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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" 17 mDo --PowEA II OtOOSING 8?' H m —cptgapl H1 Ot S I l 5 '}'2'( a� yfir{ ^. , / ii fI xop7 FORCE 11 / HO'tF,.NfRR 11µ";32j i t(t RQ `HE GA,.E40r I�ili�J ' -L REAR OFINS R PCPERA OR (3SEETirjri Viewed From Interior 1ii k L� 4 L S-feed@r Exterior 4 42" Qoorlgt 4r 1 t._ i A ‘. +•4 r Pow. -YI. —o. YIk— ,I,, . 'A.A2t rf(441.fx-s =A.&t 0 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: 1+X1 1 o- .1 L n,TT