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23B-046 (77) Versionl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL OESjGN AND bONSTRUCT10�1 SER1/�CES F-ORBUILDINOStAND-STRUCTt1 ES EJECT O CONSTRUCTION CONTR&L PLIRSUMT TO 780 CMR 116.(CONSAlN1 IG,MORE THA[�I35,000 C F,OE ENCC $ED'4.S 9.1 Registered Architect: Not Applicable Name(Registrant): Registration Number 'Address -� Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number ! I Signature Telephone Expiration Date Name Area of Responsibility i r Address Registration Number Signature Telephone Expiration Date ! j f Name Area of Responsibility Address Registradon Number Signature Telephone Expiration Date I Name Area of Responsibility ! Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor AA S"O Not Applicable ❑ Company am' N— - eye T i Responsible In Charge of Construction �i(fcS f Addim" Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 r $ECT10N:1 Q STRUCrTURAL.e�EE�R� (74 CMR ���1� w� _°�� •;c' Independent Structural Engineering Structural Peer Review Required _Yes O No SECTION 1 t-=IOWNER AUTHORIZATION-TO BE COMPLETED:'WHEN .' OWNERS AGENT.6k CQNTRACTOI2APPLIESlFORBOILDIyGpERlUI1T l ,as Owner of the subject property hereby authorize! to act on my behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date I, 1 t ,as Owner/Authorized Agent 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 penury - - h Print Nam igrature of Owner/Agent Date ' -SECT1ON92.-CONSTRUCIION;SERVICES. 10.1 Licensed Construction Suoervisor: Not Applicable ❑ T I Name of License Holder:! � i I Uce�nse Number Addres^ Expiration Date ignature Telephone SECTION 13-WORKERS':COMPENSATION INSURANCE AF�tDAVIT(M.G L c 1.52,§2506)) Workers Compensation Insurance affidavit must be completed and submitted with this application.Failure to provide this affidavit will result in the denial of the issuance of the building permit Signed Affidavit Attached Yes © No r I I _ Version 1.7 Commercial Building Perrot May 15,2000 ZU Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size I L Frontage Setbacks Front p �J ----=, Side L:= R:� L:�,—�-,1�R:� Rear �1 8 i1lTdiNg 1TEtg BIdg. Square Footage Open Space Footage I % (Lot area minus bldg&paved -parking) #of Parking Spaces Fill: (volume 8•.Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW Q YES ' IF YES, date issued: IF YES: Was the permit recordde�d` at the Registry of Deeds? NO O DONT KNOW o YES g IF YES: enter Book `T' p l Paged 7 and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO Q DON-r KNOW O YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needd tto b © Obtained © , Date Issued: L ' 7 C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: I AGCJ Si-<:17S A D. Are there any proposed changes to or additions of signs intended for the property? YES O NO IF YES, describe size, type and location: 1 E. Will the construction activity disturb(clearlT,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES O NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. r .r Versionl.7 Commercial building Permit May 15,2000 SECT10FF3[-.�O�1STRlfiGT,(,ONS�tVf�ES� TS 0 p� ;144T�S�`T1ilA1i[35 OOa . CUBIC�E1(?Ol'.�Gt:Q$E •P�gCE�;~.; �'• ""''s • ' y interior Alterations Existing Wall Signa ❑ 'Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration 0 Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Ijescription� Ent descriptigla.here i. �V Si A-1 GCT,0h� %q P t>ti Of Proposed Work: j,t/ 1�+. j.!/r�� I lr r /��w � 4 ekV4 :'SECTION=S-:IJSE-GROGF- 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 ❑ 28 ( ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional 1-1 ❑ 1-2 1-3 ❑ 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 El Specify: i S Special Use Specify. COMPLETETEIIS SECTIO( EXISTINf3"By LM, - UNDERGOING RENQVATCONS;AQ_DITIONS AND/OR CHANGE IN USE - -•- - - .._._... ..._.�._.. . . . Existing Use Group: i Proposed Use Group: I Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): •SECT_lON'.6BUICDING°HEIGHT"AIIDAREA ::---�: . :. BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION " , Floor Area per Floor(sf) ' nd 2nd i ! 3rd _ - 3r° I i i 4'" 4w - Total Area(so Total Proposed New Co nsttniction's 1 NOV _ Total Height(ft) ,S I " Total i h tft J �3 He 9 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 E] Municipal CR On site disposal system❑ Versionl.7 Commercial Building Permit May 15.2000 City of Northampton --- - Depa-rtment P UIain Street _..._ Om'100 Nort 4 t n, MA 01060 ter,: Pb dhe 0§-58 -- 0 Fax 413-587-1272 APPLICATI6WT,6,! ONSTI C110RVEPAR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING b1HER THAN A ONE OR TWO FAMILY DWELLING _SECZI.ON S _ INFORMATIOW? - c ; > Ztiis sectiiiato tip compfefed -- H Proaerty Address: -. � �-- 13o L opus; s ixp �. s4.N.1.r� ��q x�a ."Y�.'-tiT. '�i'� .�, •��{--�l!h���Ti.nA�a'rya��j.�,- 2dx �Ot] Stn EIrFtSi.DisricYD$rtcts _ SECTION 2 P.ROPERTY'OWNERSHIPlAUTHORIZED AGENT 2.1 Owner of Record: Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: I o T— 0 i y L) Name(Print) Current Mailin Address: Signature Telephone 3 •SECTION-3-ESTIMATED,C TRUCTION COSTS` , Item Estimated Cost(Dollars)to be = Official Use=Only completed by ermit applicant 1. Building , O ermit Fes l ; 2. Electrical (b)Estimated Total.Cost of 1 �Zr © 13 r Consfriict�on.Trom'6 ' 3. Plumbing ( ( Bii liling.Permrf.Feie 4. Mechanical(HVAC) � =• 5. Fire Protection 6. Total=(1 +2+3+4+5) U Chedk Number j> x ; This Sectiori-For Official Use-Oril- BuiidiQg?Qermliju'm4W ' . r„ : • _ ...._ -pate $sued Signature: Building Corrimis'sionerhrispector.•of gdldirigs : _Date File#BP-2005-0734 APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL INC ADDRESS/PHONE c/o Richard Corder NORTHAMPTON (413)582-2000 Q PROPERTY LOCATION WEST WING STAIRWELLS A&B-30 LOCUST ST MAP 23B PARCEL 046 001 ZONE M THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE Fee Paid Buildinjz Permit Filled out Fee Paid Typeof Construction: INSTALL DIRECTIONAL GATES ON GROUND FLR LANDINGS New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin¢Plans Included: Owner/Statement or License 082324 3 sets of Plans/Plot Plan THE FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER:§ Intermediate Project: Site Plan AND/OR Special Permit With Site Plan Major Project: Site Plan AND/OR Special Permit With Site Plan ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Variance* Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval Board of Health Well Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commis Z ZO4$ 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. WEST WING STAIRWELLS A&B-30 LOCUST ST BP-2005-0734 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 c.142A) Category BUILDING PERMIT Permit# BP-2005-0734 Project# JS-2005-1021 Est.Cost: $2900.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: COOLEY DICKINSON HOSPITAL 082324 Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: COOLEY DICKINSON HOSPITAL INC AT. WEST WING STAIRWELLS A & B - 30 LOCUST ST Applicant Address: Phone: Insurance: c/o Richard Corder (413) 582-2000 () Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON.1125105 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL DIRECTIONAL GATES ON GROUND FLR LANDINGS 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: Receipt No: Date Paid: Check No: Amount: Building 1/25/05 0:00:00 40660 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo