23B-046 (5) " k
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 f 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 Ali, 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 13.
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
. • ."""-- OF THE PROJECT FOR OCCUPANCY.
4,: ' T t Subscribed and sworn to before me
Q. Q a' this Vi i' day of g4, � / 0/&/
c . No. 8355 �� A rnow _
'. STVIAPTON
f "
Q � otary Public 2
7 h' o n Ka sanos, AIA Edward L Ether+3� My Commission expires on
Notary Public
"y Commission Expires
3/30/12
1
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.
Subscribed and sworn to me
?.' c �' this 94t day of__ ______ `0/4
g No.8355
o EASTHAMPTON 4 I' I
c, otary Public
/TH pit' - Ka sanos, AIA Edward Q. E #hAredge My Commission expires on
Notary Public
My Commission Expires
3/30/12
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pho,nP i13-587-12 Fax 41:3-587-1272 ads � � �
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;PA'S . V � �. �• M
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
�ti yC'I .1 .. 1.-', I
1.-', V
NC \I
SECTION Y SrFE=INFO,RMATION - -
Fl i4 sec iCiQ o •bornpleted by offic e
1,1 Property Address: e 3,� e�
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5 00110 N.2 PROP ERTY ,.OWNERSHIP /AUTHORIZED AGENT
Owner of Record: n
COQ /e �/Dic/- / //s I iuI _ 30 /OC t s t PO / Q� E0 ,01
NErne (P t) Current Mailing Address:
4//_3 5 5 - 2 313
z-- i
Sioriature Telephone
2,2 Authorized Agent:
.2t/V 5. /'e /jet"e0 ,/ /e/ Sr. 4u //o / 0/05
,,,, -,e (print) -- Cu rrent Mnlfmg Address:
— �/ .
--,, � „%_') , 5!/.3 - S y 7_ 5 oo
Sanature Telephone
SEC1ION 3- ESIiMATEDCONSIRU ( i10N-COSTS
-rem, Estimated Cost (Dollars) to be Official -Use Only
— j — completed by permit aprilicant 1-
I. �: -rg — A, /9g1336 . Building Pcunt Fee — --
- u =.' n G /5155.00 ` � (b) Gtimated Total Costof _
C:onstrudion from ;(6)
,,I, b G ;Huildiny Permit Fee
�0 t as6. 00 _
h,e ,any _ai (� IV4C) 18,798.00 i5 (9, V
F:r, t.:ton _ 5,300.Oo -- —
i ��a - ;1 4 - - fl X53,27$.08 C h e ck- Nu (80e. L—
— - __
se Only
i This S ect on For OFrcrol ll — —
' Jii i, nr ,_� ' � r /[m[ _ �r n Puilainns e
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 /g
Fee Paid Vat 1 L 7
Tvpeof 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
THE LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF A TION 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
� (31 /1/4 to
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.
:. g BP- 2011 -0450
GIS #: COMMONWEALTH OF MASSACHUSETTS
Vapf CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building 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