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23B-046 (43) i ..... .. ._ ,.._..._.. ._............. _ _.. .. , E ` J f E.„.,..... ..... E 3 f E _ _ E € i ti .... E ..._ .. t 1.. "jt' I m.."._ ... } E Ij} Z i D I I E _, 3 I t t c E ➢ r ( I Ev f E i _ j M i i '•y 1 I pi j I E { .......__. __ .._____. ._._.......... _.... _ w __....... .. _ ! is ........, ._. Y . ......... � 3 , C I � ..n . . .......................... i __ i I f I t } � 1 I 1 i Versiottl.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN AND ONSTRUGTIOtLt SER1%ICES :FOR SUIUDINGS AND STi2UC URES UBJECTT.O: CONSTRUCTION CONTROLPURSUANT TO 780,CMR 116;(CONTAINING MORE THAN-35;000 C F:OF ENCLOSEOSPACE) 9.1 Registered Architect Not Applicable ❑ I Name(Registrant): Registration Number ! I , Address , Expiration Date Signature Telephone 9.2 Registered Professional Engineer(s). Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date j 1 Name Area of Responsibility f , Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor I Not Applicable ❑ Company Name: I i l Responsible In Charge of Construction r i i Address I Signature Telephone Version 1.7 Commercial Building Permit May 15,2000 t SECTION 10-STRUCTURAL PEER REVIEW(780,CMR 11011) endent Structural Engineering Structural Peer Review Required Yes......❑ No.... . FSE .7ION 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. Sid Lure of Owner Date .---sco. 6 , as Owner/Authorized Agent he declare that the statements and information on the foregoing application are true and accurate, to the best of my kn: . edge and belief. Si. :clerrder the pa'n an en I ' of perjury. Pri a SiF r:: of Owner/Agent Date SE 'ION 12-CONSTRUCTION SERVICES 10. '_i-ensed Construction Supervisor: Not Applicable ❑ Na ci License Holder: �� 1 l� '[ �� <'� 3 `2 License Number Ac' ss Expiratfon Date 14,7114 sic Telephone SE--: ;ON 13-WORK ERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.C:152,§25C(6)) ' W 3rs 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 1ffidavit Attached Yes....... ❑ No......' Versionl.7 Commercial Building Permit May 15,2000 Existing . Proposed Required by Zoning This column to be filled in by Building Department Lot Size I Fronta"e —i� -�__� i Setbacks Front C• �—'� Side L:= R: L:I i R:+ � I Rear i Bldg. Square Footage Open Space Footage % (Lot area minus bldg&paved y -- arl�n ) #of Parking Spaces l Fill: ' i ✓ 1 (volume&Location)I' A. Has a Special Permit/Variance/Finding ever been issued for on the site? NO 0 DON'T KNOW 0 YES IF YES, date issued: i cl i IF YES: Was the permit recorded at the Registry of Deeds? .NO 0 DOMT KNOW 0 YES ` IF YES: enter Book I ( i Page; L "Zi 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 0 Obtained � Date Issued: i C. Do any signs exist on.the property? YES NO 0 IF YES, describe size, type.and location. ( C 5 AV D. Are there any proposed changes to or additions of signs intended for the property ? YES Q 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_ Q NO IF YES,then a Northampton Storm Water Management Pemmit from the DPW is required Version]..7 Commercial Building Permit May 15,2000 As 4 r. . EEy ,OIS?1R17TlQnN E1 ESsFARO'JE1G5?CtliS APf35;00!} �LUB�-`�E.r�T'bEsEiS1�1�3�,ED,'S���E • •• •"' s: Interior Alterations Existing Wall Signs ❑ 'Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description IEnter a brief description-here. /(/ �� -`� i2-v-��. Of Proposed Work: I {a..•i^.., ">— :;--- 's'SL sECnON'`5> UsF GROUP (D 'A1'(S�TROOVOt>!,F?l 1 FE a ice. USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A71 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 16 ❑ B Business ❑ 2A E Educational ❑ 26 , ❑ F Factory OL F-1 ❑ F-2 ❑ 2C ❑ H Koh Hazard ❑ 3A ❑ I Institutional 1-1 ❑ 1-2 1-3 ❑ 381 M Mercantile ❑ 4. ❑ i4 Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility Specify: I I M Mixed Use Specify: p fY:, S Special Use Specify: i C©MPL TIISEC10gfF,EX1STING �11k DIPJG 111DAEFtGOIT�G REION,AT(ONSRQITfpNS ANb/OR�CHX+N�E,IN'USE. _ .. ;. ... ..__ ... a _. Existing Use Group: Proposed Use Group: . I Existing Hazard Index 780 CMR.34):I 1 Proposed Hazard Index 780 CMR 34): SECT10N�a i1LDiNGJ IEIGIT=�AND�1REAt i BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) st st r------'_ nd I ' X • 2nd( I 2 f I 3rd ! ! 3rd 4d; 1 i 4 1 i Total Area(So Total Proposed New Construction ns 'a V. Total Height(ft) Total Height ft 7. Water Supply(M.G.L,c.40, §54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ Zone i, i Outside Flood Zone MunicipalK On site disposal system❑ 1 Version l.7 Commercial Building Permit May 15, 2000 r.. City of Northampton -- � i � ,wilding Department Main-Street .y Room'100 9 ; NbdAarnpton, MA 01060 phone 413-587-1240 Fax 413=587-1272 APPL -ATION TOCON.SI Rti'C2,.REPAIR,RENOVATE,CHANGE THE USE OROCCUPANCY OF,OR DEMOLISH ANY BUILDING . OTHER THAN A ONE OR TWO FAMILY DWELLING' .tSEC.�TJON„. S�TE'�NFO�MATIDM;,ti„ A �a � � 4,.,lrisase tron�t bVe�o •'.ieieaw W.2 ep _ :rn', - -'F:'I-Property-Addfes ��``/r' (// I kS � �'.-nom N,���• _. ;:. ,y�-w,n' � -��h {.J V U M14 !^T- 1 i r x _.. y Y ' t n�Ne ti!r'd*l.. ,�1-. f .S!r.r ty rt 7' 2 y`1` yf`r,F+L3,yY ,t�r�;• - _ �SEG�Tfi�N 2z kF?ROPERTY raWN ER" HIPIATHOR�ZED A E N� DTs 2.1 Owner of Re rd: -71 :Van. k5,)-;,jS o�oh ��/(�r'f 1 0. Name(Print) Current Mailing Address: Signature Telephone 21 Authorized Agent: Name(Pent) Current Mailing Address: I /y+A 016 6 0 j Telephone Tele `� �l Signature P SECTtON.3 ESTIMATED,G STRUCTI'O'N COSTS _ .. Item Estimated Cost(Dollars)to be Otfciai Lase Only, corn leted b errnifapplicant . 1. Building j (a Bu,ldit"g Permrt_Eee° .+ AA 2- Electrical (b Estimated Tota'I`Cost of s a. Q Constructionrom1 3. Plumbing Bitldmg Penmtee Nod. 0 o 4. Mechanical HVAC 5. Fire Protection 6. Total (1 +2 +3+4+5) ©. Check Number ' Thrs_Sectron'ForOffictal•Use,Onl , rgU)Id�ngaPerrnii°Nuts Xer 'Daie ':-Issued Signature( Building,Commissioner/Inspector of;Buildings Qate 10 �2-00D &�IdA5 I�1 , r File#BP-2007-0109 APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL INC ADDRESS/PHONE c/o Richard Corder NORTHAMPTON (413)582-2216 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 =5-p W71ZEE Typeof Construction: BUILD OUT NEW EXAM RM,OFFICE&RECEPTION WAITING AREA P 2000 CENTRAL STERILE PROCESSING 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 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 Pemlit from Elm Street C scion 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-2007-0109 _GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-046 CITY OF NORTHAMPTON Lot: -001 Pennit: Buildlnq Categorv: BUILDING PERMIT Permit# BP-2007-0109 Project# JS-2007-0165 Est. Cost: $26500.00 Fee: $130.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: COOLEY DICKINSON HOSPITAL 082324 Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: COOLEY DICKINSON HOSPITAL INC lipplicant Address: Phone: Insurance: c/o Richard Corder (413) 582-2216 () Workers Compensation NORTHAMPTONMA01060 ISSUED ON.81212006 0:00:00 TO PERFORM THE FOLLOWING WORK.-BUILD OUT NEW EXAM RM, OFFICE & RECEPTION WAITING AREA P 2000 CENTRAL STERILE PROCESSING 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:)v l'1''C � Rough:►vwA 41p4 House# Foundation: Driveway Final: j Final: ` L✓������ 1 �Fin a1:11/-161, y Rough Frame: d C Fire lace/Chimney: (;as; Fire Department P Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE- ITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGUL ION/S. Certificate of Occu anc �2L Signature: f FeeType• Date Paid: Amount: Building 8/2/2006 0:00:00 $130.0070516 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo