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w V,a D=?/--R 7), E N'71 p.° DUILD"1�C INS?°C t0?:5 -�
2i2 Ma;c Strcct ' Muc.:cipal Buildinc
N'orlhampton, Mass. O1000
CO)'TE sAroN >✓1sC7I-..4 -,'a A -1't r`VIT
!, _ Ra_yrr _nd•_R._Houle Construction Inc.
(limes.:•-1 � ttw} —�-_- - - - - --- - ....._._.__.
«,ici a pr"lcipa-, plaec 01busieesJresidencz at:
187 East St. South Hadely, MA 01075 413-532-9243
(s=UCi;ylstatcr�p)
do hereby cer-�ii�, under ct�.c p� tad Pell -'s o1 perjury, Z�:
�!_.rl employcr pro"'tdin Ll° IOHOnC v rnC5 CotnJCns� w = On COVC=C iOr In)'
CLUp(Ovccs «'or,—Dng on'titis}vb:
Arch Insurance Company IRWC100737 12/31/03.
('t.�s:.�� Co�r.._..r~:) CPclic: ?�`_:c;) (=:�ir_•tior, D�.�^^}
I.TUr1 a so!e propr;ttor, Seee;a? Conu-a(7Cor or homeo`vcce (6-i-cie onC) 23d hc,,'C hired
the Con-ac-to: L-5S d below vquo have (,1r e i010tVt 2 worker's Coc;)tru2-:ion pck)c5:
t'7:1 k:^ C0I 1 0ul j r�GJC i y�tl r:LC:) ( X>liJGn? Dmc)
-- (Na.-- of Coo;acor) ��s�za Com��viPolc; \i�cer) (Ex-pir.:oon Dztc)
(Name of Con.--acio,) (^sl: c- Cow;a��i?ol cJ N:tsb l fcz�i iea Daic)
C^sur2n= CompazylPo< cy N=b,: ) t•cxpu,Joo D'a—,
c Ccc-.y w c.,_'ut� °x^_..+ oc LO.l!ooc--=^)
O I sole prop^etor acd i;_ve no QZ,e a'O cog for U2P-
a-m- a hOM, e o%vn er pert-o rk mysC:`.
NGiG:.:ply:be axe-�..�1e'.k^o��F'^...i.o q!ci}-_—�•w c:.: ^ �--�.c:x_�:.,,.erk r_a C�•-.:1:=�e:
is„t�C!� -s- =C=,o,a, C ,- ��`ca=axe CL--
,"!_t i'-
I.,Y:t• a'Lz W off-!,C �
For
Versionl.7 Commercial Building Permit May 15,2000
SECTION 10 STRUCTURAL.PEER REV[EW(780 CM 110 11)
Incependent Structural Engineering Structural Peer P.eview P.ecluired Yes......❑ No......IM
SECTION 11 OWNER AUTHORIZATION TO_BE_COMPLETED._WHEN
OWNERS:AGENT.OP CONTRACTOR APPLIES FOR BUILDING PERMIT .
1. &L as Owner of the ;
{ n subl pry,:
h_ eby authorize Raymond R. Houle Construction Inc.
l.' C_
-� If, in all matters relative to or aut orized by this building permit application.
0
S at Lve o rcrw eer Date
I Timothy S. Pelletier as Ov,ner/Authorized Abe
a
he-eby declare that the statements and information en the foregoing application are true and accurate, to the best of my
kn:wledge and belief.
S;_-,ed under the pains and penalties of perjury.
Timothy S. Pelletier
Pr,r._ NamA
S:F-.ature of owner Agent Date
5ECTIONI2 CONSTRUCTION SERVICES -
10.1 Licensed Construction Supervisor: Not Applicable O
N2.-7e of License Holder : Timothy S. Pelletier 066227
License Number
187 East St South Hadley, MA 01075 07-07-2005
��- Expiration Date
—� 413-532-9243
5-�ture Telephone
SECTION 13 -WORKERS' COMPEN_SATION_INSURANCE.AFFIDAVITLM.G L c.-' 5
2,
Compensation InSUrd lie aii.?vli must be completed and submitted with this application. Failure to provide thi; a-
v:: =soft In the de.nial of the Issuance of the building perm;' --
S - = r`.davit A—ached Yes....... ® No... . 0 _
Version 1.7 Commercial Building Permit M2',' 15,2000
SECTION_9 _PROFESS.IONAL_DESIGN BIND_CONSTRUCTION SERVICES - FO R.6UILDIHGS-AND STRUCTURES SUBJECT.T
CONSTRUCTION CONTROL"PURSUANT-TO 780_Ct+tR;11e. CONTAINING MORE THAN 35;000_C F'O E6 PAC E)
9.1 Registered Architect:
Na,-ne(Registrant): Not Applicable ❑
Registration Number
Address j
Expiration Date I
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Pesponsibility
Address Pegistration Number
Signz;:,re Telephone Expiration Date
Name Area o`Responsibility
Address
Registration Number
Signature Telephone Expiration Date
Narne Area of Responsibility
Address Registration Number
Sig:-z:ure Telephone_ Expiration Date
Nzrne
Area of Responsibility
Address Registration Number
Si3-ztu" Te!ephone Expiration Cate
9.3 General Contractor !
i
Raymond R. Houle Construction Inc,
Not Applicable ❑
Com��-v Name:
Timothy S. Pelletier j
]ie In Charge of Construction j
187 East St. SOtith Har31 E'yr MA 0107S j
413-532-9243 `
S;g-a` - 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:
PublicNX Private [I I Zone: Outside Flood Zone IRX Municipal 10 On site disposal system ❑
8. NORTHAMPTON ZON'LNG
Existing Proposed Required by Zoning
This colmm to be filled in by
Building Depa.-=ncnt
Lot Size 969 427.8 ( 969427.8
Frontage 2,658' 2,658'
Setbacks Front
102 102'
Side L: 881 R: 42, L: gg, R: 47,
Rear 18' 18'
Building Height
64.5' 64.5'
Bldg. Square Footage %
402,861 402,861
Open Space Footage %
(Lot area minus bldg&paved 40.6 40.6
arldng)
-'-'of Parking Spaces 761 761
Fill:
volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON7 KNOW YES XX
IF YES, date issued: December 13,2001
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON7 KNOW YES XX
IF YES: enter Book 6504 Page 239 and/or Document
B. Does the site contain a brook, body of water or wetlands? NO XX DON7 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 XX NO
IF YES, describe size, type and location: Various Locations on Site
D. Are there any proposed changes to or additions of signs intended for the property ?YES_
No_XX
IF YES, describe size, type and location:
Versio::I.7 Co=erc%al Buildirg Permit May I:, 2000 J-i
-SECTION 4 O!`tSTRUGTiON ERVICfS�ORPRO]ECTS LESS THAT135,�00
CUBIC FEET'OFNCL�SED SPACE " � f
tY.
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ) Other [ ]
❑ r Accessory Building [ ] Repairs [ )
- BP.TF, DESCRIPTION* C'p��STRUtT�����%�sfJg/1S ��D�0��l-'(-£�'d��'�t 5
SECTIONS .USE GROUP AND'CONSTRUCTION_TYPE
USE GROUP (Check as applicable) CONSTRUCTION TYPE
FEE,ducabona�rssembly 1❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A NX
A-4 ❑ A-5 ❑ 16 ❑
Blsiness ❑ 2A ❑
❑ 2B ` ❑a_tory ❑ F-1 ❑ F-2 ❑ i 2C I ❑
H Hioh Hazard ❑ I 3A ❑
I Inst.ltutionaf ❑ I-1 ❑ I-2 I-3 ❑ 33 ❑
M t;ercantile I❑ L 4 I ❑
R Reside,ntia! 10 R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S S.o?g° I❑ S-1 ❑ S-2 ❑ 5B 1 ❑_-
U Ui!i y ❑ Spedry:
M M:red Use ❑ Specify:
S Sp==ial Use ❑ I Soecify:
• COMPLETE THIS SECTION.IFtdMN'G BUP�DING UNDERGOINGf2r1vQVA7IONS,f.DDITIONS.�IND%OR'CHAJVGE IN 115E
Use Group: 1-2 Proposed Use Group: I-2
Ex`54,7= Hazard index 780 CMR 34): 4 Proposed Hazard Index 780 CMR 3=): 4
SECTION 6 BUILDING.NEIGHTAND"AREA;:.
AREA EXIS I 1G PRO OSED NEW; a� -� -y- a
SUILDING � ? CONSTP,UCiiON =;�"�-��=OFF.fCEt15E'ONL�' ;�.�•� �,_
F;;,:"A,-ea per F ccr(s'�
37i a
` Totai He;c��c F--- ---- - -
� v
%'ersioal.7 Corrynercial Build.g Pennit Nfay 15, 2000
City of Northampton 'K"¢
Building Department
,,n 212 Main Streetfa�r
Room 100 e 1
Northampton, MA 01060 ca a
2 Mra 413-587-1240 Fax 413-587-1272 _ -
z
APPLICA ION TO CQNSTRUCT, RE AIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDIN,
OTHER THAN AONE OR TWO FAMILY DWELLING
SECTION 1 SITE_INFORMATION _
. �wyL��This�ecfior�fo�fiecompletes��y�ffice � �- -
1.1 ProaertYAddress: �:��...,. .-..�. �Y"4{�=.rs�.� ei-mac" yam_-�'r .•k+'=F. �,�, c� -
Cooley Dickinson Hospital Map O}
F^, =OYerlay Disfi7ct�'
30 Locust St.
���TTSL.VI�Ull.ls.-'an-'G�. ..-. -..~�-..-lO�DI>U ILI" 'i�.•C'.�c•.fir._;�
SECTION:Z PROPERTY.OWNERSHIPJAUTHORIZEDAGENT
2.1 Owner of Record:
Cooley Dickinson Hospital 30 Locust St.
Name(Print) Cu,—i ent Mailing Address:
` ` 413-582-2313
Si z ji,e Telephone
2.2 Authorized Agent:
Raymond R. Ho le Construction Inc. 187 East St. South Hadley, NIA 01075
Name(Print) Cur en,Mailing Aid,ess:
413-532-9243
Signa,ure Te!_phone
SECTION 3-ESTIMATED CONSTRUCTION COSTS:: :_.°
Item Es`umated Cos,(Dolla„) to be Onciai Use Only
completed by peril',aoolicant
1. Building (a) Building Permit Fee
2. Ele-ftrical �� {o)Esfimated"Fotal Cost of
L /O n�� Construction from'(6) _
3. Plumbing ��> Building Permitfee
36 00
4. hlethaniCal (HVAC)
5. Fire Prote,_-t. on
�e
Tot_' = (1 + 2 - 3 + 4 + 5) 3"7�`�c)' `` ( Che4cNurnrr S
-This Section For Official Use Only
5.ilding Permit Nucor Date Issued:
I
&gna ure:
Building Commissioneonspector of Buildings �at'-
File#BP-2005-0902
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
T_vpeof Construction: CONSTRUCT WALLS TO FORM NEW OFFICES&STORAGE AREAS
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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
THE
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 sion
e�
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-2005-0902
GIs#: COMMONWEALTH OF MASSACHUSETTS
Mai):Block: 23B-046 CITY OF NORTHAMPTON
Lot:-001
Permit: BUiidinq
Category: BUILDING PERMIT
Permit# BP-2005-0902
Project# IS-2005-1256
Est.Cost:$57108.00
Fee: $285.00 PERMISSION IS HEREBY GRANTED TO:
Coast. Class: Contractor: License:
Use Group: Raymond R. Houle Construction Inc 066227
Lot Size(sq.ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning_M Applicant: Raymond R. Houie Construction inc
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
187 East St (413)532-9243 Workers Compensation
SOUTH HADLEYMA01075 ISSUED ON:3129105 0:00:00
TO PERFORM THE FOLLOWING WORK.-CONSTRUCT WALLS TO FORM NEW OFFICES &
STORAGE AREAS
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:GV*tLS 1-1h;)5— House# Foundation:
)` Driveway Final:
Final: Final:5l11/0'- �.�
I �"vl Rough Frame:0 �i< (�_i�-a E-
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final: O6 a3•p s a
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy si nature:
FeeType: Date Paid: Amount:
Building 3/29/05 0:00:00 $285.00
212 Main Street,Phone(413)587-1240,Fax:(413)587-1272
Building Commissioner-Anthony Patillo