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23B-046 (76) Ali ap 9 9 e a r q�. ••4 # Z4 �•_7 P Jj �Vl 4.p 7 e. SPA T� co;o pl i b M r"rf w• � ����� � �` III el. low. . P L P b 16 ;lux4L 4.1 on AL. • 7-4 7'* 1. o0iii IT 'v 4.. Z- I 0 V. 4 -PP Ir /• 2 krirw Versionl.7 Commercial Building Permit May 15,2000 t Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front _ Side L:' 3 R:= L:= R:z= 'T_1 Rear } i -Buitdmg Rdirif— ---' Bldg.Square Footage % Open Space Footage �—; % —� 9 (Lot area minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO 0 DONT KNOW 0 YES 0 IF YES, date issued: t IF YES: Was the permit recorded at the Registry of Deeds? NO "0 DONT KNOW 0 YES 0 IF YES: enter Book ! Pagel and/or Document# B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW 0 YES t 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: ! l D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO 0 IF YES, describe size, type and location: f E. Will the construction activity disturb(cleariN,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 ` NO 0 IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15,2000 SECTION 9-PROFESSIONAL,DESIGN AND GONSTRICTIONERY�CES FORBUILDINGS ANQ S7 Rl7GTt7[tESS1IB,IECTO T 1 6&CONSTRUCTIQN CONTROL:;PURSUANT-04 Cmi-Z 116.GOIThTA1N1NG MORE THAN 35;000 C F,,OF ENCL0.5ED SPACE) 9.1 Registered Architect Not Applicable i r Name(Registrant): Registration Number Address Expiration Date f i .. Signature Telephone 9.2 Registered Professional Engineer(s): i Name Area of Responsibility i k Address Registration Number Signature Telephone Expiration Date � � t j L 1 f Name Area of Responsibility Address E Registration Number Signature Telephone Expiration Date Name Area of Responsibility F Address Registration Number Signature Telephone Expiration Date i E Name Area of Responsibility - Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor /`� r?7<e[Yl���/✓�`=S '� Not Applicable❑ Company Name: E Responsible In Charge of Construction Addre Signature Telephone I ' Version 1.7 Commercial Building Permit May 15,2000 . 1 SEC-T10N 16 $RUO PEER RE1lIEW(780 CMR ;1011 Independent Structural Engineering Structural Peer Review Required Yes © No SECTION 11-=01NNER-.AUTHORI7.ATION TO BE COMPLETED;WHEN OWNERS.AGENT OR CONTRACTOR APPLIES•FOR BbILDING PERMIT 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. Signature of Owner Date i 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 under the pains and penalties of pedury. i o Print Name ]a. lz l,/0 _I119-nature of Owner/Agent Date SECTION-12-CONSTRUCTION-SERVICES , 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder:1 �a i I �_• _� License Number y Address L Expiration Date ignature Telephone SECTION 13-WORKERS'.-COMPENSATION INSURANCE"AFFIDAVIT.(NLG.L..c:1,521§,25C(6)) 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 0 No r t ' S�OR ._ Version 1.7 Commercial Building Permit May 15,2000 0�1TaO v Existing Proposed Required by Zoning this column to be filled in by Building Department Lot Size i ( t q 1.41- I Frontage Setbacks Front p V0141 Side L:= R:0 L:I l R:9W �� J Rear -Bu_1Uino H-ei i • Bldg. Square Footage % —I Open Space Footage % (Lot area minus bldg&paved ( / arldn ) #of Parking Spaces Fill: (volume&Location) /y A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO Q DONT KNOW Q YES IF YES, date issued: ! VTr-''�" IF YES: Was the permit recorded at the Registry of Deeds? NO Q DONT KNOW ® YES �' IF YES: enter Book Page'Y� f and/or Document#s B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW Q YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be btained Obtained , Date Issued: ' l C. Do any signs exist on the property? YES 11W NO 0 IF YES, describe size, type and location: I U Cd J Si' 1 ; D. Are there any proposed changes to or additions of signs intended for the property? YES Q NO IF YES, describe size, type and location: ` E. Will the construction activity disturb(clearing,grading,excavation,or filling)over 1 acre or is it part of a common plan that will disturb over 1 acre? YES © NO IF YES,then a Northampton Storm Water Management Permit from the DPW is required. Versionl.7 Commercial Building Permit May 15,2000 SEGTION'4. CONSTRUC-TIOI�,SEk-W.r fO 0-ROJECTVT-ESSTHAN35,000' 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-brief descripti here. ALA T� S F��C OOIt- w r �(/ / C Qv:rat Teo ts7�9 S ci n "�2M•+ Two ,DdOdt C Tp S e�5 41A re- ��d7'�h�rvt kA Of Proposed Work:) F 'SECTION 5--'USE-GROUP9. DiCONSTRUC USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑ _ A-4 ❑ A-5 ❑ B Business ❑ 2A A E Educational ❑ 213 ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ 1 Institutional 1;-�L 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: j M Mixed Use ❑ Specify: S Special Use Specify: COMPLE CETHIS:=SECT.CON TF EXISTING BU1LDlNG llMDEFZGOII�G RENOUATfONS;ADDITIONSANDIOR CHANGE IN USE ._p - Pro pop:Use Group: Existing Use Group: po Existing Hazard Index 780 CMR 34):1 Proposed Hazard Index 780 CMR 34):�- SECTION 6 BUILDING HEIGHT;ANDAREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION " "f Floor Area per Floor(sf) w 1 5t 1 -r '�'aya".^�' �e..„"Ka .a.'� j� '-`Cr�•Y3�. nd 2nd �'"' = 3'• _ _ I 3rd - 3r° I 4m Total Area(so Total Proposed New Construction ns '= r �i/DiV _ ! _ �5 c Total Height(ft) - Total Height ft 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa Disposal System: Public Private El Zone� Outside Flood Zone❑ Municipal a On site disposal system E] Version 1.7 Commercial Building Penmit May 15,2000 gity of Northampton —,Building Department E t 212 Main Street Room'100 n r,� No jampton, MA 01060 'ptone 4137-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT PAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF,OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING _SECIL N2L: IA E INFORMATION - --- _ , This sect�oato betomp7efed hlcoilice �w --- -"-Property-Address: �Q L �' LU S 1 S � I aM po3�t• }� r y 1 l'�' �•t..sua..'.<, 1....�^S'��eE�Y.c�•y�.,,L+gs � i',�,�'?��-S_.:�.se..ar:.��� +�- On �ert�rbrstn Elm StSDistr�c _ t6 Disfrlct3 --- Y SEGTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT _ 2.1 Owner of Record: iLc,hsnh d(�,O Si S i Name(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: ! c oTL M n�S On Gys ✓ S:� Name(Print) Current Mailing Address: Signature - Telephone -SECTION--3-.ESTIMATED ONSTRUCTION COSTS- Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building Soo �� - ^� i (a)Bwld�ng--Permitfee 2. Electrical v V (ti)-Estir0ated Total"-Cost of ' "Consfruction:Trom 6 t 3. Plumbing i Buliimg PermifFee 4. Mechanical(HVAC) r L t 5.Fire Protection � 6. Total=0 +2+3+4+5) Check Number .This-Section For.Official'Use-Oiil- ;. . - Bwldi49 PermlEa�ttimbe't_ Date �lssued� r Signature: Date Building Commissioneillriipe'&.`&gdildings File#BP-2005-0735 APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL INC ADDRESS/PHONE c/o Richard Corder NORTHAMPTON (413)582-2000 Q PROPERTY LOCATION SOUTH WING STEAM ROOM-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 , 7 400 Typeof Construction: REPLACE FIRE DOOR CONSTRUCT 2 WALLS TO SEPARATE MECHANICAL FROM HALL New Construction Non Structural interior renovations Addition to Existing AccessoKy 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 INFOVIATION 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 'ef�— /-- _ LOo Signature of Building Official Date 1 . 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. SOUTH WING STEAM ROOM-30 LOCUST ST BP-2005-0735 GIs#: COMMONWEALTH OF MASSACHUSETTS Map:Block:23B-046 CITY OF NORTHAMPTON Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Perrnit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category_ BUILDING PERMIT Permit# BP-2005-0735 Project# IS-2005-1022 Est.Cost: $5000.00 Fee: $56.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: COOLEY DICKINSON HOSPITAL 082324 Lot Size(sg. ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC zoning:M Applicant: COOLEY DICKINSON HOSPITAL INC AT. SOUTH WING STEAM ROOM -30 LOCUST ST Applicant Address: Phone: Insurance: c/o Richard Corder (413) 582-2000 () Workers Compensation NORTHAMPTON MAO 1060 ISSUED ON.1125105 0:00:00 TO PERFORM THE FOLLOWING WORK.-REPLACE FIRE DOOR, CONSTRUCT 2 WALLS TO SEPARATE MECHANICAL FROM HALL 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: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType• Receipt No: Date Paid: Check No: Amount: Building 1/25/05 0:00:00 50659 $56.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo