23b-046 (107) I
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-RELOCATE ALL WALL MTD. ELECT.
C --- -- --
OUTLET 5 TO NE N STUD WALL COATS T.
FROM EXIST.WALL TO BE REMOVED
�E ITY
-TIE INTO EX15?!NC APPROPRIATE GKTS.
R
I OiI=!
7_0x,5,fin ;w `►s �a Ram;►,
I —72 REMOVE EXIST. WALL GON5T.
rlx I J INCLUDING WINDOW IN H.M.FRAME
-PATCH EXIST.WALL-,,CEILING
^� f FLOCK TO MATCH NEW ?t
EXIST. G0145T.TO REMAIN.N.I.F3 f
.gcr';aF�of 4'F w NEW FINI5HE5: NEW WALL CON5TRUC?ION;
C °° ✓� (
-FAINT p ALL WALL5 5 5/5, MTL. STUDS W/(1)
(COLOR BY OWNER LAYER 518"&YP.W. €A.SIDE
3 NEW CARPET d CARPET BASE -EXTEND TO EXIST. 5LA5 CON57.ABOVE
-EXTEND EXIST 5.A.T. CEILING SYSTEM
AS REOV. BY NEW ROOM LAYOUT '
(MATCH EXIST.GLG. TILE TYPE)
k f. ftWy. Ply
iL6"
T T!E: OFF I GE RENOVATION/ 1ST FL . Not Al
P P 0J ETT errs NO, i.
DATE: 05/05/03 SHEET 1 OF 1
DRAWN BY: KFM/DL REVISIONS
CHECKED BY:
HEALTHCARE ARCHITECT5 INC.
SU T TE# 1 64 60TH T n 57 NnRTHAMPTnN MA
Version 1.7 Commercial Building Permit May 15,2000
SECTION 9 hROFES510NbL QESIGN iND,CQNSTRUCTJOtV§ERYICES-FOR BUILDINGS AMD STRICTUitES$UBJCT TQ
�CONSTRUCTIOI CONTRQL PURSUd VT TQ, 8 MR 1�, (CONTAINING MARE THAN[:35;OQQ C.F..Q sENCLQSE[1'SP
1 Registered Architect:
Not Applicable O
Name(Registrant):
Registration Number
C,04 GO W-4
Ac!� ;s- , - �05
5d� _ 1 1 Z Expiration Date
Telephone I Z 0 7
92 Registered Professional ngine ( :
Na:,; Area of Responsibility
Ad,! ss Registration Number
Sigr„ture Telephone Expiration Date
N Area of Responsibility
AC s, Registration Number
;ure Telephone Expiration Date
N Area of Responsibility
Ac - — Registration Number
SiL, r::ure Telephone Expiration Date
N Area of Responsibility
AG Registration Number
SIZ, ore Telephone Expiration Date
9.3 General Contractor
,k j4�_, Se/ Not Applicable ¢t�
Cc any Na
— Cv f
Res; nsible In Charge of Construction
*3o /rgc-cs,- S1 /r�vn � ,��n Md.
.dc!r,ss
L ..;cure Telephone
Version 1.7 Commercial Building Permit May 15,2000
I -SECTION 10-STRUCTURAL"PEER REV IEW'(780 CMR 11011)
endent Structural Engineering Structural Peer Review Required Yes......❑ No.....
1-15E,-:'71ON 11-'OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OY..,ERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
as Owner of the subject property
her:.ry authorize to act on
m, , 3half, in all matters relative to work authorized by this building permit application.
Sig `ure of Owner Date
I,_ SG -�"� as Owner/Authorized Agent
he . .;, declare t at 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.
_ Sce� j
Pri a
SiF r of Owner/Agen Date
SE "ION 12.CONSTRUCTION SERVICES
10. Ucensed Construction Supervisor: Not Applicable ❑
Na ci License Holder : Sc v ]-T-
1 �J v A ri S Oh (0 u" � 3 .2—1-1
License Number
V
Ac' Expiration Date
Sf� Telephone
,SE,--:ON 13-WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
W ers 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.
Sit =affidavit 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 pisposal System:
ab c . Private ❑ Zone: Outside Flood Zone Municipal On site disposal system ❑
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
C L, �` Building Department
Lot Size / l 12 . [ 2-�•
Frontage C sl 2- 6 S
Setbacks Front / Q 2 / 0 X
r r
Side L: R: -12— L: R:
Rear
Building Height f
Bldg. Square Footage
373 3r7 % 3q3 III
Open Space Footage % 6
(Lot area minus bldg&paved ��' , J
parking)
#of Parking Spaces (3 l
Fill: A A
(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 M
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book V2 El Page 'Y 7 - and/or Document #
B. Does he site contain a brook, body of water or wetlands? NO DON'T KNOW —
YES l%/rn ��,Brwti 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
IF YES, describe size, type and location: ls(-Q75 -f" C-427Ly S10
1j C
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
CECTION 4-CONSTRUCTION SERVICES FOR 'ROJECTS LESS THAN 35,000
)BIC FEET OF ENCLOSED SPACE
Interior Alteration Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations DemolitionM New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs [ ]
2 cvte r
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly Io A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A Ilk
E Educational ❑ 2B I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Ins-itutional 1.1 ❑ 1.2 1-3 ❑ 3B ❑
M Nlercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R•3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Ut lity ❑ Specify:
N^,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:
Exist --g Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING,HEIGHT.AND'AREA;'
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION
Floor Area per Floor(sf) St / 6 &1 r �
k �
1s 2nd
t..
3 rd �� y � C
4th �� fi
4th }.
Total Area (sf) Z'0 0 Total Proposed New Construction (sf)
Total Height(ft)
Total Height ft Jr ` /l S
Versionl.7 Commercial Building Permit May 15,2000
City of Northampton
'Buildirg Department
-2.12 'Main Street
Room 100
"A -,gCNorthampton, 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: Thi!sseGti " e
o
p
SECTION 2=PROPERTY OWN ERSHIP/AUTHORlZED,AGENT
2.1 Owner of Record: J
Cp)le-v Arch,h s rrn Ao y ��r -�® �C�u�CIS� /o 1 /1, U41
'lame(Print) Current Mailing Address:
,q2-- 2-3
Signature Telephone
2.2 Authorized Agent:
<ScO7r Koji �y Gl
Name int) Current Mai mg Address:
'!-YL
Signature Telephone
SECTION 3 -"ESTIMATED CONSTRUCTION C05
Item Estimated Cost(Dollars)to be
Official Use Only
completed by ermit applicant
1. Building (a)Building Permit Fee
o D� r7 0
2. Electrical (b) Estimated Total Cost of
OU C96 Construction from 6
3. P'umbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 Check Number
This Section For Official Use Only
Building Permit Number: GI ' �' Date Issued:
Signature: Building:Comrrtis`sioner/Inspector of,Bull,�mgs' ; _ Date, -
v �Y
�U GU 5l Alf&
U
File#BP-2003-0988
APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL INC
ADDRESS/PHONE LOCUST ST (413)582-2313 Q�
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 --
Ttipeof Construction: ENLARGE 1ST FLR ENTRANCE OFFICE
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
i FO O WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
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 C 'ssion
u
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-2003-0988
GIS#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category: BUILDING PERMIT
Permit# BP-2003-0988
Proiect# JS-2003-1588
Est.Cost: $2500.00
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
zo Mz _ Qnr' n • '00 LEY DICKINS01'-% Hn, -SPTTAL. INC
AT. 30 LOCUST ST
Applicant Address: Phone: Insurance:
LOCUST ST (413) 582-2313 0 Workers
Compensation
NORTHAMPTON MAO 1060 ISSUED ON.5112103 0:00:00
TO PERFORM THE FOLLOWING WORK.-ENLARGE 1ST FLR ENTRANCE OFFICE
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: I House# Foundation:
/ Driveway Final:
Final: Finals/2 7/0 3�j' � a d -D3 All
Rough Frame:0� 17 ,
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:0 Y 6-- -;?g-03,
THIS PERMIT MAY BE REVOKED BY THE CI Y OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc � ./ �� s, nature:
FeeType• Receipt No: Date Paid: Check No: Amount:
Building 5112103 0:00:00 540390 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo