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23B-046 (38) ILI- 0 CO 02 Z CD O D Oil i co C C7 � o m � n T Z C7 C7 D r 0 N O m CD Z U) o O m Z N 3 U) (D N O Q V7 C11 CD -D r- Ch p O. .-. 00 N O p — 3 _ (D p O .-► 10 � PO inn ry rn I I WO CD `C Cn O p O + , =r c CD - O , O 'J (D (1) m cn n '� D Z 0 0 O (D fD 3 z c� o cn m Q. O cn v Cl) CD r =7 3 w .. o 5 cn :E 5 — (D i !y C �1 tT Q = _ O O CD o U) m U) DEP12,7ME1T T 0' DIJILDFNC INSPF C,T)0),'S 21.2 Mai❑ St:cct ' Municipal Duildin,, NOF[hampLon' Mass, 01060 VI'OFUCEP'S CO UENSATION ENSURk-NCT AF=AVIT _Z7 h 1 acas--r-j PCT-,n i t I CC) ",q LEI 2 principal plat.- oCbuslm-s-s,/rcslder)cc at. P) do hereby certify, under Ll�c p?-!M and Penalties o'Lperjury, --hal a-9 emptoyer providing t 1 Foljo�vim-, workcr5 comocns--�o;i cove awe for Illy t1l3plovccs won,�ng on -Z CPCLC-" a SOIC PrOpl-licmr, qtocraj C-00maclof OF hom�--OW-13tt (CI C;C 072t) and t.avv hired Lhe coop actors hstui below 7--/bo have eht t'ok%vmiq- worker's coroner swoon Dclk}ts (Nam,- of con�c-,C.-) (T (N=c of COGCTDCIcr) (Llsu=c� ainoa2v/-Poluc), Daic) (NmP of conEFacic.-) (Insurance m paD /-P o L-q N,Lmb:j) (Expo o3.1 Dal.-', P m C of Coca-aclar) Clzsuf-an� CompznyfPoLicy (-ExpLr�bcii Dam) etx L� 0f0,=,,-n— P--L—a�c � ij Sok-- proprietor and have no oat worming for mt, am a home 0\",ner PtrforT=' - all the work myself. 1407-L pte�•c Pceom r —nz n of woe x -ii -L'--- ch the b-rr,�- cK c,:, Lh, Ls'," —P l or-- Lh- An(G L 15 L--1(5) oa by -c=fv b --c;)I.y C, copy C tom, —Y b, oii rn c r i,a for it �Ltu L,0— 'm -,a 25 A d),IOL 151 c-,,1-G to u" =��pcculio of C LT 10"t-CO.N -"YDI iz-� o(up to C;vo w 0 y ,pu=l CD,- Perm I Numb.- S; U C D3Le I Ccn-scciT C rTrij �� Version 1.7 Commercial Building Permit May 15,2000 SECTION 10- STRUCTURALPEER REVIEW;{780_CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11 - OWNER,AUTHORIZATION-TO BECOMPLETED WHEN OWNERS AGENT OR CON TRACTOR APPLIES FOR BUILDING PERMIT I, Coo/e Y b;ckl h son h/OSpiTc(L as Owner of the subject property hereby authorize Q G R. You C D/ s oc, -,'I O P C . _to act cr my be in all matters relfa ork authorized by this building permit application. Signature of Owner AX Date I, �i a yirlDhc� �, h�DV/e Co/�s Tl'uGTio/� �h c . as Owne uthonzed A e, 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. Ti�oth i S �e/% fii�r Print Name Signature of Ow en Date SECTION 12 -CONSTRUCTIONS 10.1 Licensed Construction�Supervisor: Not Applicable ❑ Name of License Holder : //iYJd7/1% S, P8 2-1 e r' _ 066227 License Number S IVI Met S r Al 6;'1o,5-6 07-0-7-07 Address /J Expiration Date S 1711 5S17 ,25oo Signature Telephone SECTION 13 -WORKERS' COMPENSATION'INSURANCE AFFIDAVIT{M G t t 152,§25C(5)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida: t 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 PROFESSIONAL DESIGN AND°CONSTRUCTION SERVICES -FOR BUILDINGS AND STRUCTURES;.SUBJECT TO CDNSTR,UCTION CONTROL PURSUANT TO 780 CMR 116{CONTA`INING MORE THAN 35000, ENCLOSED,'SPACE) _. 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration 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 Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor n n figZVI;!2an ' M. M211l ' (. O/15�/�l/G 7�/0�1/I� Not Applicable O Company Name. amino t ,�- S- r Responsible In harge of Construction Address 3-SX726Or Signature Telephone Versionl.7 Commercial 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 P1 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, 1/27 8 96 9, 1/27.8 Frontage (0 5£3 2 6 5 8 Setbacks Front 102 ' / 02 Side L: 98' R: y2 L: 88 R: Rear Building Height Bldg. Square Footage yO2 86 % 1102,$6 l. Open Space Footage % (Lot area minus bldg&paved 7v- # 6 arldn ) of Parking Spaces 761 761 Fill: NIA N IA (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 11, 200/ IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book 6 SOy Page 239 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 if NO IF YES, describe size, type and location: VA r j 0 vs D. Are there any proposed changes to or additions of signs intended for the property ?YES — No_�f IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15, 2000 SECTION°4 cONSf It C-.1ON''�ERVICES OR RO]ECTS LESS THAN 35,00A GIIBIC.FEET OFTNCL-0SED.S,VA Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ 14v, ❑ ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs BRIEF DESCRIPTION: £iY��i�J 0.4 SECTION5 -_USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A 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: COMPLETE TtiISSECTION IFDQST3NG BUILDING UNDERGOING r2ENOVATIONS,ADDITIONS ANDJOR CHANGE IN USE Existing Use Group: 1-2 Proposed Use Group: -r-2 Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y SECTION 6 BUILDING-HEIGHTAND�AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFIC�UStNLYyF� ' Floor Area per Floor (sf) ,� i r 2nd 1st v ids ysP.�%` 3 �z 3 rd zg 4th 4th 7 t k F r Total Area (sf) Total Proposed New Construction (sf) � Y Total Height(ft) �� � ; Total Height ft—N��------- TO Verstonl.7 Commercial Building Permit May 15, 2000 City of Northampton Building Departments 212 Main Street Room 100 g Northampton, MA 01060 a phone 413-587-1240 Fax 413-587-1272 a9l - APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING 1 SECTION 1- SITETINFORMAiION G ��"�"`� �_ ��This"secfionto le"�ompleted b►office 1.1 Property Address: E 4 it.I r"a l7�n xhlt�';� Coozev Q'Chihsoh '//osDi tc 1- r1' 'hn � fir i"�' `�w'+'°fi�� 3, ^ .�� ✓";F e� 4 .ua l 3 won eta 0 4 o S * T U S � uerltay !stnct a t ,�n.�i ""1'✓ «A--„^ 3. �z��,fie, ��•°�B3?Sfi7�� �� `t a;:^� i SECTION'2 PROPERTY OWNERSHIP,JAUTflORIZED AGENT 2.1 Owner of Record: Coo/ey Dickinson 11o.s,oizol 30ioovs>` S1' --Po. fgox oo/ Name(P' t) Current Mailing Address: 4113- 58 2 -z 3/3 Signature Telephone 2.2 Authorized Agent: Tnwor-Ak S- /'e//e tier 5/I'I.'//eh 5t. Luc1/out, /ylr9 a1056 Name(Print) Current Mailing Address: 3'12- 6117 2 500 Signature Telephone SECTIONS ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official-Use Only completed by ermit applicant 1. Building (a) Building Permit-Fee 2 70 c'2 ' 2. Electrical {b)estimated Total Cost of .-Construction:froria. 6 3. Plumbing Building Permit Fee, 4. Mechanical (HVAC) _ t�G 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) 3 y cog, av _heck`Number p? This�Sec oriFor'Official Use.Onl Building Permit.Number --- Datelssued: Signature: Building Commissioner/Inspector of Buildings Date File#BP-2007-0813 APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc ADDRESS/PHONE 5 MILLER ST LUDLOW (413)547-2500() PROPERTY LOCATION WEST 5 PSYCHIATRIC UNIT NURSES ST-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 Buildin Permit Filled out Fee Paid /000F 27 Typeof Construction: EXPAND NURSES STATION WEST 5 PSYCHIATRIC UNIT 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 F9CLOWING 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 Street Co ion L zQ� Signature of Building Of ici 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. WEST 5 PSYCHIATRIC UNIT NURSES ST-30 LOCUST ST BP-2007-0813 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: BUILDING PERMIT Permit# BP-2007-0813 Project# JS-2007-001325 Est. Cost: $34008.00 Fee: $142.50 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Groin Raymond R. Houle Construction Inc 066227 Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: Raymond R. Houle Construction Inc AT: WEST 5 PSYCHIATRIC UNIT NURSES ST -30 LOCUST ST Applicant Address: Phone: Insurance: 5 MILLER ST (413) 547-2500 O Workers Compensation LUDLOWMA01056 ISSUED ON:31512007 0:00:00 TO PERFORM THE FOLLOWING WORK.-EXPAND NURSES STATION WEST 5 PSYCHIATRIC UNIT POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Rough: Footings: �f�/j Rough:�� ?�' �' House# Foundation: Driveway Final: Final: Final: j� ( ✓/ �;� .)� j'� . . Rough Frame:© > `7 023 -�7 G "'✓ Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: C7 (,1405 THIS PERMIT MAY BE REVOKED BY THE ITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy /� - si nature: FeeType: Date aid: Amount: Building 3/5/2007 0:00:00 $142.5013522 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo