23B-046 (108) i
I
I SE302 j
1
I
l
I
i
1 E3-a5
REMOVE EXIST. W.WALL j
PARTITION.-RELOCATE ALL WALL NEW GIUAD 4 DUPLEX OUTLETS,
j Mm. OUTLETS TO NEW STUD WALL GON5T.� NEW TELEPHONE JACK V`Il
LEVEL '5'OUTLET BELOW.
-TIE fNTO NEAREST EX OUTLET NFA LEVEL °51'OUTLET CENATEREI APPROPRIATE GKTS.(V.I.Fa
ON NEW WALL 0 44' A.F.F. NPAM fi-Q-AN W-poll s6uhe��t�orN �i
-TIE INTO NEAREST (o� NEW 5'-0'x 3'-0"
APPROPRIATE CKT5. (VJ F.) WINDOW IN HrI.
�„.►,KG�► FRAM I
ELECTRICIANS
I
5-06
i E3-07 IGE
NEYV 3'-0"x
11-4u+- °� 5GW DOOR
-NEVI GYP. $D.CEILING SYSTEM
W/GHAiN-rHJNb 2x4 FLUOR.FIifTuFcE
._._.Motu #;ra.,h�,r,,, pull g.Jp�l,or.�►�ern li
NEW WALL CONSTRUCTION -PANT ALL WALLS
j 5 5/8" MTL.STUD5 W/(1) (COLOR BY OWNER)
LAYER 5/5"GYP. BD. EA. 51DE
�
-EXTEND TO EXIST.SLAB GONST. ABOVE
C6vmKE VA 41. OPUY)
4105 $
� ,NO.
T i T IL E: OFFICE RENO\/ . / BASEMENT FL NILE Al
P R O J E C T coauE r w"m H wff& NO,MASSACHUSETTS
DATE: 05105/03 SHEET 1 OF 1
DRAWN BY: KFM/DL REVISIONS
CHECKED BY:
HEALTHCARE ARCHITECTS INC .
SUITE# 1 64 GOTHIC 5T. NORTHAMPTON, MA.
1SECTION S;PROFES810NAL DESIGN A D CO STRUCTI4N ERYICES FOR]SUILDING5 A�VD ix R CTtJ�ES I$UBtii:105�'0 {
CONSTRUCTOWC0114TROL PURSUANT:Td 7..80 CMR 116.(CONTAINING.MORE THAN. OOO 4
1 Registered Architect:
Not Applicable ❑
Nar:e(Registrant):
Q Registration Number
Act ., ,;5 � Oto
Expiration bate
Sig . . .,re �F"ry phone f V O
92 Registered Professional Engin r(s):
Na r Area of Responsibility
Add ss Registration Number
Sigr ;ure Telephone Expiration Date
N. Area of Responsibility
Registration Number
..ure Telephone Expiration Date
N,. Area of Responsibility
Ac . Registration Number
Si;! ..:ure Telephone Expiration Date
N : Area of Responsibility
A�. Registration Number
Sig :L,re Telephone Expiration Date
9.3 General Contractor
Cv c v Not Applicable ❑
Ca ,;.•any Name:
Res; nsible In Charge of Construction
.ddn:S
s J�2- X3/3
L;)':,ure Telephone
I.SECT'ION 10-STRUCTURAL PEER REVIEW(780MR.h& is
,;1� endent Structural Engineering Structural Peer Review Required Yes......❑ No......e=
'ION 11-OWNER AUTHORIZATION-TO BE COMPLETED,.WHEN
OY.,.ERS AGENT OR CONTRACTOR APPLIES,FOR BUILDING PERMIT
as Owner of the subject property
he:-: 'y authorize to act on
m, 13half, in all matters relative to work authorized by this building permit application.
Sig Lure of Owner Date
SC 0 JT— -0-0 11 C /V , 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. id r er the pains and penalties of perjury.
_ C0 ! / 0c)
Pri . . c�2 '1 '91 -710
4iF of Owner/Agent Date
SE `ION 12 -CONSTRUCTION,SERVICES
10. '_irensed Construction�^Supervisor: J Not Applicable ❑
Na el License Holder: O G 1 r /YI' (f?�Z ® -Z 3 Z
License Number
_ Cvo��y Elf ,h vYt � �
Ac' Ss----T� Expiration Date
_ � l
SiE Telephone
SE--. ;ON 13 -WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M G.L.t: 152,§25C(6))
W ars 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.
S;� =,ffidavit Attached Yes....... ❑ No......
7. Water Supply(M.G.L. c.40, § 54) 7.1 Flood Zone Information: 7.3 Sewage isposal System:
ibiic Private ❑ Zone: Outside Flood Zone ❑ Municipal On site disposal system E3
f 8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front l p Z /0 a r
Side L: R:— L: R:
Rear
Building Height
Bldg. Square Footage �� �� % 31 lit
Open Space Footage %
(Lot area minus bldg&paved �O` b� 9 a
arkin v
#of Parking Spaces 1�tl 2--
Fill:
(volume&Location) /
A. Has a Special Permit/Variance/Finding ever been issued�f(or/on 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
X—
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 ��I�1 S,
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: /BOA c'�I e7h,- ± CAJ !Ay S/�h
D. Are there any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
SECTION 4-CONSTRUCTION SERVICES FOR PROJECT'S.LESS THAN 35,000
)BIC FEET OF,ENCLOSED SPACE
Interior Alterations Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
❑ ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ) Other [ ]
❑ Accessory Building[ ] Repairs [ ]
jYl ,��. o D��iz� trci`� .rcafv, s Ti
SECTION 5 - USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A ❑
A-4 ❑ A-5 ❑ 113 ❑
B Business ❑ 2A K
E Educational ❑ 26 ❑
F Fa--tory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Ins: tutional tK 1.1 ❑ 1-2 1:15. 1.3 ❑ 36 ❑
M M:rcantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Ut lity ❑ Specify:
M 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
. . ,� _,OFFICE-USEeO �:
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION .
Floc, J.rea per Floor(sf) �1St lv C- Y
..
1st--- 2nd
3rd
2nc:-- wztf� ZZ.
3 d
ty
4tn
Total Area (sf) /-/0.21 U U 0 _ Total Proposed New Construction(sf)
Total Height(ft) —[ rs �Xt
Total Height ft�.....
Versionl.7 Commercial Building Permit May i.3,tuuu
City of Northampton
e Building Department
212 Main Street
Room 100
-Northampton, MA 01060
=phon�'413-587-1240 Fax 413-587-1272
lLF .
APPLICATION TO CONSTRUgT, REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING
003 OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1'=SITEINFORMATION W i�rrJC/
This section to bd'compieted�by °ffice' u .
1.1 Property Address: ,
�C � CUGUS � S
ap ,
Zone xerlay`District .
' X ��r y
`Elm St.District ` nv,: 4.aCl3 Disrtct
SECTION 2 PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record:
.3U lb C r� ITT SJ
'lame(Print) Current Mailing Address:
Signature Telephone
2.2 Authorized Agent: 0001 AiC,h01a M
SCOTT- 00AlnS 7U A5 eL) s S�
Name rint) Current Mailing Address:
3-Y2- - 23 /7
Signature Telephone
SECTION 3 -ESTIMATED CONSTRUCTION:
Item Estimated Cost(Dollars)to be Official Use Only
completed by ermit applicant
1. Building (a) Building Permit Fee
/s v0, 0 o
2. Electrical (b) Construction from of
(6
3. Plumbing Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total = (1 +2+ 3+4+ 5) 6 o. 0 Check Number
This Section For Official Use Only
Building Permit Number. Date Issued: "
I
. is 1.r,tia TItY:i„SR 3 1 Ap:n f� Y L
,.,Signature:
uildin ommissioner/inspector 6f Bulidmgs a= ,"; a: Date
File#BP-2063-0987
APPLICANT/CONTACT PERSON COOLEY DICKINSON HOSPITAL THE
ADDRESS/PHONE 30 LOCUST ST (413)582-2313() s„ _!yr�
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
Typeof Construction: NEW OFFICE FOR MAINT DEPT-BASEMENT
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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF 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 Co ssion
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-2003-0987
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B-046 CITY OF NORTHAMPTON
Lot: -001
Permit: Building
Category: renovation BUILDING PERMIT
Permit# BP-2003-0987
Proiect# JS-2003-1214
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
Zoning: M Applicant COOLEY DICKINSON HOSPITAL THE
Applicant Address: Phone: Insurance:
30 LOCUST ST (413) 582-2312 () Workers
Compensation
NORTHAMPTON MAO 1060 ISSUED ON.5112103 0:00:00
TO PERFORM THE FOLLOWING WORK.-NEW OFFICE FOR MAINT DEPT - BASEMENT
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:
T gab?': "°' ._'salation:
// - q ?
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occu anc fv � Siunature:
FeeType: Receipt No: Date Paid: Check No: Amount:
Building 5/12/03 0:00:00 540391 $50.00
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo