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ca DEPARTMEITT OP DUILDrNG INsPECT)O1JS —
212 Main Strcct ' Municipal Building
Northampton, Mass. 01060
WORX R'S CO�/CPENSAT70N MSUR -NCE A=AVI7'
/1e pier 9,h!ov/e Gaffs 7`Ir�� .
(li a-nxxJpermi tt�}
�).qth a principal plat,- of business/residence at:
5/j' Ile P S t. L v 111041 //7 D/056 _(phone!) 5Y13-5y7 2Soo
(srr t/ci ty/stalc/a P)
do hereby ccrdi ,, under the pairs and penalties of perJury, ih3l
I an employee providing die followine worker's cotnoens ion cove rzse Cor my
eluplovccs worming on'uliS job:
Al/ea -Ne/7f t aiHer/ca We- 1050033 /2-3/-05
(ianu�m Comp-=- y) lPclic: N"u lb r} - (T:,- for Due}
( ) I'am a sole proprietor, geoeral concmaor or hameowuer (cicie one) and have hued
the cones actors tasted below wbo have the `olio%wing worker's co�oe,��2�on peLicies:
(team: o.Co c c or1 (In�ra�iL^ COiL1DJSl)'/t�GUCi '.gum c:) (r:�i;aeon l�atc)
(Name of Coocracior) (1rLSUranc ComDaa.'/POJCi \unLrt] (i��ir:iOn Dale)
(Name 0f Coar aMO,) (Lasufanc; Compao)'/Pauc). Numtu; Date)
(Name of COCIEMCior) (Insu ancz Comrz.cy/Policy Numb,�r) (E.-\-p%t26oa Date)
(a6a[�u,^i;:vocal r)cC Joccmu-v to a;cuc��afocti:uua oO P=-La as wall
O I am a sole proprietor and bave no one wor4 ng for me.
( ) 1 am.a home owner performing all the work myself.
NOTE:ptcx be 1ajxt rfin wt�JO lk^cacouam ubo cnsplay Pcz o=to&m-rr�, d..c1L�of
aot nor LL--- v-irj in utic6 the rcida«oo tic p oua&I zip tr-,tbeen c.T w C�-z12y 00=&d i w tc
cmploy=3 Lhc _ ..;on Aa(GLIS2s.1(S)�Fppliatjoc try a 6ommax rw:bc=—:or p=mit rc_y c-idc Lbc
lc�l cur a or as rs*oyx under dao Workce,Coc�o Art
1 uDdQr i�d di,a>oopy of tAia mtr�mx may bo for rnrdnd to tbo Dcponmfsxt or lcca cviaf Arc d aY offs oe or lry-10 ror Jb
covcabc vcliticnioa a_,d th--i L- L—m to uuuc bovcraot Lmdct soa600 23 A of MGL 152 na Iad to the i=Pcmi600 of cim:a pcaalliro
oomc�of i rUc O(UP to S 1,500.00 an)6/or ca{a izor�of up to ooc ytz cad a%1J pcza.,jo�a 6c roan Ora Slop Wort ordc and a
ftm of 51 00.00.d_y apim me
Pcrmit NLimbcr only rt .
/2-Oep-v 1.�p — Lot
S'� tc�nsrx/Pcrm iU e .} .::.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10 STRUCTURAL PEER REVIEW(780 CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11,= OWNER AUTHORIZATION-TO BE COMP,LETED WHEN,
OWNERS AGENT OR CONTRACTOR APPLIES FDR BUILDING PERMIT
I, l_ oo l y Ncki h s/on lAys�oi Tia L as Owner of the subject property
hereby authorize Gl R you CO/ S r VC, 7-/0 C . to act on
my be in all matters relf, ork authorized by this building permit application.
Signature of Owner Date _ ,f
I, Ra VZW&7hd R, 1�le0le- Co/)s Tl UC7-/0/-7 -Zrh c . as Owne uthorized 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.
71Zwa; icy s. P-e,//e finer
Print Name p
Signature of Ow en Date
SECTION 12 CONSTRUCTION SERVICES
10.1 Licensed Constructions Supervisor: /� Not Applicable ❑
Name of License Holder : /lwe?1 4% S, Ag Ae- 712 2�' 066 ,227
License Number
Iler s r L 61 al/o w. /!'I.9 d/o'5-6 07-07-07
Address Expiration Date
17113- 575'7 22 ,60o
Signature Telephone
SECTION 13, WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G t:,L152,- 25C(5)j
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affida:'-Y
will result in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes....... R No...... ❑
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9 PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES FOR_BUILDINGS AND STRUCTURES SUBJECT.TO
COrNSTRUCTIQN CONTROL PURSUANT T9780.CMR 13'6.{CONTAINING MORE THAN 3S000,C F OF ENCLOSED;SPACE)
9.1 Registered Architect:
Not Applicable O
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
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
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
1��t U o/7�� yovLB �Oh51/?11C7 /D,'02-TAC Not Applicable O
Company Name:
Responsible in harge of Construction
/'> S T jZcj
Address
�_113- 5-y72500
Signature Telephone
Versionl.7 Commercial Building Permit May 15,2000
7.Water Supply(M.G.L.c.40,§54) 17.1 Flood Zone Information: 17.3 Sewage Disposal System:
f 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 116 9, 112 7. 8 96 9, 512 7.8
Frontage 2(c se 2 6 5 8
Setbacks Front 102 ' 102
Side L: 88 R: 5�2 L: 88 R: S/2
Rear /g' /'9"
Building Height 6((S ' 6 5!5'
Bldg. Square Footage 1/02,1364 % 1102,961.
Open Space Footage %
(Lot area minus bldg&paved
arlan
#of Parking Spaces 761 761
Fill: N/A NIA
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES X
IF YES, date issued: De n13, 200J
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES l�
IF YES: enter Book 6 6011 Page 2313 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 1� NO
IF YES, describe size, type and location: VA h o vs
D. Are there any proposed changes to or additions of signs intended for the property ?YES_
No-
IF YES, describe size, type and location:
Versionl.7 Commercial Building Permit May 15,2000
=SECTIUTI 4 CONSIRUCIiON�RVICESi�OR.R07E&r LESS THAN 35;000,
CU BIC,FEETOFNCLI)SEDSPACE # ,4
v
Interior Alterations E xisting Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
.� ❑Exterior Alterations emolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building [ ] Repairs [ ]
BRIEF DESCRIPTION: /77,ho/' /,?c no vafla&s 7'o The E1),eneehcy rQa En rR fw4%tr�I
SECTION 5--USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly 10 A-1 ❑ 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 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 TRISECTION IFEXISTING,BUILDING UNDERGOING RENQVATiONS,ADDITIONS_`ANDJO,R 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 HEIGHTAND7AREA
SEON
OFF C U P
;
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ,w r F,
ON 041110-402,
r..
Floor Area per Floor(sf) n pp �¢ kst;
1 2 5 Renovations � s $�I 4
nd
15t 12500 7n
EJ� AN i.�c �-'�'e'1tCu4"p,�-s""�`"a•]xra, r '"� _:
2 d �f
°d f
aty€t2� i
3 7 s x
3 � Y x "
4th
4thc t
x e W f
Total Area (sf) Total Proposed New Construction (sf) Ar
IMF
'� Total Height(ft)
—
Total Height ft----- Y
IV---------- yw M, r
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department
212 Main Street x
Room 100 .
Northampton, MA 01060
*phone 413-587-1240 Fax 413-587-1272 a
F
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
-SECTION I-$ITENFORMATION
1.1 Properly Address: 111khis�ecfio x dee��completed office
COD�G�V iD;ckihson Hosoi taL Mapr �[ut
30 4oCUS >- ST ' one : yer ayct �� � z.
'. * «,,,,,.ya,' � • x,' �.�„�� .TES, ? ,� � ��Mi � -
SECTION 2 �P.RQP.ERTY OWNERSHIPJAUTHORIZED AGENT
2.1 Owner of Record:
Coo ley Dickir►soh Alosai?'ol 30Lo0yst SY Po. Box Do/
Name(P i t) Current Mailing Address:
y13- 582 -2 3/3
Signature Telephone
2.2 Authorized Agent:
_Tiwo-Ay 5. Pe Ile 1-%er 619?,'11eP 57'. Lucl/oul, 070,66
Name(Print) Current Mailing Address:
5'i3- by7-2 500
Signature Telephone
.SECTION 3 'ESTIMATED CONSTROCTION-COs'T -
Item Estimated Cost(Dollars)to be official-Use Only
completed by rmit applicant
1. Building tai)-Building.-Permit-Fee
2. Electrical oa {b)estimated tal
Cost of.;
O OD
� O. Constriction To`frflm
6)a7
3. Plumbing ,� O e_ Building Perm�tfee -
4. Mechanical (HVAC)
5. Fire Protection $000•°=�
6. Total = (1 + 2 + 3 +4+ 5) 0:10— Check`Number p —►
This Section ForOfficial'Use.Onl
Building Permit Number `=' Rafe Issued: -
Signature:
Building Commissioner%Inspector of Buildings Date
File#BP-2006-0647
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
Buildiniz Permit Filled out
Fee Paid c
Typeof Construction: MINOR RENOVATIONS TO EMERGENCY AREA ENTRY&WAITING
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
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 Commi ion
Signature of Building Official ate
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.
)VA
30 LOCUST ST BP-2006-0647
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2006-0647
Proiect# JS-2006-0948
Est. Cost: $185000.00
Fee: $650.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq. ft.): 667077 84 Owner: COOLEY DICKINSON HOSPITAL WC
Zonine:.M Annllcant:R?Volorl�I r l i I It? 'mictr!— io I i n_
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
187 East St (4-j) 532-9243 Workers Com)ensq+1011
SOUTH HADLEYMA01075 ISSUED ON.1211912005 0:00:00
TO PERFORM THE FOLLOWING WORK.-MINOR RENOVATIONS TO EMERGENCY AREA
ENTRY & WAITING
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:11 Rough: Rough: -i`, #/�/�ouse# Foundation:
Driveway Final:
Final: Dina 4� '�. ��' ✓,�'
Rough Frame: o
Z z5
Gas: Fire Department Fireplace/Chimney:
r" ,..
a_.1: — Insulation:
Final: Smoke: Final:o�j t^ l -c' =R�r"1�6K
P Ry6k FINAL 014 6S(W'09 La>;Aj
THIS PERMIT MAY BE REVOKED BY THE C Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS
ems.
:.�
Certificate of Occupancy Signature:
FeeType: ate Paid: Amount:
Building 12/19/2005 0:00:00 $650.00
212 Main Sheet,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthovy Patillo