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23B-046 (57) O d- C LO LO N L � L' W QC v M-P-j CD C/) O .0 o U = 2 :3 C LL E O N O O a) J C v N o LO Uo C) Lo o � C) a) 0 (a) co a) N E o .Oo � 3 ai .= OE — o c ca .� L O >,:� ::60E an UAL cu 3 a� a� U M L U c � 0 O a> -= z � s 0 - -0 M — z �� •� a� 0 o_ o � CU -' °o 03 E 3 co C: 3 a> o � � aa) 0 E 0 z S-. ° 0 L N Ca � W M C!3 .O 0 o C/) = D cxv U o O oo ai O J � U N o U o o � L OO C OOM � 00 _ a) ¢ (d -0 O L E O N O a) aj _ O C (II 0 � E an U � � � a d) m 3 a� a� -r- 0- U Cti L V C � Co O 3 � a) z � y 0 L_ Q) "-' -D z .N a) (4 - ' O O 0 F — a) 3 a) > co O . a) O E � zU ° a) C � CIS N 5 d' O .0 O � 77 t cn 2 W LL 0 O (n O O a) J N 0 5 � ti L O U O O0 Lo L T-- — V -0 Lo E c L .O O Q) OE Q) . — 0 c cu L O 0 E M n U OT L0Jd m 3 Y Q) a) L Q U (U L U (II O z 0 L •co — F— (1) :t- 70 z3 � I 1 ^l 1 W 0 I 0 Q L I L _ I 0 0- 0 y_. _ — as c a� U 3 a) � 4= 3 v 0 . a) 0 a� 0 z 0 ° ry m Cr' of PC`T)filalll} foil �l+s�xthlncrlla" _ " ate DEPAR TEIJ7 OP Ut fLDNG fNSPPCT101:S 212 Ma Lc Strcct ' Niuoicipal BuildinE Northampton, 7fass. 0050 0P-I(IIZ'S C 0-1VM E N S A Tl 0 N G'�Su7NCF A F=AVIT 5, � _s�' /1 /�4?% 7L-/7c . (1 i ccu xJperrn�;t t�) �11i�h a principal place oFbusiflesslresidence 21 5/��'//er s t. L v�/dw /�Ii� D/o56 Uhone ') 5'/3-5t'�2500 (sumac/ci t}/staLc�zi p) do hereby ccrai ;, under the pzirs and penalties o'perjury, ?hal I -,r0 a_n employer providing Ule Followinc wori<cr's comocns--�Jon covcrzsc (or my tluplovccs wori�n� on'ulis j��. ) 2--31-o4 (l1SlLf�� Co ar.�c�) <PcLi c, Nt. r) no ri Dztc.) ( ) loam a sole prooncm, general coocrac>or or homeov,-ner (cucic one) 2no have- hired [7e coop ac ors Lst belovr who hzve cue foi_loc"ine wort ens co�oe, anon pc!cies: (Nara: c Cony;-ic-,or) InRrnnc Comoan)i-Pout, -- (N:)rne of Coocraclor) (LnsafaDc,. ComanwPolicv Numccr) u c n Due) (Name 01 Coacracno,) V (tasuraac Compa"3)'/Pouq N;imb� ) (—L�:pinion Daic) (NLMC of Cooaacor) (Insurance Co©cwy/Pot cy Numb ; ^ (E.�roon D�^) ( ) I am a sole proprietor and have no ooe worming for me. ( ) I am a home owner performi�Q all cht myself. NOTE:plc be ao--c the w jc bc�v ,wto cloy p w s w r, -moo c �� o X oa.d• 11_�of nee error t;^.:L_`7o-r�r,, in re d the bormcr the��a��p.:tt-cr_c=t.6e-...n�'c o p-�-i11v o_-c'c..--ai Lo t< c,-flay v"i LL--'-: (GLI5L^.1(S))_ =P7t;c.D OO b-f ,bornro 4�fc1-�c�c_a pc�nn�.:r cvid z l;v 1 o e o-,=p I o y —der dw—,Iynrthil m y r and orrte;d CfL—orU gram eo v e- -c vai(C=Li on a--,d th1 L-il��-e w eeo�r'w vcr���.,�-s i ca 2 5 A of M01- 52 c n 1r d w the"L e o of e-vrIatl pee11 Jo of,Gi o c up to S I,}pp"00 a cm i:-oumc.Ji o r u p to cx <rd 6,-j p-�Y�o�c Gc cc,,o c,slc�'Wort Ord-- (t om o S 100.DO .d_y i Pik¢D,- s r ,h _ v D_ rip Lot Version l.7 Commercial Building Permit May 15, 2000 SECTIONIO- STRUCTURAL PEER REVIEW(780 CMR 110.11) Independent Structural Engineering Structural Peer Review Required Yes......0 No......El SECTION 11 -g WNER,AUTHORIZATION--TO BE;COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES F.OR'.BUILDING PERMIT I, COO/e/V D cki h s/o/n� /7IOS�i 7T�1 L as Owner of the subject property hereby authorize Q Gf /� A/OU e C O/ _S r/'U -/-/0 G . _to act cn my be in all matters reK ork authorized by this building permit application. Signature of Owner Date I, Z?a l//YIDh� /�, �OV/e Cohs 7" uG7T/O/-7 -Z'h C . as Owne uthonzed A en 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 perjury. Troth i S Print Name Signature of Ow en Date SECTION 12 - CONSTRUCTI.DNISERVICES 10.1 Licensed Construction Supervisor: Not Applicable O Name of License Holder /% f'i e _ 066227 License Number ZV, 56 07-07- 07 Address � Expiration Date yr - s y7 0 Signature Telephone SECTION 13 -WORKERS' COMPENSATION INSURANCEAFFIDAVIT(M:G L c Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... R No...... 0 Versionl.7 Commercial Building Permit May 15, 2000 SECTION `9 PROFESShONAL DESIGN AND°CONSTRUCTION SERVICES FOR BUILDINGS''AN D STRUCTURES SUBJECT TO CONSTRUC., 1A CONTROL PURSUANT TO 780 CMR 116{CONTAINING MORE THAN 35',000'C.F. OF ENCLOS;ED_SPACE) Il 9.1 Registered Architect: Not Applicable O Name(Registrant): Registration Number i Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): I 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 Signatcre Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor /� // n —7 �Q Uzj,,9 )� /`f Z�2 6 (. Oh5I/PUC1/D/2 1 /) Not Applicable ❑ Cornpan—y Name: ,vo r Responsible In harge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7. Water Supply(PM.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ Zone: Outside Flood Zone Municipal 14 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, y2 7 8 96 9, y2 7.8 Frontage '�6 5 8 12,6 5 0 Setbacks Front 102 ' / 02 Side L: R8 R: �i'2 L: 88 R: y2 Rear Building Height Bldg. Square Footage y02 86 % L102,9 6 1. Open Space Footage % (Lot area minus bldg&paved arlan ) #of Parking Spaces 76 761 Fill: N/A 111A (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 1312001 IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES V IF YES: enter Book 6 SOY Page 239 and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON? 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)-10 vs D. Are there any proposed changes to cr additions of signs intended for the property ?YES — No IF YES, describe size, type and location: Versionl.7 Commercial Building Pernut May 15,2000 SECTION 4=CONSIRUC7iONERVICES FOREiO7ECTS LESS THAN'35,000: C,FEET NCLOSEbSPAGE GUBI OF' ' Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: Crect;'"49 /j1uL7i�vi"�S G �iY1 SECTIONS --USE<GROUP:` N C.ONSTRUCTIONTYPE,' _ 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: COMPLETE THIS SECTION;iFDQST3NG BUIMING,UNDERGOING RENO MONS;ADDIT ON AND/OR CHANGE;IN USE Existing Use Group: 1-2 Proposed Use Group: Z -2 Existing Hazard Index 780 CMR 34): y Proposed Hazard Index 780 CMR 34): y SECTION.6 BUILDING,H EIGHT.QND�AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION 2,- Floor Area per Floor(so rt 2 nd hy�U �� 4 L Fr 1St ' - ��, G � 2nd 3rdf. � 5 3rd J A 4th Total Area (sf) Total Proposed New Construction (st] � A Total Height(ft) N1,4 Total Height ft-- - ------------- a Versionl.7 Commercial Building PemZit May 15, 2000 City of Northampton Building Department ti a _� REM 212 Main Street Room 100 Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 a@s ° APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN ONE OR TWO FAMILY DWELLING c a� SECTION is SITEZNFORMATION c`� 1.1_Property Address: u _ Thhssecfion�oeompleted broffice r �' `2'2� ayi.�k ° r.k'xa �� fir. � Z �c.�;'r•xs .y '�' +i' y Mar ii«uAcu�O �JiF` .r (7L�lt r d K mv= 'ryi5.-y, a^�Ya t •h� '1 yss,: ^`-. / net < r i'� 3oD AII :5,:.3e-x.' 1Z`tra4c.'I •^k x ,`�x.,,�..y ?F ;a ex. i".✓.tT f a .-..,'�`• r+'x,.v'' .8�? L}t k SECTION 2 PROPERTY>OWNERSHIP,JAUTHORIZEU AGENT 2.1 Owner of Record: Coo/e v D6:kinsoh /losai?'al 30Zooyst 5 t. Ro. 3ox boo/ Name (P' t) ' Current Mailing Address: (113- 58 a - z 3/3 Signature Telephone 2.2 Authorized Agent: Tir>othy S. /°e//e tier 5/I'I,'1/eh 57'. IUdlau/, O1056 Name(Print) 'S Current Mailing Address; ' 7t��_ 5'i3 5y7 2 6 00 Signature Telephone SECTION=3_— ESTIMATED CONSTRUCTION COSTS ". Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a) Building Permit-Fee_ 2. Electrical ODD 4{b�1=stimated Total Cost of :Construction from" 6 3. Plumbing Building Perm►tfee_ 4. Mechanical (HVAC) _ 5. Fire Protection 6. Total = (1 + 2 + 3 +4 + 5) Z °� Check.''Nurhber This Section For Official Use Onl Building Permit Number - Date Issued. .l Signature: Building Commissioner/Inspector OfaBaildings Date File#BP-2006-0729 APPLICANT/CONTACT PERSON Raymond R.Houle Construction Inc ADDRESS/PHONE 187 East St SOUTH HADLEY (413)532-9243 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: CONSTRUCT WALL TO CREATE MULTIPURPOSE RM-OLD LOCUST ST ENTRANCE New Construction Non Structural interior renovations Addition to Existing Accesso1y 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 INFYIkMATION 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 20 bGt0) Signature of Building Officiralf Date Ir 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 LOCI)ST ST BP-2006-0729 GIs#: _ COMMONWEALTH OF MASSACHUSETTS Map:Blo(.k: 23B-046 CITY OF NORTHAMPTON Lot: -001 Permit: Building Category: BUILDING PERMIT Permit# BP-2006-0729 Project# JS-2006-1116 Est. Cost: $7267.00 Fee: $50.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Raymond R. Houle Construction Inc 066227 Lot Size(sa. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC Zoning: M Applicant: Raymond R. Houle Construction Inc T. .)u L.01-Uv ! vT Applicant Address: Phone: Insurance: 187 East St (413) 532-9243 Workers Compensation_ SOUTH HADLEYMA01075 ISSUED ON:112012006 0:00:00 TO PERFORM THE FOLLOWING WORK.-CONSTRUCT WALL TO CREATE MULTIPURPOSE RM - OLD LOCUST ST ENTRANCE 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� �� Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: ` 1' Insulation: Final: Smoke• Final: (j /` 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 1/20/2006 0:00:00 $50.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Comnussioner-Anthony Patillo