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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! 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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