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23B-046 (35) k U 1 €�- Cj U_© . InF ® Cl ®,� i 1 S � Y rm 3 1 3� i { } x ! r� t _. £ f=� 4 � E Y � F LF Flu#,�l,'------ll . ......... cl ................. . € F I; � 3 € E l-. ::- € Ch i , t } 3 � € � l } e r i } rl ............ IN, ............. -------------- ----------- .......... ........... i E I } } ! O[ ! ! E } i } [ I } C [ I 4 < 3 v i ....'.._., _ i ti F [ t /� { S 1 t S t i i } i s f I S S Versionl.7 Commercial Building Permit May 15,2000 SECTION .9-PROFES1 ,ALDESI.CNANDCONSTRI CfIOPtSERIIICES-�FORBUILD1NGS7WDSTRUCTt1RE5 UB.�ECT.TO CONSTRUCTION CONTROL PURSUANT TO 7$0 AMR 116_CONTAINING MORE THAN 35pOQ C:F,OF ENCLOSED SPACE) 9.1 Registered Architect: i Not Applicable ❑ i Name(Registrant): ! Registration Number Address 1 , 1 i Expiration Date I Signature Telephone 9.2 Registered Professional Engineer(s): i Name Area of Responsibility Address Registration Number f I ! i Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date. c I } Name Area of Responsibility � f Address Registration Number Signature Telephone Expiration Date I i 1 Name Area of Responsibility I { y Address Registration Number i c I i j I Signature Telephone Expiration Date 9.3 General Contractor Not Applicable ❑ Company Name: Responsible In Charge of Construction r i . i Address Signature Telephone rION 10- STRl9CTURaiL PEER REVIEW(780.CNt�2 X1 *�gj :e endent Structural Engineering Structural Peer Review Required Yes......0 No......® SE "10N 11 =;OWNER AUTHORIZATION. :TO IIE:COMPLETEII WHEN Ov TIERS AGENT OR CONTRACT®17 AP�tIES FOR �U9LbgNG PERMIT. F he!- as Ow ner of the subject property y authorize to act on half, in all matters relative to work authorized by this building permit application. Sig `ure of Owner Date [he� / I / )11,2�.C� , as Owner/Authorized Agent ', declare that the statements and information on the foregoing application are true and accurate, to the best of my :,. edge and belief. Si. •d under the pains and penalties of perjury. Pri i j SiE of Owner/Age a SE "ION 12 :COtdST.RUCTION SERVICtES�; 10, '._icensed Construction Supervisor: Not AWicable 0 .Na cl License Holder : �l 0 11 C �tJ d/ �/ License Number 3 o Acl ,sy Expiration Date SiE: . ::r-; Telephone SE--;ON 13 WORKERS' COMPENSATION INSURANCE Ar, IDAVI1 25C(6� W ors Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit wi ,su!t in the denial of the issuance of the building permit. Is id =,ffidavit Attached Yes::..... 0 No,.... i v i i Version 1.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size ' 1 Frontage Setbacks Front ra Side L:' I R:: y u L:[ i R:j , i 4Tj Rear -Building FIel�t-- I i j __ _ Bldg. Square Footage + j % Open Space Footage ✓f % ; (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 (D DON' KNOW 0 YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DON' KNOW 0 YES IF YES: enter Book l ! Page! i and/or Document#' i B. Does the site contain a brook, body of water or wetlands? NO 0 DON'T KNOW 0 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 0 IF YES, describe size, type and location: Q D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO IF YES, describe size, type and location: I 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 Q ' NO IF YES,then a Northampton Storm Water Management Permitfrom the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SEGTI.OIJt ' COSTRLJGTION 5ER1/10ES�F.C��PROJECS$CESS?HAN 35;000 C.CBIC FEET OFHCLOSED'SPAGE Interior Alterations 9 -Existing Wall Signs ❑ 'Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description'_ Enter brief descrij�on here. i 4% C, U 2 --'A'/ Tv TUIC �Lo-r Of Proposed Work:; C Zti Gt d/ Ck :'Y-er 121U✓-1c r 0&1D,,e4 /-A- 7- --i '77,t_- 01:5- 7�7 c SECTION 5.=USE GROUP AND CONSTRUCTJON TYPES 4 USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 . ❑ A 72 ❑ A-3 ❑ 1A ❑ ❑ A-5 ❑ 1B ❑ B Business ❑ — 2A 1 E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional l-1 ❑ 1-2 0, 1-3 ❑ gB ❑ 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: I S Special Use Specify:i COMPLETE THIS SEC ION 1FEXISTING BUILD'lNG UNI7El�G0(NG RENDUATIONS,ADQITtONS AND10R CEIAN'GE,IN I'SE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34):1 Proposed Hazard Index 780 CMR 34): SECTJONi6tBUILDINGHEIGHT AND AREA; BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(so ist Ist t 2nd nd 2 �. . 3d ' i 3`d I i 41h 4m , Total Area(so l ' f Total Proposed New Constructions _ # ice . hip,.. '��}�. µq 4 r Total Height(ft) I _ Total Height ft 7.Water Supply(M.G.L. c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa a Pisposal System: Public Private ❑ Zone! 1 Outside Flood ZoA Municipal On site disposal system[] Versionl.7 Commercial Building Penn it May 15,2000 City of Northampton Building Department 212 Main Street Room'100 , Northampton, MA 01060 Phone 41 272 APPLW,A-'ION TO CONSTRUCT,1kEPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECZION? S{TE'fiNFORMATION,'� fit-Property Addres Ttris >ctroc�to be cornpieted try office ! t -.vp... 7 d- t 4 T Z R a # as i �� (!� lr'V ✓/ 14��r�# - z , r - �rca� } ti 4.rsx� -'�,r.. .�, a:...,rte �'a t s�.x`A9*"v r' ,s ila�` a' �u' pr -y�'€ St DlSCro4q, kr, SECT10N2 PROPERTY pWNERSNIPMTHORIZED AGENT 2.1 Owner of Record: 1/160 iv ZA- Name(Print) Current Mailing Address: 2 i Signature Telephone 2.2 Authorized A ent: Name(Print) Current Mailing Address: i J-Z Signature Telephone SECTION'S.-,.ESTIMATEDI;C STRUC 164 CASTS Item Estimated Cost(Dollars)to be Qfficialalse Only completed by ermit applicant 1. Building J(,v Q Building Permit Fee i 2. Electrical { ��G'i i @)Estmated Total Cost I r ConstruCiiOn nom 6 1 c 3. Plumbing Z, o p BuildmgPermltFee 4. Mechanical(HVAC) I i 5. Fire Protection Q 6. Total`={1 +2+3+4+5) dQ 0 --Chedk Number hrs.YSect�on ForOfficial Use.`Onl Bal{dmg Pecinif Ptumi�er 16 ate TSSGed Signature: Building,Commissior edlnspecfor.ofZu-ildings Date /ap . File#BP-2008-0148 APPLICANT/CONTACT PERSON Scott Johnson/CDH ADDRESS/PHONE 30 LOCUST ST NORTHAMPTON ()582-2313 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 T eof Construction: WEST 4 RENOVATION-DIVIDE ICU INTO 2 ROOMSO INSTALL PRIVACY DOORS AT END OF CORRIDOR New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 082324 3 sets of Plans/Plot Plan THE ELOWING 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 S t Commission 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-2008-0148 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 e.142A) Category.. BUILDING PERMIT Permit# BP-2008-0148 Project# JS-2008-000227 Est.Cost: $20000.00 Fee: $100.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Scott Johnson/CDH 082324 Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning:M Applicant: Scott Johnson/CDH AT• 3g 1.0,C RT ST Applicant Address: -- - - Phone: 111sasr since: 30 LOCUST ST O 582-2313 1) NORTHAMPTONMA01060 ISSUED ON:8 1I7 12007 0:00:00 TO PERFORM THE FOLLOWING WORK:WEST 4 RENOVATION - DIVIDE ICU INTO 2 ROOMS & INSTALL PRIVACY DOORS AT END OF CORRIDOR 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: ' g k" House# Foundation: Rough- "��, J.�Rou h:. mar/c''� g x �)�r Driveway Final: Final:.- f final:�� '� �l f�' 1 � Rough Frame: r) Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke f. .�G 1 Final: O K 016-4/016-410-7 Lo vt rs 4 THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATION(':` Certificate of Occupancy t� - %-� Signature: FeeType• Date Paid: Amount: Building 8/17/2007 0:00:00 $100.0090453 212 Main Street,Phone(413) 587-1240,Fax: (413) 587-1272 Building Commissioner-Anthony Patillo