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23B-046 (48) ° e ° : ♦ .. .. p v o.yv o ° ° � C C ` � O • ♦ d _ o p ♦ d p d ° ° o e ♦ 39 O1S 11Vl ♦ uo V ,{ wo— 5 Y o O Q Ld Dri i PER q:, 00 0 C) ,' LLJ LLJ L H ° ► d p.v. 9 1 R 1 • .. Q WW m Z o.. a. VN F 8/1 ':Q K-1 IX _j p v N z g S z D o, ~� U v ED O 0 e II o- N v. o. I I I o o Q Z - ° J — .► — e-- � ' 1 I I o o z-< " °' Q L— J o Er 8' '' Cn 0 ® Q Q O p m N Q z d o • N U L • Z tI� Z Q) c LV ° s..p ' ♦ °.' W -Fa��tie Eih,) of �lTrrt(ja1il�toll _--_ DEPARTMENT OP ©UILOr�G INSPECTIONS 212 Alain Strcet h�naicpnl Building Northampton, Mass. 01060 �N'OTUCER'S COi=NSATZON LNSU, A CE ?.=1 AVIT z, -7-�1'�i,1. 5�/1�1ier�lt'4��-roi�a� (li a-cscrJpermi tt�) �>,�th a principal p!acc of business residence at: 7�. L v /ow /yl� O/oS6 (Shone'j Y/3-u�y7 25"00 (sa-�Jc�t}/statc�a P) do hereby cord_ ., under Lhc pFsns and penalties of pCrJury, .-ha) an employer providing Lite iollowine tvorkcr s comocnsLuon cave �o Cor sn� etuployccs wor ng on'tl>is job "l- 6-'eI4Pd.Z,15 ea. — —�R�vC jC0/0.5 /Z-3 /06 (Lnstiu---c-- Coar ,) (Pcicr ( ,) I_= a sole proprietor, general contractor or how eowner (cuc;e one) and hive hired Lhe coGD-actors listed below who h2ve the `ollowine workers compen 'Don pr-Lcies, (i�sruc o�Co�.r:�.c;or) (Instr�n�. Colnout)'�i'cOc,' '�'umcc) (ri:pi,-d�o;? D,itc) -- (N,,,mc of Cooa-acior) (1rLSUrz�c Company/?ol�e, N nccr) (Ex Dt C.J0ri Date) Name of Coaa-aclor) (Franc Company rPot c� N;imb�) (E p r[ioo Date) (Namc of Cooaacior) (Laura-- Comca�/PoLicy Numir:_r) (Et,piraaoo Date) (n a,.u-h •pia. orsl chcC f❑<oc 1 to c>c.'v�iafa'ct,�oc pclaut>❑,S to J.1 eccr�.0 ) O I am a sole proprietor and bave no one woF4dng for me. ( ) I zm a home owner perforroinC all the work myself. NOTE:pl x cw xr-t�,,u�jc 6cccovvcn .t>o c=ploy pcwm tv w cc.-r oo r rpa •o z on .d 1L of ntx nx: l^t o � n r c6 x bor�r 6 or cc the U,uUG DO =11y o.�c d--,i Lo Cc ploy-�unG,;.BSc w—k—c o=-,>�cc A--I(GL157-1(S)� =,WUnrjoa by.bomroaac(a c bc2_a �r c-idract tt:c I rtL-ut o -:P I o yet ua d d,4 W o(4.d r C.oc ,..twa Ac- u-dc"�d >copy of thii cai<mam—y bo r--d-6 w u-Dop�o r ;l'v-&oLy Offs oa or(r---for be col - ,^e ve,-i(eiioo a-td th1 L- Lrc w ueurc'mv;rdo�tom...-r—jc,25A of MGL 1S7 nn Ied La the L-Pazasoo❑f=='a--1 PeesLb- oo=�of.Got of up to S 1}00.00 .nyor -i,o�eal o(up W Doc year end aril P,a ja is 6c roan or.Stop W ort orde-.❑d . rtro 0(5100.00 r d--y .pica For Pc-rmit Numbcr lip" Lot S'i� +cx�srxlPcrmitic:. '�L}3Ce ) ,G�-::. Versionl.7 Commercial Building Permit May 15,2000 SECTION 10- STRUCTURAL PEER REVIEW-1780 R 110.11) Independent Structural Engineering Structural Peer Review Required Yes......❑ No...... SECTION 11;f-OWNER AUTHORIZATION-:TO BE-COMPLETED,; WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR.BUfLDING PERMIT 1, l_ oolc y Diekih s/ R. U onn s flo 'P;T�lL as Owner of the subject property hereby authorize Q G Yo e C D/ S r/1 Lic, t Q G , _to act or my be in all matters rel< ork authorized by this building permit application. Signature of Owner Date I, R-aI l'n6h /Loy/e Co/�5T11 uCT/o/-7 the asOwne Authorized 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. Print Name Signature of Ow en Date SECTION 12 - CONSTRUCTION SERVICES 10.1 Licensed Construction Supervisor: Not Applicable [I Name of License Holder :__I//ylp�il% S, Ag//e e/" _ 066227 License Number Sr L vow_ U1o56 07-0�-07 Address Expiration Date y/ - 5�17 O Signature Telephone SECTION 13 WORKERS' COMPENSAT]ON INSURANCE AFFIDAVIT(M G t -c 152,§;25C Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this a*fida' wJl result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... W No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION S,Ef�V10ES FOR,BUILDINGS AND STRUCTURES SUBJECT TO C©NSTRUCTION CONTROL;PllRSUANT T0,780 CMR 116 C. NTAINING MORE THAN 35;004„C f O'F ENCLOSED.`SPACE)'` 9.1 Registered Architect: Not Applicable El Name(Registrant): Registration Number Address , Expiration Date Signature Telephone 92 Registered Professional Engineer(s): Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date I Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number I Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor 1'94 Le,92 R yDUL C-' {. O h 5 7"t'UC /(}�?1/?� Not Applicable ❑ Corn— pa�—yName: Responsible In Charge of Construction Address Of %r3-55'72500 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 11 On site disposal system ❑ S. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size 96 9, 112 7 8 96 9, y2 7.8 Frontage 2(0 5 8 2 6 5 8 Setbacks Front 102 ' / 02 Side L: 88 R: 'S'2' L: 88 R: '1,2 Rear 18' 18 Building Height y 6 y 5 Bldg. Square Footage %02,13 6 % 1102's6/ Open Space Footage % (Lot area minus bldg&paved 6 y0. 6 parking) #of Parking Spaces 761 1 7 6 Fill: N/A NIA (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES X IF YES, date issued: Dec 131, 200) IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book 6 60y 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 NO IF YES, describe size, type and location: VA h 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: ' Versioal.7 Commercial Building Permit May 15,2000 7;77!S�RIiGTiON ER1/ICES OR RO7ECTS LESS THAN 35NCLQSED�Pa4CE � � �,-ns Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ ons Demolition❑ New Signs [ ] Change of Use [ ] Other Accessory//Building [ ] Repairs [ ] BRIEF DESCRIPTION: av�L�a��' / R0,04 /'/ R'.gj"q 7, OV N TlI Q/'a IN 3�qSe n a-Al 7- SECTION 5 --USE GROUkAND 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: COMPLET ,THIS SECTION IFDQST3NG,'B LDING UNDERGOINGRENOVA ONS,ADDITIONS ANDJOR CHAt(GE IN'USE Existing Use Group: 1-2 Proposed Use Group: 1-2 Existing Hazard Index 780 CMR 34): IY Proposed Hazard Index 780 CMR 34): y SECTION 6 BUILDINGHEIGHTAND7>REA. BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION " � �OFFICEUSEONLYF Floor Area per Floor(sf) gpp�i 1rt �ZBp � �+ x�� 4 nd r x Y WgF xz s s wr �4% s 2nd 3 d ` t � y;u ty 3rd 4t 4m Y _hS t — a U�0 d New Total Proposed ose Con rus , s �t Total Area (si] `-- P p — ction — (Sf) Total Height (ft) t NSA Total Height ft------------- --- '` - Versionl.7 Commercial Building Permit May 15, 2000 City of Northampton Building Department a x ` 212 Main Street F - Room 100 Cos 11 Northampton, MA 01060 a r� phone 413-587-1240 Fax 413-587-1272 a APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLXNG - S_EC73QN 1s SiTEZNFORMATION '' J n ? { i iuCC 1.1 Property Address: _ o> e�ompletedfi offcek Coole S/ ID CZCjp Son L k:MaP �` � r� w of irG soh y A 'ta- k 'ta'f Yt, ? R aS 4 YYbh / //�� �^ c�{— ' 30 �I,LU.S S / toned tirer�ayD�s�ctrnl� ,an+ ,n�'""h wu 's2 J' ..wK,:�y, •-w,sr w t .-.-., ROPER7Y OWNERSHIPIAUTHORIZED AGENT 2.1 Owner of Record: Coo/e y D6ckinsoh Hoses/Tol _�O�ocvst St. Po. f3ox Soaf Name(P' t) Current Mailing Address: y/.3- 582 - 2313 Signature Telephone 2.2 Authorized Agent: 71ww0 y S. /°e/%tier 'I/e 5 u /out 0/056 Name(Print) Current Mailing Address: — 522- 51/7- iR 5 00 Signature Telephone SECTION 3 'ESTIMATED CONSTRt1CTION1COSTS Item Estimated Cost(Dollars)to be Official°Use Only completed by ermit applicant 1. Building a g 90 a� i O uildmg`Perrnit.Fee 2. Electrical �O pdOr o� {b)Estimated Total Construction`from. 6 3. Plumbing o� Suild�ng Permrtfee Z yes®. 4. Mechanical (HVAC) ,so 5. Fire Protection /gyp©• d° - 6. Total = (1 + 2 + 3 +4 + 5) /Se ©pp, 1O Check Number_ This Section For'Official Use.On1 - - Building Permit Number Date Issued: . Signature: Building Commissioner/Inspectorof:.Buildings Date File#BP-2006-0817 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 Typeof Construction: BUILD OUT 1 ROOM RADIATION THERAPY BASEMENT NEAR 3 BANK ELEVATOR 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 INF9461ATION 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 C ssion 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-2006-0817 GIS#: COMMONWEALTH OF MASSACHUSETTS Map.-Block: 23B-046 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category_ BUILDING PERMIT Permit# BP-2006-0817 Project# JS-2006-1253 Est.Cost: $158000.00 Fee: $578.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Raymond R. Houle Construction Inc 066227 Lot Size(sct. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: Raymond R. Houle Construction Inc AT! 30 LOCUST ST Applicant Address: _ Phone: Insurance: 5 MILLER ST (413) 547-2500 O Workers Compensation LUDLOWMA01056 ISSUED ON:212312006 0:00:00 TO PERFORM THE FOLLOWING WORK.-BUILD OUT 1 ROOM RADIATION THERAPY BASEMENT NEAR 3 BANK ELEVATOR 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: 3�7� J Rough Frame: (� jV.a'e,0 CvU�n. Gas: Fire Department Fireplace/Chimney: Rough: 1112" Ttir::8 qt?,•�•. Final: Smoke: !�"r' Final: eK 3— y, THIS PERMIT MAY BE REVOKED BY THE Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy G' Siunature• FeeTYpe: Date Paid: Amount: Building 2/23/2006 0:00:00 $578.0011972 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner-Anthony Patillo