23B-046 (121) AUG, 1.2001 12:05PPI ARCHITECTS INC, ETRL NO 157 P.3
G-�- A-!Z
` O
ro-uyn�, too
��r�iiu��.P�v,, .vt�,5s�.�.,�•ws�-�o
J31/10-,t HEALTHCARE
Oft 1iAM p�0
Crz#LT Of 'Wart hall rpfun
8 B f.�asancEjnsrtta`
DEPARTMENT OF BUILDI],,TG INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
I, Pi Con, Inc./Pioneer Contractors
(licensee/permittee)
with a principal place of business/residence at:
P.�. e I1n� tdortMar�pt4r�y--tl�: 819�a (phone#)�T3-�Q �i�4�
• (street/city/stafrlap)
do hereby certify, under the pains and penalties of pegJury, that:
(x ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
II i"narfV lviu ttal 'Tnsurance C VdC1-31S-499822-0501 6/30/02
`fy (Insurance Company) (Policy Number) (Expiration Date)
( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
=. the contractors fisted below who have the following worker's compensation policies:
(Name of Contractor) (Insurance Co mPan y/Poli c7 Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(Insurance Company/Policy Number) (Exp )
(Name of Contractor imtion Date
r' (anach additioml sheet ifnxus.uy to inoludo information p=uiniag to all 000hactm)
O I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:please be aware that while homeowners who cmplay persom to do main c=stuction or repair work on a dwelling of
W more than three unit:in winch the homeowner reside or ou the grounds appudm nt thereto arc not generally coandemd to be
employers tender the wocka cornpeasation Act(GL152,s3 1(5)),application by a homeowner for a license or perm¢may evidence the
Iegal status of an employer under the Wockeet Compensation Act
I undetitaad that a copy of thin aitemmi may be forwarded to the Dcpwtn.3d of Industrial Aocideott Offioe of Insurance for the
coverage vcnficztuon and that failure to secure coverage under section 25A of MGL 152 an lead to the imposition,of criminal penalties
coasLving of a fine of up to$1,500.00 andlor imprisonmetd of up to one year and civil pcnzItie,in the form of a Stop W ode order and a
tine o(5100.00 a day against t>x
/ / For de use only
/!'7 h Permit Number
Im p# Lot#
Signahrre of Li ermittee e
Version 1.7 Commercial Building Permit May 15, 2000
SECTION 10=STRUCTURAL PE RR REVIEW(780'CMR 110:11)
Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑
SECTION 11=-OWNER AUTHORIZATION -TO'BE COMPLETED WHEN
OWNERS AGENT OR COINTRACTOR APPLIES FOR BUILDING PERMIT''
I, C_. 7��;�i 1✓t �nnCs� S�l as Owner of the subject property
hereby authorize r '�`e`�s�1 C �� to act on
my behalf, in all matters relative to work authorized by this building permit application.
tt
Signature of Owner Date i
1, �,�r2 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 perjury.
1.5,E>-�(NJ a u`
Print Zkvz/ �) S�— I � ') 6)-
Signof wner gent Date
SECTION-12 -CONSTRUCT10WSERVICES
10.1 Licensed Construction Supervisor: / Not Applicable ❑
Name of License Holder
License Number
Address Expiration Date
S;-VG _S c
Signature Telephone
SECTION 13;=W,O,RKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L. c 152, §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....... ❑ No...... ❑
Versionl.7 Commercial Building Permit May 15,2000
SECTION 9= PROF.ESS.IONAL°'DESIGN.AND';CONSTRUCTION SERVICES =FOR BUILDINGS AND STRUCTURES SUBJECT TO
.CONSTRUCTION CONTROL,PURSUA'NT TQ 780,CMR 116(CONTAINING MORE THAN 35;000 C�F. OF ENCLOSED'SP.ACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address /1r�
`fir ✓1� Expiration Date
Signature Telephone
92 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
Not Applicable ❑
Company"Name:
Responsible In Charge of Construction
P-/) , ed>o 1 l t--YJ ly , ✓' ft . 001',
Address
SignatLfre Telephone
Version 1.7 Commercial Building Permit May 15,2000
7.Water ipply(M.G.L. c. 40, § 54) 7.1 Flood Zone Information: 7.3 Sewage QKposal System:
Public 16 Private ❑ Zone: Outside Flood Zone ❑ Municipal VOn site disposal system ❑
S. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be filled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building Height
Bldg. Square Footage %
Open Space Footage %
(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 DON'T KNOW V YES
IF YES, date issued:
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
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:
D. Are ere 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
:SECTION 4 CONSTRUCTION SERVICES:FOR;PROJECTS`LESS THAN 35,000
CUBIC fiEET OF ENCLOSED.SPACE,
Interior Alter ions Existing Wall Signs Existing Ground Signs Additions ❑ Roofing ❑
Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ]
❑ Accessory Building[ ] Repairs
[ ]
G�uS� ixo'Yw(--A
�6Z I-� Oki,
SECTION 5 -,USE GROUP AND CONSTRUCTION TYPE
USE GROUP(Check as applicable) CONSTRUCTION TYP
A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1A El
A-4 ❑ A-5 ❑ 1B ❑
B Business ❑ 2A ❑
E Educational ❑ 213 I ❑
F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑
H High Hazard ❑ 3A ❑
Institutional 1-1 ❑ 1-2 1.3 ❑ 313 ❑
M Mercantile ❑ 4 ❑
R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑
S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑
U Utility ❑ Specify:
M Mixed Use - ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS, ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34):
SEPTIIQN,116;BU.I WING'H,EIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION ' CFFICEF�� �'
R l 1 a
Floor Area per Floor(sf) St
� s
1st
2nd u�`
3`d 9z�
2nd
3rd
4 th
4'h
Total Area (sf) Total Proposed New Construction (sf)
..................... .............
