17C-231 (3) CDity of Xvrt4amptan
DEPARTMENT OF BUILDING INSPECTIONS
b 212 Main Street • Municipal Bui;ding
Northampton, MA 01060
1 ITC'1'OR
Jeffery Guiel
187 Powell Road
Cummington, MA 01026
March 3, 2008
17C-231
Dear Jeff,
Building permit number BP-2004-0722, issued on January 23, 2004 and amended December 8,
2005 for interior renovations at 34 North Maple Street is still open. Final inspections for a number of
electrical, plumbing and gas permits have not been completed, the final building inspection has not
been done and we have not yet received a letter of substantial completion from the architect of record. I
have included a list of the permits for this project indicating the status of each permit.
visited the property on Thursday, February 28, 2008. It appears that the work covered by that
permit has been completed. Final inspections must be completed and the permit needs to be closed.
We will not issue additional permits involving that same building until that happens. The build out work
for AM B Care Ambulance Service in tenant space 17 cannot proceed at this time.
Please make arrangements to complete the required inspections and submit the architect's
letter of substantial completion as soon as possible. If you have any questions, please call. Our
telephone number is 587-1240 and our office hours are Monday through Friday, 8:30 am to 4:30 pm,
excepting that we close at 12:00 noon on Wednesdays. My email address is:
Ihasbrouck @city.northampton.ma.us.
Thank you for your cooperation in this matter.
Louis Hasbrouck
City of Northampton
Local Inspector and Zoning Enforcement
Ihasbrouck(a)-city.northampton.ma.us
cc:
Robert Chapdelaine
AM B Care Ambulance Service
15 Sawin Street
Marlborough, MA 01752
Eric Suher
LHIC Incorporated
P.O. Box 771
Holyoke, MA 01041
20 -- 0 10 /
Ail
10 x X � x
CREW OFFICE/
LOUNGE 36x80 36x80 OFFICE ssxso Clst.
R.H. L.H. L.H.
36 80
R.H 14"Metal Pipe Fencing
9 / _ 10 /,
CREW RM.
1 DOLKXAS
BEST
MECH
Nm 29045
3 / _ 4 //
E
certified by: Am-B-Care Ambulance - Northampton Base
34 North Maple St. Florence, MA
D .#:
wg
OFFICE BUILD LAYOUT OB-1
Date: Drawn by: Scale:
03-24-2008 ROBERT J PHILLIPO None
I
64`-6„
I
20` 10, 10, NEW 12'X19
CREW OFFICE OFFICE/ GARAGE DOOR
10, LOUNGE Clst
DOUGI AS E.
BEST
12` MEO"NK��
9,_10„ 20, No. 29045
CREW RM. _..
WASH BAY
CEM I_ DRAINS W/.
SPRATOR
i
I
30' I 65,_S„
i }
co
Co
sting j
D i EXIStING DRAIN o.
30`
certified by: Am-B-Care Ambulance - Northampton base
34 North Maple St. Florence, MA
Dwg.#: -
BASE LAYOUT BLA
Date: Drawn by: Scale:
03-24-2008 ROBERT J PHILLIPO None
CONNECT TO EXISTING FIRE
SPRINKLER SYSTEM
3.
—-----—----------
Single Head Sprinklers
00.
CREW
OFFICE-1 OFFICE-2
LOUNGE
6X80
36X80
H. L.H.
36480
1 Metal Pipe Fencing
R,H� —2
e
0
3 0 36X
36X80 fI' 36X8
, L L
R.H. L H H
Total Run Lenth-50'
H
Use of match to exising sprinkler Heads to maintain
DOUGLAS E.
system integrity. No design flo changes required.
BEST
CREW RM.
MECHANICAL
5icel - 10'x10' Roorn-Qty I -Single Head
Office
No, 29045
Office 2 - 10'x10' Room -Qty I -Single Head
Crew Lounge - 10'x20'Room-Qty 2-Single Head
Crew Rm. - 10'x10' Room-Qty 1 -Single Head
Layout and Equipment to be design &specified by Bay 7—G
State Sprinkler, Inc. Holyoke,MA
certified by: Am-B-Care Ambulance - Northampton Base
34 North Maple St. Florence, MA
Dwg.#: -
FIRE SPRINKLER LAYOUT FP-1
Date: Drawn by: Scale:
03-24-2008 ROBERT J PHILLIPO None
i
2 O / 10 / 0 j
1W
10
i
i x x x
CREW OFFICE/
OFFICE
LOUNGE 36X80 36X80 36X80 CISt.
R.H. L.H. . L.H.
36 80
R.H 14' Metal Pipe Fencing
I
CREW RM.
ooUMu►s E.
1 BEST
MECHANICAL
No. 29045
3 / ® 4 //
certified by: Am-B-Care Ambulance - Northampton Base
34 North Maple St. Florence, MA
Dwg.#:
OFFICE BUILD LAYOUT OB-1
Date: Drawn by: Scale:
03-24-2008 ROBERT J PHILLIPO None
CONNECT TO EXISTING FIRE
SPRINKLER SYSTEM
it
Single Head Sprinklers
10
CREW
O
FFICE-1
...........
O
FFICE-2
LOUNGE
36X80 36X80 36 X80
R.H. L.H. L.H.
( R H 80
1 2 Metal Pipe Fencing
Total Run Lenth-50'
Use of match to exising sprinkler Heads to maintain
system integrity. No design flo changes required. DOLQAS E.
11IM
CREW RM. ST
Office 1 - 1 O'x 10' Room-Qty I -Single Head MECHANICAL
9045
Office 2- 10'x10' Room -Qty I -Single Head
1 Q'x20' Room-Qty 2-Single Head
Crew Lounge t7-
Crew Rm. - 10'x10' Roam-Qty 1 -Single Head
Layout and Equipment to be design &specified by Bay
State Sprinkler, Inc. Holyoke,MA
certified by: Am-B-Care Ambulance - Northampton Base
34 North Maple St. Florence, MA
Ljwg. .
FIRE SPRINKLER LAYOUT FP-1
Date: Drawn by: Scale
03-24-2008 ROBERT J PHILLIPO None
64'-6"
i
20' 10' 10' NEW 12'X 10'
1 0
CREW' OFFICE OFFICE/ GARAGE DOOR
LOUNGE Clst.
12'
9'-10" 201
CREW RM.
I '
VyASH BAY
_ DI2AINS W' `
—4 ® OIL_WATER
SPj�RATOR
30' 65'-5°
DOUQAS
MST
kAWAL
NO. 29045
............
I
® =� 00
i f
_. 2i4 i 1 LE: L_,
i A". i =E
.__._... isthg
c E ISTING DRAIN s i
. 6
30'
certified by: Am-B-Care Ambulance - Northampton Base
34 North Maple St. Florence, MA
Dwg.#:
BASE LAYOUT BLA
Date: Drawn by: Scale:
03-24-2008 ROBERT J PHILLIPO None
77ie Commonwealth of Massachusetts
Department oflndustrial Accidents
w l;�rJ
w� Of`ice of Investigations
_ 600 Washington Street
5,
F
= ' Boston,MA 02111
www.massgov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Apalicant Information Please Print Le-ibly
Name (Bog../Orza„i=on/Individual) 611 , e- f
Address: ( 7 7
City/State/Zip: Tc a Phone.
Are you an employer?Check the appropriate box: Type of project(required): �l
4. I am a general contractor and I
1.❑ I am a employer with ❑ 6. New construction
employees(full and/or part-time).* have hired the sub-contractors
2_Q I am a sole proprietor or partner- listed on the attached sheet 7. Remodeling
shi✓A—i have no e-^^ioyees These sub-contractors have .g. ❑Demolition
working for me in any capacity. employees and have workers'
9. ❑Building addition
[No workers'COMP. Insurance.Insurance comp. tnszrrance.+
required_] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have`exercised their
3"❑ I am a homeowner doing all work 11.0 Plumbing repairs or additions
myself. [No workers'comp. right of exemption'per MGL 12.7 Roof repairs
insurance required-]t c. 152,§1(4),and we have no
employees. [No workers' 131-1 Other
comp.insurance required.]
'Any applicant that checks box#1 must also ED out the soon below showing their workers'cor=m=c+*on policy information"
t Homeowne s 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=ached an additional sheet showing the name of the sub-contractors and state whether or not those=tines have
employe-`s. If the sub-contractors have employees,they must provide their'worke s'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:
Policy F or Self-ins.Lic. Expiration Date: "
Job Site Address: 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 S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fi�P
of up to 5250.00 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 certify under the pains and penalties of perjury that the information provided above is true and correct
Signature: Date: 6>
Phone
Of use only. Do not write in this area,to be completed by city or town official
City or Town: Pe'rmit/License T
Issuing authority(circle one):
I.Board of Health 2. Building Department 3. City'Town Clerk 4.Electrical,Inspector 5.PIumbinEInspector
6. Other
Contact Person: Phone=:
Versionl.7 Commercial Buildin-Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required 'Yes O No O
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l jS 11&69-1 j-7/- as Owner of the subject property
hereby authorize - to
act on m ehalf,in afters relative to work authorized by this building permit application.
Sig ture of er.__-- Date
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 underthe pains and penalties.of perjury.
Print Name
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES o1
10.1 Licensed Construction Supervisor: D o°L / S 0 / Not Applicable ❑
Name of License Holdert' `� - � ,�l..�= .. __.
License Number
y j"S-0
Address Expiration Date
Sig our 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 Q
F
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
Name(Registrant):
Registration Number
Address
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 I Expiration Date
9.3 General Contractor
Not Applicable ❑
r. -
Company Name:
Responsible In Charge of Construction
Address
e7/ c4
Sign; 're Telephone
a
Version 1.7 Commercial Building Permit May 15, 2000
S. 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 DON'T 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 kV DONT KNOW Q YES
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 1( 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 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 E
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
R
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. ( ( 0 14 T TE A Ck- l-7
Of Proposed Work:
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 ❑ 18 ❑
B Business 2A ❑
E Educational ❑ 26 I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ 1-2 ❑ 1-3 11 313 ❑
M Mercantile ❑ 1 1 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(so
1 St
1st d _
2nd 2nd
3rd 3rd ,
4th
Total Area(so C,0C,- Total Proposed New Construction(so
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❑ Municipal E] On site disposal system[]
Versionl.7 Commercial Building Permit]Aav 15.2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
Room 100 Water/V�
Northampton, MA 01060 Two Sets®f' ru�lrl�la
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans r
Other Specif
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 -This section to be completed by office
1.1 Property Address:
Map Lot Unit
Zone Overlay District
UPt � ?
Elm St.District CB District
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
Name(Print) (d ��On Ho C 10�El (51 O� � Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
K, 4)1576 r
Name(Print) ��PGi E c k Current Mailing Address:
Signature i Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building G3 5 (a)Building Permit Fee
2. Electrical // (b)Estimated Total Cost of
Construction from (6
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) I )ev)
5. Fire Protection
6. Total=(1 +2+3+4+5) O� Check Number
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-0838
APPLICANT/CONTACT PERSON JEFFREY GUIEL
ADDRESS/?HONE 187 POWELL RD CUMMINGTON (413)634-0182
PROPERTY LOCATION 34 NORTH MAPLE ST-UNIT#17
MAP 17C PARCEL 231 001 ZONE SI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
T_ypeof Construction: #17 NEW TENANT SPACE,OFFICE&ROOMS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included•
Owner/Statement or License 029501
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF04MATION PRESENTED:
proved Additional permits required(see below) /U r Pratt
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
� ,a Q
Signature of Building 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 1VIGL 40A. Contact Office of
Planning&Development for more information.
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