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Are'O R1 O l U S C 0 Ate'E N S A M 0 N
%�?i� 1/o v/e Co/-;-5
k. F pr;ncipal plan;, of business/r(-,si--'jcnce z!
_Cony.
do hereby cm-11Y, under Lhc pens and pcuallies of perjwj Thal
(� t um ?n employes prouding Jae following workcA comoensruon coymy For in),
up'oycc5 wori�ng on t]L joh
(L ns = (PcL c. Nu---a'E-zr)
100 a sole prooneror, general coni--3ctor or hoaieorvicer (conic one) �-rld I7Eve hired
lie conuawoz 550 'below n0o have r foLowioQ worke scope, ��on pe'��cies:
(NapjC Oi
-- (N;�c oc Cou-actor) (Losinicc Compa2y/Poljcr \roc°r) (-L>:-cu-:ho Dot
cr'=mr of co=M0, (Ins rant, Comgany fPO5q N=L'1 ) '7 pu--.6 D Datci
of C—ollaactor) jjls-d any cvm�-10-'YIPOLCY Nub ) (Exqu um Dom)
(�e��_.'l�.:„c.�l c�-e v�❑cepeY'w_'_ �r_(o�tv.�ee �+.�-t�-,c._n�L-, .-ll m_c-moo:
proprietor and nave no oec� for me.
( j i acl a homi;e o"rner periorT[I'Mg all the -WCr;; myStjf,
NG�:ply N��rc�h�u�1c bc�=o-.�m_.-�wto splay r,.czom w u; ��c_�--��:o c rcyar, .orx� .d.•.1L:;,of
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I c�J titer o f c��� o•/r, un dcr dw W
o(th:, c�.csy.L c�:.y��[�.-,.-.,.1-rC _.,r. of IW�vv.^:J
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Vers ion 1.7 Commercial Building Permit May 15, 2000
SECTION..10- STRUCTURAL.P,EER REV[EW,`(7MCMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No..,._.❑
SECTION 11 OWNER AUTHORIZATION.-TO BE,C WHEN
OWNER R S AGENT O CONTRACTOR APPLIES FOR_SUILDING PERMIT
rnC7O C' / DiCklp s/onn as Owner of the subiect property
hereby authorize Q Gf lC ��OU e C D/ S r/'UG t/O/� T/7 G _to act or
my be in all matters rel + ork authorized by this building permit application.
Signature of Owner Date
Gt 1//YID/�c� �, ryDl1/� CUSS �`l'uGTie7/� Zh 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.
Print Name
Signature of Ow en Date
SECTION 121:-OONSTRUCTION SER1!10ES
10.1 Licensed Construction Supervisor: Q Not Applicable ❑
Name of License Holder : 72W, 7/e`' 066227
License Number
//er S r yc��a�/ �i9 c /e,,7 5 6 07-07- 07 ---
Address. Expiration Date
Signature Telephone
SECTION 1,3 -WORKERS' COMPENSATION INSURANCEAFFIDAVIT(M.G 1 c-.:6-15 2,-§:25C(5))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this a'Pda
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... �' No...... ❑
Version 1.7 Commercial Building Permit May 15,2000
SECTION -9-`PROF,ESSIONAL DESIGN AND CONSTRUCTION SERVICES - FOR BUILDINGS AND STRUCTURES SUBJECT T.0
CONSTRUCTION'CONTROL' PllRSUANT Tb,780 CMR 116{CONTAINING MORE THAN 35;000 C.f.:OF ENCLOSED,'SPACE)'
9.1 Registered Architect: _
7Not Applicable ❑
Name(Registrant): _
istraticn 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
i
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address I Registration Number
Signature Telephone Expiration Date
I
9.3 General Contractor
RQ V 115 1PVC /Oh 1/?C. Not Applicable O
Company Name:
Respons'ble In Charge of Construction
Address
Signature Telephone _�
Versionl.7 Conunercia: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 ❑ Private ❑ Zone: Outside Flood Zone Municipal ;1 On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This colurrm to be filled in by
Building Department
Lot Size C/ 9, 1127 8 96 9, y27,B
Frontage 8 r' se., 12650,
Setbacks Front 102 , / 02
Side L: 88 R: y2 L: 88 R: X12
Rear
Building Height
Bldg. Square Footage y02 $6 % y0z,8b 1,
Open Space Footage %
(Lot area rninus bldg&paved l�/D 6 y0. 6
parking)
#of Parking S aces 761 761
Fill: N/� N�i4
(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: Der 1.31, 200)
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book ! 50y Page 2 39 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: VArl 0 t1
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
SECTION 4-'CONST-RUCT ON SERVICES FOR PROJECTS LES§,THAN 35,000
:UBIC FEET OFfNCU0SEp-i§'kt Y
nterior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑.. .:xterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
3RIEF DESCRIPTION: /I or /`eAdiatran S T� Cdea7e rv'a{7i.A�G �de<s a.ret o cB-S 1A ��e- �o;.47
_ �'e•r7"�c^
;ECTION 5 =_USE GROUP AND CONSTRUCTION TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A {
A-4 ❑ A-S ❑ 1B ❑
Business ❑ 2-A, ❑
Educational ❑ 2B ❑
Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
I High Hazard ❑ 3A ❑
Institutional ❑ I-i ❑ I-2 I-3 ❑ 3B ❑
I Mercantile ❑ 4 ❑
Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
1 Utility ❑ Specify:
d Mixed Use ❑ Specify:
> Special Use ❑ Specify:
COMPLETETHI5§ECiION j1=8dSIINGBUILDING UNDERGOINGK2ENgVWN5,ADDITIONS ANDJOR CHANGE IN USE
xisting Use Group: 1-2 Proposed Use Group: Z-2
:xisting Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y
SECTION 6'.BUILDING HEIGHTAWAR.EA
�OFFIC SEQNQ Rr
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION r- ;
IN L'n ::ti ':
,5
Z J
Floor Area per Floor(sf)
/ w
ga
�ay
M oW,z v v s
r
2nd 3rd }
3rd
4th x
F -
Total Area (sr) Total Proposed New Construction (sf) A Y
Total Height (ft)
Total Height ft—-------------- s
Versionl.7 Commercial Building Permit May 15, 2000
City of Northampton
Building Department } : 1 ►a e = _
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587-1240 Fax 413-587-1272 j ans Z
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,I,CH�1N?iE,T E lE pRiOCCItPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN d bNi�0 0 Ei Iii tYbWELLING
U U L.
SECTION 1S .SITEINFORMATION
_..... Map ;
s.'e at �ompSac eK yo'P fA�f Lc.l..e j
'Lr tfi 1t
1.1 Propery Address. S
Coo/e v D'Ckihs,on Ho5Di tQ�- p xt
f
30 /
4 ocus / 5s4�ay crvn Yc
p�yi��.-.a�r�sl�y Y'"t5,�y�.,.�,[4�-{�.'r, w d� a+^�'r'.�F��y���3-✓yp-"��x y-.-rte Ci yt' +'i C:
SECTION 2 PROPERTY OWNERS. IPJAUTHORIZED AGENT
2.1 Owner of Record:
Coo/e v DtckinsonfHosol2_�oI 30iocrrst S t. P0. l9ox 5aol
Vame(P t) Current Mailing Address:
S'/3- 582 - z3/3
Signature Telephone
2.2 Authorized Agent:
7/7m071-Ay S. /'e Ile t%ee 61n/lleh 5t. L,ud/oul, AW 621056
Vame (Print) Current Mailing Address:
0
5'i3- 5S'7- 2 500
Signature Telephone
SECTI643' ESTIMATED CONSTRUCTION COSTS
[ter Estimated Cost(Dollars) to be Official-°Use Only
completed by ermit applicant
L. Building 21 , 3 �O ov (a) Budding Permit-Fee
?. Electrical p {b)estimated Total Cost of
Construction from; 6
3. Plumbing ��� a'° BuildmyPermitfee.
1. Mechanical (HVAC) /, C2 C70- •• __
3. Fire Protection
3.
°
Total Q
•_ Check Number
;This'section For Of IC161 Use''.Onl
3uilding Permit Number Date Issued:
signature:
Building Commissioner%Inspector of::Buildings Date _.
File#BP-2008-0058
APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc
ADDRESS/PHONE 5 MILLER ST LUDLOW (413) 547-2500 Q
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
Building Permit Filled out
Fee Paid
Typeof Construction: RENOVATE 1 ST FLR JOINT CTR TO CREATE WAITING AREA&OFFICES
New Construction
Non Structural interior renovations
Addition to Existing
AccessoKy 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
INF916IATION 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
Zaa
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.
30 LOCUST ST BP-2008-0058
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: B.IUILDING PERMIT
Permit# BP-2008-0058
Project# JS-2008-000084
Est. Cost: $27840.00
Fee: $117.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq. fw: 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M Amplicant: Raymond R. Houle Construction Inc
Applicant Address: Phone: Insurance:
5 MILLER ST (413) 547-2500 O Workers
Compensation
LUDLOWMA01056 ISSUED ON.81112007 0:00:00
TO PERFORM THE FOLLOWING WORK.RENOVATE 1 ST FLR JOINT CTR TO CREATE
WAITING AREA & OFFICES
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Insper:nr of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: - %;�'�� House# Foundation:
Driveway Final:
Final: Final: -x11
Rough Frame: L
Gas: Fire Department � — � Fireplace/Chimney:
Rough: Oil_ insuiatio,i:
Final: Smote: Final:01< 12'/t4o P t""i t
THIS PERMIT MAY BE REVOKED BY THE CITY-,OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULAT NS.
,
r,
Certificate of Occupancy signature: `r
FeeType' Date aid: Amount.
Building 8/1/2007 0:00:00 $117.0014018
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner- Anthony Patiilo