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23B-046 (131)
Q--tlwr�T (1,Ih) of &'Mol;tllalliptoil t y � - �t 41eA({1 11L(t14 �•tl ot� DEPARTMENT 01' DUILDft\TG INSPECTIONS 212 Main Strect ' Tfunicipal Building Northampton, Maas. 01060 ' WORICER'S COoUENSATION MSURANCK AFFIDAVIT lei' , Aepwo hD� -f- (liccus Jp�rrnittcc) Cerra \vith a principal place of busmess/residence at W l - --5 —Vv? (stns 4/ci tyinatciz�p> CIO hereby certify, under the pains a0d perladties o,1 perjury, thy! I am an employer providin tll•° ioilo%vin(t workcr's compcns<:"on covet-a;c (or nl�, employcCs WOI�11[T, of) Lilts )o1) " bT uIS 7-AIKI A-PHx9g --iz_31—c)ex (Insu=-C:� Cora= v) (Pclic; Nu_mi,,r) CL-,pir uon D 2 1 ( ) I am a sole proonctoi, general cont7-actor or homeowner (ci;cie one) z_nd Dave hired '""* the cotlLraciors listG'i below who }lave ii]c iollO�vlyQ vOr ,ef S GO�JCR ?il01) !01 ICS - - (Name of Co: tracto 1- -- (ln ur.3nc Cotnnan)iTciic, umCC;) (!.>.:> o: l�atc) - (Maine of Contractor) --- —(lns.Irancc. Comoauvi-r oi1c" NumCc T) - (-E.xPir..ion Date) (Name of Conn-acio,) (Insurance Comp30)-1Pot;c) Numb-,) (E�pir,:tion Date) (Name of C.ont7<CtOr) (Lnsllranc Compzny/Polio• Numbws) 7��r<<r[ion D;ttc) (a¢xc�r add:::ocal c'�c:if nc._c:.r;t�c�_'uc�-i�rcxlntiioc pcw.r:ii�to all O I am a sole propnetor and have no one vvor4 ng for me. O I am a home owner Per-forming all the work myself. 14011:ptc k aW uc tt,,.w Jc hccracc,�_n utr cu play pctoct w d�c,.• c x - r ratr .cr o r C.•cll_ of nn n xt L n l 7o f t in ulic'a tb.-Lrom w.vu rcid; cx oo tb c a�yodt z,x rl v thcc n Tot f� =11:r axt:d ti tti cGX)cYc3 ua? Ltic-06,&m cc:=P,_:,m Act(GL152-�- I(5)l,nppLini)on, try D l:omcoa�fcr c UC -v cc f-r7= n;:y tl�c Icgil 0 au of cn—�PIoYo- under dto Wor-k""Coazp—Lion A<i I undc: d dw>ropy of tbii rz>lccxxnl rs y bo foe---d.d to tbo l?c[xirtzxxsa=of Iod-�,riJ At d—ly OfIffioo of Ir—for tlx covcn.Sc Ymficlioa n_nd t}Lt L•ihur to sec 00.-T �uz-Acr SoU ou 25 A or 1.(GL 152.Icad to th i,^.ItMSd1cA of cinibtl pcveliics 00oai3li of a FIDc of up to S 1 500.00 end!(x of up to mtc yc:r r, a i)pcz tau is tx fc of a Stop Work Order End e (im of S 100.00 4 day tgA1RT1¢r_. s Permit Number Lot (n't'i" )f Liccsl_cell cnntftcc =— —, � Versionl.7 Commercial Building Permit May 15,2000 SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11) 'dependent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11 .OWN ER;AUTHORIZATION -TO„B,E.COMPLETED WHEN O111KI1ERS'.,AGENT OR°CQWTRA TOR APPLIES,F`OR BUILDING PERMIT A-.1. as Owner of the subject property h r.eby authorize to act on y b alf, in all matt s relative to work authorized by 1his building permit application. r- (V— Signature of bwner Date I, In C�S�jI� 1 � V'�Pr`5C1� as Owner/Authorized Agent hereby declare that the state nts 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. P prat.,N ame Signature of Owner/Agent Date f10.1 ECTION 12-CONSTRUCTION SERVICES Licensed Construction Supervisor: / Not Applicable ❑ Name of License Holder: l a.'ox—g o /// D 6z� License Number Or dres Expira ion Ate Signature Tel one SECTION 13, COMPENSATION 1NSURANCE 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...... ❑ r � ` Versionl.7 Commercial Building Permit May 15,2000 SECTiOIV - - PR4FESS,IONAUDESIGN AND I!*f NSTRUCTIt I SERVICES - FGR',3UILDIN0S ANC,STR[1CT ICES vl, .IECT T<7 C<3WRtlT I+QIV CONTROL PURSUANT TD 780 CMF211S'(CON GAINING MQRE`THAN 35;o00,t �F. a ,ENCLSEDSPACE�, 1 Registered Architect: Not Applicable ❑ Name(Registrant): 4?� Registration Number Ad Ex iration Date Sig ture Telephone 92 Registered Profe io I neer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number >gnature 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 Contr�apctor �DL�AD 0 Cc--F�-, C C Not Applicable ❑ Company Name: Responsible In Charge of Construction 11 va i� r ddress 413554-4t�2z Signat re Telephone 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: ublic ❑ 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 Building Department Lot Size - �-I 1-7.� �� q Z7. 9 Frontage 'Z, Q 5 9 2,C S C Setbacks Front i 0'2�' 1 wz Side L: R: 4 1 L: R: y Z, Rear IS' 1 ?-,' Building Height , 5 , Q,14 Bldg.Square Footage 2,99 % 39"3 �� 39-3 �9y Open Space Footage % (Lot area minus bldg&paved E�t?�7 Go.7 parking) #of Parking Spaces ( - Fill: N �4/A volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES X IF YES, date issued: t' i9y 5 -GV_a L LA-1()(e GTekI - , Ikv�)tit. � i 9 1 Q IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES X IF YES: enter Book 49 F3 i _ Page LA 7 and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES X IF YES, has a permit been or need to be obtained from the Conservation Commission? i-1 c7 Needs to be obtained _Obtained Date Issued: C. Do any signs exist on the property? YES X NO _ IF YES, describe size, type and location: 'R Stly► - G�',Alr D. Are there 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 SECTION 4o CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000 FEET OF ENCLOSED SPACE nterior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ ❑ ❑ 1 1 Exterior Alterations Dernolition❑ New Signs Change of Use Other ❑ Accessory Building Repairs 3j� Lu c. (t),6* SECTION 5- USE GROUP AND CONSTAUCTIONIYPE USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ IA ❑ A-4 ❑ A-5 ❑ 1B ❑ B Business ok Off& a-yxt�w 2A ❑ E Educational ❑ 1 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ " tkt.02: 3A ❑ I Institutional ❑ I1 1-2 ❑ 1.3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 513 ❑ U Utility ❑ Specify: Mixed Use ❑ Specify: S Special Use ❑ Specify: COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS ANDJOR,CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): SECTION 6 BUILDING 'HEIGHT AND AREA 155- R,"OfFrU 44 '17 BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION L �q p, Floor Area per Floor(sf) St 1st O s G j ii 2nd ............ ......... ....... .......... 3rd 0, %46 2nd - 41 th 4 rd A 4 % 3 - W "Ar v 4th IF! /1 01R,,-, F"11111 Total Area (sf) 2 Total Proposed New Construction (sf) 11 5"M .................... Total Height(ft) Total Height ft .....N-/ w, ........ t e Version 1.7 Commercial Building Permit May 15,2000 icy L�,�r,w..._.