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version 1-7 Commercial Building Permit May 15, 2000
SECTION 10 PEER REVIEW(780 CMR'110.11)
lade endent Structural En ineen Structural Peer
ew es Revi Required _ `' _...❑ No._._❑
P g g Q - -- -----
SECTION 11 - OWNER AUTHORIZATION -TO;BE_COMPLETED. WHEN
OWNERS AGENT OR CONTRACTOR APPLIES:FOR:BUILDING PERMIT
i
I, 00/e y blCk1i) as Owner of the subject property
- / Rn
hereby authorize Q Gf , You e- C 012 S r/'UG
:Zbe , in all matters rel ork authorized by this building permit application.
Signature of Owner Date
_ /YIDh �, rIDU/— COh.S 7W e-G) /� zh C . as Owne uthcrized Agcn-
hereby declare that the statements and information on the foregoing application are '.rue and accurate, to the best of my
knowledge and belief.
Signed under the pains and penalties of perjury.
Tir/D 1`h S -
Print Name
Signature of Ow en Date
SECTION.12:- CQNSTRUCTI ON.SERVICES
_1_0.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder : ///l1O�i1 % S. 0 ���e 7�/2f" _ __ 066, 2 / —_
i
License Number
I
07
Address Expiration Date
Signature Telephone
SECTION 1-3 -WORKERS' COMPENSATION 1NSURANCEAFFIDAVIT
Worriers Compensation Insurance affidavit must be completed and submitted with this application. Failure to prov',de this a�iio"
wiii result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... &J No...... ❑
Version l 7 Commercial BuiI din a Permit May 15, -noo
L SE C. TIO'N 9' PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT 0
CONSTRUCTION CONTROL PUP,SUANT TO 780;;CMP, 1-1(CONTAINING MORE THAN 35,000 C.F. OF ENCLOSED.'SPACE) j
9.1 Registered Architect:
fJot Applicable O
(dame (Registrant):
Registration Nurrber
Address
-- - ---- -
Expiration Gate I
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address — Registration Number ------
Signature Telephone Expiration Date
I
Name Area of Responsibility
I
Pddress Registration Number
Signature Telephone Expiration Date
—
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
-- I
Name Area of Responsibility
_ I
Address — Registration Number
I
Signature Telephone Expiration Date
9.3 General Contractor
�I
ro h 5 7-/'l/c 7`iof� 7/7 G'. _ Not Applicable ❑
Company Name:
ino�/y�gfResoonsible In hanstruction
4:57 10_6
I
Ad"dre s s
hone
Signature _ T°'ep
Versionl.7 Commercial Building Perrrt May 15,2000
L7. Water Supply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
ublic ❑ Private ❑ Zone: Outside Flood Zone Municipal g On site disposal system ❑
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 96 9, x/27 8 96 9 527.8
Frontage 2 6 5 8 2 6 5 8
Setbacks Front 102 , / O 2
Side L: 88 R: 12' L: 88 ' R: y2
Rear /8 /8 l
Building Height y C ' 6 y
Bldg. Square Footage y02 $6 J % y�Z g6
Open Space Footage %
(Lot area m nus bldg&paved 1 6 �Q• 6
irking)
#of Parking Spaces 761
1 7
Fill: NIA
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES X
IF YES, date issued: De-C l3. 200
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES V
IF YES: enter Book 6 50`1 Page 239 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 l� NO
IF YES, describe size, type and location: VA)"J o 4/5
D, Are there any proposed changes to or additions of signs intended for the property ?YES ._
No
IF YES, describe size, type and location:
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4 CONSTRUCTiQNSERVICESFORpROJECTS LESSTHAN35000
CUBIC FEET OFENGL.OSED SPACE '
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other
❑ Accessory Building [ ] Repairs [ ] co mlj vl ' 01F F(GF S
BRIEF DESCRIPTION: 4y4�/f?y'r 4AG re/.0;L'/'�''I 7� of S/L -IT
e
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE ,
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A
A-4 ❑ A-5 ❑ 16 ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ I-2 I-3 ❑ 3B ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLET THIS SECTION'FDQST3NG-7 ING UNDERGOIN�OVA3 0N5,ADDITIONS ANDJOR CHANGE IN USE
xisting Use Group: I-2 Proposed Use Group: Z -2
Existing Hazard Index 780 CMR 34): 'y Proposed Hazard Index 780 CMR 34): y
SECTION 6 BUILDING'HEIGHTANDAREA
a�`���,TM`,x�L3FF.�C-Ei�SEONLY
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Fla ' .
Floor Area per Floor (sf) rt � 5 A� k
1
1 �. -
1 r `e
r
2nd ,64"W"
iSi 14yf' l� qhY�LNn
2nd
3`a r ,
3`a
4h
'pr .
r f V
Total Proposed New Construction (sf)
Total Area (s�
— ---------------- 4 r
Total Height (ft)
N/A
Totai Height ft--------------- s
i v i.1. Iui 1. 11,11ILa 1Vld Z-uvu
epa anntte_on -W=
City of Northampton °w Y
Building Department
I 212 Main Street uv railab _. �
Room 100
Northampton, MA 010601 "3
phone 413-587-1240 Fax 413-587-1272
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCWpANCY OF, OR bEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION . :SITE INFORMATION
�3axT � Thissecfion�o be�ornpleted tioffice
1.1 Property Address: �
r "Ti F '"y1$ ✓5 s 4r �. &'vK. n.
Ma e•`St` y 0� '.a.�.a- { .. ".o
CO DAG� V D r �'I }� au�17111t
ckihsoh Hos.oi tcaL r�
Af I'1.K-
.�
To30 // C // U s r / n
Ol D r
istrict
SECTION 2 PROPERTY OWNERSHIPJAUTfiORIZED AGENT -
2.1 Owner of Record:
Coo/e v Dickitisoh Hospi7'ca t. Po. lGoX SOof
Name (P t) Current Mailing Address:
y/3- 582 - z3/3
Signature Telephone
2.2 Authorized Agent:
Ti�oy-hv 5 loe Ile t;er 5-1912"I/eh 57'. I'Udlau/, 01056
Name(Print) Current Mail'.ng Address:
y//J 7-- 2 5 00
Signature Telephone
SECTION 3—(ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Officiai°use Only
completed by ermit applicant
1. Building P {�) Building Permit Fee
2 s-
Z. Electrical 0j.0-0 {6)estimated Total Cost of
�r-,.Construction`from'"6-,� - _
3. Plumbing Burldrng-lP -it Fee-
4. Mechanical (HVAC) 2 c(°0 `�
D. Fire Protection FOO.o 0
�. Total = (1 + 2 + 3 + 4 + 5) 3 '33 ?,(ic'7 Check.Number ..
This Section For-'Official Use Onl
3uilding Permit:Number'
- Date Issued,
>ignature:
Building Commissioner/Inspectornf Buildings Date
File#BP-2008-0862
APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc
ADDRESS/PHONE 5 MILLER ST LUDLOW (413)547-2500 Q
PROPERTY LOCATION 30 LOCUST ST
MAP 23B PARCEL 046 001 ZONE M
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: CONVERT OFFICES IN ULTRA SOUND AREA
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 FO OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 OfficiaT 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.
30 LOCUST ST BP-2008-0862
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 2313-046 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Buildir0 DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Category: BUILDING PERMIT
Pernut# BP-2008-0862
Project# JS-2008-001313
Est. Cost: $31337.00
Fee: $156.50 PERMISSION IS HEREBY (RANTED TO:
CComt. Class_ Contractor: License:
�Jlu jL_ Raymond R. Houle Construction Inc 0662.27
Lot Size(sc. ft.): 667077.84 Otimer: COOLEY DICKINSON HOSPITAL INC
Zoning: n_I Applicant: Raymond R. Houle Construction Inc
<IplVicant Address: Phone: Insurance:
5 MILLER ST (413) 547-2500 O
1_U,'__!_0W l\AA01056 ISSUED ON:41912008 0:00:00
TO PERFORM THE FOLLOWING WO.RK:CONVERT OFFICES IN ULTRA SOUND AREA.
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
1 nc?errround:
Service: iVIeter:
Footings:
Rou<�'tt: )2ougti. /a�/D�c Driveway# Foundation:
liri�eivap Final:
Final: Final: wo �
l/ Rough Frame: (j 0
Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
;aol:e' Final: 0't
Tl 1 I PERMIT MAY BE REVOKED BY THE C OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND RE, GULA JONS.
Certificate of Occupancy si nature:
FeeType: Date aid: Amount:
4/9/2008 0:00:00 $156.5014886
12 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo