23B-046 (47) 1
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Versionl.7 Commercial Building Permit May tS,2000
SECTION 9 PROFESSIONAL DESIGN LWD0 NSTi�UCT10SE
RCES FORBUILC1lNGS AND STi2UCTLIRES�UBJEGTTO:
CONSTRUCTION CONTR%LPURSUANTTO 780'=CMR i16 CONTAINING MORE THAN 35,000-C.F OF'ENCLOSEDSPACE)
-9.1 Registered Architect
I
Not Applicable ❑
Name(Registrant):
Registration Number
I i ,
Address ( r
i Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
i
Address Registration Number
i � I
Signature Telephone Expiration Date
i
Name Area of Responsibility
I i
� 1
Address Registration Number
Signature Telephone Expiration Date
j
Name Area of Responsibility
i
Address Registration Number
Signature Telephone Expirabon Date
i
Name Area of Responsibility
t I I i
Address Registration Number
Signature Tefephone Expiration Date
9.3 General Contractor
I
i Not Applicable ❑
Company Name:
I
I 1
Responsible in Charge of Construction
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Address
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
i-
SECTION';10-`.STRUCTURAL PEER REVIEW'(780'CMRI-. !1)_
771
Independent Structural Engineering Structural Peer Review Required Yes 0 No 0
SECTION!11 -`OWNER AU.T,.HORIZATION 70.13E G0MPLET.ED,WHEN
OWNERS AGENT`OR CONTRACTOR ABPLIES FOR'Bu1LDJNG"P_ERMIT
as Owner of the subject property
hereby authorize
act on my behalf,in all matters relative to work authorized by this building permit application.
I
Signature of Owner Date
as Owner/Authorized
Agent hereby declare 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 pedury.
i y°, - i
C- 6 Print N
Signature of Owner/Agent cX Date
SEGTfO'N 12-CO N'STRUCTIOJV`SER1/<ICES.
10.1 Licensed Construction Supervisor: Not At Applicable ❑
Name of License Holder: A fl-S 5
License Number
Address Expiration Date
Signature Telephone
SECTION 13-WORKERS',,COMPENSATION 1NSURANCE AFFIDAUJT,(M.'G.L.c:"1'52,'§-25Ct6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes 0 No _
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Version -7 Commercial Building Permit May 15, 2000
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
i I t
Frontage
Setbacks Front E. VC,L j_
Side
Rear
�uTding Heist
Bldg_ Square Footage % �1
Open Space
(Lot arca minus bldg&paved
parking)
#of Parkin S aces
Fitl
(volume&Location
A. H:as a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW 0 YES
IF YES, date issued'
IF YES: Was the permit recorded at the Registry of Deeds?
NO ..0 DON'T.KNOW YES
IF YES: enter Book r^�y� Page i and/or Document#j
B. Does the site contain a brook, body of water or wetlands) NO 0 DONT KNOW Q 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
IF YES, describe size, type and location: ! �� e f
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: i
E Will the construction activity disturb(clearing, grading,exc vation, 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
SE Ez IU�TtICN1rESRO,'.lEl�*LSSHAI�f 35;000
fC[IGEETa1DEEEEN :�SED
w
t t
tnterior Alterations 00xisting Wall Signs ❑ Demolition❑ .Repairs❑ Additions ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description IEnter a N f des4ri tion here.i
Of Proposed Work:i 0 1 � xr( lam• y') �L CAI k�C C i
-.....,y.�-, +�«r— i•=-- L,- >, i� ^q et N'
SEC=TION$ ROUPAND(AfSrTRt�,GTdAtIIAEt
USE G,ROUP.(Check as applicable) CONSTRUCTION TYPE
A Assembly. A 71 ❑ A-2 ❑ A-3 ❑ 1A
❑ A-4 ❑. A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 2B ❑
F Factory ❑. F-1 ❑ F-2 ❑ 2C ❑
H High Hazam ❑ -
3A ❑
Institutional f-1 ❑ 1-2 1-3 . ❑ 3B
M Mercantile ❑ 4 ❑'
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A []
S Storage ❑ s-1 ❑ S-2 p sB ❑
U Utility 1�j Specify
i
M Mixed Use 0 Specify:
S Special Use Specify:k
C®M�'LET} I �SEGTIJN� TF�EXISTINGBUILRt1aPG 1 lDEE GQI G"REIIX�UA�fIQNS ARrWTiONS"ANb/OFtjCHANGE USE
(Existing Use Group: �z k Proposed Use Group'
Existing Hazard Index 780 CMR 34):. f Proposed Hazard Index 780 CMR 34):
SECTION r,i ILDING klEIGIiTy�,ND7aREA}
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION } 11
Floor Area per Floor(sf)
1sr
_ I
2nd
n4 ^ I -
2 �
3 rd
l
4th ( 4 n
Total Area(so I Total Proposed New Construction s
x
Total Height(ft) i � ��tir a
iN ^y R
Total Height ft j
7. Water Pupply(M.G.L.c.40,§ 54) 7.1 flood Zone Information: 7.3 Sewage Disposal System:
Public Private ❑
Zone'------7 Outside Flood Zon MunicipalX On site disposal system❑
a ,
Version l.7 Commercial Building PernutMay 15,2000
City of Northampton
Building Department
rr 212 Main:Street
xLV
'4. .�,i 2 ,` Room'100
I
Northampton, MA 01060
phone 413-687-1240 Fax 413=587-1272
APPLICATION TO.CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OROCCUPANCY OF,.OR DEMOLISH ANY BUILDING . .
OTHER THAN A ONE OR TWO FAMILY DWELLING'
S�C31aN„� �S NF�I�MATION`�
a O'
-- t I PropertyLtddres. + > tro�'t be�cn �Tt+ r-S.t � ►'fi�i ic`+D�/E
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sSECaT10�1'2�}P.,R�OP�ERT,`1R�O�WN�ER�SH�P>;A�1�HOR�ZED,��'�1�GEN�T ���;
21 Owner of Record:
Name(Print) Current Mailing Address: _(
signature Telephone-5 '-
2,2 Authorized Agent:
Name(Print) Current Maifing Address
OOF
! 50 d G-t�j�
Signature Telephone 21
iSEGMA 3 ESTIMATEDnCONSTRUCTI'ON COSiS
Item Estimated.Cost(Dollars)to,be Official l ise,Only
completed by ermit a pkc:ant
1. Build in ll (aiBu�lc�idg Perin+Ceey i I
g 00 Q I ;
2. Electrical ; i (tt)Est�matad Total Cost of
ru
_.
Consfction'fom,
3. Plumbing Permlt;Fee
4. Mechanical(HVAC)
.,L i
5. Fire Protection
6. Total'=(1 +2 +3 +4+5) 0 Gheck,Numbe'r
Thrs:Section`'For,:Oiicial Use,Onl
�Br�tdrng�Pe`r'rnii�Nurn'bxer'� _ � ;r'D`ate�' '
Issued,
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Signatures
Buildmg,Commissioner/lnspeefor df58uildings' Date
We,) F Ac l 1 • I Icpci / G' ,r, vC1
File#BP-2006-0997 I
APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL
ADDRESS/PHONE 30 LOCUST ST NORTHAMPTON (413) 582-2313
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
Typeof Construction: INSTALL NEW DOOR TO WEST 5 UNIT&REPLACE DOOR TO UNIT,CHANGE
ACTIVITIES ROOM ENTRANCE&STORAGE SPACE
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
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
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-2006-0997
GIS#: COMMONWEALTH OF MASSACHUSETTS
` "`' CITY OF NORTHAMPTON
t
Lot: -001
Permit: Building
Cate og ry: BUILDING PERMIT
Permit# BP-2006-0997
Project# JS-2006-1482
Est. Cost: $21000.00
Fee: $105.00 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
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
30 LOCUST ST (413) 582-2313 Workers
Compensation
NORTHAMPTONMA011060 ISSUED ON:312812006 0:00:00
TO PERFORM THE FOLLOWING WORK.-INSTALL NEW DOOR TO WEST 5 UNIT &
REPLACE DOOR TO UNIT, CHANGE ACTIVITIES ROOM ENTRANCE & STORAGE 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: 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 3/28/2006 0:00:00 $105.0060019
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo