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Versionl.7 Commercial Building Permit May 15, 2000
SECTION10- STRUCTURAL•PEER REVIEW(780 CMR 110.11) 777�
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......D
SECTIONi.11,:--OWNER AUTHORIZATION-TO BE�OMPLETED WHEN
OWNERS'AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT " .
i
I, Coole y D�ekiy� s !/os,ol' L as Owner of the su'ojec', property
hereby authorize Q vlwond on l?n /7 0U e C 0 12 s r/"o t/Oh Tf0 6 . _to act cr.
my be in all matters rel + ork authorized by this building permit application.
Signature of Owner Date
Tl'uC7 iC7/7 �h C , as Own-, A en'
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 perjury.
Print Name
Signature of Ow. Fen Date
SECTION 12:-CONSTRUCTION SERVICES
10.1 Licensed Constructions Supervisor: Q Not Applicable D
Name of License Holder : //'0'5' 1 o% S. 0 eI% 066227
License Number
ll16, 07-07- 07
Address Expiration Date
�/ - y7 00 _
Signature Telephone
SECTION 13 -W ORKERS''COMPENSATION INSURANCE AFFIDAVIT(M,G!t c 152,§:25Ci( ;
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this a:ida
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... �Z No...... D
Version 1.7 Commercial Building Permit May 15,2000
SECTION .9 PROFESSIONAL DESIGN -AND CONSTRUCTION.SERVICES FOR BUILDINGS AND STRUCTURES SUBJECTJO
CO.NSTRUCTION'CONTROL PUPSUANT;TO,_7. O, 116{CONTAINING MORE THAN 35;000 C.F OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(,Registrant):
Registration Number
I
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
I
'
Signature Telephone Expiration Date J
I
_ I
Name Area of Responsibility
I
Address Registration Number
I
Signature Teiephone Expiration Date
I
Name Area of Responsibility
i
Address Registration Number
i
Signature Telephone Expiration Date
— I
Name Area of Responsibility
I
I
Address Registration Number
Signature Telephone Expiration Date —J
9.3 General Contractor
l`f..rvvZC (. O/7S7 11)UC7—,10,-')_52 6. NotApphcab!e ❑
Company Name:
Responsible In harge of Construction
Address
.55'72500
Signature Telephone __�
Versionl.7 Commercial Building Permit May 15,2000
7. Water Supply(h1.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System;
Public ❑ Private ❑ Zone: Outside Flood Zone jS( Municipal 14 On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size 96 9, 1-127 8 96 9, y27.8
Fronta e 2 6 59 2 6 5 8
Setbacks Front 102 / 02
Side L: 88 R: yZ L: 88 R: y2
Rear 18 /.9"
Building Height
Bldg. Square Footage %
1102,96
Open Space Footage %
(Lot area minus bldg&paved 1/0- 6 7 d 6
parking)
#of Parking, Spaces 761 761
Fill: N/A NIA
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES X
IF YES, date issued: Dec 131, .200J
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book 6 SDy Page 239 and/or Document #
B. Does the site contain a brook, body of water or wetlands? NO DON'T 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: VA h l o vs
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-CONSTRUC710NSERVICESTOR�ROJ.ECT LESS THAN35,000
CUBIC FEET°OFNGLOSED SPADE �' _
Interior Alterations Existing Wall Signs Existing Ground Signs Additions 11 Roofing ❑
� ❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION: 04,4 U,- A k/
(T'�x>S%'y� a ,4 0 r0 X) ' n d/
SECTION 5 USE GROUP AND CONSTRUCTION TYPE '
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
I Institutional ❑ I-1 ❑ I-2 I-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:
CON1PLEi E THIS SECfION,IFD35T3iVG�UILOING UNDERGOIN;r2ENOVAIONS,ADDITIONS ANDJOR CHANGE IN IJSE
Existing Use Group: 1-2 Proposed Use Group: Z-2
Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y
'SECTION 6:BUILDING HEIGHT AND,
BUILDING AREA EXISTING l
PROPOSED NEW CONSTRUCTION y�,.. ����OFF.IC-EUSEONIY 2
44 ""4
Floor Area per Floor (sf) n '�
t
2nd t 5 e a
nd
2 3rd
3 rd
a
4
4th -
dl L -
a
� J ) 4
Total Area (s Total Proposed New Construction (sf) 3 `t
4 ' y
Total Height(ft)
Total Heig'it ft i
Versionl.7 Commercial Building Permit May 15, 2000
City of Northampton
t
Building Departments
212 Main Street
Room 100 -- e . . . .
Northampton, MA 01060 eta ax
phone 413-587-1240 Fax 413-587-1272 ads a � .
_mss-a`�'``
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY Of, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
.. �..,f '1
SECTION YY SITE INFORMATION rt
Th"ssecfioo a corn feted
1.1 Property Address: ' , p F
3'�
prGk!l�son
ON-
3 O K 3K N V Mz t 4 �6 J 4 f
0 U S t SZone� 4�a �verlayD�S�ctr w
SECTION,2- PROPERTY OWNERS HIPJAUTfiORIZEDAGENT
2.1 Owner of Record:
Coo/ey Dickinsoh HaSD%Tal 30Lorost Sr. Ro. I3ox �aa7
Name(_�' � Current Mailing Address:
X13- 582 - 23/3
Signature Telephone
2.2 Authorized Agent:
71vo7-hy 5. /'e Ile t-;er 6177,'lleh 57. I-ucl/ouJ, /-Pd Q/056
Name(Pr Current Mailing Address:
o
5'%3- y7- 2 500
Signature Telephone
SECTION 3:- ESTIMATED CONSTRUCTION-COSTS
Item Estimated Cost(Dollars)to be Official-Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
2. Electrical y��- {b)estimated Total Cost of
- Construction from 6 _�
3. Plumbing 7C d 0. �a ing
Build Perniitiee.'
4. Mechanical (HVAC)
5. Fire Protection
S. Total = (1 + 2 + 3 + 4 + 5) (0 3 yeRQ Q° Check Number_
This Section For Official Use Qnl `
---
Building Permit Number - Datelssued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2008-0863
APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc �ROW 1-4e
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 _ 14;p IQ
Fee Paid
T_ypeof Construction: CONSTRUCT SHOWER ROOM IN BASEMENT P2000 ENTRANCE(NEW WELLNESS
AREA)
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
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 Commission Permit DPW Storm Water Management
Demolition Delay
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.
0 LOCUST ST BP-2008-0863
GIs#: COMMONWEALTH OF MASSACHUSETTS
i\IaP:Biock: 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)
Cateeorv: BUILDING PERMIT
Permit# BP-2008-0863
Project#, JS-2008-001314
Est. Cost: $63480.00
Fee: $317.50 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
7oning:i/l Applicant: Raymond R. Houle Construction Inc
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
5 MILLER ST (413) 547-2500 O Workers
Compensation
LUDLOWMA01056 ISSUED ON:411112008 0:00:00
TO PERFORM THE FOLLOWING WORK.CONSTRUCT SHOWER ROOM IN BASEMENT
P2000 ENTRANCE (NEW WELLNESS AREA)
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:/v$ House# Foundati on:
on:�ROU h: J�l�
Driveway Final:
Final — — e Final: ;' —•�
v g; Rough Frame.
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
k./ f / 1�
/'
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy e� si nature:
FeeType: Date Paid: Amount:
Bolding 4/11/2008 0:00:00 $317.5014884
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo