23A-291 (11) 190 NONOTUCK ST BP-2017-1037
GIS a: COMMONWEALTH OF MASSACHUSETTS
Map: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-2017-1037
Project# JS-2017-001784
Est. Cost:$10000.00
Fee: $100.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: MARK SARAFIN 053434
Lot Size(sq. R.): Owner FMC ASSOCIATION
Zoning:Gl(100)/ Applicant: MARK SARAFIN
AT: 190 NONOTUCK ST
Applicant Address: Phone: Insurance:
42 Pomeroy Meadow Road (413) 527-7812 Workers
Compensation
SOUTHAMPTONMA01073 ISSUED ON:3/17/2017 0:00:00
TO PERFORM THE FOLLOWING WORK:INSTALL HAND! CAP OPENERS TO FRONT
LOBBY DOORS ** PER AAB REGULATIONS
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 3/17/2017 0:00:00 5100.00
212 Main Street, Phone(413)587-1240,Fax: (413)587-1272
Louis Hasbrouck-Building Commissioner
File#BP-2017-1037
APPLICANT/CONTACT PERSON MARK SARAFIN
ADDRESS/PHONE 42 Pomeroy Meadow Road SOUTHAMPTON (413)527-7812
PROPERTY LOCATION 190 NONOTUCK ST
MAP 23A PARCEL 291 000 ZONE GI(100)1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid y/
Building Permit Filled out
Fee Paid
Typeof Construction: INSTALL HAD CAP OPENERS TO FRONT LOBBY DOORS
New Construction n ''(��e,I."
/
�
Non Structural interior renovations ^ .I 1 {}!�U Q 1
Addition to Existing c J I I M I
Accessory Structure
Building Plans Included:
Owner/Statement or License 053434
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION 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
olition Delay
Signa ure of of Building 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.
Version I.7 Commercial Building Permit May 15.2000
..... Dportmentum oely
I AAR I I - City of Northampton Stabs of Pmmit
Building Department Curb cuvOdweay Petrol -
L 212 Main Street Sever(SepueAs Wtp,
Room 100 WMerM $Availelblly
Northampton, MA 01060 Two Select Structure]Fles
phone 413-587-1240 Fax 413-587-1272 PbuSS Warn
O/ler8pera7
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
Iqp lAmno\-.-)L1/._ Map Lot Unit
—I:\Uvt (Il= 1/1/ Zone Overlay District
Elm SL pallet CB Matt
SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
cWL Va.,+oc+a-1-t0^ P,o Bb,t lab a5?
Name(Print) Current Marling Address'.
loo art,C, UV% OIOID")
4 ,&Signature 1, r - •- "1- Telephone
2.2 Authorized Mont:vkikG �,1 /I
`AtL J1a✓L�4-F,vs �-1a Pow,y401 WI-PAdo ea.
Name(Print) Current Mailing'Address:
t)Jk
r\00,4A 13
do %M"A d\07.3
Signature Telephone 1-113-5(03-gel 510
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building 8, (a)(a)Builtling Permit Fee
2. Electrical O (b)Estimated Total Cost of
Q ooO. — Construction from(6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC) /06_. _._.
5.Fire Protection
6. Total=(1 +2+3+4+5) 10.000 , — Check Number 0517y
This Section For official Use Only
Budding Permit Number Date
Issued
Signature:
Building Commissionernnspector of Buildings Date
Version!.7 Commercial Building Permit May 15,2000
SECTION 4 CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,803
CUBIC PEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions❑ Accessory Building❑
Exterior Alteration 0 Existing Ground Sign❑ New Signal] Roofing❑ Chang ❑
ye of Use❑ Other
Brief Description Enter a brief description here-:i,e.,. \\ \A0 V c' Cpe ter 5 40
Of Proposed Work: , _b.n/- LO '))./ (3oDrt S
SECTION 5-USE GROUP AND CONSTRUCTION'NOE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly A-I ❑ A-2 0 A-3 0 IA I 0
A.4 0 A-5 0 IB 0
B Business 0 2Att ❑
E Educational 0 28 $i 0
F Factory ❑ F-1 0 F-2 0 2C { 0
H High Hazard ❑ 3A I ❑
I Institutional 0 i-1 ❑ I-2 0 I-3 0 38 n
M Mercantile 0 4 n
R ResidenTal 0 R-1 ❑ R-2 0 R-3 0 5A 0
s Storage 0 S-1 0 S-2 0 58 J 0
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 8 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
DI
lsl
2no
2nd
3 d 3e°
4°
4th
Total Area(s8 Total Proposed New Construction(sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.0.40,k 54) 7.1 Flood Tone information: 7.3 Sewage Disposal System:
Public n Private 0 Zone Outside Flood Zoned Municipal 0 On site disposal systema
Version 1.7 Commercial Building Permit May 15,2000
B. 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 90
Open Space Footage
(Int area minus bldg&paved
;taking)
II of Parking Spaces
Fill:
(volume&l.,r.eon) -
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO O DONT KNOW fYES O
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO O DONT KNOW O YES O
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO O DONT KNOW 30 YES O
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained O Obtained O , Date Issued:
C. Do any signs exist on the property? YES i) NO O
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES O NO 0
IF YES, describe size, type and Location:
E. Will the construction adivity disturb(clearing,grading,excavation,or filling)over 1 acre or is it pad of a common plan
that will disturb over 1 acre? YES O NO te
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 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
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Ansi of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of ResponsibiUty
Address Registration Number
Signature Telephone Expiation Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiation Date
9.3 General Contractor
Not Applicable 0
Company Name:
Responsible In Charge of Construction
Address
Signature Telephone
Version I ?Commercial Building Permit May 15,20g0
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes O No ((��{{yy
SECTION 11 -OWNER AUTHORIZATION-TO BE COMPLETED WHEN F
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT n p
fi t1 �`R,�YJ 4teAcv 1r3' Coaucs 0,,,oc A L:
t. t butiuv—y� _ ,as Owner of the subject property
hereby authorize S14ck 61.PaffiZAV\V`. to
act on my half, in all mfrs relative to work authorized by this building permit application.