�- Clay bf;Northampton uktdilg Department 't 4 2I Main Street :Rohm 100 ... X§'iffii p on, MA 01060 1.P ',0` e:`4-3:3=5 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: This sectietn to be cr�mplete �ffrce` 30 �.OW4 Map M y Urt �y .,,j�,j//��} jw_-1,... (�/�►g// \`/'�// /� - ri` y� v trl+c'A ♦�I l V`O l l EInSi ltrict SECTION- -.PROPERTY OWNERSHIP/AUTHORIZED`AGENT 2.1 Owner of Record: 1l � + Crm e. l Glc-I Y1.a tin ��f,S' i t -3O ame(Print) I Current Mailing Address: Signature Telephone 2.2 Authorized Agent: S(Print) Current Mailing Address: Signature Telephone SECTION 3» ESTIMATED CONSTRUGTION�COSTS Item Estimated Cost(Dollars)to be Official Use Only completed by ermit applicant 1. Building ODC) (a) Building Permit',Fee� 2. Electrical (b) Estimated Total Cost of Construction from 6 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 +4+ 5) Check Number + This Section For Official Use Only Building''^Permit Number: Date Issued: Signature: Building Commissioner/inspector of Buildings ' Date e r File#BP-2001-0093 APPLICANT/CONTACT PERSON Aquadro&Cerruti Inc ADDRESS/PHONE P O Box 656 (413)584-4022 PROPERTY LOCATION 30 LOCUST ST MAP 23B PARCEL 046 ZONE M THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Buildinp,Permit Filled out Fee Paid Typeof Construction: IN RIOR RENOVATIONS 1 ST FLR SOUTHWING ONCOLOGY PROGRAM New Construction Non Structural interior renovations Addition to Existing Accessory Structure Building Plans Included: Owner/Statement or License 062357 3 sets of Plans/Plot Plan V F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: pproved as presentedibased on information presented. Denied as presented: Special Permit and/or Site Plan Required under: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Variance Required under: § _w/ZONING BOARD OF APPEALS 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 Co 'ssion Permit from CB Architecture Committee 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. L Y t OWN, ARM Rtoy Koo NO Koo�t # � � s 30 LOCUST ST' BP-2001-0093 GIs#: 0M0NWEALTH OF MASSACHUSETTS SETTS M :Brock:23B-046 JUL 31 CITY OF NORTHAMPTON Lot: 1 Permit: Wilding %w y 9,gory:No lum ral kudw re QUAN a BUILDING PERMIT Permit# BP-2001-C}Og3 Proiect# JS-21-0144' FA Qs_t:$30000.00 ,Eeg:$I50.QQ PERMISSION IS HEREBY GRANTED TO: Quit CIM: Contractor: License: Use Grouu: Aquadro & Cerruti Inc 062357 LA ;;§7077.$4 1 C!U LPY PICKl�i„ ON QSPI AL INC oning:M � ~ t Aat�d &t' �.t iris AT 30 L90 0T $l' Avnlican#.Address: F, hone: .Ins,mrunce P 4 jjgN 656 413 584-4 `22 Workers C©m�e� on NORTHAMPTONMA01061D►„QN:112 /Q(10:I1(1:0 TO PERFORM THE FOLLOWING WORK.-INTERIOR RENOVATIONS 1 ST FL.R SOUTHWING,ONCOLOGY PROGRAM' P ST TIBS CAjRk fiQ TT S 3g§ STREEIT Itnepector of Plumbing . �ttor of Wlring D.P.W. Inspector of Buildings Underground: Service: Meter: Footings: Rough: Rough: Hoge# Foundation: Final: Final: Rough Frame: Gas rim Row n eat Fireplace/Chimney: Rough: Oil. Insulation: Final Snuokea Fin a1:43” t" THIS PI'wRMff MALY BE REV0IMD RY THE CI =0F NOR N ANY OF ffS RULES AND REGULATIONS. Fee 2-. Deceit o, 'd +Cbe N©: Am Building 7127100 0:00:00 46994 $150.00 212 Main Street,Phone(413)587-1240,Fax:(413)587-1272 Building Commissioner Anthony Patillo