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C 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