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23B-046 (55) . �. , � \ � © . � ' � . \ ` � 4 f � � � �* . >��y . ^~© :,�� . � *�� �� � �y � � � -� �� / % ` � � �9 � �\. : ^�.� ~~� � � %� . \: % ` � % � �¥ � �. y \ � f �� �� �� 4S4 c;E A6. '0000or �� �^ :.�^. ,� A, } ��: �. j f f 4S4 E�(%Si ,hS SPAce Versioni.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL DESIGN ANDCON3T(3UC710N SEfLVkQES FOR BUILDINGS AND STR _U --S- UPT _ CONSTRUCTION CONTROLPURSUANT TO�t30-CMR 116'(CONTAINING MORE T}!AN 35,000 C.F OF ENCLOSED SPACE) 9.1 Registered Architect I I Not Applicable ❑ Name(Registrant) Registration Number I I , Address I Expiration Date I Signature Telephone 9.2 Registered Professional Engineer(s): —7. I _ Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date i Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date f Name Area of Responsibility 1 Address Registraton Number Signature Tetephone Expiration Date Name Area of Responsibility Address Registration Number jI Signature Telephone Expiration Date 9"3 General Contractor I t Not Applicable ❑ Company Name: r j Responsible In Charge of Construction r i � I Address Signature Telephone ................b .... SECTION 10-STRUCTURAL.PEER REVIEW(780 CMR 110;11) ,4-o"- A endent Structural Engineering Structural Peer Review Required Yes......❑ No....'. SE.7ION 11.OWNER AUTHORIZATION-TO BE COMPLETED WHEN OY...ERS AGENT OR CONTRACTOR APPLIES FOR,BUILIARP 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. Sib lure of Owner Date as Owner/Authorized Agent he ; declare that the statements and information on the foregoing application are true and accurate,to the best of my kr.: edge and belief. Si. -d :!,ider the pains and penalties of perjury. Pri L SiF - of wner/Agent Date SE' `ION 12 CONSTRUCTION SERVICES Y; :" 10. '_ir-ensed Construction Supervisor: Not Applicable ❑ Na rf License Holder: S� ��� /Z �S d'�j �� License Number ZL6 �z_z, � -61b Ac' ss Expiration Date _ S41 Sic Telephone SE:" ON 13 -WORKERS' C PENSATION INSURANCE AFFIDAVIT(M.G L.1:'152, §25C(6)) W ors Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit w :s.rt in the denial of the issuance of the building permit. Sid affidavit Attached Yes....... ❑ No...... Version l.7 Commercial Building Permit May 15,2000 ° Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front E. j f , Side L= R:Y7-1' I R:W_ Rear •�uTding t-�et�ice— l , t i i --_ Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arlan ). 111 #of Parking Spaces Fill: (volume/k,Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES IF YES, date issued: AiA I IF YES: Was the permit recorded at the Registry of Deeds? NO . 0 DONT KNOW 0 YES ` IF YES: enter Book I C ( ; Page; ' and/or Document#1 B. Does the site contain a brook, body of water or wetlands? NO Q DONT KNOW 0 YES IF YES, has a permit ben or nZto be obtained from the Conservation Commission? Needs to be obtained Obtained Date Issued: s C. Do any signs exist on the property? YES NO i IF YES, describe size, type and location: j yCIG �h f� `� �� �✓j A D. Are there any proposed changes to or additions of signs intended for the property ? YES NO IF YES, describe size, type and location j E. Will the construction activity disturb(clearing,grading, vation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 1 1' NO IF YES,then a Northampton Storm�Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SECsI'I N 4 x ;QIgSTRIfCTa�T7 EIVACESwf,�1 PROJEC S I ESS THAN 35,OOQ CCIBIC"hEkT�FsERl'CL`US�ED,�PJ4"+�E " . :; ;° , - Interior Alterations Existing Wall Signs ❑ Demolition❑ Repairs❑ Additions ❑ Accessory Building❑ Exterior Alteration '❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑ Brief Description (Enter abrief description bete. e J 01//-YI x/ S ''`'? x3A 7 /Lvc;m Of Proposed Work:��'� /t,� 16 �° ti�• /}%rl�jl2.U � s 4 I SEC,TIiDN 5..ISE GRQUP1NDONS Rl�C1Dt1fPE� USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A 71 ❑ A-2 ❑ A-3 ❑ 1A ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A E Educational ❑ 213 El F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional 1-1 ❑ 1-2 1-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility Specify:( I i M Mixed Use Specify: S Special Use Specify: i O[v]PLf E Tf1SSECT11)"t�iF LEXISTI@}G C11kDING 11iDEkGOING RELAY)UATIONS„ADD(TfOt�tS:AfVD70R CHAN 1N GE USE Existing Use Group: 1 Proposed Use Group: i Existing Hazard Index 780 CMR 34):( ( Proposed Hazard Index 780 CMR 34): SECTION=68UILDINGIEIGiT�ANDREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION Floor Area per Floor(sf) St k 2nd 2 n W I i 3rd ! 3 1h 4 f 4d Total Area(sf) Z7 0 Z ��} I Total Proposed New Construction(so s � 2 Total Height(ft) '— Total Height ft I `� x ) 7.Water Supply(M.G.L. C.40,§54) 77.1 lood Zone Information: 7.3 Sewage Disposal System: Public Private ❑ ! Outside Flood Zone( Municipal. On site disposal system❑ Version 1-7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street Room"!00 �g Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CON.STRUCT;RFPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING' �SECaT�ON Sli'E(NFORMATiON` w 1 Property-Ad dres a, �r F - . s,,.`4 .. SECTII�N 2 PROPERr1f OWNERSNIP�IATHORIZEDNAGENT h4 2.1 Owner of Record: id-7 Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: I G' o f l� van i (� d G vs S Name(Print) Current Mailino Address: Signature "`�' G` C Telephone ✓/ SECTlON.3 'O M-COSTS Item Estimated.Cost(Dollars)to be Ofitcial Use Only completed by ermit applicant ilding Permit Fee ?` 1. Building Ul-4✓���✓ .F 2. Electrical O ost of tz Estmated Total`C _.. G ,_ Q �`i ii ., ConsfructionTi%om1 6.' 3. Plumbing # �) (� I ButldmgPermrtFee 'y 4. Mechanical(HVAC) I X• ; r , �a i ,i S. Fire Protection 6. Total=(1 +2+3+4+5) �✓L Cfieck.Number Section'Fbfri0ffi cial Use•QrT yt J. BwldtngaPermd°Number` :Issued Signatures Buiiding.Commissioner/Inspecfor.of.Buildings Date 1 S'c c_unG /C;c? /� iv-- 1,3 t 1��j tt"% �v�p� t tjl%6 Vie) Mkt File#BP-2006-0782 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 T_ypeof Construction: CONSTRUCT 2 NEW BATHROOMS-2ND FLR ADMIN BLDG_ 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 INFORMATION 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 2 0 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-2006-0782 GIS#: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23B-046 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0782 Project# JS-2006-1192 Est. Cost: $16000.00 Fee: $80.00 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 Zomng: M Applicant: COOLEY HOSPITAL Applicant Address: 'hone: Insurance: 30 LOCUST ST (413) 582-2313 Workers Compensation NORTHAMPTONMA011060 ISSUED ON:21712006 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT 2 NEW BATHROOMS - 2ND FLR ADMIN BLDG 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��-jam ' � Rouglt-'I117)J (Z House# Foundation: Driveway Final: r Finale; `� ' Final:)/-�-7�( Rough Frame: 0 z 7��) h L o 1 s Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: ��-`" Final:O k THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occu anc si nature: FeeType: Date Paid: Amount: Building 2/7/2006 0:00:00 $80.0059643 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Buildino,Co:ninissiont,-r-Anthony Patillo