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23B-046 (59) WAITING (13 SEATS) i '-6 4'-0" 4'-6° N `®l N WAITING (11 SEATS) N 0 �ECURITY 77 FAM I LY ROOM r VEST I = o n c:j 0 °° C I C f�l I ' I I ' I I i s6—s" I I D z I I O II � I I 0 '-0' 4'-0" 4'-10" I `®1 z ' WAITING Lu It W/C STO R CORRIDOR CHILD WANITINGI ----------- SECURITY r--------------- , r -----------I IIIL -----------J ----------------- CONSULT VEST I ' � � I w -----------, - -,-----�-TY I I I I i 1 1 U I I I II I n I I ry I I i I .o ! 4/4 LLJ I CD z fir- _-- n Ir 1t Q cn ! i iii � ° I o ! I II ! J L� i � I I - fll w ! ! III O U I O = � a- n ED .v.>•r nT ��Oy `e Crif� of Trz f(falll}ltoil \ -qZRSinchntrtls' - -_ ca DEPARTMEITT OP DUILDrNG INsPECT)O1JS — 212 Main Strcct ' Municipal Building Northampton, Mass. 01060 WORX R'S CO�/CPENSAT70N MSUR -NCE A=AVI7' /1e pier 9,h!ov/e Gaffs 7`Ir�� . (li a-nxxJpermi tt�} �).qth a principal plat,- of business/residence at: 5/j' Ile P S t. L v 111041 //7 D/056 _(phone!) 5Y13-5y7 2Soo (srr t/ci ty/stalc/a P) do hereby ccrdi ,, under the pairs and penalties of perJury, ih3l I an employee providing die followine worker's cotnoens ion cove rzse Cor my eluplovccs worming on'uliS job: Al/ea -Ne/7f t aiHer/ca We- 1050033 /2-3/-05 (ianu�m Comp-=- y) lPclic: N"u lb r} - (T:,- for Due} ( ) I'am a sole proprietor, geoeral concmaor or hameowuer (cicie one) and have hued the cones actors tasted below wbo have the `olio%wing worker's co�oe,��2�on peLicies: (team: o.Co c c or1 (In�ra�iL^ COiL1DJSl)'/t�GUCi '.gum c:) (r:�i;aeon l�atc) (Name of Coocracior) (1rLSUranc ComDaa.'/POJCi \unLrt] (i��ir:iOn Dale) (Name 0f Coar aMO,) (Lasufanc; Compao)'/Pauc). Numtu; Date) (Name of COCIEMCior) (Insu ancz Comrz.cy/Policy Numb,�r) (E.-\-p%t26oa Date) (a6a[�u,^i;:vocal r)cC Joccmu-v to a;cuc��afocti:uua oO P=-La as wall O I am a sole proprietor and bave no one wor4 ng for me. ( ) 1 am.a home owner performing all the work myself. NOTE:ptcx be 1ajxt rfin wt�JO lk^cacouam ubo cnsplay Pcz o=to&m-rr�, d..c1L�of aot nor LL--- v-irj in utic6 the rcida«oo tic p oua&I zip tr-,tbeen c.T w C�-z12y 00=&d i w tc cmploy=3 Lhc _ ..;on Aa(GLIS2s.1(S)�Fppliatjoc try a 6ommax rw:bc=—:or p=mit rc_y c-idc Lbc lc�l cur a or as rs*oyx under dao Workce,Coc�o Art 1 uDdQr i�d di,a>oopy of tAia mtr�mx may bo for rnrdnd to tbo Dcponmfsxt or lcca cviaf Arc d aY offs oe or lry-10 ror Jb covcabc vcliticnioa a_,d th--i L- L—m to uuuc bovcraot Lmdct soa600 23 A of MGL 152 na Iad to the i=Pcmi600 of cim:a pcaalliro oomc�of i rUc O(UP to S 1,500.00 an)6/or ca{a izor�of up to ooc ytz cad a%1J pcza.,jo�a 6c roan Ora Slop Wort ordc and a ftm of 51 00.00.d_y apim me Pcrmit NLimbcr only rt . /2-Oep-v 1.�p — Lot S'� tc�nsrx/Pcrm iU e .} .::. Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEER REVIEW(780 CMR 110 11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11,= OWNER AUTHORIZATION-TO BE COMP,LETED WHEN, OWNERS AGENT OR CONTRACTOR APPLIES FDR BUILDING PERMIT I, l_ oo l y Ncki h s/on lAys�oi Tia L as Owner of the subject property hereby authorize Gl R you CO/ S r VC, 7-/0 C . to act on my be in all matters relf, ork authorized by this building permit application. Signature of Owner Date _ ,f I, Ra VZW&7hd R, 1�le0le- Co/)s Tl UC7-/0/-7 -Zrh c . as Owne uthorized A en 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. 71Zwa; icy s. P-e,//e finer Print Name p Signature of Ow en Date SECTION 12 CONSTRUCTION SERVICES 10.1 Licensed Constructions Supervisor: /� Not Applicable ❑ Name of License Holder : /lwe?1 4% S, Ag Ae- 712 2�' 066 ,227 License Number Iler s r L 61 al/o w. /!'I.9 d/o'5-6 07-07-07 Address Expiration Date 17113- 575'7 22 ,60o Signature Telephone SECTION 13, WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G t:,L152,- 25C(5)j Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida:'-Y will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... R No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR_BUILDINGS AND STRUCTURES SUBJECT.TO COrNSTRUCTIQN CONTROL PURSUANT T9780.CMR 13'6.{CONTAINING MORE THAN 3S000,C F OF ENCLOSED;SPACE) 9.1 Registered Architect: Not Applicable O 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 1��t U o/7�� yovLB �Oh51/?11C7 /D,'02-TAC Not Applicable O Company Name: Responsible in harge of Construction /'> S T jZcj Address �_113- 5-y72500 Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L.c.40,§54) 17.1 Flood Zone Information: 17.3 Sewage Disposal System: f 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 116 9, 112 7. 