23B-046 (60) i
Versionl.7 Commercial Building Permit May 15,2000
SECTJ0J+1 1'0 ST RUCTURAL.PEER*REVIEW(78U CMR 1]Q 11�
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 11 -OWNER AUTHORIZATION -`TO BE".COMPLETED:WHEN
OWNERS:AGENT OR•CONTRACTORAPPLIES..FOR.BUILDING'PERMIT
I• ' as Owner of the subject property
hereby authorize'
to
act on my behalf,in all matters relative to work authorized by this building permit application.
i
Signature of Owner Date
(�T 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 un r/the ains d na(' of perjury. _
' ..• r° I
Print Na e
Signature of Owner/Age% Date
SECTION 12 CONSTRUGTION.SER;UICES'
10.1 Licensed Construction Supervisor: Not Applicable ❑
Name of License Holder:��/ r S� i
_ License Number
Address Expiration Date
C� 40 C
i
Signature , e V 8 Telephone
SECTION 13 WORKERS .CQMPENSATION"NSURANCE AFFIDAvIT,(M G:L:c:"152,`§•2SC(6))
I.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 Q No`
r
i
Version 1.7 Commercial Building Permit May 15,2000
x
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage - G
Setbacks Front ' ZIr
Lam' - --�—
Side L:'--�� R: L:[ irR: !
Rear 1
Building Fre r f--
Bldg. Square Footage % 1 1
Open Space Footage %
(Lot area minus bldg&paved i /y,( 1 n
parking)
#of Parking Spaces
v
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW Q YES
IF YES, date issued: /,
IF YES: Was the permit recorded at the Registry of Deeds?
NO Q DONT KNOW 0 YES
` IF YES: enter Book Pager;' and/or Document#`:
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 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 0 -
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the—property? YES 0 NO
IF YES, describe size, type and location: j
E. Will the construction activity disturb (clearing,grading, xcavation,or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES O NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
Ze'd -10101
Versioni.7 Commercial Huildigg Permit May 15.2000
Interior All3embons Existing Wall Signs ❑ Demolition❑ Repairs❑ Additlem ❑ Accessory Building❑
Exterior Alteration ❑ Existing Ground Sign[I New Signs 0 Rooting❑ Change of Use❑ Other❑
Brief Description Enter a brief dem iptioa here. oj,�r, P V*Y d.-)t5 F,-r rUt 3
Of Proptlsod work TA P/� R C�U�'Li i TU . T7-4-,d 0/`r �L t
USE GROUP(Cheex as*Wiieabie) C UCTn E �
A Assetrtt)ly 0 A-1 ❑ A-2 ❑ A-3 ❑ 1A []
A-d A�5 Q 1 B ❑
B Business ❑ 2A
E Educatanal O 28 ! ❑
F Facto ❑ F-1 ❑ F-2 [] 2C ❑
H High Hazard ❑ 3A ❑
I Institutional l-1 ❑ 1-2 1-3 ❑ 3B ❑
M Mercantile ❑ 4 []
R Resldentlal 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ 5-1 ❑ S-2 ❑ 58 Q
U Utility :a Specify
M Muted Use in Specify:
S Special Use Specify:
tai E S� � tLaR-�ltil�Ett�i IISE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34).1 Proposed Hazard Index 780 CMR 34):E— —--
SECTIk}�S(BUILbII��E�.�_-_r•,•�
BUILDING ARVA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf)
�9
1"
2°tl l I
3b e
Ar' 4N
Total Area(sf) Total Proposed New ConWuCbon s
I
f
Total Height(h) , I
Total Height h 1
7.Water Supply(M.G.L.r^40,S 54) 7.1 FlpaAZ2pv Information: 7.3 Sewage Dispoaaf System:
Public[] Private❑ I Zone Outside Flood Zone Municipal[] On site disposal systemQ
ZO/cfe'd GS6E FGS 2Te NOSMADIG J,3-100J 2:0:9T Seel–ST-00N
Version 1.7 Commercial Building Permit May 15,2000
- -»
fffi
V.,,
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i
_ City of Northampton
-Building Department
212 Main:Street
Room'100
_I —Nprlthaimpto n MA 01060
Chone 413-587=T'240 Fax 413-587-1272 r
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 TOW"Y
�� a [hls�sectroa to be compCeted hyoffti
_
-"-Property-Ad
locus; �IRYMT-i
a ! �Ot �IRIt
NO�erCahDlSfnc '
?� a-
! A/�/Cf'4 02.011 1 A"A. V/ V(✓ ® I
Eitm'StQisrc � :_— a cH�Dtsfrict — - <. '_ �fir.
SECTION 2 =PROPERTY OVNNERSHIPlAUTHORIZE0.AGENT �?
2.1 Owner of Record:
levW® ✓ lam' C�� �J
Name(Print) Current Mailing Address:
1( 2—
Signature Telephone
2.2 Authorized Agent:
i
Name(Print) Current Mailing Address: e`
i
CJC UJ '
Signature Telephone 3 /
SECTION.3-::ESTIMATED CONSTRUCTIORI CQSTSd
Item Estimated
ed Cost(Dollars)to be Official lise.Onlq
completed by ermit applicant
1. Building �+ C) (a)`l3ulldmg'Permit Fee j -
i
2. Electrical j (b)Estimated Total.Cost of?'
.. M Constructlori"from 6
3. Plumbing f ®0 i .Buildlj . ermif ,-
4. Mechanical(HVAC) e
i .
5. Fire Protection �TI
6. Total=(1 +2+3+4+5) S CJ(� Check.Nurnber
TtisaSection Fir Official+Use On' ,
BulidO Permit Nurnt ef`-
ls`sued;
r. ..
Signature;
Building,Commissioner(Insoecfoc.of.Buiidings Date
File#BP-2006-0561
APPLICANT/CONTACT PERSON SCOTT JOHNSON
ADDRESS/PHONE 1482 CAPE ST WILLIAMSBURG (413)628-0217
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: REMOVE PLMBG FIXTURES&CONSTRUCT WALL TO CREATE 2 OFFICES-
SOUTH WING 2ND FLR
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
INFO 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 Commis 'o
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-2006-0561
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category BUILDING PERMIT
Permit# BP-2006-0561
Project# JS-2006-0819
Est. Cost: $6500.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: SCOTT JOHNSON 082324
Lot Size(sq. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M Applicant: SCOTT JOHNSON
AT. 310 ST
Applicant Address: Phone: Insurance:
1482 CAPE ST (413) 628-0217
WILLIAMSBURGMA01096 ISSUED ON.1111612005 0:00:00
TO PERFORM THE FOLLOWING WORK.-REMOVE PLMBG FIXTURES & CONSTRUCT
WALL TO CREATE 2 OFFICES - SOUTH WING 2ND FLR
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://f17/4��}� House# Foundation:
Driveway Final:
Final: 1"i �"����,bi ;� Final.1-2-11A5
-4� Rough Frame: ��
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE ITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATION
Certificate of Occupancy, Signature:
FeeTvpe: Date Paid: Amount:
Building 11/16/2005 0:00:00 $50.00
212 Main Street,Pbolie(413) 587-1240,Fax: (413)587-1272
Building Corrn,tissioner-Anthony Patillo