23B-046 (32) ,t
i tt�
_ 1 i E L_.._.---- __...
i
._ £._.__._._y...._.__.._t
i
i�
1
U
3 EI
LI - b E
!!V E E
E€ 3 E ..._
;
! 1�
1^�j� E
L ....._..._—..__ ".
Jl
is
E!
i
1... .._._ :.... : f
fr I
€
rs i
F
!
I
� E
Ei
,
( i
z
E
J
------ E '
�.
I'
Ix_ �^
E
i � ..m. x----_ ,
EE !
E
N
O 0 Q
1
1 .
� 1 �
-' i/Jr�L_L�,i�.- _.-_f_. ��,--� =�-- �_',l i�'. ✓, i�-'( /� � ���•_'/ � � i�-'rid � ! ; /C
iii:' ,ir Ili''
it �Jn ti 1! I,J� -
i�
L ur---c C (°c G :pirucr, Uz
�T d So :° pr0OFj c C c,3rj CCof of ho G1 ovti—u (cL:i lL o�C) CL1C b.Evc hLf._0
U)e co0u'dC',u I S?t--i �iov, rr�0 `U VF (hF iOI�D,', �Q `tlGil:Z S �JOJ°P_ �70f� 7CC�CIZ;
,i�:�r�, �� C„ � . �.o:l li �,n r� ic� _✓T�oir��ii'c'Gc ��!utncc) �_- � -�� , '��ic)
�•,_ o CoGc-,_c- -- L,s f!D'-,-- CLw u� o��c ���c_r1 �. ✓,uc�n D�
Versionl.7 Con inercial Building Pern;it M�'.v 5, _)000
SFL.TION 10- STRUCTURAL P
- -' EER REV[EW (780 CMR 110.11)
I In_o:ndent
Structural En g'�neerin g Structural Peer Rerie�� Required ❑
SECTION,11 - OWNER AUTHORIZATION- TO BEOM
OPLETED WHEN
OWNERS AGENT OR CONTRACTOR`APPLIES FOR BUILDING PERMIT
I
I
— OD— D i C 1 S OCJ - 7–i::1 L-- – -- as 0v,,ner of t'ne su'ojecI D p r;
hereby authorize Q d R /VOU P_ C O/ S r/?�-L-/o
my be n all matters rel + orF; authorized by this building permit application.
/4- 3-v 7
Signature of Owner Date
I �l
as Owme, authorized Abe
hereby dec are 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 Owl en Date
SECTION 12 - OONSTRUCTfON'SERVICES `
FNI 0.1 Licensed Construction Supervisor: Not Applicable ❑
a me of License Holder : //�% S Pe//e ti e l 06622 7 _
License Number
r --
� Address. � Expiration Date
ZL�
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCEAFFIDAV;IT..(M.,G t c..152.,§ 25C(6))
1'tork ,rs Compensation Insurance affidavit must be completed and submitted with this appllcatlo-i. Faliure to prov'de
rdill result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... W No...... ❑
Bu; a rc-I 2`);l:')
CONSTRUCTION C NTOOL PUPSUANT TO 700 Ct SERVICES n,OP�6 BUILDINGS, STRUCTURES SUEJECT l 0
-0�dS1 00 C.F -OF INCLOSED SPACE)
9.1 r_eglstered Architect.:
=r .7
?fstraticn Number
<<
tk.)ira lun
Date
S'°natur° elephJne
I :Z -Registered Professional Engineer(s):
I
I
Name Area of ResponsiDdity
address Registration Number
i
--�
----------- ---
I Signature — Telephone Expiration Date I
Name Area of Responsibility
Address Registration Number
I
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
i
i
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature _ T epho-I e E xpiration Date _ —
9.3 General Contractor
I
—7-
��__�� Not A p p l i c a b l e ❑
CoF-npany Name:
Responsioie in Charge of Censtructio❑
cress
I
�lep'r
Version 1.7 Cominercia113u1ding Permit May 15, 2000
I
`F. Water,Supply(ht.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone:_ — Outside Flood Zone jP Municipal �1 On site disposal system C
S. NORTHAMPTON ZONING _
Exist ng �— Proposed Required by Zoaing 1,
I his column to be nllcd in by
Building Dcpartmcnt —
Lot Size 96 9, y27. 8 96 9, y27.B
Frontage
8 2658
Setbacks Front 102 102- ,
Side L: $8 R: S'2 L: 88 R: y2
Rear
Building Height y 5 6 y J`
Bldg. Square Footage y02 S6� %
Open Space Footage %
(Lot area minus bidg&paved
parking)
# of Parking, Spaces �b 76 /
Fill: WA N/A
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES_ X
IF YES, date issued: Der- /3-, 20c)
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES V
IF YES: enter Book 6 $0y — Page 239 and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO _ DONT 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 1� NO
IF YES, describe size, type and location: vg,P)o vs
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No -4/�
IF YES, describe size, type and location:
Versioal,7 Commercial building Permit May 15,LUUU
S E._ ON 4-:CON SRU GTION SERI/ICESOR�ROJ ECTS LESS THAN 35,0 00
CUBIC FEET_OF ENCLOSED SPAGE _
interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
-0' ❑ ❑
E,cterior Alterations Demolition[] New Signs [ ] Change of Use -r--j-Other [
❑ 12a v v Accessory Building [ ] Repairs [ ] n
BRIEF DESCRIPTION: �G�v�a7rG B" elt ee-t 7o e/e a t-c C(4a ✓
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 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ ZB 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:
COMPLETE T{iIS EttION IFFXIST3NG BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDJOR CHANGE IN`:USE
Existing Use Group: I_2 Proposed Use Group: -2
Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y _
SECTION 6::BUILDING HEIGHTANDIREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION aFFCE�SEflNIY e
jig
Y
Floor Area per Floor(sf) '200 �' rt s ��
r ,
5 t
if
2nd
s +
r
Zia 3d �t
3rd
t K
1 t
4
F
Total Area (s� — _ Total Proposed New Construction (sf) {
G {
Total Height (ft)
Total Height ft--N/ ---- --- s
v vl JlV 111.I L.Vlllllll.l Llcll Luu WUlJ' t l,1llLLl!Vldy' 1,? L�VyVV j+,,�
Northampton
BillHding Department
---- 212 Main Street
QCT %Oi oom 100
Northampton, MA 01060 la
hone 413-a87-140 Fax 413-587-1272 aas
APP41.CATI4N TO CON—STRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTIONS SITE=INFORMATION
c,..,�--x.'� .x.T ES•'° -Thisseclion�to-be�cornpleted-b �ffi ��; �
1.1 Property Address: �� r �'
t'r � s iii. f ` �
r k3'
Coo% � �iC�C1J'l soh HOSD/ fictL Map�k r fIo � ��Unrt r
t y-+7 x
3 0 7—.
/a -{— b
L- C U / a ARE, uNL xt. L —
-rrit
SECTION 2: PROPERTY fJWNERSHIPJAUTtiORIZEDAGEHT)
2.1 Owner of Record:
Coo/ey D1ckihsoh Hasp/7a/ 30 �oo41s;` St. fro. 1966 Eaol
Name (Pi t) Current Mailing Address:
y/3- 53R - 8313
Signature Telephone
2.2 Authorized Agent:
7`ii„o 7-,i v 5. /'e l/e t-/e r 6-1 l/eh St. L,u cal o u/, ,PW
Name (Pent) Current Mailing Address:
L=E2 5'i3- 3y7- 2500
Signature Telephone
SECTIONr3:`— ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official e Only
completed by ermit applicant
1. Building 2 3 1)' Budding Permit Fee
2. Electrical t D O , " (b)estimated Total Cost of
Construction from;.6
3. Plumbing Bu,ldmg Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
S. Total = (1 + 2 + 3 + 4 + 5) 2 000. "O Check,Number_
ThisSection`For Official Use Ohl
Building Perrn'it Number Date Issued:
signature:
Building Commissioner/Inspectoraf:Buildings Date
File#BP-2008-0366
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
Building Permit Filled out
Fee Paid
Typeof Construction: RELOCATE BREAK RM TO CREATE NEW COURTESY ROOM P2000
New Construction
Non Structural interior renovations
4dition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 066227
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
I-A
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 Co ion
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.
30 LOCUST ST BP-2008-0366
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL e.142A)
Cate�,ory: BUILDING PERMIT
Permit# BP-2008-0366
Project# JS-2008-000529
Est. Cost: $2800.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sL. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Applicant: Raymond R. Houle Construction Inc
Applicant Address: Phone: Insurance:
5 NJILLER ST (413) 547-2500 Workers
Compensation
LUDLOWMA01056 ISSUED ON.10/11/20070:00:00
?'O PERFORM THE FOLLOWING WORK.RELOCATE BREAK RM TO CREATE NEW
COURTESY ROOM P2000
Pt;'ST THIS CARD SO IT IS VISIBLE FROM THE STREET
L.sileeior of I'lumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:�G
Rough Frame:
Gas: Fire Department Fireplace/Chimney-
Rough: Oil:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATIQN OF
ANY OF ITS RULES AND REGULATIONS. ,
Certificate of Occu ancy & Signature:
Fee"Type• Date Paid: Amount:
Building 10/11/2007 0:00:00 $50.0014258
212 Main Street,Phone(113) 587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo