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/ oFPn,�.T r.,Fl�rr o,° o u1 r�. c Ir.specrlo�:s
212 Maio St:cct �Sunicipal Building . �,a
NorthampLcm, Mass. 01000
�'Y O MCE I Z'S C MU EN S A TI O N 5�S UP,'�N CTL
(l;oa sxJpermittC-->
irn z pr�nclpal place olFbusiness/residcncc at:
55 6,al/r? �
ty/stalcIn*p)
do hereby certify, under tlhc pLins and peua1lies of perjury, _haI
(�) I am a_n employer provlLnj the followine worker's colnocr's--uon cove^;c for Wn '
eluplovccs «orng on Jris job
7 el
(Losu. Coo=v') (Pc�c; e rr) �:piruon Dom)
2 sole proprietor, 9e0cral contractor or homeow-Der (cl:zie one) and havt hired
tale cont actors Lsted below wbo Piave the followioQ worker's cop--Jen_a�on pokles:
(Nam: of Co,. �c orl
Nn2r-3nc; Compai)-/PG c-
of Coocracior) (tnsirznc;. Comoanv/Po1'jc,, Narncrr) (—L.\ui,-uon Dzc)
6M, 0 C0amiC-1C.) lLnsuranco Company/PoLc,, N;imttil) (E p rooa Datc)
(1`amc of Coot actor) CLnsuraac-- Comcwy/PoLicy Numb;r) (E.x-pr2noa D2')
(na.�,„t�.::cctiJ�...0 t(❑cam rr.� cx!u� i,�fo:cu�ca p.�'t2.irv.ns � .11 cx�c-�n-�) .
( 1 i an a sole propne[or and have no Oct wcAdrlg for me_
( i 2a a home orvrler performing all the work myself.
;'JOT-E:pl�s<be nw-�re Lr.�{:Je btm-�Ay-n who e-r�loy rX-t.oai eD w „-;;�-�c oo c re-,�r•ori;oo .d�JL;,or
ch the bon�om�rr c{oc U'c.6ou z .:.�.�t;x c.n c�" ar_-:
w-' loyc;u^l-.-�-.�.0 i:t.-`i —• An(G 1.152--1(5)) t4pliL�z ca trf. hom�onu:fv c��<
I"pj't .r c( o cgfayx unC d o Wo ! G lima I i
L- ac Lo ccu c'c am v izc'j ca 2 5 A c }.I GL 15 7 cj to Lh L ? a or c-iauni peril:i o
0 En e(vjp Lo:I}Q0.QC ..r�Nor r--u., oax::cIl o(u0 L� yc�.r e. n�ti7 p�ja
(tom of
010 C-0
S gnaC n ctr /?crnuUc — D13 e - ,�
Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10 STRUCTURAL'.Pt£R REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes......D No......0
SECTION 11,- OWNER AUTHORIZATION--TO BE_COMPLETED. WHEN
OWNERS AGENT OR CONTRACTOR APPUES FO DING PERMIT
I, ( 00 lC' l/ 1� cki✓� s/o//C n� as Owner of the subject property
hereby authorize Q Gf Aloe e- C O/ -S r U t O G . -to act on
my be in all matters rel ' ork authorized by this building permit application.
Signature of Owner Date
1, 66t Dhd �, /�0�1�e Cohs Tl'ucTio/-7 -Z'h c . as Owne u
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.
Ti�r/af-i� i S �e/% tier
Print Name
Signature of Ow en Date
SECTION 12 -CONSTRUCTIOtdSERVICES
10.1 Licensed Construction Supervisor: Q Not Applicable D
Name of License Holder : rl-w,M% S. 0 a//e 7-i e r _ 066227
License Number
//e r S r 67.1O 56
Address Expiration Date
yr - sy 0
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCEAFFIDAVIT{M.,G t c 152,§2SC(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... 14x7" No...... 71
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9 PRDFESSIONAL DESIGN'IAND CONSTRUCTION SERVICES F.OR BUILDINGS AND STRUCTURES SUBJECT TO
�,
CONSTRUCTION CONTROL PURSUANT T0,7.80 CMR 116{CONTAINING MORE THAN.35 000C F. OF ENCLOSED`SPACE,)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
/T4�ulVe /� K fY0(J�C-' [. Oh5�/�UG /0�1/��. Not Applicable [I Company Name:
71-
ino Mv S. `e//g-7-ier
Responsible In harge of Construction
5/W,'//e r> C r �v all oul ITV O
Address
%r3-sy�25oo
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
7. Water Supply(M.G.L.c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System:
Public ❑ Private ❑ Zone: Outside Flood Zone Municipal 14 On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size c(6 9, 1127 8 96 9, 1/27.8
Frontage
Setbacks Front 102 , / 02
Side L: $8 R: yZ' L: 88 R: 412
Rear 18 /s,
Building Height (1/5 y 5
Bldg. Square Footage 4102 8 61 %
Open Space Footage %
(Lot area minus bldg&paved 7 . 6 ya 6
parking)
#of Parking Spaces 761 7
Fill: N/A 111A
(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: Dec 131, 200J
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book 6 SOy 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 l� NO
IF YES, describe size, type and location: VA P 10 vs
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 'C ONSTR-UC7MON--�SERNICESTOR�PRO]ECTS LESS THAN35.000 y ,
CUBIC FEET OFNC60SED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
14er ❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs
BRIEF DESCRIPTION:/9GC'/' G�X���/'Sspac T✓����'✓,��' 4f7��/N'�Ye �'�JT/;Y�vT�� ,Toy"/�T �"Q�T�i'
SECTION 5 USE-GROUP:AND CONSTRUCTIO
N TYPE`; 4
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A -.kr
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:
COMPLETE Tf i S SECTION.! DQ 3NG BUILDING UNDERGOINGRENOVATIONS"ADDITIONS ANDf OR CHANGE'IN USE
Existing Use Group: I-2 Proposed Use Group: l-2
Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y
SECTION &.'e L-D.ING,HEIGHT-AND.IREA
_ . . _-.. -
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
e
'r0'6a.-5 s.�t ,�,�
/ 5 �r rR €
Floor Area per Floor(sf) 6/d t In 7p =4`ka
Y +,s +' car- .✓' i
av
'k ,-a-^ r
sr�---fig• 7,Y'`^l A qy�"°.E, S+. � l t
2nd Sh rs c z F 4
}
2nd 3 rd
rd
d,� 5r ,.�v I •,
iw r` Y w yL
3 ry i'
4th
JY
Total Area (sf) Total Proposed New Construction (sf) �;
_------- -----------
Total Height(ft)
Total Height ft—N��-----
Versionl.7 Commercial Building Permit May 15, 2000
City of Northampton
E
Building Department u;ra � 4
212 Main Street �� }
Room 100
Northampton, MA 01060 a '
phone 413-587-1240 Fax 413-587-1272 a F`
asp �;,-:�...��.,:�. �_• � ���
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION ly SITE3NFORMATION
1.1_Property Address:
r*� �Th�ssecfiorii�obecomp1eted boffice �
t-
r �'�•;'�,� 'i"' kF.f'^s>�S �*n.. '"- '`?r, wµ' "".E�ja '�re''.SpA'�S� •''� i' z*
3 - g.N c Me ea msrpt..�D / nsN //05,0/'f -+t�""'^'�G,�'x"'f°,'`�rSu�a m t�aS'A�'=�.a.l i�a a-0,�x".y�}U s.ttC+�+,•C.�'E�''..��',�&t E c`�nz.�tiw w'S(y..
q
;X
C. � aiv'c2'' „�ca't i`-C .k `"`-�'�,' e"-f-:' o�„ss-T.„r9f kii" '€'�.t �..r'1•t
i-�LIp2�°��t°:�15trJG'f'!*a '+caa 1-an.-�r�..�s'"',R�+r ,a.°�.B ...vh•,'c 'T"�s u�.
SECTION2 PROPERTY OWNERSHIFJAUTfORIZEDAGELAT
2.1 Owner of Record:
Coo/e v Dtckinsoh 410SD%7r01 30Z0041Sf St. PO. .Sox 0o/
Name(P' t) Current Mailing Address:
(//-3- 582 - 2 3/3
Signature Telephone
2.2 Authorized Agent:
E/ ///V' 57h.
Name(Print) Current Mailing Address:
.� y12- 5 Z 7- 2 500
Signature Telephone
SECTION3— ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars) to be Official Ilse Only
completed by ermit applicant -
1. Building /J lnd ,., (a) Building Permit-Fee
2. Electrical 3 ZOO {b)fstimatedTotal Cost of.
on from 6
3. Plumbing �a. Building Perm�tFee.
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 + 2 + 3 +4 + 5) r.00 Check_:'Number_
This Section`For Official Use Onl
Building Perinit.Number 1 s sued. .
Signature:
Building Commissioner%Inspectorof:Buildings Date
I
File#BP-2007-0858
APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc
ADDRESS/PHONE 5 MILLER ST LUDLOW (413)547-2500 Q
PROPERTY LOCATION 30 LOCUST ST-P2000 2ND FLR OFF PHARMACY
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
Buildin g Permit Filled out -a 6k4
Fee Paid
Typeof Construction: ALTER EXISTING SPACE TO PROVIDE ENTRY TO THE JOINT CENTER
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�O�LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF CATION PRESENTED:
Approved 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
701 e
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.
t
BP-2007-0858
FROW
GIs#: COMMONWEALTH OF MASSACHUSETTS
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-2007-0858
Project# JS-2007-001412
Est.Cost: $23600.00
Fee: $84.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M Applicant: Raymond R. Houle Construction Inc
AT. 30 LOCUST ST - P2000 2ND FLR OFF PHARMACY
Applicant Address: Phone: Insurance:
5 MILLER ST (413) 547-2500 () Workers
Compensation
LUDLOWMA01056 ISSUED ON:311912007 0:00:00
TO PERFORM THE FOLLOWING WORK.-ALTER EXISTING SPACE TO PROVIDE ENTRY
TO THE JOINT CENTER
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 3/19/2007 0:00:00 $84.0013583
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo