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Versionl.7 Commercial Building Permit May 15,2000
E SE
` C f ION 10-STRUCTURAL PEER REVIEW(780,CMP:
endent Structural Engineering Structural Peer Review Required Yes......❑ No.....
OE 71ON 11.OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OE AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
l , as Owner of the subject property
he: y authorize to act on
m, ' 3half, in all matters relative to work authorized by this building permit application.
Sig lure of Owner Date
as Owner/Authorized Agent
he ; declare that the statements and information on the foregoing application are true and accurate, to the best of my
kn edge and belief.
Si. d under the pains and penalties of perjury.
_Sc.o' J�i�zsoh
Pri
V
SiF of Owner/Agent Date
SE `ION 12 -CONSTRUCTION,SERVICES r'
10. '_if-ensed Construction Su ervisor: Not Applicable ❑
Na of License Holder: C 0 J U 14's Q,r)
License Number
_C
L)y� � �%� d o �� IV, 2- 3 -
0�
Ac'
Expiration Date
SiE Telephone
SE -;ON 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152, g 25C(6))
W 3rs Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit
wi :su't in the denial of the issuance of the building permit.
SiL Iffidavit Attached Yes....... ❑ No......
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:
ibi c ❑ Private ❑ 1 Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: 2 L: R: yZ
Rear
Building Height U J� / S--
Bldg. Square Footage % 3 6
Open Space Footage E� %
(Lot area minus bldg&paved C)
parking) // 77 I 40
7
#of Parkin Spaces 6 12— 6 / Z
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW YES _
IF YES, date issued: Aug
Ile I
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES --
IF YES: enter Book Page and/or Document #
B. Does the site contain a brook body of water or wetlands? NO DON'T KNOW
. YES Y _ 51- K
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 c�
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
Version 1.7 Commercial Building Permit May 15,2000
UC
`�ECTION 4-CONSTR' TION SERVI'D C ES FOR PROJECTS LESS THAN 35,000
1BIC FEET OF ENCLOSED SPACE . .
Interior Alteration Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ �� ssory Building[ Re airs [ ]
I, A Te"71 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 Fa--tory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Ins- tutional 1.1 ❑ 1.2 1.3 ❑ 3B ❑
M V.-rcantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
11-1 Ut lity ❑ Specify:
V xed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Exist .-g Use Group: Proposed Use Group:
Exis` Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
OFFI EIJSE=
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION w; �
` MM
Floc, Area per Floor(sf) ist
2nd
3rd
2nd � fi "!W-1w f
— `n
Id 5
4th
3'd-- �
4th
Tota' Area (sf) Total Proposed New Construction (sf)
_ woivy
.............................
Total Height(ft)
Total Height ft
Version 1.7 Commercial Building Permit May 15,2000
City of Northampton
Building Department
212 Main Street
Room 100
Northampton, MA 01060
phone 413-587.1240 Fax 413-587.1272
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE, CHANGE TH C i 0 0 MOLISH ANY BUILDING
OTHER THAN A ONE OR TWO
NOV - 4 2004
SECTION 1 -SITE INFORMATION -
� , 1n` ee
o �� d bye ffice
1.1 Property Address:
�7a OC Map � Lo ,
R
/�� / Zorre _. � �Over��ybistrl 'Y �n
/4 CD,/U,6 L) "..,,,
�Elm Stpistrict ��= b CBD�stnct
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record: l ^
game(Print) Curren S � z t Mailing Address:
Z3 � 3
Signature Telephone
2 2 Authorized Agent: /
:col T o6,7�S y /'1 Coo 1�r DI'G ih�s an /yos"Olt
Name(P ' t) Current Mailin Address:
13
Signature Telephone
SECTION 3 -'ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only "
completed by ermit applicant
1. Building S-60 D (a) Building Permit Fee
2. Electrical -- ,l (b) Estimated Total Cost of
C..)
v 6 Q Construction from 6
3. P'umbing �--O v Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection /d o G . 00
6. Total = (1 +2 + 3 +4+ 5)1 O U Check Number '
t This Section For Official Use Only
Building Permit Number, Date Issued:
Signature:
Building Commissioner/lnspec#or of Buildings Date
File#BP-2005-0559
APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL
ADDRESS/PHONE 30 LOCUST ST NORTHAMPTON (413)582-2313/d�
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
Typeof Construction: ADMIN BLDG TRAINING RM-REMOVE BATHROOM&CONSTRUCT NON
BEARING WALLS
New Construction
Non Structural interior renovations
Addition to Existin
Accesso1y Structure
Building Plans Included:
Owner/Statement or License 082324
3 sets of Plans/Plot Plan
THE FqLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
1NF,QXMATION 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 ssion
Z�
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-2005-0559
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-046 CITY OF NORTHAMPTON
Lot:-001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2005-0559
Project# IS-2005-0738
Est.Cost: $8500.00
Fee:$50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: COOLEY DICKINSON HOSPITAL 082324
Lot Size(sq.ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning:M Applicant: COOLEY DICKINSON HOSPITAL
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
30 LOCUST ST (413) 582-2313
NORTHAMPTON MAO 11060 ISSUED ON.11 115104 0:00:00
TO PERFORM THE FOLLOWING WORK:ADMIN BLDG TRAINING RM - REMOVE
BATHROOM & CONSTRUCT NON BEARING WALLS
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 11/15/04 0:00:00 MO $50.00
212 Main Street,Phone(413) 587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo