10D-046 (13) BP-2021-2263
135 MAIN ST S1-4-11 COMMONWEALTH OF MASSACHUSETTS
Map:Block:Lot:
10D-046-001 CITY OF NORTHAMPTON
Permit: Alts Renovations
Repair
PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS •
DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
BUILDING PERMIT
Permit# BP-2021-2263 PERMISSION IS HEREBY GRANTED TO:
Project# GOLF SIMULATION ROOM Contractor: License:
Est. Cost: 238000 AARON PUNSKA 105542
Const.Class: Exp.Date: 10/22/2023
Use Group: Owner: NORTHAMPTON GOLF INC
Lot Size (sq.ft.)
Zoning: URA/WP Applicant: AARON PUNSKA
Applicant Address Phone: Insurance:
220 NORTH WEST RD (413)626-6033
WESTHAMPTON, MA 01027
ISSUED ON:12/10/2021
TO PERFORM THE FOLLOWING WORK:
GOLF SIM ROOM ADDITION WITH DECK ABOVE
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.
Signature:
Fees Paid: $1,666.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Office of the Building Commissioner
'"--.7 -,t SOLLIF, P)-I\I‘i_. .
OFF ,
E� e&"�°qU/���a The Commonwealth of Massachusetts
MnT G,,v Office of Public Safety and Inspections
o�a,,q pPc). Massachusetts State Building Code(780 CMR)
Building Pe P'c:rplcation for any Building other than a One-or Two-Family Dwelling
(This Section For Official Use Only)
Building Permit Number.-7/-,oto).(/3 Date Applied: Building Official:
SECTION 1:LOCATION
i3s Insom 'L LTA) t t.os3 -- A);.411.0.vvi-witC c
No.and Street City/Town Zip Code Name of Building(if applicable)
10t-D sib-001 — >
Assessors Map# Block#and/or Lot #
SECTION 2 PROPOSED WORK
Edition of MA State Code used gift If New Construction check here 0 or check all that apply in the two rows below
Existing Building 0 Repair 0 Alteration 0 Addition ail Demolition 0 (Please fill out and submit Appendix 2)
Change of Use 0 Change of Occupancy 0 Other 0 Specify:
Are building plans and/or construction documents being supplied as part of this permit application? Yes ("No 0
Is an Independent Structural Engineering Peer Review required? - / Yes 0 No
Brief Description of Proposed Work f+thi LL( A golf s1N1 rbiwn c JlS'ii WA A. S&.&.. C I&Jute
SECTION 3:COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATION,ADDITION,OR
CHANGE IN USE OR OCCUPANCY
Check here if an Existing Building Investigation and Evaluation is enclosed(See 780 CMR 34) ❑
Existing Use Group(s): itt%w(got bac Proposed Use Group(s):
SECTION 4:BUILDING HEIGHT AND AREA
Existing Proposed
No.of Floors/Stories(include basement levels)&Area Per Floor(sq.ft) /F cir t3Z Sr
•
Total Area(sq.ft.)and Total Height(ft) /CAI,' t bei _ /UU y SF
SECTION 5:USE GROUP(Check as applicable) l'it's hf- = fy'
A: Assembly A-1 0 A-2 0 Nightclub 0 A-3 0 A-4 0 A-5 0 B: Business 0--- E: Educational 0
F: Factory F-1 0 F2 0 H: High Hazard lq-1 0 H-2 0 H-3 0 H-4 0 H-5 0
I: Institutional I-1 0 I-2❑ I-3❑ I-4❑ M: Mercantile 0 R Residential R-10 R-2 0 R-3 0 R-4 0
S: Storage S-1 0 S-2 0 U: Utility 0 Special Use 0 and please describe below:
Special Use Description: 31O LKL
SECTION 6:CONSTRUCTION TYPE(Check as applicable)
IA 0 IB ❑ IIA ❑ IIB ❑ IIIA ❑ IIIB ❑ IV 0 VA 0 VB 0
SECTION 7:SITE INFORMATION(refer to 780 CMR 105.3 for details on each item)
Trench Permit Debris Removal: /
Water Suppl : Flood Zone Information: / Sewage Disposal: / Licensed Disposal Site[9'
Public Check if outside Flood Zone li Indicate municipal L A trench will not be p
Private 0 or indentify Zone: or on site system❑ required 0 or trench or specify:
permit is enclosed 0
Railroad right-of-way: Hazards to Air Navigation: MA Historic Commission Review Process:
Not Applicable 0 Is Structure within airport approach area? Is their review completed?
or Consent to Build enclosed 0 Yes 0 or No 0 Yes 0 No 0
SECTION 8:CONTENT OF CERTIFICATE OF OCCUPANCY
Edition of Code: Use Group(s): Type of Construction:
Does the building contain an Sprinkler System?: Special Stipulations:
Design Occupant Load per Floor and Assembly space: Ste,Pi
City of Northampton
r, Massachusetts `"
, '�. t w.
' DEPARTMENT OF BUILDING INSPECTIONS �, ft
Y 212 Main Street • Municipal Building `
-^� Northampton, MA 01060 ��°'s
PROCEDURE FOR OBTAINING A BUILDING PERMIT FOR COMMERCIAL &
MULTI-FAMILY NEW CONSTRUCTION/ADDITIONS/ALTERATIONS
1. Building Permit Application signed by legal owner and filled out by owner or authorized
agent.
2. One set of plans and specification of proposed work(digital and hard copy).
3. Site Plan with location of proposed structure(s)and setbacks.
4. Construction Debris Affidavit filled out and signed by applicant.
5. Worker's Compensation Insurance Affidavit filled out and signed by applicant.
6. Contractors must supply a copy CSL and proof of Liability Insurance.
7. Energy Conservation Compliance Certificate (if applicable).
8. Note any Conservation and/or Special Permit requirements (if applicable).
9. Driveway Permit(if applicable).
10. Proof of Water and Sewer entry fees paid(if applicable).
11. Trench Permit(if applicable).
12. Initial Construction Control Documents filled out and signed by the Registered Design
Professional in responsible charge.
A-„,, ()k.,,K,i- 1 ol7e fi..- Let.j"
N C( i3s fitotk If Lecci,s M O( V7
. SECTION 9: PROPERTY OWNER AUTHORIZATION
.'' Name and Address of Property Owner
viDrne,s e N4titt ,Zo Ogoe 4 1-:;-1 ive 9 ala Z
Name(Print) No.and Street v/V Al as— City/Town Zip
Property Owner Contact Information: C"'—'
121.4./iji,rt.) 9j3 5-3o -1, _ SSG /89F ve_.z, 'j0-7,,,--- €arc, , h e/
Title Telephone No.(business) Telephone No. (cell) e-mail address
If applicable,the property owner hereby authorizes:
nµ fwl - z-zMI/2o des L At< ZAIV'
Name Street Address City/T n State Zip
to apply for and act on the property owner's behalf,in all matters relative to work authorized by this building permit application.
SECTION 10:CONSTRUCTION CONTROL(Please fill out Appendix 1)
If a building is less than 35,000 cu.ft.of enclosed space and/or not under Construction Control then check here❑.
Otherwise provide construction control forms(see section 107 in the code)as required.
10.1 Registered Professional Responsible for Construction Control(the professional coordinating document submittals)
g•hu�� 1,eti- _ ,Q AcItv►GEft,4i(9 t 39't'12
N v. i i� anill t) WEH 11 eMt e-mail A4e p/3� R ttnet(ation umber
Street Address City/Town State Zip Dis spline Expiration Date
10.2 General Contractor .
fhk ,/Ilrl v • frcfl I Gls DCompany Name t
/trot, emsktf' C5- loccy2 - tonsirbviro Svesivisor — It
Name of Person Responsible for Construction License No. and Type if Applicable
Zti .wee m,0 ed. aiditAer . Olat7
Street Address City/Town State Zip
y/3_ bzj P33 - - iffrvas 9huld• (t4
Telephone No.(business) Telephone No.(cell) e-ma address
SECTION 11:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§25C(6))
A Workers'Compensation Insurance Affidavit from the MA Department of Industrial Accidents must be completed and _
submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit.
Is a signed Affidavit submitted with this application? Yes 0 No 0
SECTION 12 CONSTRUCTION COSTS AND PERMIT FEE
Item Estimated Costs:(Labor
and Materials) Total Construction Cost(from Item 6)=$ Z S 51 0°0
1.Building $ f// fifi� ''�
i J" Building Permit Fee=Total Construction Cost x (Insert
2.Electrical $ Z6® : , 443 appropriate municipal factor)=$
3.Plumbing $ wO. 7, pe..2• "'
Si c.J Note:Minimum fee=$ (contact municipali
4.Mechanical (HVAC) $ l
5.Mechanical (Other) $ / tily :1-• ,/4-44
Enclose check payable to
6.Total Cost $ 2181 OoV, 1:"' (contact municipality)and write cheekS
number here 'ZD '
..sr-^
SECTION 13:SIGNATURE OF BUILDING PERMIT APPLICANT
By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this
application is true and accurate to the best of my knowledge and understanding.
Ay. 413 k4 owe- %3-4 - 4033 Oa / ?7-4
Please print and sign name Title Telephone No. Date
7i7,o A/w gto 144 ki i As. OW 7--`Z ai,s k' 4 �
c L,.
Street Address City/Town State Zip Email Address
Municipal Inspector to fill out this section upon application approval: .2.� 0
v
Name
•
hOr
CITY OF NORTHAMPTON
SETBACK PLAN
MAP: LOT:
LOT SIZE:
REAR LOT DIMENSION:
REAR YARD
SIDE YARD SIDE YARD
FRONT SETBACK
FRONTAGE
City of Northampton
Sl „,.
Massachusetts tom,
4. rt
DEPARTMENT OF BUILDING INSPECTIONS
�f
212 Main Street • Municipal Building
Northampton, MA 01060 rs� ,K3
CONSTRUCTION DEBRIS AFFIDAVIT
(FOR ALL DEMOLITION AND RENOVATION PROJECTS)
In accordance of the provisions of MGL c 40, S54, a condition of Building Permit
Number is that all debris resulting from this work shall be disposed of in a
properly licensed waste disposal facility, as defined by MGL c 111, S 150A.
The debris will be disposed of in:
Location of Facility: LI Ife, e!r'L/
The debris will be transported by:
Name of Hauler: Add w,h ki41 le_ re kn-u ate!
Signature of Applicant: / Date: /. /
1
The Commonwealth of Massachusetts
Department of Industrial Accidents
I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov/dia
Worken*Compensation htsurance Affidavit:Bulklers/ContractorsiElectricians/Plumbers.
TO RE FILED Wald THE PERMITTING AL11101t1'11`.
Applicant lnfàr,natimi Please Print Legibly
Name I,Rus r. .I r .tn-zJu,rl I nay,!ohm!): //rA ku IL.10
Address: Iro
City/State/Zip: tsrd)iitir.-- 01 JV7 Phone 64 °3 3
Are you as employee Cheek the opproprinte box: Type of project(required):
1.0 I am a employer With employees lull anikor pail-wort.* 7. CI New construction
2.2(ian a sole proprietor ur purtnerstup and have no employees*inking for me in g. 0 Remodeling
lay1paciP No workers't.:ornp.anoranct retptiond]
9_ Demolition
30 t am a hoinetrwaer doing all work my-sat.[No%otters eonr trennance nestuarnil
10 Building addition
4.C3 i an a homeowner and*Al tse luring einirracturs to cenduet alk%elk on ivy properry. I wdl
ensure tha all ccawnwturs eidatr have workers'eunipensation insurance or are sole 11.0 Eltx-trical repairs ot additions
proprietors with nu niaployetni.
12.0 Plumbing repairs or additions
50 I am a general contractor and 1 have ninth the sub-contrattors listed un the anactied short
13.Ej Root repairs
These mils-eontracton,have eariployeei and Isits'e*offers'comp.insurance:
14.C3Othet__
6.C]wc are a C.AorporAtadts and its Officers have exercised tiletT right of exempnon per c.
t41 and we!trot nu employees.[No ti,orkers curry insist...met required!
*Am.applicant that checks Sin 8 meg Java fill out the totnon brio*showing the a ,:onipermation informatiera
1-6anictov nets*hi,submit this affidavit inairating they ire tieing all work and then hat outside,:oninwtors mini,utintat neo affidro it indica:tog sucla.
k'ocuraetor that elieck w-st Iselwd an arldiramal showing L.name at the xub-zusuraekx,and date,4 nether or nut those;Tome,lt
empluytteL tithe Sub-i-01.: • .. .txt rh, MINE Idi. polky rmitthei
I am an employer that is providing workers'compensitfion insurance fur ott erop/osecA. Below irt the policy and job Aire
information.
Insurance Company Name:
Policy#or Self-ins.Lac. Expiration Date:
Job Site Address: CityState,2ip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under NIGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and or one-'var imprisonmtnt,as well as civil penalties in the form of a STOP WORK ORDER and a tine of up to S250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage i,err.liction.
I do hereby I.crtiti•under the pains and penalties of perjury that the information provided above is true and correct.
SLignature: di. i Z-e)
if/3 i )
11.14,"6.1)11. Do not it in rhiA area,to be ctorapletcd hy city or town'official
l'ity or Town: Per flit.
Issuing Authority(circle one):
I. Board of Ilealth 2,Building Department 3.City/Town Clerk 4.Electrical Inspector I Plumbing I s per titr
6.Other
ctollf Peruk11: Phone it:
.1 .
. .
Initial Construction Control Document
) * 1
To be submitted with the building permit application b3.-a
..,
• . i
-
1.. i Registered Design Professional
. t i
../ . for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR„ Section 107
it4i-dh.:44,41 #cf.