1-------- 3-1 1-3-
SignatureofOwner Date
I v"' i\E- 5tat 7.N Fatah ,as Owner/Authorized
Agent hereby declare that the statements and mfonnation on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury..
'\w4L\G c c,.vh
Print Name
Ad ` /_
A .J —jN—,
Signature of Owner/Agent Date
SECTION 12-CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor Not Applicable q
Name of License Holder: Ok‘aveL .. []V+2v.1 fr-•"A. .cs -C63,4 3L1
/ License Number
Lk , R at vEALa SOArnwpL,,, klt 6to13. `-{-a5- f
Address /j t'� Erpimtion 0ffie
�// Lig' sas fast
Signature Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT IM.G.L.c.162,§25C(6N
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 I
City of Northampton 212 Main Street,Northampton, MA 01060
Solid Waste Disposal Affidavit
In accordance of the provisions of MGL c 40, S54, I acknowledge that as
a condition of the building permit all debris resulting from the construction
activity governed by this Building Permit shall be disposed of in a properly
licensed solid waste disposal facility, as defined by MGL c 111, S 150k
Address of the work: \ °I D ✓\0..t) Ltle
The debris will be transported by: Swrtw-F‘,.. 'R0 \gAen-S
The debris will be received by: kick\lay ts
2aact ( �r
d
Building permit number:
Name of Permit Applicant Aa,/ S.gizw51
/l1 //tY
Date Signature of Permit Applicant
The Commonwealth of Massachusetts
Department of industrial Accidents
v aft=;t Office of Investigations
die•!_ i4 1 Congress Street,Suite 100
",,__le-
Boston,MA 02114-2017
www.mass.govldia
Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers
4.ppiicant Information ('� Please Print Legibly
Name(Business/;hganizatiionntlndividual) ?W2 latch --a,}v1„ s Neckc-r _.
Address: t{-ia RAKE. /.Lr‘
(�M1/1'aatSto
City/State/Zip: Jca.-A)t4e.av-A YVl ea. Phone#: 1413- < " - 2117
Are pu an employer?Check the aperopriate box: O CO
4. 1 am a general contractor and Type of project(required):
i. am a employer with JG.,.._ g 6, ci New construction
employees(full and/or part-time).* have hired the sub-contractors
2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. Demolition
workingfor mc in anycapacity. employees and have workers'
P 9, 0 Building addition
[No workers'comp.insurance comp.insurance.•
required.) 5. Cj We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions
myself fNo workers' comp. right of exemption per MGL
12.0 Roof repairs
insurance required.)' c.152,§I(4),and we have no
employees [No workers' 13.9\Other
comp.insurance required.)
`My applicant that checks box el must also fill out the section below showing their workers'compensation policy information.
'Btvneuwners who submit this affidavit indicating they are doing all work and then hire outside contreaors must submit a new affidavit indicating such.
:Contractors that check this box must et:acheden additional eheet showing the name of the subcontractors and state whether or not those entities have
employeeslithe subcontractors have employees,they must provide their workers comppolicy number.
I am an employe that is providing workers'compensation insurance for my employees. Below is the polity and job sire
information. p�
Insurance Company Name:,'A y e to-La h�
Policy#or Self-ins.Lie.tl_ vac ^f_pb-lrO k 113 - '`Epirekionlae: —t — to
Job Site Address: 00 ✓LQ4b10CL 5'+'- City/State/zip: 1'Idppi,CG '040' oIbtoa
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 Mol e. i 52 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 Pine
of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Otftce of
Investigations of the DIA for insuf ce coverage :rification.
Ido hereby certify rr s qh¢pe .,.-s of - . that the information provided above is true and correct.
Signature' /yCI is .: J '{- 1'-
Phone a: 1/4-113- 71/o?-67a CLO
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Penult/License
Issuing Authority(circle one):
I,Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#: -..
March 14, 2017
Louis Hasbrouck
Building Commissioner
City of Northampton
212 Main Street
Northampton, Ma. 01060
I Request you grant a modification to waive the requirement for construction control of
the project at The Florence Medical Center located at 190 Nonotuck Street in Florence
because the work is of a minor nature, will not affect health, accessibility, life and fire
safety, or structural requirements and is impractical in that the cost of construction
control is considerable when compared to the cost of the proposed work. Thank you for
your consideration.
Respectfully,
Mark Sarafin
Sarafin Builders
42 Pomeroy Meadow Road
Southampton, Ma. 01073
ELECTRICAL----u"
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t°``# NrAt INTERIORLeft Hand Outswing;
120NDIS camp Line Power
z-stanlerHeavy airs+AsieMagic Fora Automatic Swag Door Operator 10PBS16
2—Dark B,o ueAnadted Standard Flash To Be Brought Into The
2-MC321 Control Bw
2-Outswmg000tArm Assembly No.amp
Latch Side of the Door
2-0n Of-Ncid Open 5wItd
4-Radio ContrdkdSSnies steel Push Platefict'wrtmnswitChes Header by Others.
STANLEY
IMPORTANT:THIS DRAPING MOST BE
STAN/.BX ACCESS TECHNOLOG4ES Magic Force APPROVED AND RETURNED TO STANLEY
ACCESS TECHNOLOGIES IN ORDER IO
SZ 2nd Street Beach Lake,PA6-5 18405 Phone PFI,FARE NOR FABRICATION J�(yj///
5I8-618-1449 :Fax 8fi6-537-5 t7i
Automatic Door Operator �il
Quantity 2
DOOR TYPE: Magic Force Florence APPROVED BY:
FINISH Dark Roast Spaniard Am/1gaFish Low Energy Application DATE: : ;,r))-./-1,,
ANSI 156.19
on
STANLEY Territory an New 99 England-CT Road Branch
i Territory Manager(Eastern NY-Western 3544 Luke Rand
a MA) Cortland,New York
Access Technologies NS,13045
Tel:607-7S3-7531
Estimating Department ', Quotation x108170-1 Fax:866-537-5171
Condo Florence Mass Mobile:S18-221-8316
MA
AltPhone:
UcenseNumberl:
LlcenseNumber2:
Email:Aaron.Leclere@sbdinc.com
04 November,2016
Stanley Access Technologies,LLC is pleased to provide you a quotation to Furnish and Install the following:
2-Stanley Heavy Duty Single Magic Force Automatic Swing Door Operator 1 left Hand Outtswing)
2-Dark Bronze Anodized Standard Finish
2-MC-521 Control Box
Z-Out-Swing Door Arm Assembly
2-On-Off-Hold Open Switch
4-Radio Controlled Stainless Steel Push Plate Activation Switches
One Year Warranty On AN Parts&Labor
Prevailing Wages Are NOT included
•
Net Price:
Add/Deduct as Required:
ADD 52,200.00 For Door Mounted Safety Scusku Systems.—
Scope
ystems.Scope of Work:
We Are Pleased To Quote The Foliowing:
Furnish and Install TWO(2)Stanley Magic Force Single Swing Door Operator With Radio Controlled Push Plates.
All Material To He Dark Bronze Anodued.Door Operators As per ANSI 156.19 Low Energy Operation. The Owner Is Responsible
For Bringing 110 Volt 10 Amp Power And All Comml Wiring Into The Header Of The Operator. Stanley Will Make Ali Final
Wiring Connections Inside Of The Operator Header.Power Should Enter From The Latch Side Of The Doors.
Exterior Door and Interior Door Require Exit Signs To Be Relocated Prior To Instalation.Clearance Required Each Opening interior
Side Is 6"From Wall Out And 7 Up From The Top Of The Door.
Headers will be 45'In Length Centered Un the Openings.The interior Door Appears to Have Clearance Issue With The Fire System,
Please Verify There Is Clearance For Mounting The Header.
Lead Time/Warranty:
Lead Time:Current equipment lead time is 2-4 weeks from receipt of order and approved dimensions.Equipment is furnished and
installed during normal business hours,($LOAM to 4:30PM,Mort-Fri).
Warranty:1 year parts and labor,During normal business hours Mon-Fri 8:00AM to 4:30PM.
If you would like to pay by Credh card,please contact us at 1800 722-2377 Ext&
t pW�eeaaccccept the idbwing Credit Canis:
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