Total Height(ft)
Total Height ft -- --- ----- ---
Versionl.7 Commercial Building Permit May 15,2000
DD lu f Northampton o
ling Department
2 Main Street
k�
I ,IAN - 8 Room 100
No rth mpton, MA 01060 o:: etotr c
, 58 -1240 Fax 413-587-1272 l e ,
OFP7 Q.gui. .,
01060
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
:This sectiono be completed by"office
1.1 Property Address:
Zone ___ p�erlay�bisrict _ �
Elm St District, CB District
SECTION 2 - PROPERTY OWNERSHIP/ UTHORIZED AGENT
2.1 Owner of Record:
Name(Print) t Current Mailing Address:
Signature Telephone
2.2 Authorized Agent:
Name(Prin Current Mailing Address:
Signa re Telephone
SECTION 3 - ESTIMATED CONSTRUCTION.COSTS
Item Estimated Cost(Dollars) to be OfficiaFUse Only
completed by ermit applicant
1. Building (a) Building Permit Fee'
2. Electrical (b) Estimated Total Cost of
Z.d�7 Construction from 6
3. Plumbing ' Building Permit Fee
4. Mechanical (HVAC)
5. Fire Protection
6. Total =(1 + 2 + 3 +4 + 5) Check Number P I '—�
Th's Section For Official Use Only
Building Permit Number: 6 - Date Issued:
Signature:
Building Commissioner/Inspector of Buildings Date
File#BP-2002-0629
APPLICANT/CONTACT PERSON Pioneer Contractors
ADDRESS/PHONE PO Box 1145 (413) 586-5491
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: INT REN-CARDIOLOGY RM G 412-CLOSE DOORWAY SOFFIT IN EXISTIN G
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 017890
3 sets of Plans/Plot Plan
THE F 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 Commi ' n
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.
k
x, +`�d
." � h
,
x F �, S £ ,o'Al
I
X
? ka
s�" s r a e
y ...Mn: g w
-t f m z t ro c
c r t 7 �� K 171,
r � r:
st a=t.�. 3 a�'# �` x ,.a•. i{ .r .F`n 11�Room MAWN
��,, c�_�,,-� __ AM 1 g " 1� -. a- -.
a
e,
' n
t
`.t, >i
_ f.5 ` z:ssf
£ ; 4 Tel', t
1 : , . f" ., I , , , � SAW', " . ,� '', ,,_,�_',""",, —� :",
g v
.*'t�.o
I I 01 , r , , - � : �, � : � � 1,1�01N 4 "� "40 ;. - - �� - ;fit
J
i
f A#
3 .x
k ,5 % Po 3
p K
n, � � ,,, . «. xa. k a z t» �.`,'' .,'1` t to
-:a r t r xr# t -s k t>`'3" ^ fs b'';" , ,n:- s
5 n S y,„sk' x > kz r�
- * r Ar»°u"�` 5 ra r 11
_ ,", . ,x z � ,. 1 d 11`u^ w= z, r� a ' t x,�x 11
- ss` - ,ck
$ r _ s `
,- t
k
Y
ti
- j
,
4
v
,_
e
s
} x
T
r, t .,a t
y
I I 1 - , -�&��' �,q - 0,�-,,�, �7TZP'
, I - �,�k I ,i r " � i «u
MR'
'�.,'x 'ks , i " '46'# .c k'F a ',; » a'FP }-3 kt "' C kz UK
«. � s u ; k #. T i L ra .r. r k
n k
i x` ,�"wag `�sue. f - ""' a '' �
a t ? s fir'��'�.
xF x �� « c
`� s
e. �.�� «. .,s. �,�.,w,.,�.«u, ,.1 _. a ,..0,�._„s�.� �s� .r( s.,n., .. �. :.,an.�,�.,. _ .��. ”` 'v '
1
Ni�
11 11 I $ 'S?
96L,1.,,1-,i�,,",�1--'l_-'-,T�-1�,-_-1�,i',,`r,��'�1,',,I,,,
�1 sa,4-�,,,,l,":s:,�Z,,",-"'�o��-'�-_,�,11-,,,-F,"I.,
%I.I:r��'�,'—I,,I'�,_��,-�,-,, "_-,_���"i-"I'',�,",�,�-,-�,l—_`-__,�I'-"1,"1�,,'_I,,_-_�:,���,�-1�,,�,"`,I�_,1,',,1�1I1�,-I I�14,,,I,��s1�,10�-,,I—',.1,l.',,.�l i1"1.,i,,._,i'.,,-,.,,;�,-�s'_,I�,".-I 141,I���-�I-,,-,�,I_'�„ .; $ .'
`_-"t,,,", ,2,-I
I-I�s-�I I—,I,I�I I,,','�-,��: AI Iq t,,�1'1m�1'1I 1 I,k-:,,—,�-,4I�0 I&I t�1I I 1 I,1-:,�I-2!I I I,'�3�,`_�,01I;,I,1:,I-',—,—�,',"'.I�';#1�l1,I-;,,�,�:,,,_������_,t�:_-,�,1-i,"1�,,�--_''�,-,,,:"'—,�,',�,_�:''__,��:-,,,�J�,-��
���
�, W 1�-1 A-,",:",'�`,""_"�'�I�s�",_—t�,'�,,'_�";,,—1�",,i--'I"�-i:',_,,,—_��s��,-1�,'',''',,�,I�,�;_���,,_,�,I,,-',,�,"�—s�',,1_-,�,,,�l�i4-,3,-�-'1��l"l,�i�,,��,_l,,��-,-�:�,�',„,„':_l�,�;"�,�,-',I�-,-,�,,,,,:,_",_,",�i,l�,,�_,,,",,,%;�'�:,:,1-:���-1,,,-I���,iI���-,-,-"I��'1.'-,'�s,_1,�,l,_,�,�,,,,��,-,��,�"�,!"�,z�.�,`,,”,.,��,,,,-�—,,�,,��,'�,,��,�;-_"�,��l`'!,_,�-,,,-';,'t;-,,'�!!:„�_,�'—"-_i�„,s,��,"4,,�-.,”".�I:lI,,.�.-.'c...�.,I."�,'�!`�,;"_��,',,�,-,!,�,`d-�'f,_-�"t,,P':"1',,��",�,,',",,,�,,�,s'l!ts,1,�,'"1 I,
,,;,��,1_
�,I
�� {� .� I I
x,43 k
� 5
y
' 1, 11 "� l -1 #� � �g r �(
11 Z
G
c3ur 2fi€ �{R`K 11 11 `�. .' .. :' 3 ilk g�rt'Ts' ,c�..x..,a ,4.._.y. 'i i
i.' .,..•rs" o- , `fin '-"�.+-^' -� .-�.--�-. M^^.°a° „<""r, *';.x ...-�.,, -c- _
a .� # '.1111+
11 �- l f z� x
P 1P4 -, } R
# i ' 4' K '{'1 S 11,
3 7
R { � ��
y
T ,t. j}F 11�. ! ii
�7.}rf r - `i" 5
r
:, x '" .� p Kti 11
11 , r� I �` - - �
0
"' K 3 xs u� -'� "k s a
_�,:� ��,IROIN I, i I 1, , -,-��-A�l,%,v " -r �`" x - p p- 4t #Is-
- �. A 't",= , I , ""�:�..-, I I-A P,§0 w It F '""I V_'1f'',is,1_"�' � , ,
i
3 +
11 Yip R le f
-
{
I I ", ,_ � I - -, - - I I - , � I- J I I - IN I I i -i
SCE A`r- = `.,:..-_rte'-,"ter- -�-w.__--- --� --""",-"r=` --_-< '
n ' $ s s
}; Y -Isk,
S 4 � "S kl
� ��� I t `N - -91
� 11 �w
t t �,d - ; a t �-jvea �, - -i ,, TIF6-
y 3 t .x, ,11-1 11 I {" ,1..a f x '' s r<< - k. 3` fi 11 I I'll x � x #.11-
M ww
a r w
v z a i
{p
? b
' '
, '
�OtYftlilSS1OTI6I-Anthony Pa