23B-046 (4) *
CITY OF NORTHAMPTON, MASSACHUSETTS
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: HAI -09 -83 DATE: November 10, 2010
PROJECT TITLE: Renovations for Central Registration
PROJECT LOCATION: 30 Locust Street, 1st Floor
NAME OF BUILDING: Cooley Dickinson Hospital
SCOPE OF PROJECT: Addition and Interior Renovations
IN ACCORDANCE WITH THE MASSACHUSETTS STATE BUILDING CODE, 780 CMR,
CHAPTER, SECTION 116, I, RICHARD E. KATSANOS , MASS. REG.
NO. 8355 , BEING A REGISTERED PROFESSIONAL ARCHITECT /ENGINEER,
HERBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE
PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS
CONCERNING:
ENTIRE PROJECT I ARCHITECTURAL STRUCTURAL
FIRE PROTECTION ELECTRICAL MECHANICAL
OTHER (specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE
ENGINEERING PRACTICE AND ALT, APPLICABLE LAWS FOR THE PROPOSED
PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR BASIS
TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE
DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE
RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2:
1. Review of shop drawings, samples, and other submittals of the Contractor as required by the construction contract
documents as submitted for building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required controlled materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in appendix B.
PURSUANT TO SECTIONS 116.2.3, I SHALL SUBMIT PERIODICALLY, A PROGRESS
REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR.
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AND AN
AFFIDAVIT OF COMPLETION AS TO THE SATISFACTORY COMPLETION AND
R •" fi,sINESS OF THE PROJECT FOR OCCUPANCY.
• 45 @ 5 N Subscribed and sworn to before me
(5) b this t* day of A fi'? 0/4
P1o. 8355 �� �� _
STHAMPTON o rv� J!:�i /1f���
otary Public 2
�` 1= w rd D. Etheredge My expires i Ka sanos, AlA M , Commission ex on
Notary Public
' Commission Expires
3/30/12
CITY OF NORTHAMPTON, MASSACHUSETTS
CONSTRUCTION CONTROL AFFIDAVIT
PROJECT NUMBER: HAI -09 -83 DATE: November 10, 2010
PROJECT TITLE: Renovations for Central Registration
PROJECT LOCATION: 30 Locust Street, 1st Floor
NAME OF BUILDING: Cooley Dickinson Hospital
SCOPE OF PROJECT: Addition and Interior Renovations
IN ACCORDANCE WITH THE MASSACHUSETTS STATE BUILDING CODE, 780 CMR,
CHAPTER, SECTION 116, I, RICHARD E. KATSANOS , MASS. REG.
NO. 8355 , BEING A REGISTERED PROFESSIONAL ARCHITECT /ENGINEER,
HERBY CERTIFY THAT I HAVE PREPARED OR DIRECTLY SUPERVISED THE
PREPARATION OF ALL DESIGN PLANS, COMPUTATIONS AND SPECIFICATIONS
CONCERNING:
I ENTIRE PROJECT I ARCHITECTURAL STRUCTURAL
FIRE PROTECTION ELECTRICAL MECHANICAL
OTHER (specify)
FOR THE ABOVE NAMED PROJECT AND THAT, TO THE BEST OF MY KNOWLEDGE,
SUCH PLANS, COMPUTATIONS AND SPECIFICATIONS MEET THE APPLICABLE
PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE, ALL ACCEPTABLE
ENGINEERING PRACTICE AND ALL APPLICABLE LAWS FOR THE PROPOSED
PROJECT.
I FURTHER CERTIFY THAT I SHALL PERFORM THE NECESSARY PROFESSIONAL
SERVICES AND BE PRESENT ON THE CONSTRUCTION SITE ON A REGULAR BASIS
TO DETERMINE THAT THE WORK IS PROCEEDING IN ACCORDANCE WITH THE
DOCUMENTS APPROVED FOR THE BUILDING PERMIT AND SHALL BE
RESPONSIBLE FOR THE FOLLOWING AS SPECIFIED IN SECTION 116.2.2:
1. Review of shop drawings, samples, and other submittals of the Contractor as required by the construction contract
documents as submitted for building permit, and approval for conformance to the design concept.
2. Review and approval of the quality control procedures for all code required controlled materials.
3. Special architectural or engineering professional inspection of critical construction components requiring
controlled materials or construction specified in the accepted engineering practice standards listed in appendix B.
PURSUANT TO SECTIONS 116.2.3, I SHALL SUBMIT PERIODICALLY, A PROGRESS
REPORT TOGETHER WITH PERTINENT COMMENTS TO THE BUILDING INSPECTOR.
UPON COMPLETION OF THE WORK, I SHALL SUBMIT A FINAL REPORT AND AN
AFFIDAVIT OF COMPLETION AS TO THE SATISFACTORY COMPLETION AND
-.� INESS OF THE PROJECT FOR OCCUPANCY.
45/ �. � � C/A, Subscribed and sworn to before me
2 Q' this // ' day of , , 0/O
c,, t o. 8355 u,
E
P ;STHh�Y1PTOP! L�[ /��� elde4f)r• /,fir y� Public
,TH o t'» S�; Ka sanos, AIA Edward D. Etheredge My Commission expires on
Notary Public
My Commission Expires
3/30/12
_ ..,_ _ __ _ --
. _Yr.;
-,./
I ;YU' L,),I /,.,----- ./ / /
1 k ,,,1111.75,12,1_,•:',._,-,) _. i (.0 -'
di: JO :XIII:, '7 To 'Ii
:)
. .
u,p-,--431-u-,■:-::-; cr, p CII ., ,H; aiDN jo - ' , „..%; - , - :;17-pn,:%::: I01 :. ?_71 CI - .)-171r: - .'j 1I pttd 0 Ppr;;PIT,1
:- 70 :.....u p4 7.':-`.:' 7 T. --,-,--:■=u u.--..p..,,,L3,1 c , ltt-a trql o .itt- t -Fru Tuu- 1
.ot, ;.-11 jo ti7,
=7 Z ,'.,--Cv-1;::,11..ci ,13 .:1 - 4 C■Dj 'r ,I.q CIC:;,,:_rr V ;.17'7SI'll ITIV DC1; 00 0 T1 2C r.J. T
,,, LI . ),cci ,J, c_„,-2 TUr.1.7- ,T .... uo .. , - - ,...t1 - 1....Tuay..c......: , .D..ucl, :Al; tpr.Sph Ul rl= CQJTI 'a thl )
F 2 [.-71,-..... 2 7. urD -...;,p E,.., pp, r-,:, u,c1,71 `,.. ■,
0 1., 0 17-: , Cli LI. C,C,V, \ Llz.<1.1VZ0
1.j t',TiS/,'.11 '1.1. ,s..... ...1 1 IT: 01.1IE11...10TiC _.1",:+ 0 C..)11710 P. 11.113 1
. c)TJ-1 :0j d'UTY,..1 0 k... 11110 00 g i',..12 P p1.111 . C.) l',D lid Did 0 (-_,.',' I: u:,2
(SCICIa.c.Cp, [1, C S'CI.. poy;:clu..DIP 0pfiry.p, ,pp /..,,,-.....,,u,y, 1.u-P-qs CrOCF1,:piirl, tprIV)
("3113C' UCY,Icii.(13.:,..;) 1,5 0 2- ::-T00 (JC._21LIVUO:j JO C'pilrt.P.N)
- -
.c..0no p.7. al: cTI ) 0 0 II arftSTI (.1 011O0 10 0 ILTE . •,,T . - :)
— - - - — -
(211? a 1-,op (i;•,..:), ,(201',.:,,v,CuvcIraoD 1± (._:3ii 00 Jo
(oluc10t 0111 1:031 .z 1.(7,q0600.1 f..;: UT-0TIS ( OD JO LcCiTUND
Isgiotioj, uov,2, c,; 0CI1400 0i10:,_ OLD ',1), 0[7,10, 0:0o11 ;1; 1):::/..S1[ 1J0 00
0.7)1 ,-.), purp, (-00c, o ',;`, 1,)0:1,D Jo 11411 '0 . iy_100'. , )3 10:)' 3102 11 1E72
(130101 :._o) (icIredial 00 007300T0 lip
/ o 6 Z s-5vog z i-/ -s 4,/ r fir
.. sil[7: S0. OI1
uo11 v;:;i0)d11.10: ':1: : IR11_, :Y 2 tii ptAo_ici JoicoF1 u12, UTE
Vs.1 4. C.) '.'");) I 1 p;I0j-2 d 011114 nil d ":_)1 yopun 1D ,c( ol
(dp_ /,(:,.9
0 ::::,,Joi., Ei
,\-,)
i 1
::,)';"; ',";-D J ( , , ,-;S:DUIS - i — IC1 JO g- Fcc_ilauud 17. lilm
I_;ITE.J..."Ar,.
' .7 /7 - i c / 7 .?M A. -7-r >1 1- .( 1/4
([11,!1, ,±1.:) !...i {.1 _',,T. ()II S21 ' (I OD P 21 a:A (-) iY\
09010 ' '1.0. o
'0Y 1 3/ 1 , -iriro:q :i; rrt.lf yI 3 Ur,
/ (WI ■V R, j7:j1 L:) PIO .1 N.:- Y'Ll,,
5tiplm4 ':M./.6T;-:?.,,,,',,,',
(
. , },- ;:./-y.:::.-:i i•: ;
--:----_-7_-_±_--.:----
_ ____-„,..„-_-_,, v'-
:.:
1 .
it - I , i. I i) _ I �``i,2i) ..,hr'II _� .
-)� r � � I.i - t
i .. C I r.= C:1 _ :5 F01,; l IILLII` LRf4IT I
7 r
vi
����,�K.v:,.`".
- J
r
Ir'
r i�: ��� , . ' , ,1�
E IOH CONSTRUCi;Otq SERV1CLS
c■
YI2 /' %1 ' ` ' / //e
i
1 1"r0M -,_RS' COir,PJNSA] ION 11 NCE I;FFIII), "-,VIT (i,i:G L c "152, §'25C(b); '
��., „ , ■'
>� y.4 4,t4' t.p� � 1 T
- A
(,k
1
J ,
- -- pay ■)s " a,Tef,J paw.L4q0
r , f . _lIN;gG a 01> _ pp@?.I
, _i I Ji_ c_ .ir: -J-11 ,� - 1 pc)i nq y G, p 1S .10 I,'�,CH l !LL.L i ^ E.
•`, - -; 0; ,J ;JC-2h .v ,_ - �7,\ IC. •;;;2'13q i1 E ' _; t-I; JO] _
:1JJn:_)0(1 i0,/;7• - cd 09 9 7cc
,:,.]'� DI.11 uC/a - ..RA• Iru' l , HE!fv " .� 1F , 1�!I5 L SELJ
y.
) - :ed ,: ,) 1
0 T c: l" r ()
I � I
,8/ J_ ,
(a: 9',. s- 9 7!
i1=. ,,
'. -' ,E`�0c ; (, 1f A,.: .- i, C I' '. ,d() .L, T Z � ' ':i -- 1-,-,:v1,, „ !,) ci,`
1
TIO� =:C 0,N , ?'U1 ER!llCE:.:3f0.1 PRf, -,'E ;S LE_ I �3it = ,470[3
l �3JL t E>`IC) a i:' , 1 C1_uSl �� SPh(,E „ . -I
>1F ' )I '111,-' trl(',,.., 1 ' F - _. . IrCII`Q ll d1 51i11S L�IS IIg C�Iol.1(] `:Iglu - l ACI.l l>Y - LS — . I I'L,'Jt 1
I
;1:C.f ICI E�.Itc f IIIOTI�, I- �C�IIOJIi�I�� I�E'�,',i �I�j I_, 1 )e UI l L f O:h -.
A ccessory Building J ,r.puirs , i
1
1 (. € �, (' � ? 'c \ �J 1 i s ,..0.! c ,,, _ a( ` ,, .
--r FI.0i.1 5 - J;E GF,OUP . CCi`,1Si 1GT U OH TI PE . 1
1
USE GROUP (Checd; _,s _,pplicnble` - F APE
COr1 SThU� - - - - - - -- _
[.11 ' l
31._7 sjr1 F -1 ------ - - - - -- -. - _ - - - - -- -- — _ ._ _. -- __. ; : _I
Cd' T.iLiOlal 1 L1 il
1-- r( or 1,' F- r 1 i I. - -- — - - - --
III i111a1)- utJr131 _, L1' 1 r
1.
1
1 1
nt1! ❑ 11 1
c 1d1 - )`lal 1 ,
.,_, H S Li I
LI 1_I'- 'alit„ 11 , 's_ _Ifv:
;r Use �1 _. ii
- 1II'PI r C rHI_, _SECIIO.N T, F�.1_ 1?�d� l3U_LD1fa(� IPDI '(JOUi� RENO`VMIO ADDI U _ 1 i i,J, - I, - °iI .N ,
F r,l _ d Use - 1 rup. e._
C �� - - _
I, ;gym a -.�,I r�r,c , X 11 ��1 : ?
F_,isti Q'raze -
1Ide, I n .1,1.
r�'l - (Ol'� bt3UILL)Ii�aG s`IrI�,t� t ;�1'�D AFtF
f -
_
F
0 ACLU [=ONLx
�, �� VS 'I, ,�1 1
T 4
p r Floor 1 4(. , C. i ., b c(- 7
4 �
,
,
1
_
-- - - � st h :�-� 'i3epa�r�ent�� �n1y -� t
Northampton R- 6fQ:e4 ti � x k,
1udoma Departm er�t g ar b ' lanweswa4'.e • � - f� �:
- � � M �- � ��� � Yom, t4
1 i ivlall Street weF je s.! � a lift . ` �.:� >t ��t-
Room 1100 \tVra e-g p° al !] 1 n � E ti -
Northampton, MA 01060 1NO`. t - fi psi rat1a r , - % `y,7
L oce 9 Fax 413-58 1�_, 5ze aas,,. � : �� � ; � � 3 -
( A'„-S! g G 0.s t, t :` d u r"7 0. 7a1 7,
, P Pi-ICA - rZ0N TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
N n , ',� ; r~ cu i
U i
SECTION -Yi- SITE; INFORMATION -
S Thtssection� - o'be cornplete df0Io ce er
_,2 Property Address: �,� b Y r �+? t • '�"�
// S7° P L . k k 3� • i k c r N
.__�., 0 0�e1 Q C/c in 5 HoS / 0I f ct � h3ap t �o � . r �l7n t
r �, • is 1, " i F s 1 u
Y T l scr
• r
C: / / _ d �' overla IDiSi ict
F-L d C U , 2 7 - �-rz 'S.. y 11^ � r � � T . -. a >t r r '� vx ��s- L
im5t isc2 D_t1 `tm; +� , E IDi ict
S EC.I10N.2. PROPERTY,. OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
' 0 Cie y D!� 7 _hsohf /a s 7"c4 - 30 1 0 0 (is t S t. PO• l QZ SDa/
Name (P t) Current Mailing Address:
I/ /3 - 5 z 313 --
signa!ure
Telephone
%." Authorized Agent:
. l /e S uc(!aul 0/05
��. l
a Current ME:inc Address.
i
/�/J!IP -- yam= �7= °o
Si gnature elephone _ --
Fr 3 CSIIMATED CONSIRULf10N COSTS .„
_ r- -
Item Estimated CO, Dol to be I _ O Official - Use Only
completed by permit _applicant L
.avino /93 336 (a) Cuildmg •Pem,,te
7 EI �'c' 25 5. 00 (b) imated To tal Cos of —
l - GonSt uctio (6)
fro
Flu r i� 9 �O 2 86 00 „Building ▪ Permit Fee = '- •
L - 5 , 6 5 —
r , �,,,,,Ical (H' -- 19,798.00
,� Prptection I 5_,300,00 -- — — —
*253,27.5
„ r a + 4) .06
i
� This Section For Of Use, Only
L - i _ c:
UatE
q 1 ,�,I�zns er In t, or c - ilcinq
File # BP- 2011 -0450
APPLICANT /CONTACT PERSON RAYMOND R HOULE CONST INC
ADDRESS/PHONE 5 MILLER ST LUDLOW (413) 547 -2500 0
PROPERTY LOCATION 30 LOCUST ST
MAP 23B PARCEL 046 001 ZONE M(99)/URB(1) //WP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid jam / , � &5
Typeof Construction: RENOVATE CENTRAL REGISTRATION
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 066227
3 sets of Plans / Plot Plan /4 y9-
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
IN 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 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
( L-'cJ2
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 MGL 40A. Contact Office of
Planning & Development for more information.
`F'e
BP- 2011 -0450
GIS #: COMMONWEALTH OF MASSACHUSETTS
itiapi.e2it. 046 • CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildiinc DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0450
Project # JS-2011-000730
Est. Cost: $253275.00
Fee: $1519.65 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: RAYMOND R HOULE CONST INC 066227
Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M(99)/URB(1) / /WP Applicant: RAYMOND R HOULE CONST INC
AT: 30 LOCUST ST
Applicant Address: Phone: Insurance:
5 MILLER ST (413) 547 -2500 0 Workers
Compensation
LUDLOWMA01056 ISSUED ON:11/22/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: RENOVATE CENTRAL REGISTRATION
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 11/22/2010 0:00:00 $1519.65
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner