23B-046 (17) a
20"d ldiOl
t
contr. supervisors Lic.No. 011878
0 Tel. 413-584-1387
YOUNG a, D 0 413-888-9167
Fax 413-585-0226
PA.13=00 W PL0HM=MA.011 0W6
Customer : Tbo Cooley Di•ckinsoa Hospital Hate: 5/19/09
Address: 30 Locust St. Norttxa.mptopw ,�
Sob Location
The Old entrance - - ---
SPECMCA.T rONS:
I. Remove the following ezcisting roofing,ballast stone,insulation, edified bituthene,and 3/4 inch
fiberboard insulation down to the decking.
2. Apply 3.3 inch polyisocyanumte insulation over the complete 1.0 ed to the concrete
decking ith Spot Shot adhesive. Aged R Value 2*r
3. Install C parlisle 'so.060_gauge fully adhered roofing system.
4. Flash all walls,edges,;rid roof penetrations with an apgrgred Carlisle detail.
5. Fabricate and install .032 gauge gray aluminum edge - 1W locked to a:kicker strip.
6. Install all necessary wood nailer and flash three new 40 inch by 70 inch curbs.
7. Obtain a building permit for the roofing work.
8. Remove all our roofing debris from the job site and dispose of in a legal land fill.
9. Upon completion of the work Carlisle will inspect the job an issue the owner a Fifteen (15) year
Tanta],Svatem warranty.
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Signature-16chard XOUA�8ldeat
Acceptance of Proposal-rm abme p>riceespocittcetiana
and conditions are sadsfaetary and are bemby I,= Yvu arc avdWZed signature
to do the work"gecifled.Payment w• be s n above.
A=ept=e Date of Acceptau0s
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Versionl.7 Commercial Building Permit May 15,2000
SECTION 10-!STRUCTURAL PEER:REVIEW(780 CMR:110:1.1):
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION:11 -OWNER AUTHORIZATION TO`BE.COMPLETED WHEN._. ..
.OWNERS:AGENTOR:CONTRACTOR APPLIES FOR BUILDING PERMIT'::::>
_ .
i, � T� ������ ��� ��,as Owner of the subject property
herebyauthorize _ --_--- _ — ---_ _... ----- -...._..------- --...- --...__..._._.....---......__....--.....__._........... -..._...._-...._.................._...._..............._to
act on my behalf,in all matters relative to work authorized by this building permit application. _
Signature of Owner Date
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.
Si ned under t i s an�er]alties f�equrv.
6l
Print Name
Signature Owner/Agent Date
SECTION 12 CONSTRUCTION SERVICES
10.1 Licensed Construction Suaervisor: Not Applicable ❑ _ _
Name of License Holder
License Number
Address 7 � �:
Expiration 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 ® No
Versionl.7 Commercial Building Permit May 15,2000
3EGTION:°9-PROFE3310NAL dE61GN AND G('JN3TRUGTION.SERVICE3'-FOR BUILDINGS AND:STRUGTURES.SUBJECT TO
CONSTRUC.VON.CONTROL;PURSUANT TO`7.80:GINR'118(CONTAiNINCi:'NIORE THAN'35,1100.C:F OF°ENCC:OSED SPACE
8.1 Registered Architect:
Not Applicable ❑
Name(Registrant): t
Registration Number
Address t I
Expiration Data
Signature Telephone
9.2 Registered Professional Enginee 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
_ _ _ 1
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
_• Not Applicable❑
company Name:
Responsible In Charge of Construction ��
Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
NM
Ta
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Fronta e --
Setbacks Front
Side L:= R:= L:,= R:C_= I�
Rear
Building Height
Bldg.Square Footage % r 1
Open Space Footage %
(Lot area minus bldg&paved t. ...l
parking)
#of Parking Spaces
Fill:
vvlumo&Location
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO Q DONT KNOW ® YES 0
IF YES, date issued: I J
IF YES: Was the permit recorded at the Registry of Deeds?
NO ® DONT KNOW ® YES
�� and/or Document//
IF YE5: enter Book F Page
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW ® YES 0
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 0
IF YES, describe size, type and location: L--
D. Are there any proposed changes to or additions of signs intended for the property? YES ® NO
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or Is it part of a common plan
that will disturb over 1 acre? YES ® NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4=CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 39,000
CUBIC FEET.MENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing I4 Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: (J4 c,( w c[ Voc ts(� .
SECTION 5=:USE GROUP AND.CONSTRUCTION:TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 11 A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 113
❑
B Business 2A ❑
E Educational ❑ 2B ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ 1-1 ❑ I-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 ❑ Specify
S Special Use ❑ Specify
_�.
COMPLETE:THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: L ___� ___ . � Proposed Use
Existing Hazard Index 780 CMR 34):L.__ � W_u_� Proposed Hazard Index 780 CMR 34):
SECTI0N:.6 BUILDING HEIGHT AND AREA.
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
OFFICE USE ONLY
s t
Floor Area per Floor(so
lot
lot
2
nd
2nd ------------°.._.
_ _ _�• -- _. s
rd
3�
3 ---
4th 4"' ;
Total Area(so Proposed New Construction Isf)
Total Height(ft)
Total Height ft {� _
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 ❑ On site disposal system❑
r
Versionl.7 Commercial Buildin Permit Ma 15,2000
City of Northampton
� Building Department
212 Main Street
Room 100
a1 '6 Northampton, MA 01060
pbone 413-51240 Fax 413-557-1272
APN'CATION,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:
—/�- y--- _---------- --`— --- - --
�,i:Ll Lot..:Umt
on :Overlay,District
'C8 oistrl&t
SECTION 2;..PROPERTY:OWNERSHIP/AUTHORIZED.AGENT
2.1 Owner of Record:
iC kiy�`l�l �( �1)i �� —I EIL11 fi
Name(Print) Current Mailing Address: _
Signature Telephone
2.2 Authorized Agent:
Name(Print) Current r Mailing_Address.
22:Signature � �` Telephone
SECTION 1w ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building
E::1:::r,:
.(a)Building Permit Fee
2. Electrical - �- (b)Estimated Total Cost of
Construction from 6
-...............
- --
3. Plumbing :Building Permit Fee
4. Mechanical(HVAC)
5.Fire Protection
6. Total=(1 +2+3+4+5) Check Number
This.Section For Official Use Onl
Building Permit Number.. Date
is
Issued
Signature
Building Commissi6her/Inspector of Buildings Date.:. - ..
,
. " BP-2009-1077
GIs#: COMMONWEALTH OF MASSACHUSETTS
:Block:23Brt 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-2009-1077
Project# JS-2009-001560
Est. Cost: $21750.00
Fee: $130.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: YOUNG ROOFING CO INC 011878
Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M(99)/URB(1 /L Applicant: YOUNG ROOFING CO INC
AT: 30 LOCUST ST
Applicant Address: Phone: Insurance:
P O Box 60056 (_413) 584-1367 Workers
Compensation
FLORENCEMA01062 ISSUED ON.611912009 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL INSULATION 7 ACARLISLE ROOF SYS
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 6/19/2009 0:00:00 $130.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo