17D-012 (24) •
Aspen Square
Management Inc.
380 Union Street, Suite #300
West Springfield, Massachusetts 01089
Dave Grzybowski, P.E.
Ph: 413-781-0712 Fax: 413-781-1277 •
Email: Dave_Grzybowski @aspensquare.com
' . , HSPEN SQUARE 146 P82 SEP 3e ` 02 :13:O3
Version 1.7 Commercial Bw`ldingyormkMoy{J,2VOO
9.1 Registered Architect: I
Not Applicable El
Address / 0.
) 4/y 976 ; ba Expire ti Date
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Name. Area of Respons■biEty
alk 4 -ill ),/ -- 0 7 / c 3 0
Si: ature Telephone Expiratior ate
Name Area ot Responsiblity
Address Registration Number
Signature Telephone Exp;ration Cate
-
Name Area of Responsib,lity
Address Registration Number
Signature Telephone Expiration Date
■
Name 1 Area of Responsibrlity
Address
Signature
9.3 General Contractor Telephone . Registra Number
Expiration Data ,
Not Applicable 0
Company Narne
Responsible !rii Charge of Construction
-
Address
_~-_~_. _ __
Signature 'w __ - ____)
___ -- . - - -__-_' _______ ____
• • ASPEN SQUARE 146 P01 SEP 30 '02 13:02
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DePARTMENT OF BUILDING INSPECTIONS j' _^ /�i
INSPECTO 212 Main Street • Municipal Building •:
Northampton, MA 010 60
CONSTRUCTION CONTROL DOCUMENT
(for prof ession l Engineers/Architects responsible for Entire Project)
/7/M jet /04 r #ve lion
Project Title: � f " '1_ Date: g /5,94 Z
Project Location: 'f Q, Ol'�Q��� Map ;�� - -- _Parcel' Zone. -_ _
Scope of Project: /�l� ✓ 4f* Go lf j �h ?;Y f t71; j f f
In accordance with the sixth edition Massachusetts State Building Code, 780 CMR SECTION 116.0
I, K 4 _jYaW " — Mass. Registration Number 424
Being a registered professiona1C-nisreerlArchitect hereby CERTIFY that I have prepared or directly
supervised the preparation of all design plans, computations and specifications concerning:
(,.Yg Project
for the above named project and that to the best of my knowledge, swat plans, computations and
specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable
engineering practices and all applicable laws for the proposed project.
Furthermore, I understand and AGREE that I shall perform the necessary professional services to
determine that the above mentioned portions of the work proceed 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 documents as submitted for the building permit, and approval for the
con;ortrmanee to the design concept.
2. Review and approval of the quality control procedures for all rode - required controlled.
materials,
3. Be present at intervals appropriate to the stage of constra tiot: to become generally familiar
with the progress and quality of the work and to determine, in general, if the work is being
performed in a manner consistent with the construction documents.
I shall submit periodically, in a form acceptable to the building official, a progress report together with
pertinent comtnexus. Upon completion of Cie work, I shall submit to the building official a final report as
to the satisfactory completion and readiness cf the project for occupantiv
Signature and Seal of registered professional: , • aus.t,
X 221-.,---_„„.. .' , atil aia , '
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Ma 4293 , 1
MONSON,
MASS,
Fax 413-587-1272 - phone 413 - 587.1240 +a
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.+ m DEPARTMENT OP BUILDING INSPECTIONS 4 utir___.-,--------- 212 Main Street • Municipal Building =
Northampton, Mass. 01060 " •'"
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, f) EAsA
(liccnseeipermittee)
with a principal place of business/residence at:
•
. 3 - 'C) `mot nirA Si LID.SpI1d V)( c j5 7 (phone)t // 3 ?S'I 0
(stme_ticity/s
do hereby certify, under the pains and penalties of perjury, that:
(4'I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Li b -r s ki MtA-1crr)-t_.1 WAD i t Da5 3 (t70 - cxa 311 It)3
(Insurance Company) (Policy Number) (Expiration Dat
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
z. (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(attach additional sheet if necessary to include information pertaining to all contractors)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE: please be aware that while homeowners who employ pc sans to do ms i*rtrninn, comstrution or repair worst on a dwelling of
not =cc than three units in which the homeowner resides or on the grounds appurtenant thereto erc not generally ooasidcrcd to be
employers under the worker's compeamstion Act (GL152„es 1(5)), application by a homeowner for a licrase or permit may evidence the
legal status of an employer under the Woricods Compensation Act
I understand that a copy of this ctaremmt may be forwarded to the Department of Industrial Accidents' Office of Insurtoco for the
coverage verification and that failure to secure coverage under section 25A of MUL 152 can lead to the imposition of criminal penalties
consisting of a fine of up to S1,500.00 and/or imprisonment of up to one year and civil penalties in the form of a Stop Work Order and a
fine of 5100.00 a day against inc.
For dgzartnr.tesl mho oaly
/; . 1 Permit Number
6 )'`-` ♦ dlt pk L--' 7 (I ° Z — Map# Lot #
:
,: Sigma 5Lit.us 4,. - • ermittee Fite
AliVititilitrataw.ummiim... __
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10- STRUCTURAL PEER REVIEW (780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑
SECTION 11 - OWNER AUTHORIZATION - TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, , as Owner of the subject property
hereby authorize to act on
my behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
I, '! )c Id 6c71196 ask( , as Owner /Authorized Agent
hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Pr Name b - q(I( (0 2,
Signature of wne Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder :
License Number
Address Expiration Date
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M.G.L. c. 152, § 25C(6))
Workers Compensation Insurance affidavit must be completed and sibmitted with this application. Failure to provide this affidavit
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes l3 / No ❑
Versionl.7 Commercial Building Permit May 15, 2000
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public , Private ❑ Zone: Outside Flood Zone ❑ Municipal KOn site disposal system ❑
8. 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
Open Space Footage
(Lot area minus bldg & paved
parking)
# of Parking Spaces
Fill:
(volume & Location)
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DON'T KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES / NO
IF YES, describe size, type and location: t 'Fc src,A 41- Enf` "c" ci )(4 g"-" "
D. Are .here any proposed changes to or additions of signs intended for the property ?YES _
No t/
IF YES, describe size, type and location:
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions El Roofing ❑
❑ Cl
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
El Accessory Building [ ] Repairs [ ] _
JTteilul (C-►'iOJ&fi° h Z52 ap6vfwieviE c Q CtP►�1r+7 ,mjf� y,J IcQv+ j l►^j u4fi" / nc,- 4" iv.c►x0,ic
�Esett - jt'» 3 (b ithJ1 CTtfc-r ' ., inch s Oc.liw c( urn s d∎rf
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A -4 El A -5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F -2 Cl 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential El R -1 ❑ R -2 ❑ R -3 El 5A ❑
S Storage ❑ S -1 El S -2 ❑ 5B ❑
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 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY,
Floor Area per Floor (sf) 1 st
1st 2nd
3rd <
2nd
3rd
4 th
4th
Total Area (sf) Total Proposed New Construction (sf)
Total Height (ft)
Total Height ft
' Versionl.7 Commercial Building Permit May 15, 2000
g
7 t-, --
Northampton c ., y ) °
E. (r� E\\ v 6 g Department
l� * f
' • ain Street w
om 100 s
1 n , . ' °n.
I SE? 1 1 2 ort .meton, MA 01060
1` phone 413- ;:7-1;40 Fax 413-587-1272 �;a
APP r ICATIO01 4 i1 ' - 1 , REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1- SITE INFORMATION
This section to be , office
1.1 Property Address: r t - � , - V ; m s
eouo a .i L-A�E C)TX1rE.S m ap -, Lot Unit
4-91 gR l DGC KoA -f Z Overlay District
f
Fix IceNt,c_C i OR 0i0(02-- Elm St.'District , '` ' CB Di '
SECTION 2 - PROPERTY OWNERSHIP /AUTHORIZED AGENT
2.1 Owner of Record:
M�ACHOE -11.J I��.,� - I 1 UNITED CRT 3 Us.ion! YWILET i;� .)(Tilti66 C6I
Name (Print) Current Mailing Address:
( 1 (413) DTI - C "712
Sig tune I Telephone
2.2 Authorized Agent:
Name (Print) Current Mailing Address:
Signature Telephone
SECTION 3 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building ' 0 37 8"O (a) Building Permit Fee
2. Electrical . , (b) Estimated Total Cost of
' Construction from (6)
3. Plumbing Permit Fee
g 764 g
4. Mechanical (HVAC) .302, 3So
5. Fire Protection q g 6
6. Total = (1 + 2 + 3 + 4 + 5) j 633 65 C heck Number Q ° 0 � .—.
/� ii
This Section For Official Use Only
Building Permit Number: ' "C 3 55 l Date Issued:
Signature:
Building Commissioner /Inspector of Buildings Date
•
File # BP- 2003 -0351
APPLICANT /CONTACT PERSON ASPEN SQUARE MANAGEMENT INC
ADDRESS /PHONE 380 UNION ST SUITE 300 (413) 781 -0712
PROPERTY LOCATION 491 BRIDGE RD- COUNTRY LANE ESTATES
MAP 17D PARCEL 012 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out ! t �2ly e .7 19.0
Fee Paid 7 `
Typeof Construction:_ 252 INTERIOR APARTMENT RENOVATION INCLUDING SIDING - SECTION 116
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFOR 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 ommission
0 •
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.
491 BR113G1 RD-COUNTRY LANE ESTATES BP- 2003 -0351
GIS #: COMMONWEALTH OF MASSACHUSETTS
$ap;Block:17D - 012 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: renovation BUILDING PERMIT
Permit # BP- 2003 -0351
Project # JS- 2003 -0502
Est. Cost: $1633656.00
Fee: $7190.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor_
Lot Size(sq. ft.): 1169150.40 Owner: MASS NORTHAMPTON LTD PART
Zoning: URB Applicant: ASPEN SQUARE MANAGEMENT INC
AT: 491 BRIDGE RD- COUNTRY LANE ESTATES
Applicant Address: Phone: Insurance:
380 UNION ST SUITE 300 (413) 781 -0712
WEST SPRINGFIELDMA01089 ISSUED ON:10/30/02 0:00:00
TO PERFORM THE FOLLOWING WORK:252 INTERIOR APARTMENT RENOVATION
INCLUDING SIDING - SECTION 116
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:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 10/30/02 0:00:00 602930 $7190.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo