOSEr
"S 5
'j
2WI
A_—
DOU IS P, FERRANTE
BOOK 21C9, PACE 161
GC7
211 ♦ 2—
auiLanc
55'5'i';7- A, c
t
STANLEY L SYMANSKI
2679, PAGE 115 ENLARGED VIEW OF NEW OFFICE ADDITION & NEW OFFICE BUMP-OUT
N ROOK 31. PAGES 76-77
MARK R BERENS SCALE. 1'* = 10'
3-OK 4515, PACE 73
- - - - -- - - - - I-
T
LOCUST STREET
- - - SCALE; 1 20'
SITE PLAN FOR PROPOSED BUILDING ADDITIONS
NORTHAMPTON AREA PEDIATRICS
NORTHAMPTON, MASSACHUSETTS
,RCN PIPE F, 10 0 PREPARED FOR
R.1 DAG F,010 NOTES.' NORTHAMPTON AREA PEDIATRICS, LLP
BOUND FG- 193 LOCUST STREET
CONTOUR
O 1.) FOR REFERENCE TO ENCLOSED PERIMETER, SEE BOOK 4369, NORTHAMPTON, MASSACHUSETTS DATE. NOVEMBER 23 2009
ON TO P NTER�IL ------------- 21, ------------- PAGES J,�5 & 339,
CG'T011 ATERVAL --'----275--___ - -
SPOT ELOvADON --- 2) UNDERGROUND UTJL,Y LOCATIONS SHOWN HEREON ARE BASED UPON HERITAGE SURVEYS, INC.
GRAIN MANHOLE 0 SURFACE FEATURES AS LOCATED BY SURVEY AND AVAILABLE RECRO
SEWER MANHOLE 0 DATA, AND ARE APPRCXIMA-,E. ACTUAL LOCATIONS SHOULD BE VERIFIED REGISTERED PROFESSIONAL LAND SURVEYORS
W,T1THE APPI-PROTE UTILITY COMPANY AND/OR MUNICIPAL DEPARTMENT COLLEGE HIGHWAY & CLARK STREET
OATC, GAS, 1110,TO FINAL DESIGN AID/CR POST OFRZE BOX I
UTILITY POLL SOUTHAMPTON, MASSACHUSETTS
WET,A10 DE-EAT-01 FIC (4,3) 527-360O
3960-040301 396C,,Gl 3966-91123
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NEW OFFICE ADDITION
205 sf new, 120 sf renovate
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Secretary
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Mark O. Gelotte Architect.
70 Elm Street
Hatfield, Massachusetts 01038
413 247- 9624 Fax 247- 3092
August 30, 2011
Mr. Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, Ma. 01060
RE: 193 Locust Street, Northampton Area Pediatrics
Dear Mr. Hasbrouck,
We would request that the Building Commissioner grant a modification to waive the requirement for Sec.
107.6, Construction Control for the project at Northampton Area Pediatrics on Locust Street in
Northampton because the work is of a minor nature that will not affect health or accessibility, and is
impractical in that the cost of Construction Control services is considerable when compared to the cost of
the proposed work. Thank you for your consideration.
Sincerely,
Mark Gelotte
`d6W
�me 4
Omasta Builders, Inc.
General Contracting
21 North St
Hatfield, MA 01038
Phone/Fax(413)247-5666
Mr. Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main St
Northampton, MA 01060
RE: Northampton Area Pediatrics 193 Locust St, Northampton, MA.
August 30, 2011
Dear Mr. Hasbrouck,
I am writing to you as the building contractor for The Northampton Area Pediatrics. I am requesting that
a deviation from the requirement for Section 107.6 be granted based on the minimal construction cost
for a 205 square foot addition to existing office space. Granting this deviation will not affect accessibility
or health for said project. Thank you for taking this under advisement.
Sincerely,
Roy L. Omasta
President — Omasta Builders, Inc.
Permit Listing Report
Date Range: Submitted after Sep -01-2010 by Permit Type
SQL Statement: Street No. like "193" AND Street like "LOCUST ST" and ([Type of Permitl="ZONING PERMIT APPLICATION')
Printed On: Mon Aug 22, 2011
Permit Type Address (Work Location) District Zoning Owner Work Category Est. Cost Proposed Use Details
Map/Block/Lot Permit No Online Permit No Permit Status Date Issued Contractor (Phone #) Work Description Fees Paid Check #
ZONING PERMIT 193 LOCUST ST 30500 SI(100) 193 LOCUST ST ASSOCIATES LLP Zoning Permit $0.00
APPLICATION
2313/011/001 MP -2011-0044 APPROVED Oct -25-2010 193 LOCUST ST ASSOCIATES LLP ZPA - ADDITION
$15.00 2603
Permit Type ( ZONING PERMIT APPLICATION) TOTALS: ESTIMATED COST: $.00 NUMBER OF PERMITS: 1
FEES INVOICED: $15.00 FEES PAID: $15.00
BALANCE: $.00
GRAND TOTALS: ESTIMATED COST: $.00 NUMBER OF PERMITS: I
FEES INVOICED: $15.00 FEES PAID: $15.00
BALANCE: $.00
GeoTMS® 2011 Des Lauriers Municipal Solutions, Inc. Page 1 of 1
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
wr^ 600 Washington Street
w -t Boston, MA 02111
` www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information 2 !/ Please Print Leaibly
Name (Business/Organization/Individual): Sffl
Address:
W .AU o16 38 Phone #: e:�>`- 7 —'Sy�66
Are you an employer? Check the appropriate box:
Type of project (required):
1. [!J11'am a employer with 1-t
4. ❑ I am a general contractor and I
6. ❑New construction
employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7. ❑ Remodeling
ship and have no employees
These sub -contractors have
g. ❑ Demolition
working for me in any capacity.
employees and have workers'
9 ❑ Building addition
[No workers' comp. insurance
required.]
comp. insurance. -
5. ❑ We are a corporation and its
10. E] Electrical repairs or additions
�. ❑ 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.❑ Roof repairs
insurance required.] t
c. 152, § 1(4), and we have no
13. Other
employees. [No workers'
comp. insurance reauired.l
*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. 7
Insurance Company Name:
Policy # or Self -ins. Lic. #: 5 L� 3 4%3 f Expiration Date:
Job Site Address:—/ 47,2� L,0C t. �, r- Sr City/State/Zip:
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 DLA for insurance coverage verification.
I do hereby certify
rt_under
/the pains and penalties of perjury that the information provided above its true and correct
Signatur5ty Date:
Phone #: aZ
Of use only. Do not write in this area, to be completed by city or town official
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 CMR110.11)'
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 11 - OWNER AUTHORIZATION - TOBE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES' FOR BUILDING PERMIT
I, ... _w ._...___._w... _. , _W _ _.. _. .w__ �_._ _.___._. _ . _P, as Owner of the subject property
hereby authorize ......
act on my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
Owner/Authorized
as
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 ams and penalties of oear ury _
Print Name
Signature of Owner/Agent Date
SECTION 12 - CONSTRUCTION: SERVICES
10.1 Licensed Construction Supervisor:
Not Applicable ❑
Name of License Holder:
-�
License Number
Address
Expiration Date
Signature Telephone
SECTION 13 -WORKERS.'.COMPENSATION INSURANCE AFFIDAVIT (MG.L. c. 15211:25C(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 N No
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:
Not Applicable El
Name (Registrant):
......... . .
Registration Number
Address
Signature Telephone
Expiration Date
9.2 Registered Professional Engineer(s):
Name
Area of Responsibility
Address
Registration Number
Signature
Telephone
Expiration Date
Name
Area of Responsibility
Address
Signature
Telephone
Expiration Date
Name
Area of Responsibility
Address
Signature
Telephone
Registration Number
. . . .......... . ..... ........ . . ..
Expiration Date
Name
Area of Responsibility
Address
Signature
Telephone
Registration Number
Expiration Date
9.3 General Contractor
.. .. .......
41
Not Applicable El
Company Name:
Responsible In Charge of Construction
O� 7
Address
'v
Signature Telephone
s Versionl.7 Commercial Buiidine Permit Mav 15. 2000
8. NORTHAMPTON,,ZONING
J
F
Existing
Proposed `
Required by honing .
This column to be filled in by
Building Department
Lot Size!
Frontage
Setbacks Front
Lai—;
_.
Side
L: R•
L. R:'7�
Rear
s .,._
A)Q
Building Height
`f— 44* C
Bldg. Square Footage
t
Open Space Footage
(Lot area minus bldg & paved
%
pr
1
-- •.-•
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 YES Q
IF.YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW YES
IF YES: enter Book Page!and/or Document #'
B. Does the site contain a brook, body of water or wetlands? NO 9 DONT KNOW 0 YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained, Date Issued
C. Do any signs exist on the property? YES @( NO
IF YES, describe size, type and location:,tr}�
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 NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Version 1.7 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.
Of Proposed Work
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE'
COMPLETE THIS SECTION IF EXISTING BUILDING: UNDERGOING': RENOVATIONS, ADDITIONS AND10R CHANGE IN USE
Existing Use Group __._.1L5 ►l �S S _ Proposed Use Group:�tN�'?_.
Existing Hazard Index 780 CMR 34):'---- : Proposed Hazard Index 780 CMR 34):
Total Height (ft) 1 N
- - 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 Zonej Municipal CK On site disposal system[7]
USE GROUP (Check as applicable)
CONSTRUCTION TYPE
A Assembly
❑
A-1
A-4
❑
❑
A-2
A-5
❑
❑
A-3 ❑
1A
1B
❑
❑
B Business
1?0�,
I F-1
❑
F-2
❑
2A
28
2C
❑
❑
❑
E Educational ❑
F Factory ❑
H High Hazard
❑
1-1
` _
❑
_
1-2
-
❑
1-3 ❑
3A
3B
❑
❑
I Institutional ❑
M Mercantile
❑
1
4
❑
R Residential
❑
R-1
S-1
❑
❑
R-2
S-2
❑
❑
R-3 ❑
5A
5B
❑
S Storage ❑
U Utility❑
Specify: ,
Specify: � �
`"`""""`-"•"•
""�"_�,•..._..�....�
.__,_____
�_...�...�_�w_..-.,___._.
_________,__._..
._...___. ,_
M Mixed Use ❑
S Special Use
❑
Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING: UNDERGOING': RENOVATIONS, ADDITIONS AND10R CHANGE IN USE
Existing Use Group __._.1L5 ►l �S S _ Proposed Use Group:�tN�'?_.
Existing Hazard Index 780 CMR 34):'---- : Proposed Hazard Index 780 CMR 34):
Total Height (ft) 1 N
- - 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 Zonej Municipal CK On site disposal system[7]
r
Version 1.7 Commercial Building Permit May 15, 2000
1 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING I
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION' '
1.1 Property Address:
This section to be completed by office
Map Lot Unit
�p�i�r jo ✓ U�I�G b Zone Overlay District
EIm.St." District CB District`
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _
Name (Print) Current Mailing Address: 010 0
Signature
Telephone
2.2 Authorized Aoe6i:
D( Izp57,a ( /L e,afil�
Name (Print) Current Matlrnq Address _. _ _N .
Signature L t —; Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building C c (a) Building Permit Fee
2. Electrical__ (b) Estimated Total Cost of
Construction from 6 _. _._. _µ_ ..... _....:
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) d(�a7�'
5. Fire Protection _ _.. __ ... ..._........
6. Total = 0 + 2 + 3 + 4 + 5)5 pew i Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature: _
Building Commissioner/Inspector of Buildings Date
lDr
City of Northampton�a
e:
Building Department
212 Main Streets
epaflpafn
Room 100
ate a�r
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272
s u
Plo�t/te s
1 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING I
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 SITE INFORMATION' '
1.1 Property Address:
This section to be completed by office
Map Lot Unit
�p�i�r jo ✓ U�I�G b Zone Overlay District
EIm.St." District CB District`
SECTION 2 -PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: _
Name (Print) Current Mailing Address: 010 0
Signature
Telephone
2.2 Authorized Aoe6i:
D( Izp57,a ( /L e,afil�
Name (Print) Current Matlrnq Address _. _ _N .
Signature L t —; Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building C c (a) Building Permit Fee
2. Electrical__ (b) Estimated Total Cost of
Construction from 6 _. _._. _µ_ ..... _....:
3. Plumbing Building Permit Fee
4. Mechanical (HVAC) d(�a7�'
5. Fire Protection _ _.. __ ... ..._........
6. Total = 0 + 2 + 3 + 4 + 5)5 pew i Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature: _
Building Commissioner/Inspector of Buildings Date
File # BP -2012-0227 4 f
/y
APPLICANT/CONTACT PERSON Omasta Builders, Inc.
ADDRESS/PHONE 21 North Street HATFIELD va
PROPERTY LOCATION 193 LOCUST ST
MAP 23B PARCEL 011 001 ZONE SI(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
Tyeof Construction: ADDITION 205 SOFT offices
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 6763
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
Septic Approval Board of Health
Water Availability Sewer Availability
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
90 lay
i nature
oftuifjiofficial 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.
193 LOCUST ST
GIS #:
Map:Block: 23B - 011
Lot: -001
Permit: Building
Cateeorv: ADDITION
BP -2012-0227
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Permit # BP -2012-0227
Proiect # JS -2011-000538
Est. Cost:
Fee: $102.50
Const. Class:
Use Group:
Lot Size(sa. ft.): 39465.36
Zoning: SI(100)/
BUILDING PERMIT
PERMISSION IS HEREBY GRANTED TO:
Contractor: License:
Omasta Builders, Inc. 6763
Owner: 193 LOCUST ST ASSOCIATES LLP
Applicant: Omasta Builders, Inc.
AT. 193 LOCUST ST
Applicant Address: Phone: Insurance:
21 North Street
HATFIELDMA01038 ISSUED ON.
TO PERFORM THE FOLLOWING WORK: ADDITION 205 SQFT offices
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W.
Underground: Service:
Rough: Rough:
Final: Final:
Gas: Fire Department
Rough: Oil:
Final: Smoke:.
Meter:
House #
Driveway Final:
Building Inspector
Footings:
Foundation:
Rough Frame:
Fireplace/Chimney:
Insulation:
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 9/9/2011 0:00:00 $102.50
212 Main Street, Phone (413) 587-1240, Fax: (413) 587-1272
Louis Hasbrouck — Building Commissioner