17D-012 (35) 'o: Building Inspector Louis Hasbrouck Page 1 of 2 2008 -02 -19 19:15:35 (GMT) From: Gregory Szy►uk
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FAX COVER SHEET
TO Building inspector Louis Hasbrouck
COMPANY City of Northampton
F \X NUMBER 14135871272
FROM Gregory Szyluk
DATE 2008 -02 -19 19:15:23 GMT
RE Meadowbrook Apts Demo Permit
COVER MESSAGE
Mr. Hasbrouck,
Thank you for taking the time to met with Mr Dzialo and
myself this morning. I have included the owners
authorization page of the demo permit. If you need any
further information I can be reached at Gluk2100 @aol.com
or directly at 413 -246 -2093.
Regards,
Gregory Szyluk
LaCrosse Builders, Inc
86B Cenetr St.
Chicopee, MA. 01013
www efax. corn
- o: Building Inspector Louis Hasbrouck Page 2 of 2 2008 -02 -19 19:15:35 (GMT) From: Gregory Szyluk
To: Afexa Dailey Pogo 2 of 2 7008 -02 -19 18:18 0 (OMT) t'rcarn: GI tuijor :i yluk
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Signed Affidavit Mashed 'to, No 0 . _ • . •
•
TO 3Et#d 06GG8T96Eb Zg:30 Z00Z /T0/60
Dec 03 07 07:06p F.J. Dzialo & Company Inc 413 247-5740 p.2
•
Frederick J. .Dzialo, Ph.D. 19 Pleasant View Drive Hatfield, MA 01038
Position: Professor Emeritus, Civil Engineering Department,
University of Massachusetts, Amherst, Massachusetts
Structural Consultant, F.J. Dzialo and Company, Inc.
Education: B.S.C.E., University of Massachusetts, 1954
M.S.C.E., University of Massachusetts, 1957
Ph.D.C.E., Rensselaer Polytechnic Institute, 1965
Field of Specialization: Structures, Applied Mechanics, Structural Dynamics, Earthquake
and Blast Loading Analysis
Professional Experience:
Bureau of Ships, Navy Department, Washington, D.C.
Structural Naval Architect, 1954-1956
Bureau of Ships, Navy Department, Washington, D.C.
Structural Naval Architect, Summer, 1957
David Taylor Model Basin, Carderock, Maryland
Structural Naval Architect, Summer, 1965
University of Massachusetts, Civil Engineering Department, Amherst,
Massachusetts, Professor of Civil Engineering, 1957-1994
Dzialo t and Company, Inc., Structural Engineers
Hatfield, 14=-Isqar.hiispfts, Structural Consultant I 96
Registration:
Massachusetts, Coririectic4 New York. Veil Rhode Island,
New 1-fam_nshire, Colorado, New ic-rse,v, Perinsylv-nia
Professional Societies:
American Society of Civil Engineers
Boston Sodiety of Civil Engineers
Tau Beta Pi
American institute 01 Steel Construction
Dec 03 07 07:06p ' F.J. ' Dzialo & Company Inc 413 247 -5740 p.1
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T
November 26, 2007
F. J. Dzialo & Associates
Lacrosse Builders, nc. Consulting
86B Center Street structural
Chicopee, Massach setts 01013 Engineers
RE: Meadwood A. artm; nts
Meadowbroo . Apa tment Units 411, 412, 413, 414, 415
491 Bridge R I ad
Florence, Ma Bach setts 01062
Dear Mr. Szyluk,
This is to co .firm bat on November 26, 2007, I had inspected
the above referenc:s. Th- purpose of my inspection was to evaluate
the damage that wa. pro uced by a sewage backup which had
flooded the baseme. t ap: rtments to a height of about two feet and
had contaminated t 1 e va ious structural members of the apartments.
The structural me. bers . onsisted of wood bearing and non bearing
walls and wooden . osts. Since the structural members are
contaminated, I re .oman : nd that they be replaced. To accomplish
this task, I recom s end t I at shoring be provided. Before shoring is
to take place, the e• isti i.g dry wall is to be removed from the
studded walls, and he c. ilings of the first floor, or basement
apartments. The ex stirs_ framing of the ceiling of the apartments
can then be determ ned. . horing of existing girders supporting floor
joists can then talc: plac and new studded walls and posts can be
put in place.
Wood bearin: wall. that are to be replaced will then be
replaced by two ad acen studded walls with transverse beams
supporting the bearing . ails from the second and third floors.
Calcul tions to det • rmin • the required size and placement of the
shorin members , ill be made. After the shoring has taken place,
the ar a must be m: de c can and decontaminated before new
construction is to ake p ace. Also, electrical services must be
discon ected and plumb "ng and HVAC services must be addressed.
Yours truly,
l
Frederick I. Dzial ►, Ph. a .
19 Pleasant View Drive. Hatfield. MA 04038 Tel /Fax 413.247 -574.
The Commonwealth of Massachusetts
Department of Industrial Accidents
II — t
_1; Office of Investigations
_
_ 600 Washington Street
=t1 < Boston, MA 02111
,� � °` www. mass.gov /dia
-Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers
Applicant Information Please Print Legibly
Name ( Business /Organization/Individual): 1.- ✓ ( &O L. -- ?7 , •11 , L,,,
Address: eei5 Ce t« St
City /State /Zip: `i - ll ' a ' - , AA A- Phone. #: `k i - M C o 2-041
Are you an employer? Check the appropriate bo • Type of project (required):
1. ❑ I am a employer with 4. I am a general contractor and I
have hired the sub - contractors
employees (full and/or part- time). * 6. ❑New construction
listed on the attached sheet. 7. ❑ Remodeling
2. ❑ I am a sole proprietor or partner-
ship and have no employees These sub - contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9. ❑ Building addition
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
officers have exercised their 11.❑ Plumbing repairs or additions
3. ❑ I am a homeowner doing all work
myself. [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs
insurance required.] t c. 152, § 1(4), and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have
employees. If the sub - contractors have employees, they must provide their workers' comp. policy number.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: Expiration Date: -
Job Site Address: City /State /Zip;
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 MGL c. 152 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 fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certi _ .,,,,,,, , penalties of perjury that the information provided above is true and correct
Signature: 41111MIP Date: 2 /8
Phone #: f" /°3 • a4i6 - 13
Official use only. Do not write in this area, to be completed by city or town official
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Version1.7 Commercial Building Permit May 15, 2000
f ..
SECTION 10- STRUCTURAL PEER REVIEW"(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes No Q
SECTION 11- - OWNER AUTHORIZATION - TO IBE 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, I , 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.
Print Name
Signature of Owner /Agent Date
SECTfON't2 :CONSTRUCTION` SERVICES
10.1 Licensed Construction Supervisor: J �j' Not Applicable El
Name of License Holder : c�� G / ✓ Z' YL C.7 d (0 e r I
License Number
E L -er 5 r CA.►re.d. AAA. vi o 6 ! t - 2.oe:45
Address Expiration Date
t3 -2-
Signature Telephone
SECTION 13 WORKERS' COMPENSATION INSURANCE AFFIDAVIT(IVl G L..c 152; 25C(6))
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 buil ' permit.
Signed Affidavit Attached Yes No 0
•
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 9- PROFESSIONAL DESIGN. AND CONSTRUCTION SERVICES - FOR BUILDINGS -AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO780 CMR 116 (CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
! Not Applicable ❑
3 i
Name (Registrant):
Registration Number
Address
£ Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
•
Name Area of Responsibility
1 9 P f ea sa s► -I U,e) D r 1-IcifFrefol MG, i I/
'A
Address Registration Number
/ I C %-- • x' 7-57 4 0 //6/0r
II
Sign. re / Telephone Expiration
1
Name Area of Responsibility
Address Registration Number
� I
Signature Telephone Expiration Date
3 i(
i
Name Area of Responsibility
( j
Address Registration Number
1
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
LAC 010 I Lt24415 � - S'e` �— Not Applicable ❑
Company Name:
L �icg�..y �zyialc ,
Responsible In Charge of Construction
I NS 'ear S T r - , ' , AAA oho(
Address
IMO iiir3-vta-2€023
Signature Telephone
•
Versionl .7 Commercial Building Permit May 15, 2000
;w. ttY '.',..04.:
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size ! , 1 E
Frontage f 1 1 ` 1
Setbacks Front f I I 1 1 1
Side L:1 1 R:i Z_ L:i I R:I I j 1 i I
,
Rear 1 l i I
- Building IHeight ' ` z j
f
Bldg. Square Footage : I
I i
Open Space Footage %
(Lot area minus bldg & paved I I I j l
Parking)
# of Parking Spaces I 1 I 1
Fill: ' I;
(volume & Location) 11 I
A. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO 0 DON'T KNOW 0 YES 0
IF YES, date issued: I 1
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DON'T KNOW YES 0
IF YES: enter Book I Page; I and /or Document #
B. Does the site contain a brook, body of water or wetlands? NO Q DON'T KNOW GI YES Q
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained 0 Obtained Date Issued:
C. Do any signs exist on the property? YES Q NO.
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ? YES Q NO 2
IF YES, describe size, type and location: ! ~_]
E. Will the construction activity disturb (clearing, grading, excavation, vatio or filling) over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES Q ' NO - '
IF YES, then a Northampton Storm Water Management:Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15, 2000
SECTION 4- ,CO,NSTRUCTLON', SERVICES.fOR P 35,000
CUBIC"FEET'OF ENCLOSED;SPAGE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition Repairs El Additions ❑ Accessory Building ❑
Exterior Alteration ❑ Existing Ground Sign ❑ New Signs ❑ Roofing El Change of Use ❑ Other ❑
Brief Description ' Enter a brief description here. uw r.TS i{-(2 - � (5 � (C.DCIS 1- { L-- i 4 P
Of Proposed Work: � AS $E STos REMED1 A- t0 0 � /Z..,e. -&oVE 5 Roc (�( M re2nn I
SECTION 5 - USE GROUP AND CONSTRUCTION '
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly A -1 ❑ A -2 ❑ A -3 ❑ 1A I ❑
A-4 ❑ A -5 ❑ 1B 1 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F -1 ❑ F -2 0 2C ❑
H High Hazard ❑ 3A ❑
I Institutional El I -1 ❑ 1 -2 ❑ 1 -3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential El R -1 ❑ R -2 V R -3 - 5A ❑
S Storage ❑ S -1 ❑ S -2 El 5B l ,]
U Utility ❑ Specify:
M Mixed Use 0 Specify: 1
r
S Special Use 0 Specify: 1
.
COMPLETE THIS SECTIOF EXISTING BUILDING UNDERGOING RENOVATIONS,. ADDITIONS AND /OR CHANGE
NJ IN' USE
Existing Use Group: I , Proposed Use Group:
I
Existing Hazard Index 780 CMR 34):' I Proposed Hazard Index 780 CMR 34): I I
SECTION" 6BUILDING HEIGHT ANDAREA
BUILDING AREA EXISTING PROPOSED NEW CO ►TRUCTION '" ' =g � • ,
K , -Ky X41 ,., ,.
4-
n. 4.d a 5 r. f 5
Floor Area per Floor (sf) �v x 1,- 7
1 I
St t a "'y lc.a. ,
0 ^i4 ' y v` s .� a +,
1st 4 . +
2nd i -r r`• F F , m ', �.:' w
3 `� Y
2 nd f 2 ( f 'a" ,, ro °' � r �' j,' �-
m
r te. � r
Total Area (s ! Total Proposed New Constru on (sf) �� 1 4 , ..te „..41, ,-
g r 4 °rn if, °}C ' S ry tl
Total Height (ft) 1 i s
Total Height ft I ;, �ty� �
7. Water Supply (M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone I I Outside Flood Zone❑ Municipal ❑ On site disposal system❑
Versionl.7 Commercial BuildinL Permit Ma 15, 2000
City of Northampton � � ° aI w Y "£� a�
Building Department. '' . H , om —.
212 Main :Street �� , " � —
Room '100 rgjL •.
Northampton, MA 01060 � m `�
phone 413- 587 -1240 Fax 413-587-1272 „,,
13- 587 -1272 e = � . . : � ;�
e i s te w .
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 - SITEINFORMATION .
t 1 Property Addres _
This section to be, completed byroffice `;-
� i b, , 4
i�C t '3Q�dge � Map Lo Unit
�l 4 MktS I '
w (C�.j�n< y Q -i-} L 11- i ' tZone t 9hrerlay District ,
,)0021 v4'1v1+ rD1/1 I itA f/z I ,2 I m'SL District C Disfi3c '1
E s�� ,M X
SECTION 2 - PROPERTY 01NNERSHIP /AUTHORIZED' AGENT
2.1 Owner of Record:
Name (Print) ' . Current Mailing Address:
I s
Signature Telephone
2.2 Authorized Agent:
L� Gue f k3 v; l as u-5 'E.�c_ j L5411 } e r- 51- G1,.a<`Zorz�o.� ”
Name (Print) Current Mailing Address: ' 0� Jf A
y, i3 - (0 -3
Signature -,41111111111. Telephone
SEC 3 - ESTI ' CONSTRUCTION COSTS
Item Estimated Cost (Dollars) to be Official Use Only
completed by permit applicant
1. Building j " (a) Building Permit Fee
! I i
2. Electrical 1 (b) Estimated Total Cost of
Construction from (6)
3. Plumbing $ j Beiilding Permit Fee
i.:
4. Mechanical (HVAC) I 1 I
5. Fire Protection 1 / f
6. Total (1 + 2 + 3 + 4 + 5) Check Number - ' of
This'Section For Official Use Only
Building Permit Number > Date
Issued
P
Signature:
Building Commissioner /Inspector of Buildings Date
File # BP- 2008 -0708
APPLICANT /CONTACT PERSON LACROSSE BUILDERS INC
ADDRESS /PHONE 86B CENTER ST CHICOPEE (413) 246 -2093
PROPERTY LOCATION 491 BRIDGE RD
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 di* ��
Fee Paid
Typeof Construction: INTERIOR DEMO UNITS 411,412,413,414 & 415
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License 067404
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO A TION PRESENTED:
pproved 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
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.
BP- 2008 -0708
CIS #: COMMONWEALTH OF MASSACHUSETTS
zr. 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- 2008 -0708
i'roiect ;� JS -2008- 001098
Est. Cost: $35.00
Fee: $35.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: LACROSSE BUILDERS INC 067404
Lot Size(sq. ft.): 1169150.40 Owner: MASS NORTHAMPTON LTD PART
Zoning; URB Applicant: LACROSSE BUILDERS INC
AT: 491 BRIDGE RD
Applicant Address: Phone: Insurance:
86B CENTER ST (413) 246 -2093
CHICOPEEMA01013 ISSUED ON:2/22/2008 0:00:00
TO PERFORM THE FOLLOWING WORK:INTERIOR DEMO UNITS 411,412,413,414 & 415
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 2/22/2008 0:00:00 $35.002969
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo