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23B-046 (89) t PRE-CONSTRUCTION REQUIREMENTS: 25. The applicant shall notify the Commission, in writing, as to the date that the work will commence on the project. Said notification must be received by the Commission no sooner than (10) days and no later than five (5) days prior to the commencement of the approved activity. 26. Prior to the pre-construction meeting, the boundaries of all wetland resource areas, limits of work, and grading boundaries, shall be identified by clearly marked flagging and/or stakes, spaced at intervals not greater than 25 feet apart. Flagging used to identify wetland resource areas shall be a color different from any other flagging used on the site. CLEAN -UP BEYOND LIMIT OF WORK: 27. Any foreign material located on the surface of the ground beyond the limit of work, shall be removed by hand or pulled out with the use of chains. No heavy equipment shall be allowed beyond the Limit of Work,unless activity in this area has been permitted under this Order of Conditions POST CONSTRUCTION SUBMITTALS & WORK IN BUFFER ZONE: 28. Upon completion of the work covered by this Order, the applicant shall submit an as-built plan, signed and stamped by a registered professional engineer or land surveyor, together with a written request for a Certificate of Compliance. 29. The plan and written request shall specify any ways that the completed project differs from the plans referenced in the Order. The as-built plan shall include, at a minimum, and as applicable to the project: elevations of all pipe inverts and outlets, pipe sizes, materials, and slopes; all other drainage structures; limits of clearing, grading, and fill; all structures, pavement, and contours within 100 feet of wetland boundaries; all alterations within the wetland resource areas; all wetland replication areas; and all dates of fieldwork. "ATTACHMENT A" 18. The owner of the property described in this Order must advise any potential buyer of the property that any construction or alteration to said property, including brush cutting or clearance, may require approval by the Northampton Conservation Commission. Any instrument conveying any or all of the owners' interest in said property or any portion thereof, shall contain language similar to the following: "This property is subject to the Northampton Wetlands Protection Ordinance and/or Wetlands Protection Act. Any construction or maintenance work performed on this property requires an Order of Conditions, and/or a Determination of Applicability from the Northampton Conservation Commission. 19. A copy of this Order and associated plans shall remain on site during all construction and/or building activities. The project manager and all equipment operators shall be familiar with the approved plans, and shall be informed of their location on the site. This location shall be accessible to all contractors whenever work is occurring on site. 20. All required permits must be obtained from the Army Corp of Engineers (Section 404, Water Quality Certification), Planning Board, Zoning Board, Department of Public Works, or Building Inspector prior to the start of projects involving fill within any wetland resource area; 21. No disposal of soils or other materials shall be allowed within: a 100-year floodplain; 40 feet of the 100-year floodplain elevation; any wetland; or any area within 100-feet of a wetland, unless such areas are specifically approved by the Commission, in accordance with 310 CMR 10.00, and City of Northampton Ordinances - Chapter 24; 22. All revised plans, referenced within this Order of Conditions, shall be approved by the Conservation Commission and incorporated into this Order by reference and shall be followed during the course of construction. 23. Ongoing conditions that shall not expire with the issuance of a Certificate of Compliance areas follows: ### 24. Prior to the start of any site work, excavation or construction, a pre-construction conference shall be held on the site,between the contractor conducting the work, the site/project engineer, the applicant, and a member or agent of the Conservation Commission, in order to ensure that the requirements of this Order are understood by all parties. Prior to the pre-construction meeting, all erosion control devices must be installed. Massachusetts Department of Environmental Protection ' Bureau of Resource Protection -Wetlands DEP File Number: ' WPA Form 5 - Order of Conditions 246-541 Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and the Northampton Wetlands Protection Ordinance - Chapter 24 D. Recording Information (cont.) Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission. -------------------------------------------------------------------------------------------------------------------------- To: Conservation Commission Please be advised that the Order of Conditions for the Project at: Project Location DEP File Number Has been recorded at the Registry of Deeds of: County Book Page for: Property Owner and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: Date If recorded land, the instrument number identifying this transaction is: Instrument Number If registered land, the document number identifying this transaction is: Document Number Signature of Applicant Wpaform5.doc•rev.12/15100 Page 7 of 7 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions 246-541 Ll Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and the Northampton Wetlands Protection Ordinance - Chapter 24 C. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions. The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant, if he/she is not the appellant. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. D. Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information on Page 7 of Form 5 shall be submitted to the Conservation Commission listed below. Conservation Commission Wpaform5.doc•rev.12/15/00 Page 6 of 7 Massachusetts Department of Environmental Protection ' Bureau of Resource Protection -Wetlands DEP File"Umber: WPA Form 5 - Order of Conditions 246-541 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and the Northampton Wetlands Protection Ordinance - Chapter 24 B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw: See"Attachment A" This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions#4, from the date of issuance. June 28, 2004 Date This Order must be signed by a majority of the Conservation Commission. The Order must be mailed by certified mail (return receipt requested)or hand delivered to the applicant. A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office (see Appendix A) and the property owner(if different from applicant). Signature LK I ' On This Twenty-Fourth Day Of June, 2004 before me personally appeared ;_ fib. �•. the above-named ,1 to me known to be the person described in and who executed the foregoing instrumen acknowledged that he/she executed the same as his/her free act and deed. �,,.. 1, �---• l w,. Notary ublic My tommission Expires This Order is issued to the applicant as follows: ❑ by hand delivery on ® by certified mail, return receipt requested, on June 28, 2004 Date Date Wpaform5.doc•rev.12/15/00 Page 5 of 7 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands WPA Form 5 - Order of Conditions 246-541 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and the Northampton Wetlands Protection Ordinance - Chapter 24 B. Findings (cont.) 15. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland, the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or water body. During construction, the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission, which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. Findings as to municipal bylaw or ordinance Furthermore, the Northampton hereby finds (check one that applies): Conservation Commission ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Citation Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards, and a final Order of Conditions is issued. ® that the following additional conditions are necessary to comply with a municipal ordinance or bylaw, specifically: Northampton Wetlands Protection Ordinance Chapter 24 Municipal Ordinance or Bylaw Citation The Commission orders that all work shall be performed in accordance with the said additional conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the conditions shall control. Wpafcrm5.doc•rev 12115/00 Page 4 of 7 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP He Number: WPA Form 5 - Order of Conditions 246-541 1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and the Northampton Wetlands Protection Ordinance - Chapter 24 B. Findings (cont.) 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply: a. the work is a maintenance dredging project as provided for in the Act; or b. the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance. If this Order is intended to be valid for more than three years, the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill. Any fill shall contain no trash, refuse, rubbish, or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles, or parts of any of the foregoing. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of the registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. The recording information shall be submitted to this Conservation Commission on the form at the end of this Order, which form must be stamped by the Registry of Deeds, prior to the commencement of work. 9. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words, "Massachusetts Department of Environmental Protection" [or, "MA DEP"] "File Number 246-541 " 10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 14. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order, and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that evaluation. Wpaform5.doc•rev.12/15/00 Page 3 of 7 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 5 - Order of Conditions 246-541 Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 and the Northampton Wetlands Protection Ordinance - Chapter 24 B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of the above-referenced Notice of Intent and based on the information provided in this application and presented at the public hearing, this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: • Public Water Supply ❑ Land Containing Shellfish ® Prevention of Pollution • Private Water Supply ❑ Fisheries ® Protection of Wildlife Habitat ® Groundwater Supply ® Storm Damage Prevention ® Flood Control Furthermore, this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above, the following General Conditions, and any other special conditions attached to this Order. To the extent that the following conditions modify or differ from the plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect these interests, and a final Order of Conditions is issued. ❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions is issued. A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). General Conditions (only applicable to approved projects) 1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. Wpaform5.doc•rev.12/15/00 Page 2 of 7 Massachusetts Department of Environmental Protection File Number: r Bureau of Resource Protection -Wetlands WPA Form 5 - Order of Conditions 246-541 L11 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP and the Northampton Wetlands Protection Ordinance - Chapter 24 A. General Information Important: When filling From: N 19004 out forms on The Northampton Conservation Commission the computer, use only the DEPT O 9 uilLl"dG INSNtf i I0°aS tab key to This issuance if for(check one): pie°.,0 move your cursor-do ® Order of Conditions not use the return key. ❑ Amended Order of Conditions QTo: Applicant: Property Owner(if different from applicant): John Furman, Vanasset Hangen Brustlin, Inc. Richard Corder, Cooley Dickinson Hospital Name Name 505 East Columbus Avenue 30 Locust Street Mailing Address Mailing Address Springfield MA 01105 Northampton MA 01060 City/Town State Zip Code City/Town State Zip Code 1. Project Location: 30 Locust Street Northampton Street Address City/Town 23B_ 46 Assessors Map/Plat Number Parcel/Lot Number 2. Property recorded at the Registry of Deeds for: Hampshire 7013 94 County Book Page Certificate(if registered land) 3. Dates: June 3, 2004 June 24, 2004 June 28, 2004 Date Notice of Intent Filed Date Public Hearing Closed Date of Issuance 4. Final Approved Plans and Other Documents (attach additional plan references as needed): "Cooley Dickinson Hospital, Parking Garage, Northampton, Massachusetts, Site Plans"packet of 19 sheets June 2, 2004 Title Date Title Date 5. Final Plans and Documents Signed and Stamped by: John J. Furman Civil Engineer Name 6. Total Fee: $525.00 (from Appendix B:Wetland Fee Transmittal Form) Wpaform5.doc•rev.12115/00 Page 1 of 7 Radiator leave existing Floor curb Existing shower rough Remove O _ �_ - _ _ _ _ _ _ Existing Toilet Rough -'- - -- - s - - - - - - - - Remove i r i � O _r - - - - - - - - General Scope: Sprinklers r Floor curb HVAC - r Plumbing Lighting Voice Data r = _ general power ' carpet Paint Acoustical Ceiling Area below is offices. Finish dimensions are approximate 8.9 ft 14.6 ft Date: 04/30/04 Project: East Wing 2nd Flr Cooley Dickinson Hospital Raymond R. Houle Construction Inc. 187 East Street South Hadley, MA 01075 Phone: 1-413-532-9243 Fax: 1-413-532-0413 e-mail: ncc@valinet.com Radiator leave existing Floor curb Existing shower rough Remove O �_ _ - _ _ - - - Existing Toilet Rough -'- - - - - ; - - - - - - - - Remov r . r O r _r - - - - - - - - General Scope: Sprinklers Floor curb HVAC -" r Plumbing Lighting Voice Data general power carpet Paint Acoustical Ceiling Area below is offices. Finish dimensions are approximate 8.9 ft 14.6 ft Date: 04/30/04 Project: East Wing 2nd Flr Cooley Dickinson Hospital Raymond R. Houle Construction Inc. 187 East Street South Hadley, MA 01075 Phone: 1-413-532-9243 Fax: 1-413-532-0413 e-mail: ncc@valinet.com Radiator leave existing Floor curb `J Existing shower rough�171 MAY 2 5 2004 Remove r I � Q pEF�pt GU1tD1"�G INSPEC140?tiS • I , _ _ - - - - - - - Existing Toilet Rough ' Remov -r - - - - - _ _ q-r r _r - - - - - - - - General Scope: ' ` - - - - - - - - -t 1 Sprinklers ' + HVAC Floor curb Plumbing -+ Lighting Voice Data r - _ general power carpet O Paint Acoustical Ceiling Area below is offices. Finish dimensions are approximate 8.9 ft 14.6 ft Date: 04/30/04 Project: East Wing 2nd Flr Cooley Dickinson Hospital Raymond R. Houle Construction Inc. 187 East Street South Hadley, MA 01075 Phone: 1-413-532-9243 Fax: 1-413-532-0413 e-mail: ncc@valinet.com �E (yify� Cf t(�aliivio>> - �a Oc" P 13 ttL.O.>tiG INSP�CT)0!:5 � 212 Train Strcct ' Muc.icuoal Duildinc , No,rtha-,pion, Mass. CIOGO WO-RI -l"S CO'o=NsAT_LoN >✓1s>J-n. c� r'�� r�'.«� Z, _ Rad_ R._Houle Construction Inc. (lip/p�-,n�.,.�) ---'- - - •• ---- ___ _ ....._._.__. a pr4ricipa' place of buSlo_-sSlres1d°nC.e at: 187 East St. South Hadely, MA 01075 U hor?c :) 413-532-9243 do hereby cer-Zf , under talc p?-'TLS and pen2llties oL perJury, hat I =. an employer pro'�rldin� die fo!!o'.vin� work �e For Intl' ta)plovccs wo Ong on-CrIls job. Arch Insurance Company IRWC100737 12/31/04 ( ) I'am a sole propritzor, general conuaccor or homeOv,-j= (C;_--Cie one) 23d hzvt hired Clle CO�u 2.CiG:� I:St°� be40';Y c,'u0 h?ve ire :`O).10�'r'�:2 WOi l:Zf'S GG�Je�Zczdon pe!icies: Gi CO^' :•Ci0') (IP.SU ncC COtII !I i-PouCj' Oi C a a Cr ac,or) CLPS ZII r Co Da1Y/mac 01JC1' \'�C�1) \J'J'lO l Dztc) orCocraeo.) CUa7,L-Z-_C^- Com—rzz)•/?OUC Datc) of Coca-actor) ( rznw Compzzfflloucy NLMllx;) tc��ir ioo Dz^). drec�f o cc��-�to n:! �:�c*'^--,.�oc -�cn -L..1! I z- sole propmnO7 zyd Cove no oae worLicg for me. L-,c work caysc1 . L� .tLJc bcoco-+x- �o e lc/�e r a w- - —�e as c -.-orx of to `� c,^% �� Sc �oo•�r-�G�oe oc c� _a,:°- z d LO t^ caio uG=�ScK _���• CC A-= GL.S` ! S) �9�==°ro .0 �4xfc:LC=<or try-, dote Ic^y.1 c•'^"o��;cjloy.f,a�1�duo V✓or'<.y.Coc�.`ro�T4 L L.o D o r La�:tn cl Ana f.�.! ce a r x �� uJ� _ 4ccc;'�. v.! x cc21/ c };CjL152cnlc�'��Sc —^ �ocof^ !po 0 n' o!t ry or LCP L S 1�OO.C� c.-ili'or -r•�,G or.;) W cx r^ - c� pc'.ia,c ax- Onj is pa, ,of LI c�.�./Pcn-L;uc:. � ZS _e � Versionl.7 Commercial Building Permit May 15, 2000 SECTION 30 STRUCTURAL PEER REVIEW(780 CMR 110.11) - Incependent Structura! Engineering Structural Peer P.eview P,equired Yes......❑ No......IX SECTION 11:- OWNER.AUTHORIZATION-:TO.BECOMPLETED WHEN OV,NERS AGENT OR CONTRACTOR APPLIES_FOR BUILDING PERMIT I. gc© 7 1 c-S as Owner of the subject p e sub ro authorze Raymond R. Houle Construction Inc. tc ac- c m; behalf, in a!l matters relative to work authorized by this building permit application. Signature of Owner Date Timothy S. Pelletier as Owner/Authorized Age--,, he-eby declare that the statements and information on the foregoing application are true and accurate, to the best of my kn_h-ledge and belief. S:_-ed under the pins and penalties of perjury. Timothy S. P lletier Pr:-.: Name Sig-.ature of Own=_r7A6er, Date SECTION.12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable O Na.^e of License Holder : Timothy S. Pelletier 066227 License Number 187 East St South Hadley, MA 01075 07-07-2005 F c'ess Expiration Date j ---- 413-532-9243 S!3-ature Telephone It SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.GIJ c. 152, §25C(6)) 6._� Compensation Insurance a;iidaVlt musi be completed and subs fitted with this application. Failure to provide this a?Ic.- v;:' --sult in the denla! of the Issuance of the building permit. Arjdav . ,'.,ached Yes....... 0 No 0 -- - Version 1.7 Commercial Building Permit May 15,2000 SECTION =J PROFESSIONAL DESIGNyAND CONSTRUCTION SERVICES - FOR BUILDINGS AND.STRUCTURES SUBJECT TO CONSTRUCTION_CONTROL PURSUANT TO 780.CM_R 116{CONTAINING MORE THAN 35,000 C.T OF;-ENC(OSEDSPACE) 9.1 Registered Architect: Not Applicable ❑ Na•rne(Registrant): Registration Number , Address , Expiration Date Signa:ure Telephone [:9:2 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 i Name Area of Responsibility Address Registration Number Signa`ure Telephone Expiration Date Na'—,e Area of Responsibility Address Registratior, Number I, Sg atu'e Telephone Expiration Date 9.3 General Contractor Raymond R. Houle Construction Inc. Not Applicable ❑ Cornea-y Name- I Timothy S. Pelletier I es-^-s pie In Charge of Construction I 187 East St. SQUth HaC"P)Z.F MA 0307S 413-532-9243 —elephone 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: PublicNX Private ❑ 1 Zone: Outside Flood Zone IRX Municipal IM On site disposal system p 8. NORTH.ANIPTON ZONT NG Existing Proposed Required by Zoning This colurrm to be filled in by Building Department Lot Size 969 427.8 969427.8 Frontage 2,658' 2,658' Setbacks Front 102 102' Side L:_88!R: 42' L: PRI R: 421 Rear 18' 18' Building Height 64.5' 64.5' Bldg. Square Footage % 402,861 402,861 Open Space Footage % (Lot area minus bldg&paved 40.6 40.6 arldng) #of Parking Spaces 761 761 Fill: volume R Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES XX IF YES, date issued: December 13,2001 IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES XX IF YES: enter Book 6504 Page 239 and/or Document m B. Does the site contain a brook, body of water or wetlands? NO XX 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 XX NO IF YES, describe size, type and location: Various Locations on Site D. Are there any proposed changes to or additions of signs intended for the property ?YES _ No X_ IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15, 2000 -SECT ION�4 -'ONS-MtIiZON'S_ERVICESFORPROJECTS LESS THAN 35,U00 GUBIC'FEET OF E N CLOSED Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing Cl ❑ Cl Exterior Alterations Demolition❑ New Signs [ ) Change of Use [ ) Other [ ] ❑ Accessory Building [ J Repairs [ ] BRIEF DESCRI--nION: �c1,4/U�9;7- ivlfv ,�}�✓ SECTION 5 -USE GROUP AND-CONSTRUCTION TYPE USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly 1❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A l:X A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C I ❑ H Hi 2h Hazard ❑ 3A ❑ I Institutional 10 I-1 ❑ I-2 I-3 ❑ 33 ❑ M Mercantile I❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage 4❑ S-1 ❑ S-2 ❑ 58 , ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: - _ „COMPLETE_THIS SECTION IF E(LMNG BUILDING UNDERGOING f2cNOVA7ION5,f.DD1TIONS-MD/OR_CHANGE IN USE Existing Use Group: 1-2 Proposed Use Group: I-2 [Ex;stinc Hazard Index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 34): 4 SECTION 6.BUILDING HEIGHT AND AREA _ BUILDING AREA EXISING PROPOSED NEV/CONS RUC"i i0N OF1-3C i1SEONLY'' C p Fiocr Area per Fiocr(sr� 3J I r. g . Y �� l .. 3 .� �.. _ i T ?: Total Propose' Nevi ConswrucuOn (r,� -= r Lol- - Veaionl.7 Commercial Building Permit May 15, 2000 i#m`eT�tisen -7_ - City of Northampton `' Building Department 212 Main Street iT - Room 100 Q Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE THEXSE �FR LISH ANY BUILDING OTHER THAN A ONE OR TWO fWL L N y _ M AY 2 5 2004 SECTION I.; .SITE=INFO, TION � � - tt. 1.1 Property Address: "� i�Plet �y flfftce _ Cooley Dickinson Hospital 30 Locust St. IM_ SL�istnct SECTION:2.- PROPERT..OWNERSHIP,/AUTHORIZED AGENT FOwner of Record:Coole Dickinson Hos ital 30 Locust St. e (Pr' Curr ent Mailing Address: 413-582-2313 Signature Telephone 2.2 Authorized Agent: Raymond R. Houle Construction Inc. 187 East St. South Hadley, NIA 01075 Name(P int Curr=ent hailing Address: 413-532-9243 Signature Telephone SECTION 3 --ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Do(la,,s) to be Official Use Only com feted by mit aoolicant 1. Building 60dv , ! W_Building Permit Fee 2. Electrical {o)Estimated Total Cost d_f Z©c o ' -Construction from;"6 3. Plumbing o QC] ;Buildigg`Permitfee' . - 4. Mechanical (HVAC) Fire Protection 3`�`� E. Toy! _ (1 + 2 + 3 + 4 + 5) Chet Number This Section For Official Use Only 5uilding Permit Number -- Date Issued: I Signature: Building Commissioner/Inspector of Buildings Date File#BP-2004-1202 APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc ADDRESS/PHONE 187 East St SOUTH HADLEY (413) 532-9243 PROPERTY LOCATION 30 LOCUST ST-2ND FLR EAST WING 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 Perniit Filled out Fee Paid ¢h�d Typeof Construction: CONVERT SHOWER AREA INTO AN OFFICE 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 INFORMATION 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 ssion S L Zapc Signature of Building fficial 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-.�..i LR EAST WING BP-2004-1202 GIs#: COMMONWEALTH OF MASSACHUSETTS Man 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-2004-1202 Proiect# JS-2004-1816 Est. Cost: $16000.00 Fee: $80.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: IA Contractor: License: Use Group: I2 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 - 2ND FLR EAST WING Applicant Address: Phone: Insurance: 187 East St (413) 532-9243 Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:611104 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONVERT SHOWER AREA INTO AN OFFICE POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Buildiug Inspector Underground: Service: Meter: Footings: Rough: Rough: i � � Douse# Foundation: � ..'-s/ ' Driveway Finial: Final: Final: y ,,;. ' Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS` Certificate of Occu anc s nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 6/1/04 0:00:00 9181 $80.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo