13-073 (39) 25 COLES MEADOW RD BP-2006-1175
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 13 -073 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1175
Project# JS-2006-1733 •
Est. Cost: $84300.00
Fee: $164.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Roger Clark_ 021310
Lot Size_(sq. ft.): 492663.60 Owner: NEW ENGLAND DEACONESS ASSOC
Applicant: Roder Clark .
AT: 25 (.rOL_C` !:1iMI_)Uh'/ a' Ij - .
Applicant Address: .l urae: Insurance: •
P 0 Box 34 (413) 584-1170
LEEDSMA01053 ISSUED ON:5/4/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE 3 WALLS, ENLARGE DOORS,
INSTALL KITCH CAB & NEW CEILINGS
Oil POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
0 Undergra:►ud: Service: Meter:
Footings:
Rough:( - c/,d& Rough:'7 7 D House# Foundation:
y�0 Driveway Had:
Final: 6- / :ob %' 1
inal:/e�/�G/Q ��.✓ �0"/��L oRough Frame:Plc 7- /el- B74, � 4
�i G
Gas: Fire Department Fireplace/Chimney:
ttouga: r..�,10 o...:
r iiiai: Smoke: 0/! . , Final:OK 5' ,30 —cc,, --(c
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION .
r
� ., am
.
Certificate of Occu anc Signature: 41—e
r R
r,
t: pe: Date Paid: Amount:
Building 5/4/2006 0:00:00 $164.005192
212 Main Street,Phone(413)587-12 iG,f:a:_. (413)587-1272
Building Commissio:.er. An:hcr:; Paullo
25 COLES MEADOW RD BP-2006-1175
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 13-073 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-1175
Project# JS-2006-1733
Est. Cost: $84300.00
Fee: $164.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Roger Clark 021310
Lot Size(sq. ft.): 492663.60 Owner: NEW ENGLAND DEACONESS ASSOC
Zoning: SR Applicant: Roger Clark
AT: 25 COLES MEADOW RD
Applicant Address: Phone: Insurance:
P O Box 34 (413) 584-1170
LEEDSMA01053 ISSUED ON:5/4/2006 0:00:00
TO PERFORM THE FOLLOWING WORK:REMOVE 3 WALLS, ENLARGE DOORS,
INSTALL KITCH CAB & NEW CEILINGS
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 5/4/2006 0:00:00 $164.005192
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo
File#BP-2006-1175
APPLICANT/CONTACT PERSON Roger Clark
ADDRESS/PHONE P 0 Box 34 LEEDS (413)584-1170
PROPERTY LOCATION 25 COLES MEADOW RD
MAP 13 PARCEL 073 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out '901 /G ,1,�,,
Fee Paid l�, y
Tvpeof Construction: REMOVE 3 WALLS.ENLARGE DOORS.INSTALL KITCH CAB&NEW CEILINGS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 021310
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
/Apprroved 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 • on
S- 2a 0.G
Signature of Building Official Dat
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.
Version1.7 Commercial Building Permit May 15,2000
-• Department use only
__ --- City of Northampton Status of Permit: . .
C Q Building Department Curb Cut/Driveway Permit -
212 Main Street Sewer/Septic Availability
— 2006 \ orthampton,iRoom 100 Water/Well Availability
3 MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Piot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1-SITE INFORMATION
1.1 Property Address: This section to be completed by office
`' ,Lti? )
,/ 1 ✓r (L� Lot Unit
1 CS .f-/��1��,,c' Map
4/0 r,t)t,ior1d n , ' l r Zone Overlay District
Elm St.District CB District
SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Ow9er of Record:
i 417 C0!'n
Name(Print) Current Mailing Address:
�/t1 c,svt y13 5 Z x a/ ! --977— 369-575/
Signature Telephone
2.2 Authorized Agent:
Uc)e; ` %at'-k f'.U. a0K 3 y Lt�Dsi /7% 0/0, 3
N e(Print) �� Current Mailing Address:
�. ae 3 -
Signature Telephone
SECTION 3- ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical �) 40� (b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
oty, Sao . de
4. Mechanical (HVAC) 3.3 ja, e e • d 6
5. Fire Protection 9.Cp 0 O .t1�1
6. Total = (1 + 2 + 3 +4 + 5) L-/ .7 06'OD Check Number 79(Q . 1 J( 411 a
This Section For Official Use Only
Building Permit Number: Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
t, 0 0
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
0 Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION: i-'c,,i,, ; in.),-/Is %y'tiKe 91elves• 1a•y<-• , d^sfiI/ 11 ;/cJ c'i C U, ,ets, a(''u''e'llnyS
SECTION 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
A Assembly I❑ A-1 ❑ A-2 0 A-3 0 1A I 0
A-4 0 A-5 0 1B ❑
B Business 0 2A 0
E Educational 0 2B I ❑
F Factory 0 F-1 0 F-2 0 2C 0
H High Hazard 0 3A ❑
I Institutional 0 I-1 0 I-2 0 I-3 0 3B ❑
M Mercantile 0 4 0
R Residential 0 R-1 0 R-2 0 R-3 0 5A 0
S Storage 0 S-1 ❑ S-2 0 5B 0
U Utility 0 Specify:
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUL I ION OFFICE USE ONLY
Floor Area per Floor(sf) 1st
2nd
1st
2nd 3rd
3rd —
4th
4th
Total Area (sf) Total Proposed New Construction (sf)
—
Total Height(ft)
Total Height ft
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 Er Private ❑ Zone: Outside Flood Zone 0" Municipal la On site disposal system 0
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page 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 NO
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property ?YES
No
IF YES, describe size, type and location:
Version 1.7 Commercial Building Permit May 15,2000 f •
SECTION 9- PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116 (CONTAINING MORE THAN 35,000 C.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
R P. CL 4R ( G-EA/ R, L CONTRAC To Not Applicable 0
Company Name:
Responsible In Charge of Construction
Box 3 9/ L r EDS ) /IA C]i 053
Address
Y13--S74-19f/
Signature Telephone
t Version1.7 Commercial Building Permit May 15,2000
SECTION 10- STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION 11- OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, VQ e r rY► , 0 C-- (1U6) fii ...44 0001) , as Owner of the subject property
hereby authorize pa 4 e r-- 1a etc to act on
my behalf, in all utters relative o work authorized by this building permit application.
_1--o4
Signature of Owner 1 Date
I, IUD Q'e r e £/a r- A , aswQwner/Authorized Agent
hereby declar 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.
Re ye:- {'• ci &
Print Name P M.,‘L
Signature of wner/Agent Date
SECTION 12 - CONSTRUCTION SERVICES
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder : feell f• C er hkc k ® / 3>
License Number
/309L 311 4ee6PS ,AM D/c133 ionJ
Address Expira Date
Signature Telephone
SECTION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L, c. 152, § 25C(6))
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 EI' No 0
�o goy �J11 ) 1I1 iCl:iI aiii ion
Q i ,alastarlincrlla• '
al.PE.-wwi_
k::=, DEPARTMENT OP cuiLDINC INSPECTIONS 4
212 Main Street • Municipal Building
Northampton, Mass. 01060
WORKER'S COMTENSATION 1I SURANCE AV 1:I)AVIT
ge f'e-/4
(l;ccns.crJpc'rrni ace)
with a principal place of business/residence at:
80K 3 y , L eEDS)./VA O/O- (phone) 9/3•-5 b?f—/#9/
(sa t/cty/suicJap)
do hereby certify, under the pains and penalties of-perjury, :hai
( ) I am an employer providing the following worker's compensa ion coverage Cor my
employees wor'ng on'this job.
(lnsur-:nc Company-) (Folic: Number) (E).pirtion Date)
( ) I,am a sole proprietor, general contractor or homeowner (circe one) and have hired
the contractors listed below who h2ve the following worker's compensation policies:
(Name of Co_^.'•.1cior) OnRf3ttt^ Corrloaiyi?oUCi Nuirlrcr) (E pip uon Date)
(Name of Contractor) (lnsuranca Company/Potic' Numcrr) (La)ir.:tion Date)
(Name of Connector) ansurancz Company/Poticy Nash!) (Expiration Date)
•
(Name of Contractor) (Losurance Company/Policy Number) (Expimion Date)
(atuch ad�i;,oca.l doco if 000cia y to cwuct:iafortna600 pcv.iaias to.n 000cracora)
(••••)(I am a sole proprietor and have no one woridng for me.
( ) I arn.a home owner performing all the work myself.
NOTE:pl=ae be aware th4 w4]e bomcowocra who ctapltry pesotn w do c-a r»r cc�cJoo c reaat work oo of
not mom th o t41oo tmrr is which the bomoowocr rttida oc co tb.c p-ou.a6 apptulco- t o a.-c cot.Ca-arty ocQ deed to be
cciploye'a•+ the wag-Suez rY-r :whoa Act(GL157s I(5)).application by s bommava for z bc=c or parna ray etidrorx the
legal mania of.o esployer awdcr tbo Workee's Coccrp.caetkna Act_
I uodcst.od tbet a copy of thi.cat.eorara roey b.forwarded to tbo Dopanmrra of in-'-•+'rid Oa-cadence O{1 o.of rrcur.00e for tb.
oovcrasc vaiLetioo and that Giltae to scout bovclase trndcn socGion 25A of MOL 152 as lad to the pn ioo of criminal pcdaltia
comiaixrg of a floc of tap to S),300.00 and/or impriaciacncat of up to ooc ycor tod evil pcaahio in 6c focal of a Stop Work On and.
fin of S I OO.00 a day tptittst me
For dcp.rta.=at u.c oat),
Permit Number
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MULTI-EENSORY
AREA
1 r -� -r -r --�c- r
ELEV 7 1I-
UNIT UNIT UNIT UNIT UNIT • UNIT UNIT UNIT UNIT UNIT
AS4 AS2 AS2 AS2 AS1 S WER AS2 AS2 AS2 AS2 AS4
0246 047 �48 049 0350 {�p( • L 029 0330 0331 0/32 033
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EX. EX. -�o a`L ie I _ .
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1 1 I 1 1 1 I I
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SHOWER
EXISTNG STAIR EllSTI STA R
b �z1 LIFE SKILL CENTER
----C''-r—' . _. _ _ .. 3.,.
LIFE SKILL CENTER
I 1
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9// 1 1 11 KITCHEN ) 1 1 ". '
DINING
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`� UNIT UNIT UNIT UNIT R1OM/ I 1 1 UNIT UNIT UNIT UNIT
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- -- - , , _r{a �1 , AS2 AS2 AS2 AS4
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EXISTING WALLS TO REMAIN
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