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23B-046 (41) L,,,x7-F] cl- I C"i F ry x I [--r-� � I x ixD D x E�l c FFI CD F7 I a I I � o I o x - ri I Z T FcT7i— I I I I [--+- CA (o w I I co co x D • F-1 FM � x 71 x ' I � D - - Z F)7F T � i rev w 1 I x i D � I C x FF� D x � � O I � C C I ' Cj� F-F I FT� 1 o x � Rl F- n rn x I m D x ' D r � $ -- - I 1 m ' x m L p} i r- > T (/)Z I �C S i i m IrL m I I ° x T I 1 p I I I 1 1 V) m r r O0 OC O 1 1 7z Z 1 m O If I pp I w 1 I p I 1 1 I -------- m-o I T I x D I 1 I I m� � D I I D D�-- ' -7 I m r ' --I D W T , - K I � I I I D r I I I I m ju CO D x I I -------- ' _I ' D W ' I O '""I -1 I I 1 C- 3 1 r 1 0 O r o 1 i D n D 2 W .« O 1 I - - - - THI I 1 I I I I I 1 I 1 1 � I e I I EL I 1 1 I I I T Sao � I I 4 I I yy i I I I � I � � I I I I I (rri� lo? yc,,a:iIlalli�toil DEPARTMEWTI OP ©UlLDD\1C [NSPECTIoi,S 212 Alain Strcct ' Municipal DuildinC Northampton, Mass. 01000 VYORICER'S CONtPENSATON LEISURANCE ?.I'TTI�A 11' /1�7ier 1l'rg yl%loi? R _f/ov/e Ceg \�qth a principal place of busioess/residenct at'. 6/I?,/%r S t. Lvim//dew /';W O/6156 (phone ') 5'/3-�5y7 2500 p) do hereby cc rd ;, under Jic pans acid penalties of pujury, ��-hal 12-M a_n employer providing dl followint v"01- ce s comDens--non cove^ge 'Lor my eluplovccs working on'uiis job. N®r 6-'Mpd.Z,'C CO. RAUIC (.1010Sl iZ3 06 (lasur�c� Coo=-Y) (PCbC-. N ter) (r:pIrruor, D P i ) ( ) lam a Sole propr;elor, general conrramOT or homeowner (c�c;e one) and hZve hired tree coop actors Used below who h2ve the `ollo%ving woFke>'s comoe,n�zaon pe>icies: (Name of Co^t �c,orl (In2ran Comoi�}vPclicr '`um <r) (r>:pir�aon l�ntc) -- (N.'Mc of Coaaactor) (insurance Comoan}•iPQIjC-v ?.uocer) FL.vuTZ6on Due) (Name of Coaarimo,) (IItrancc Compan)•/Po�-c�' N;,mbcr) (t prtioo Dztc) (Namc of CODCraclor) (Insurance Comc'Q /PoLicy Dat'-) (nai.c�.�::ocal beC iIa«1 to cr_'tr�info-a,.�oc pctaiains to.1J cx�-r�:s) O I am a sole proprietor and have no one wor4dzg for me- ( ) I am,a home owner performing all Lbe work myseif. NOTE:plea be ewzrc Le'-Ejl bcCD.Cov+vm-tc=Plvy pc--o tow ,.•. cc�:.uoo c r�air•orz oa.d.,•.1Lv of CIA mor•c tJ^.; ` --is-�Dch'.bc boc�r=do a ca cbc p-aan6 x. :,-tc�:.�tbec-o�-c ox C�—'Qv Lo tc employ-�u�G._c5c wu-S;c r�r-x---+'oa An(G1.15�:-I C5)��P9�-'"moo trY bo arc fc c tics.a p.--snit c-r&CD=Lhc I c�l ttz�i o f ca cri l oy�undo d> W or�u,Co�/k, L t and✓r.�d dirt a o�py o!this catcmrru may ba L.tbo pcq�zm 2 o f iaiw;J nco G its'om-of L�—rot tS. ocvc-s,o^c vcrijcti�a-,d ttu Cil�zc Lo cmuc'co ;r-f^c m�.7 socUoa 25A a!MaL 167 on lcd to the L=Pcsaioo of c-.Mao'J per_+ltie oD=ainz of a no,or LT to S 1)00.00 ,nNor azT: • or up to ox yvr end civil rcn.lJo iz be roan or,Stop Wort;&tic and a Czr of S100R0.d---y apLa:a me /J For dcp.",--,j ux o"Jy _ pc7r llt 1`�t1II]UC7 1 gyp- Lot 4 Siena cu�Pcrm ttcc �Ce Versionl.7 Commercial Building Permit May 15, 2000 SECTION 10=STRUCTURAL,PEER REVIEW:(780_CMR 110.11) 77771 Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11, -OW'N'ER AUTHORIZATION:-TO BE:COMPLETED ,WHEN OWNERS AGENT OR CONTRACTORAPPL'!ES F.d UILDING PERMIT (_'oo lc y D;cki h s/o R. //O-S 71:1 L as Owner of the sub ect property hereby authorize Q G1 /� You e°_-,(f O/ S r U f O G . _to act on my be n all matters rel ork authorized by this building permit application. 12--2 Signature of Owner Date I, RQVZW6I / /i)QaAt COh-s 7-/IuC7—/O/7 -Zh . as Own e uthorized A en 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 wothi S. Pe,//e7`ier Print Name Signature of Ow en Date SECTION 12 -CONSTRUCTI.ONSERVICES 10.1 Licensed Construction Supervisor: Q Not Applicable El Name of License Holder : r lw r,7/1% S. 0 e/% ti e.� _ 066 ,227 _ License Number Ile,,.- S T / 41 /o,5-6 07-07-07 Address Expiration Date - 5S17- 0 Signature Telephone : SECTION 13 -WORKERS'COMPENSATION.INSURANCEAFFIDAVIT{M;G t t 152,§25C(6)) 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....... R No...... ❑ Version 1.7 Commercial Building Permit May 15, 2000 F SECTION. 9 PROFESSIONAL DESIGN A, ND SERVICES -FOR BUILDINGS AND STRUCTURES SUBJECT TO C©NSTRUCTION CONTROL P1IRSUANT T0,'780.CMR 116{CONTAINING MORE THAN 3S,OOQC F OF ENCLOSED:SPACE) 9.1 Registered Architect: Not App'icable ❑ 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 Rd? U/Z&1D IQ. .7/ov CO O1)5I-PUC7`/D)')-7/76 Not Applicable ❑ Cornpany Name: TitoM - tzer Responsible In harge of Construction Address %r3-.S5'72�op Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7. Water Supply(N1.G.L.c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone: Outside Flood Zone Municipal N 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, 1-12 7 S 96 9, 112 7 B Frontage '0'6S'9 ' 2 6 5 0 Setbacks Front 102 ' / 02 Side L: 88 R: yZ' L: 88 R: 112 Rear /8' /'9" Building Height 6((5 ' 6'y 5/ Bldg. Square Footage 11D2 86 % Open Space Footage % (Lot area minus bldg&paved 7 6 7 6 arlan ) #of ParkinE Spaces 761 761 Fill: n//A NIA (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 /3. 2DOI IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book 6 6011 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 1� NO IF YES, describe size, type and location: VAl'j 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 CONSTRUM-4 N ERNICES OR R07ECTS LESS THAN 35,DQO - CUBIC FEET OFNCL�OSED SPACE ' ; Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ n Accessory Building [ J Repairs I [A] BRIEF DESCRIPTION:/ ,/,oO' 1440047joli S To ek�L�"t R, T-0 c4,4 O S G SECTION 5 _USE GROUP AND-CONSTRUCTION TYPE _ USE GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A -;Er- A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B ❑ 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: COMPLETETt1IS-SECTIONIF,BGMNGBUILDINGUNDERGOINGR 1NOUA3TONS ADDITIONS ANDJORCHANGEIN;USE Existing Use Group: I-2 Proposed Use Group: Z-2 Existing Hazard Index 780 CMR 34): 'y Proposed Hazard Index 780 CMR 34): y SECTION 6`"BUILDING HEIGHT ANDREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION9 ��FFEUSEONLY Ll v a �F Apr r. r `�i ! GFti„i3 Floor Area per Floor(sf) 1 4 ty a A �Hda Eli Z ,� �V:th�'� "tom"� ^•s s'^ 2 4 1... 2nd fk rc �r t � 3 rd 41}1 41h 4 a Y Total Area (sf) Total Proposed New Construction (sf) r s x ti n Total Height (ft) r \ ' Total Height ft Versionl.7 Commercial Building Permit May 15, 2000 Dam en ' 51;00 City of Northampton Building Departments ; .. 212 Main Street - 3 Room 100 -Northampton, MA 01060 e# phone 413-587-1240 Fax 413-587-1272 ads APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION lT SITE INFORMATION 1.1 Property Address: a; h�ssecfiont e ompletedab� office F �; w r ?, � s yn''{w xtacr, w SY"rP}. v�'-�'+} ' �� .5 gpw Ig Coo%y Qckihsoh hosoitciL C�� e3-0-'� z ,w'. �Ec. z . II,SIJ SECTION r2 PROPERTY OWNERSHIPJAUTUORRED AGENT 2.1 Owner of Record: Cooley Dickihsoh Hos,oi>ul _301ocvsf St. Po. /3oX boo/ Name(P• t) Current Mailing Address: y13- 582 -2313 Signature Telephone 2.2 Authorized Agent: Ti,�ofi5y 5. 1°e//e�"%er S/I'J.'//eh 57. Lug/ou/, /yld O/D56 Name(Print) Current Mailing Address: 5'i3- by7 2 500 Signature Telephone SECTION 3 ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed b permit applicant - 1. Building �a) Building Permit.Fee 2. Electrical o� (b) rstimafw-total Cost of 2 �� 7 0 . Construction from: 6 3. Plumbing mo Bwlding PermitFee. . 4. Mechanical (HVAC) f�$�?O•�� 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5 (� 08 y,30. �� Check'Namber__, -Th►s 5ectioni-For Official Use Onl Building Permit Number Date Issued: - Signature: Building'Commissioner%Inspectornf Buildings Date File#BP-2007-0682 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 71M A5 09(0 Typeof Construction: MINOR RENO TO EMERGENCY DEPT EXAM ROOMS TO ADD MEDGASSES& CREATE MORE SPACE 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 Stree ommission 1 d0 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-2007-0682 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 c.142A) Category: ]BUILDING PERMIT Permit# BP-2007-0682 Project# JS-2007-001 032 Est. Cost: $108430.00 Fee: $323.00 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 Applicant: Raymond R. Houle Construction Inc AT. 30 LOCUST_ST Applicant Address: Phone: 5 MILLER ST (413) 547-2500 O Workers Compensation LUDLOWMA01056 ISSUED ON.11212007 0:00:00 TO PERFORM THE FOLLOWING WORK.MINOR RENO TO EMERGENCY DEPT EXAM ROOMS TO ADD MEDGASSES & CREATE MORE SPACE 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:.,Z,' Rough: /6/��v House# Foundation: t. P " Driveway Final: Aw� I F� Y Final -1 – Final: - r q� �� �' Rough Frame:v , Gas: Fire Department Fireplace/Chimney: Insula*inn: r• Final: Ott �-``� -7 Final: Smoke: '✓_ THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULA IONS Certificate of Occu anc si nature: — FeeType: Date Paid: Amount: Building 1/2112007 0:00:00 $323.0013330 212 Main Sheet,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo