Loading...
23B-046 (36) 3 1 F E E Ji gi r t : x7....;...d tj [ if... ...,.,.«......d a €£ t}yy €3 S a + d i € x € ...E I f Lli LJI E xa € i F€ € t __ { I--f I = j j3 3t l} { { 4k ' .: a. t Ll Li i tilt i S 1 z,..._..._....__ _ .............._.. ..�...,...__._..�j ..."? �j�� -- [ 1 e3 j _.. ._ tx , 4;a � a. 0 cJ Ix F ..1 ... Y aMaaMr 14 io n t S t 1 i Y , £. t 1 3 € ELI ` LA n 7 t _ y .A..,....w-...o �......., # u, 3 a R Version 1.7 Commercial Building Permit May 15,2000 :SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110,11 4¢ I I �G endent Structural Engineering Structural Peer Review Required Yes......❑ No......0 SE:'ION 11 -OWNER AUTHORIZATION -TO BE COMPLETED,WHEN. OV..,ERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT, as Owner of the subject property he: y authorize to act on m, :half, in all matters relative to work authorized by this building permit application. Sig `ure of Owner Date Agent as Owner/Authorized A g he declare that the statements and information on the foregoing application are true and accurate,to the best of my kr: edge and belief. Si °d under the pains and penalties of perjury. _SC Cc) T Pri SiF of Owner/Age Date SE -ION 12 -''CONSTRUCTION SERVICES 10 '_icensed Construction Supervisor: Not Almlicable ❑ L � Asa 0 Y Na c_f License Holder : Sa � License Number Expiration Date SiE ... Telephone SE--ION 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G L.t''.452,§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. Sid ,ffidavit Attached Yes....... ❑ No...... Versionl.7 Commercial Building Permit May 15,2000 SEC710N 9,PROFESSIONAL DES)GN AND I . STRUGTlO(4t SERY�CES FOR BUILDINGS AND STf2UCTLIRES UBJECT?.O CONSTRUCTION CONT.RP'PURSUANT T0:780 CMR 116`tCONTAIN(NG MORE JHAN:35;000.0 1=:;OF ENCLO$EOSPACE) 9.1 Registered Architect Not Applicable ❑ I Name(Registrant): 1 Registration Number 1 Address I f Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s): i Name Area of Responsibility I Address Registration Number Signature Telephone I Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility I Address Registration Number. Signature Telephone Expiration Date I Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor J I Not Applicable ❑ Company Name: I j 1 Responsible In Charge of Construction r j Address Signature Telephone Version l.7 Commercial Building Permit May 15,2000 Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size f r- I t Fronta-e Setbacks Front i © r , r --� Side L:= R:= Rear i Bldg. Square Fooiage J % Open Space Footage (Lot area minus bldg&paved l �—' #of Parking Spaces Fill- (Vol urne&Location 1 li i A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO C) DON'T KNOW 0 ' YES ' IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? .NO 0 DON7 KNOW 0 YES t IF YES: enter Book —� Page' and/or Document fl B. Does the site contain a brook, body of water or wetlands? NO Q 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 i C. Do any signs exist on the property? YES NO IF YES, describe size, type.and location. j ✓/✓Tom 2 —e C I ®�( S-4-6-1 l D. Are there any proposed changes to or additions of signs intended for the property ? YES t 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 0 ' NO IF YES, then a Northampton Storm Water Management Permit from the DPW is required Versionl.7 Commercial Building Permit May 15,2000 y SELr 1,l Qt S `U 1( SEk2d CES Q '„k20°9E 5c'Lg'sS`�FlA4 35;ODQ C[Jr B��EE�"1QEsEfit11D1"��35�ED,�I�f'C`l= ) Interior Alterations�Existing Wall Signs ❑ Demolition❑ .Repairs❑ Additions ❑ Accessory Building❑ Exterior_Alteration ❑ Existing Ground Sign❑ New Signs❑ R'oofing❑ Change of Use❑ Other❑ I. $ . Brief Description r Of Proposed Work:iIi l-�w-ewe --,• r— ,-+•— � �4 k. r - Yt3^A t' t�a.L� �i im-.. SEG;TION',5=USE GROUP-+ACID COI�STRI�G�d,O�M.FPE�.�. � a . USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly _:A-1 "❑ A-2 ❑ A-3 ❑ 1A Ej A-4 ❑ A-5 ❑ 1 B ❑ B Business ❑ 2A ❑ E Educational ❑ 26 I ❑ IF Factory ❑ F-1 ❑. F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional I-1 ❑ I-2 I-3 ❑ 313 ❑ 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 Q S eci P fY I S Special Use Specify: 1 COMPLET>`YT1 1 `SECTf1J1�1F EXISTING BCJILDING j 501NG R)=NQ�A (QNS AQDfffOf�f$AN�fOR CHANGE`iN;IJSE Existing Use Group: Proposed Use Group: ! Existing Hazard Index 780 CMR 34): { .Proposed Hazard Index 780 CMR 34): SECTION SBUIUDING`ME1GHT�ANDi7�REA; H .I,..- BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION _ I Floor Area per Floor(sf) Sf 151 l 1 / �4 2nd r_ —_� I 2 ° 3t° i J 3rd E 1 4th i 4'h Total Area(So I Total Proposed New Construction(so Total Height(ft) Total Height ft I r 7. Water Supply(M.G.L.c.40,§ 54) 7.1 flood Zone Information: 7.3 Sewag Disposal System: Publi Private ❑ Zone! 1 Outside Flood Zone Municipal On site disposal system❑ a Version1-7 Commercial Buildin g Penmt.May 15, 2000 r„ City of Northampton Building Department 212 Main:Street Room'1 00 Northampton, MA 01060 phone 41 -587-i 240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR,RENOVATE, CHANGE THE USE.OR OCCUPANCY OF;OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING' -"-Prcvpet-tyiAddres r`�u �+�i w�" IS�n ,{Q�gtyilO�Cl t{� b �;�P.`18i gfp�C .0�'�5SF+$YMY� AM`s Fi1 "i,u�„w, •Y K �� "a Sw�i 6 Y SECatTON 2 fPRQPERTYlQ1lVNERSI ti1'fACa1�HOE21ZED AGENT ? a• t x t t� rri,cr y � v" �3 y �ri M s�yts�C & tt 2.1 Owner of Record' I Gam, r •�z,��c��.��� •fir � � jF7 oGv,�;- .�'✓ Name(Print) Current Mailing Address: s 3 { Signature Telephone 2.2 Authorized A ent: Name(Pent) Current Mailing Address, Signature Telephone 445ECM _3_ESTlMATEDi ONSTRU_C 10 COSTS Item Estimated Cost(Dollars)to.be O_ffclal Use Only;, c omp`leted by ermit a plicant . ..,,.i, I. Building �/, f(a3rBuyldpg Permitfee } - r c/V 2_ Electrical I (b)Estimated Total'Cost of ODU r Constiiuctlon;rom., r 3. Plumbing arBSuAdmg'PemifF.ee (Doc) I 4. Mechanical (HVAC) � ) I . .L i. 5. Fire Protection 6. Total=(1: +2 + 3 +4+ 5) 0 Gheck,Number Seci.on For:OtTicr"al Use,=Onl :. rBa�Idi�g�Permd°Nurn'ber: �'©ale" � .-1SSUed` Signature_ Builtl ngCc issioneNlnspecfor o Tulldings Date . 4165 J tv i,n ��G lJ�►t f`/�1 �. j� 0 Ilf 4 j t pT'► j File#BP-2007-1171 APPLICANT/CONTACT PERSON Scott Johnson/CDH ADDRESS/PHONE 30 LOCUST ST NORTHAMPTON ()582-2313 () PROPERTY LOCATION 30 LOCUST ST-2ND FLR WEST WING MAP 23B PARCEL 046 001 ZONE M THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE Fee Paid Buildiniz Permit Filled out Fee Paid Tvneof Construction: ENLARGE BA HROOM IN RM 201,203,CHANGE LAYOUT&CONVERT ISOLATION RM TO NURSES STATION New Construction Non Structural interior renovations Addition to Existing AccessoEy Structure Building Plans Included: Owner/Statement or License 082324 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFO ATION PRESENTED: pproved 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 Commi 'on 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. BP-2007-1171 GIS#: COMMONWEALTH OF MASSACHUSETTS 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-2007-1171 Project# JS-2007-001865 Est. Cost: $500000.00 Fee: $2500.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: Scott Johnson/CDH 082324 Lot Size(sg.1): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning:M Applicant: Scott Johnson/CDH AT. 30 LOCUST ST - 2ND FLR WEST WING Applicant Address: Phone: Insurance: 30 LOCUST ST () 582-2313 () NORTHAMPTONMA01060 ISSUED ON:513112007 0:00:00 TO PERFORM THE FOLLOWING WORK.-ENLARGE BATHROOM IN RM 201,203, CHANGE LAYOUT & CONVERT ISOLATION RM TO NURSES STATION 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 5/31/2007 0:00:00 $2500.0086509 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo