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23B-046 (92) r � r IL __ lZe�ivve ,��u��. exr�Sr`�h� Jc7odC �r►d t--,ri door. ®r .�. = v- t t �� 7M go « �M Iwo w _ AS G Scott Johnson Scott Johnson Cooley Dickinson Hospital 582 2313 or 2314 Raidology scedulars office space 460 sq feet. Remove existing wall.Non load bearing wall. Remove door and infill existing doorway. Remove existing ceiling and finishes. Install new cieling,lighting and finish. Relocate existing sprinklers. i Version 1.7 Commercial Building Permit May 15,2000 SECTION 9PROFESSIONAL DESIGN AND GONSTRUCTION`SERVICES FOR BUIL G5 AND STRUCTk11 ES SUB,�EG�T TO ,SECTION CONTROL PURSUANT TO 786'.CMR 11 (CONTAINING MORE AN, 060 C.F.�t)F ENCI,pSED SPdCE} , ' 1 Registered Architect: Not Applicable ❑ Name:(Registrant): Registration Number A<Ir ss Expiration Date Sign .t_ire Telephone 92 Registered Professional Engineer(s): Na:,i Area of Responsibility Add ss Registration Number Sigr,,-ture Telephone Expiration Date N. Area of Responsibility Ac; Registration Number ure Telephone Expiration Date N Area of Responsibility Ac Registration Number Sid .!ire Telephone Expiration Date N Area of Responsibility Au, Registration Number Si, L.re Telephone Expiration Date 9.3 General Contractor z (,o/ 1(�r.Jj s QS'1/J-/v Not Applicable ❑ Cc Name: 3 C 0 1 G A Res; nsible In Charg of Construction / �� G f/Sl Sip.,.:.u r e Telephone Version 1.7 Commercial Building Permit May 15,2000 k SEC' ECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) endent Structural Engineering Structural Peer Review Required Yes......❑ No...... :AON 11 -OWNER'AUTHORIZATION-TO BE COMPLETED WHEN 0`d.:.ERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT 1 _ , as Owner of the subject property he �y authorize to act on m, half, in all matters relative to work authorized by this building permit application. 616 'ure of Owner Date 1 �� L T— dki , as Owner/Authorized Agent he declare that the statements and information on the foregoing application are true and accurate, to the best of my kr_ edge and belief. Si: d ender the pains and penalties of perjury. Pri y Sid of Owner/Agent Date SE "ION 12-CONSTRUCTION SERVICES 10. "._irensed Construction Supervisor: Not Applicable ❑ Na i License Holder: �G OTT L) 0 License Number Ac' s Expiration Date Sid Telephone SE -: :ON 13 -WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M G.L.c.152,§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. Sid %.ffidavit Attached Yes....... ❑ No...... Version 1.7 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: iblic' Private ❑ 1 Zone: Outside Flood Zone Municipal 9 On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department z42 ELot Size b / / b / /• Frontage 2 S f Setbacks Front /C Z Side L: C6 R: 2 L: ' R: Rear / Building Height y J i / Ll S Bldg. Square Footage % C. Open Space Footage % G (Lot area minus bldg&paved /O. / �(a parking) C #of Parking Spaces b Fill: � (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/ n the site? NO DON'T KNOW YES IF YES, date issued:_! IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES y IF YES: enter Book ( ,00 y Page -2- 31— and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T 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 NO IF YES, describe size, type and location: z4 x-Z/ . C /a C /1 T4�9/? D. Are,! 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 t GECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 )BIC FEET OF ENCLOSED SPACE Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑ °�c� ❑ ❑ Exterior Alterations Demolitio)( New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building[ ] Repairs] [ ] SECTION 5 - USE GROUP AND CONSTRUCTION TYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A , . E Edicational ❑ 2B I ❑ F Fa:tory ❑ F•1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 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 U', lity ❑ Specify: R^ xed Use ❑ Specify: S SFecial Use ❑ Specify: COMPLETE'THIS SECTION IF EXISTING BUILDING,UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE(N'USE, . Exis`. rg Use Group: Proposed Use Group: ,Z Exis' ; Hazard Index 780 CMR 34): / Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING,HEIGHT AND AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ,, 31M..d, Floc, Area per Floor(sf) 15t 1 1st 2nd.. _ x 3 rd r w a {a Zt ,t 2nd , ' *. "' ' 3 r§ r W• th � a 3r ` 4th u Total Area (sf) "/ Q %_0 Q v Total Proposed New Construction (sf) Tota! Height(ft) —1 ° 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 THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING SECTION 1-SITE INFORMATION 1.1 Property Address: sectto` t0 b15-00—ml'teted by�0 C� Y1;r ` O / r Zone x OKeray Distrlc _ Nf- Y s. k Etm St.D strict x ��GCB D�sCrict'��`� $�e��y SECTION 2- PROPERTY OWNERSHIP/AUTHORIZED AGENT 2.1 Owner of Record: //U5f z/t/ �6 G r"i S �'/ y a k a 'lame(Print) Current Mailing Address: Signature Telephone 2.2 Authorized Agent: YC o 7- ohz?3 04 Name(P * t) Current Mailing Address: Z Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building (a)Building Permit Fee s 000 2. Electrical (b) Estimated Total Cost of L— Act ©o C) Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) O 5. Fire Protection nn n 6. Total =(1 +2+ 3 +4+ 5) Check'Number f . 'This Section For Official Use Only building Permit Number. Date Issued: Signature: y y Building Cortmmis'sionei-/)nspecto'r of Buildings Date File#BP-2004-1052 APPLICANT/CONTACT PERSON Scott Johnson ADDRESS/PHONE Cooley Dickinson Hosp NORTHAMPTON ()582-2313() PROPERTY LOCATION 30 LOCUST ST-RADIOLOGY 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 T_ypeof Construction: REMOVE WALL IN RADIOLOGY 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 INFQ MATION 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 S eet Commission Signature of Building O cial 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-RADIOLOGY BP-2004-1052 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-2004-1052 Project# JS-2004-1576 Est.Cost: $8900.00 Fee:$71.00 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 Applicant Address: Phone: Insurance: Cooley Dickinson Hosp () 582-2313 Q NORTHAMPTONMA01060 ISSUED ON:514104 0:00:00 TO PERFORM THE FOLLOWING WORK.-REMOVE WALL IN RADIOLOGY 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:(E/�/,c�(�S'17/u y House# Foundation: ✓ � Driveway Final: Final: Final: _ 6�� Rough Frame:©Y o Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Vt�2• r"� Final: 0 VN-\ S,1I-G� r THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS Certificate of Occu anc si nature: FeeType: Receipt No: Date Paid: Check No: Amount: Building 5/4/04 0:00:00 23791 $71.00 212 Main Street,Phone(413)587-1240, Fax: (413)587-1272 Building Commissioner-Anthony Patillo