8 96 9, 512 7.8 Frontage 2(c se 2 6 5 8 Setbacks Front 102 ' 102 Side L: 88 R: 5�2 L: 88 R: S/2 Rear /g' /'9" Building Height 6((S ' 6 5!5' Bldg. Square Footage 1/02,1364 % 1102,961. Open Space Footage % (Lot area minus bldg&paved arlan #of Parking Spaces 761 761 Fill: N/A NIA (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: De n13, 200J IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES l� IF YES: enter Book 6 6011 Page 2313 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: VA h o 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 =SECTIUTI 4 CONSIRUCIiON�RVICESi�OR.R07E&r LESS THAN 35;000, CU BIC,FEETOFNCLI)SEDSPACE # ,4 v Interior Alterations E xisting Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ .� ❑Exterior Alterations emolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: /77,ho/' /,?c no vafla&s 7'o The E1),eneehcy rQa En rR fw4%tr�I SECTION 5--USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ 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 TRISECTION IFEXISTING,BUILDING UNDERGOING RENQVATiONS,ADDITIONS_`ANDJO,R CHANGE IN USE Existing Use Group: 1-2 Proposed Use Group: Z-2 Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y SECTION:6_BUILDING HEIGHTAND7AREA SEON OFF C U P ; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ,w r F, ON 041110-402, r.. Floor Area per Floor(sf) n pp �¢ kst; 1 2 5 Renovations � s $�I 4 nd 15t 12500 7n EJ� AN i.�c �-'�'e'1tCu4"p,�-s""�`"a•]xra, r '"� _: 2 d �f °d f aty€t2� i 3 7 s x 3 � Y x " 4th 4thc t x e W f Total Area (sf) Total Proposed New Construction (sf) Ar IMF '� Total Height(ft) — Total Height ft----- Y IV---------- yw M, r Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street x Room 100 . Northampton, MA 01060 *phone 413-587-1240 Fax 413-587-1272 a F APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING -SECTION I-$ITENFORMATION 1.1 Properly Address: 111khis�ecfio x dee��completed office COD�G�V iD;ckihson Hosoi taL Mapr �[ut 30 4oCUS >- ST ' one : yer ayct �� � z. '. * «,,,,,.ya,' � • x,' �.�„�� .TES, ? ,� � ��Mi � - SECTION 2 �P.RQP.ERTY OWNERSHIPJAUTHORIZED AGENT 2.1 Owner of Record: Coo ley Dickir►soh Alosai?'ol 30Lo0yst SY Po. Box Do/ Name(P i t) Current Mailing Address: y13- 582 -2 3/3 Signature Telephone 2.2 Authorized Agent: _Tiwo-Ay 5. Pe Ile 1-%er 619?,'11eP 57'. Lucl/oul, 070,66 Name(Print) Current Mailing Address: 5'i3- by7-2 500 Signature Telephone .SECTION 3 'ESTIMATED CONSTROCTION-COs'T - Item Estimated Cost(Dollars)to be official-Use Only completed by rmit applicant 1. Building tai)-Building.-Permit-Fee 2. Electrical oa {b)estimated tal Cost of.; O OD � O. Constriction To`frflm 6)a7 3. Plumbing ,� O e_ Building Perm�tfee - 4. Mechanical (HVAC) 5. Fire Protection $000•°=� 6. Total = (1 + 2 + 3 +4+ 5) 0:10— Check`Number p —► This Section ForOfficial'Use.Onl Building Permit Number `=' Rafe Issued: - Signature: Building Commissioner%Inspector of Buildings Date File#BP-2006-0647 APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc ADDRESS/PHONE 187 East St SOUTH HADLEY (413)532-9243 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 Buildiniz Permit Filled out Fee Paid c Typeof Construction: MINOR RENOVATIONS TO EMERGENCY AREA ENTRY&WAITING 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 Commi ion Signature of Building Official ate 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. )VA 30 LOCUST ST BP-2006-0647 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-046 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0647 Proiect# JS-2006-0948 Est. Cost: $185000.00 Fee: $650.00 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 WC Zonine:.M Annllcant:R?Volorl�I r l i I It? 'mictr!— io I i n_ AT. 30 LOCUST ST Applicant Address: Phone: Insurance: 187 East St (4-j) 532-9243 Workers Com)ensq+1011 SOUTH HADLEYMA01075 ISSUED ON.1211912005 0:00:00 TO PERFORM THE FOLLOWING WORK.-MINOR RENOVATIONS TO EMERGENCY AREA ENTRY & WAITING 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:11 Rough: Rough: -i`, #/�/�ouse# Foundation: Driveway Final: Final: Dina 4� '�. ��' ✓,�' Rough Frame: o Z z5 Gas: Fire Department Fireplace/Chimney: r" ,.. a_.1: — Insulation: Final: Smoke: Final:o�j t^ l -c' =R�r"1�6K P Ry6k FINAL 014 6S(W'09 La>;Aj THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS ems. :.� Certificate of Occupancy Signature: FeeType: ate Paid: Amount: Building 12/19/2005 0:00:00 $650.00 212 Main Sheet,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthovy Patillo