Project Title: 7 Date: htc i A 4 7
Property Address: /35- ir/ „; 51
r L by..15 114 ei 0 s 3
Project: Check(x) one or both as applicable: New construction Existing Construction Aid,L- )(
Project description: fivn i(e_ . z i/ i, •
r'• V ct r. >IPPI roo,-.1 Aid,hip, ,.//k) de-evf- c i 6vAt.,..
a. 4 Leek
I MA Registration Number Expiration(I/Expiration date: ,am a registered design professional,and I have
prepared or directly supervised the preparation of all design plans,computations and specifications concerningl:
Architectural Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of mv knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project_ I understand and agree that I (or my
designee)shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
I Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quantity of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107_
When required by the building official,I shall submit field progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official_
Upon completion of the work,I shall submit to the building official a'Final Construction Control Document'.
Enter in the space to the right a"wet" or
electronic signature and seat
Phone number: F111'11: 'AVM ftewtti yvt.,,,I.kl2W1
Puildutg Official Use Only
Building Official Name: Permit Na.: Date:
Note L Indicate with an"x"project desii plans,computatons and spe‘aficatons that you pria oz±rectly supervised.If'other'is
chosen,provide a description_
Version 01_01_201S
Appendix 1
Construction Documents are required for structures that must comply with 780 CMR 107. The
checklist below is a compilation of the documents that may be required. The applicant shall fill out
the checklist and provide the contact information of the registered professionals responsible for the
documents. This appendix is to be submitted with the building permit application.
Checklist for Construction Documents*
Mark"x"where applicable
No. Item Submitted Incomplete Not Required
I Architectural
2 Foundation
3 Structural )(
4 Fire Suppression
5 Fire Alarm(may require repeaters)
6 HVAC
7 Electrical
8 Plumbing(include local connections)
9 Gas(Natural,Propane,Medical or other)
10 Surveyed Site Plan(Utilities,Wetland,etc.) X
11 Specifications ti(
12 Structural Peer Review
13 Structural Tests&Inspections Program
14 Fire Protection Narrative Report
15 Existing Building Survey/Investigation
16 Energy Conservation Report
17 Architectural Access Review(521 CMR)
18 Workers Compensation Insurance
19 Hazardous Material Mitigation Documentation
20 Other(Specify)
21 Other(Specify)
22 Other(Specify)
*Areas of Design or Construction for which plans are not complete at the time of application submittal must be identified herein.Work so identified
must not be commenced until this application has been amended and the proposed construction document amendment has been approved by the
authority having jurisdiction.
Registered Professional Contact Information
Rohe* - - kiiitis'lortt ,s 970 c mw� 387 lf Z
Name(Registrant) Telephone No. e-mail address 4tegistration Number
Pe. 4ni( Si LIEhd�II /� D13y� u.r
Street Address City/Town State Zip Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address Registration Number
Street Address City/Town State Zip
Discipline Expiration Date
Name(Registrant) Telephone No. e-mail address
Registration Number
Street Address City/Town State Zip
Discipline Expiration Date
Please follow this link for construction control forms to be used by Registered Design Professionals.
•
l e
il
Initial Construction Control Document
z K\,,* � i To he submitted with the building permit application by a_ i� . Registered Design Professional
for work per the 9th edition of the
,wo,4 Massachusetts State Building Code, 780 CMR, Section 107.6.2
Project Title:Nothampton Country Club Date: December 6,2021
Property Address: 135 Main Street, Leeds, MA 01053
Project: Check(x)one or both as applicable: X New construction X Existing Construction
Project description: Modify the existing addition and provide an addition.
I, Robert Leet, MA Registration Number: 38942 Expiration date: 06/30/2022,am a registered design professional, and
hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning':
_Entire Project Architectural X Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that such plans,computations and specifications meet the applicable provisions of the
Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I
understand and agree that I(or my designee)shall perform the necessary professional services and be present on the
construction site on a regular and periodic basis to:
1. Review,for conformance to this code and the design concept,shop drawings, samples and other submittals by the
contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and
quality of the work and to determine if the work is being performed in a manner consistent with the approved
construction documents and this code.
When required by the building official, I shall submit field/progress reports(see item 3.)together with pertinent
comments, in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a 'Final Construction Control Document'.
Enter in the space to the right a"wet"or .� �� i
electronic signature and seal: .\4„
LEET
STRI�CTUI�AL 1..
38942
s�0F, 4F(liST E � �
Phone number:978-544-8000 FssiaMAt.o's
Email: WhetstoneEng97gmail.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Note 1.indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If'other'is chosen,
provide a description.
Trial Version 10 09 2012