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�ELTICN 1-0 STRUCTURAL PEER REVIEW (780 CMR 11P-11)
r-,�E-nden' Structural Engineering Structural Peer R.evie 1 Repaired
—E-
SECTIGN 11 - OWNER AUTHORiZATIUN -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUfLDING PERMIT
_— Coo/(2
a C�. Oi -L C, S C C
hereby authorize �ersaci my be in all meI ork authorized by this building permit application.
Signature of Owner Date
Boom
____Ll a(//YIDh� /7D11/P CDhS Tl'UCT/D/V �17C , as Owne ��hzed Agee
hereby dec are that the statements and information on the foregoing application are true and accurate, to the hest of my
knowledge and belief.
Signed under the pains and penalties of perjury.
-
II Print Name
Signat—a�eo f O w en Date
7
S —_
10.1 Licensed Construction Superviso-r: Not Applicable O
Name q4 License Holder : ///Y/O� S,_0 /�e 7�/e/ _ - . 066227
'_ice nse Number
Svc//DZI/
Address. Expiration Date
y13-
Signature Telephone
' I
SECTION 13 -WORKERS' COMPENSATION INSURANCEAFFIDAVIT {M G:U c. 152,§ 25C(6))
Compensation a aced vt must mpletd and submitted wish `ris application. 'rallure pro e 11-1`esul the deni l of thei anc ithe building g permit.
_ — --
i —
Signed Affidavit Attached Yes....... W Nc-,— El --- -
F_ ',Idly
,ECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR BUILDINGS A1.'D STRUCTURES SUEJECi_T0
CONSTRUCTION CONTROL PURSUANT TO 780 CPIi', 1.16 (CONTAINING I'MORE THAN 35,000 C.F. OF ENCLOSED SPACE)
9.1 Registered Architect:
-?ratTCr �dun,oer
u':ress -- -------
Expration Case I
T
S.
n t'ire Telephone
92 Registered Professional Engineer(s):
I� !I
Name I Area of Responsibility
Address Registration Number
Signature elephone Expiration Date —�
(`dame Area of Responsibility
I
I
Address Registration Number
Signature Telephone Expiration Date
Narne Area of Responsibility
I
'address Registration Number
- — ------- ---- II
Signature Telephone Expiration D ate
I
Vame Area of Responsibility
P,egistraticn Number--- – ----- I
Signature ------ – — e ephone -------� `_y,pi�ahcn Dat----- – ---
?.3 General Contractor
Not Applicable ❑ J
,ornpany Name
'esoonsible In harge of Construction
I
Versiornl.7 Conimercia'Building Permit tilay 15, 2000
' Wager Supply (M.G.L. c. 40, g 54) 7.1 Flood Zone Information: L7.3 Sewage Disposal System:
Public n Private ❑ Zone: Outside Flood Zone unicipal 14 On site disposal system
8. N ORTHA_NUTON ZO NZNG _ _ ---------
t Existing Proposed 7 Required by Zonim, — )
this coh!mn to be filled in by
i Building Deparhnent
Lot Size 96 9, 1127 3 96 9, 1127,8
—Frontage
Setbacks Front /o2
Side L: 88 R: 12,12 L: 68' R:_ Sz2
Rear 18 l8
Building Height 5 ' 6 y 5
Bldg. Square Footage %
yoz 86i. yoz,eb� .
Open Space Footage %
(Lot area m nus bldg&paved
parking) l�
# of Parking Spaces ;76 7
Fill: N/A N�,4
(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: DeC' /_�,.2o0/
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book 6 SO jz Page 2 3 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 tl,e property? YES — 1✓ NO _
IF YES, describe size, type and location,_ VA P 10 vs
D. Are there any proposed changes to or additions of signs intended for the propery ?YES
No _�f
IF YES, describe size, type and location:- _ __
Versionl.7 Commercial Building Pen-nit May 15, 2000
iEClZ0 4 CONSTRUCTIONSERYICES OR PROJECTS LESS THAAl35 000
3U BIC FEET,OF FN CLOSE D SPACE. '
anterior Alterations Existing Wall Signs Existing Ground Signs Additions ID Roofing E-1❑ ❑
Exterior Alterations Demolition New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION: k9e l��r// u���� �r,L �r���e . i�my� ttf/rte, •o�..,4
3EC7ZON 5 -USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A �-
A-4 ❑ A-5 ❑ 1B ❑
Business ❑ 2-A ❑
Educational ❑ 2B ❑
Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
I High Hazard ❑ 3A ❑
Institutional ❑ I-1 ❑ I-2 I-3 ❑ 3B ❑
1 Mercantile ❑ 4 ❑
Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
I Utility ❑ Specify:
1 Mixed Use ❑ Specify:
Special Use ❑ Specify:
COMPLETE T.tiISSEC��ON iFFaiST1T� UILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR 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
>ECTION 6.BUILDING HEIGHTA PEA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ]r 'w..` FF CEtiSEflNLl f j
-loor Area per Floor m S 74 1n
E,n
2nd
St
S
,na 3rd v
rd
th
1 y l
n J
R t
otal Area (sf) Total Proposed New Construction (sf) 1�
otal Height (ft)
Total Height ft
N/�+
Versionl.7 Commercial Building Permit May 15, 2000
City of Northampton
Building Department ae
212 Main Street
Room 100 aI
Northampton, MA 01060 ets a , la z
phone 413-587-1240 Fax 413-587-1272 a❑s s an`^
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, 0 DEMOLISH NY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
ee
Kd
r F x,,01
SEC130N 1'-1:SITE'INFORMATION
1.1 Property Address: je-ompleAed b- "ffic °
kr". �, n
Coo% S/ O 'cklnso/,? HOSDItai �
/ �)�`
EN
_/L.. r`-�• yy�.'rZ011e ` ' f�- r ; verlay Drs�ct"r
30 4 O c V yp 1
SECTION 2 <PROPERTY OWN EPMIPJAUT{iORIZED RGENT
2.1 Owner of Record:
Cooie y Dickies oh HOSQ 1-0/ 30 Z ocvs /?o. /3ox Eoal
Jame(P' t) ' Current Mailing Address:
y/-3- 582 - (R 3/3
;ignature Telephone
1.2 Authorized Agent:
Ti„or-fiy S. 1°e 11e7-ier 5/I'I,'l/eh St. I-ud/ocy, /l'1�9 O/o56
lame (Penh Current Mailing Address:
5'/3- 5y7-- 2500
ignature Telephone
ECTION3. (ESTIMATED CONSTRUCTION COSTS
.em Estimated Cost(Dollars) to be - Of dal-Use Only
completed by ermit applicant
Building (a) Building Perriiit Fee
Electrical {b)-Estimated Total Cost of .
-cnstruction`from='6
Plumbing Building Permit Fee.
Mechanical (HVAC)
Fire Protection
Total = (1 + 2 + 3 + 4 + 5 Check Number _ 5�l�°
This Section For Official Use'Onl _
jilding Permit Number Datelssued:
gnature:
Building:Commissioner%Inspector nfBuildings Date
File#BP-2008-0164
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 M77 _
Typeof Construction: WEST3 INTERIOR DEMOLITION
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 F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Str ommission
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-2008-0164
GIs#: COMMONWEALTH OF MASSACHUSETTS
Ma: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: demolition BUILDING PERMIT
Permit# BP-2008-0164
Project# JS-2008-000228
Est. Cost:
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use GroML-- Raymond R. Houle Construction Inc 066227
Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
zon ;:M Applicant: Raymond R. Houle Construction Inc
AL. JV LCiC'J
Applicant Address: Phone: Insurance:
5 MILLER ST (413) 547-2500 O Workers
Compensation
LUDLOWMA01056 ISSUED ON.811612007 0:00:00
TO PERFORM THE FOLLOWING WORK:WEST3 INTERIOR DEMOLITION
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: _:
Final: Smoke: Final: r,t d'2
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Ow C4 4", Si nature:
FeeType: Date Paid: Amount:
Building 8/16/2007 0:00:00 $50.0014071
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Conunissioner-Anthony Patillo