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23B-011 Finding ApplicationOwner First Name * Owner Last Name OR Business Name Northampt Area Pedia * Owner Address 193 Locust Street * City *State *Zip Northampton Massachusetts 01060 Applicant First Name * Applicant Last Name Business (if applicable): Peter JKenny Northampt. Area Pediatrics * Applicant Street Address 193 Locust Street *City *State *Zip Northampton Massachusetts 01060 * Phone * E -Mail 413 584-8700 1 Ikhayes@napeds.com *Assessors' Map(s) and Parcel ID(s) * Parcel Deed Book and Page Map 236 Parcel 11 T ,—_� ? . - T * Work Location * Work Location Post Office * Zoning/Overlay Districts 193 Locust St. Northampton I Northampton 01060 SI * What PERMITS or AMENDMENTS are you applying for? 0 PLANNING Special Permit w/ INTERMEDIATE Site Plan ($200, except flag lots $1,000) El PLANNING Special Permit w/MAJOR Site Plan ($1,000 plus, unless this is an amendment, $0.05/sq ft of proposed new building) 0 PLANNING Intermediate Site Plan ($200) PLANNING Major Site Plan Approval ($1,000 plus, unless this is an amendment, $0.05/sq ft of proposed new building) Q APPROVAL NOT REQUIRED Surveys ($250/plan page) 0 PRELIMINARY SUBDIVISION ($1,000 -Type II or $600 -Type I PLUS $75 per unit) ❑ DEFINITIVE SUBDIVISION (Greater of $3,000 OR $10/linear foot of new roadway; $4,600 OR $14/foot if no preliminary, $400 PLUS $10/foot for one lot minor subdivisions; $500 for Amendments) El ZONING BOARD Special Permit ($200) 7EIZONING FINDING ($200) APPEAL OF BUILDING COMMISSIONER Zoning ($200) Q COMPREHENSIVE 40B PERMIT ($500 plus $0.05/sq ft of proposed new building) 0 VARIANCE ($1,000 plus $0.05/sq ft of proposed new building) FFF 2 2 2010FR <, El43D Pemut (Any Planned Village commercial project) *Relevant sections ofzoning and subdivision regulations ® I CITY CLERKS OFFICE; NORTHAMPTON, MA 01060 350-9.3 * Describe project and relief/approvals needed roject consists of interior renovations and small addition o Pediatrics Offices. Proposed addition is 48 sf. of added pace on south side of building. Project requires a Finding rom ZBA because of proposed expansion of pre-existing non- onforming medical use in SI zone. I HAVI discussed my application with my neighbors (highly recommended) *Indicates Response Required File ft BP -2010-0"02 t1P *i:iC']fim-CtU_'vTAC"f-PERSON ROT' OMASTA - - -- --- - --- ADnRFSS.PI1nNE 21 North St HATFIELD (413) 247-5666 PROPERTY LOCATION 193 LOCUST ST MAI' 7213PAM.'FL 011 001 ZONE SI(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZO\INI; FORNI FILLED OUT Fee Paid _ Build.;rte Pern.it billed out Fee Paid_ IYPW'_`_ r anstruciipn: CONVERT BILLING OFFICE INTO 4 EXAM ROOMS/BATHROOM & ADD 3 X 15 BUMPOUT TO EXISTING STRUCTURE New t. onstruction _Non. Structural interior renovations _ addition. to Existing A- xesSot,y Structure Buildup` Plans Included: ^•..,_Owner,. Statement or License 006763 3 sets of Plans / Plot Plan THE FOLLOWING ACPONPIAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION NTED: __.Approved Additional permits required (see below) P LA'N N I NNG 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: §S'� Finding..__._--. k�_ Special Permit Variance* Received & Recorded at Registry of Deeds Proof Enclosed yi7ther Pernuts Required: _ Curb Cut from DPW Water Availability Sewer Availability . __Septic Approval Board of Health Well Water Potability Board of Health _Permit fiom Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storni Water Management ......Demolition Delay "In Signature. of" 1'A1fl ling Official Date Not:: Istivanre-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 arc -ranted only to those applicants who meet the strict standards of MGL 40A. Contact Office of Planr.­re & Dc%- ,,Iopment for more information. MBL ------ OWNER-T--_ - - - - -- OWNER =2--- 2313-008-001 CARNALL RICHARD & PAMELA 2313-008-002 PARKER MATTHEW H & GORDON B PARKER & SUSAN L PARKER 236-008-003 KOLESZAR JOHN III & JANICE K 2313-008-004 BARANOWSKI JAMES J & SHARON L 23B-008-005 HERMAN COPEN REVOCABLE TRUST C/O JOHN COPEN (TRUSTEE) 236-008-006 VEGA MARCO A 2313-008=007 REINHART KRISTINE F & DAVID W 236-008-008 NOBLE JOHN R SR & DEBORAH D NOBLE 236-008-009 MOTAMEDI SAADI & STEPHANIE B 2313-008-010 SILVER GARY M & BARBARA R 2313-008-011 MOTAMEDI STEPHANIE B & SAADI 236-008-012 WHITMAN JOSEPH 2313-008-013._; -Q7ZI..JANICE P 236-008-014 CAHILLANE DEBORAH J & KATHERINE A HAYFORD 2313-008-015 WOOD WILLIAM L 236-008-016 CHITTENDEN GLENN JR 2313-008-017 ROSENTHAL DEBORAH G & THOMAS R 2313-008-018 HEBERT NANCY A 236-008-019 TERNBACH RUDOLF 236-008-020 ANDERSON DAVID J 2313-008-021 SWAIN ELIZABETH W --2313-008-022 HATCH MARK 236-008-023 GERMAN DENNIS LEE 236-008-024 WALDFOGEL DAVID 2313-008-025 PANNONI PAULA A& ALICE A & ELIZABETH G POWELL 2313-008-026 KREBS LOUANN M 2313-008-027 NEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE 2313-008-028 CAHILLANE STEPHEN P & W WOOD C/O RIGALI & WALDER ORTHODONTICS 2313-008-029 WOHL MARTIN A 2313-008-030 NEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE 238-008-031 NEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE 2313-008-032 NEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE mm-NE IV L--K-,-'M ILL LLC ATTN: STEPHEN=P CAHILLANE- 2313-008-034 2313-008-034 ANEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE 2313-008-035 NEW SILK MILL LLC ATTN: STEPHEN P CAHILLANE 2313-008-036 BALIN REALTY LLP 236-009-001 CURRAN FREDERICK G 11 & ELIZABETH M BARDWELL & BARBARA CURRAN 2313-010-001 FERRANTE DOUGLAS P 238-011-001 193 LOCUST ST ASSOCIATES LLP 238-012-001 VOGEL LORRAINE L 2313-047-001 NORTHAMPTON CITY OF SMITH SCHOOL 2313-047-002 SMITH SCHOOL 2313-048-001 BERNIER JAMES R JR & SYLVIA M & DAVID E 2313-049-001 LANGLAIS LINDA G & JOANN BERNS 236-050-001 CAHILLANE MARIA 2313-060-001 SHEEHAN JACQUELINE R - 2313=061 -001 -CLARK JEANETTEA & RICHARD W _---- 231-089-001 SYMANSKI STANLEY L 236-090-001 MASSACHUSETTS ELECTRIC COMPANY C/O PROPERTY TAX DEPT 2313-097-001 193 LOCUST STREET ASSOCIATES 2313-098-001 FERRANTE DOUGLAS P 2313-099-001 BERENS MARK R -----MAILING AD- --- -CITY -- _ _. -- __STATE --ZIP- --- 56 NORTH ST HATFIELD MA 01038 267 LOCUST ST #16 FLORENCE MA 01062 46 MIDDLE ST FLORENCE MA 01062 72 AUTUMN DR FLORENCE MA 01062 P 0 BOX 408 SUNDERLAND MA 01375 267 LOCUST ST #1F FLORENCE MA 01062 209 CARDINAL WAY FLORENCE MA 01062 267 LOCUST ST #1H FLORENCE MA 01062 64 PROSPECT AVE NORTHAMPTON MA 01060 3827 EAGLE CT WESTON FL 33331 64 PROSPECT AVE NORTHAMPTON MA 01060 267 LOCUST ST #2A FLORENCE MA 01062 267 LOCUST ST #213 FLORENCE MA 01062 38 LADYSLIPPER LN FLORENCE MA 01062 55 DENISE CT #2 NORTHAMPTON MA 01060 267 LOCUST ST #2E FLORENCE MA 01062 18 MARTHAS RD EDGARTOWN MA 02539 267 LOCUST ST #2G NORTHAMPTON MA 01060 P 0 BOX 273 SOUTH HADLEY MA 01075-0273 267 LOCUST ST #21 FLORENCE MA 01062 PO BOX 305 CHICORUA NH 03817 267 LOCUST ST UNIT 2K FLORENCE MA 01062 267 LOCUST ST UNIT 2L FLORENCE MA 01062 267 LOCUST ST #2M FLORENCE MA 01062 185 CRESCENT ST NORTHAMPTON MA 01060 67 WATER ST LEEDS MA 01053-9701 P 0 BOX 60266 FLORENCE MA 01062 269 LOCUST ST FLORENCE MA 01062 269 LOCUST ST #F3 NORTHAMPTON MA 01062 P 0 BOX 60266 FLORENCE MA 01062 P.O BOX 60266 FLORENCE MA 01062 P 0 BOX 60266 FLORENCE MA . 01062 P 0 BOX 60266 FLORENCE MA 01062 P 0 BOX 60266 FLORENCE MA 01062 P 0 BOX 60266 FLORENCE MA 01062 269 LOCUST ST #R -2A FLORENCE MA 01062 213 LOCUST ST FLORENCE MA 01062 P 0 BOX 60142 FLORENCE MA 01062 193 LOCUST ST NORTHAMPTON MA 01060 52 MAIN RD GOSHEN MA 01032 80 LOCUST ST NORTHAMPTON MA 01060 80 LOCUST ST NORTHAMPTON,MA 01060 216 LOCUST ST FLORENCE MA 01062 268 LOCUST ST FLORENCE MA 01062 45 BERKSHIRE TERR FLORENCE MA 01062 37 BERKSHIRE TERR FLORENCE MA 01062 33 BERKSHIRETERR --FLORENCE-- - MA---- -01062- - - -- 119 ELM STREET HATFIELD MA 01038 40 SYLVAN RD WALTHAM MA 02451-2286 193 LOCUST ST NORTHAMPTON MA 01060 209 LOCUST ST FLORENCE MA 01062 18 ARNOLD RD PELHAM MA 01002 Version.1.7 Commercial Building. Permit May 15, 2000 Northampton.. C--- qi-fig Department 2 Main Street o om 100 '010' No am ton, MA 01060 hone 41 * 87-1 40 Fax 413 587-1272 u la S r n, . — 4 . Ml -41 APPLICA Ti2tJC REPAIR, RENOVATE, CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING cz=f--r1nM 4.. --,1TE-1NFdkfVIATION 1.1 Property Address. "'Z dt —7 SECTION 2 --PRqP.FK Y OWNE l3$HjP'/K OIRIZED; 2.1 owner of Record: Name (Print). j2(-7-15 Current Mailing Address: 0- c.01T Lot Unit Name (Print) Current Mailing Address: Signature Telephone SECTION; 3- 7:',A Item Estimated Cost (Dollars) to be completed by permit ap0licant 7: 1. Building d rk.0 . faf!;c 2. Electrical r "'t'I& ub 11,; 3. Plumbing F-grTI -!J ee 4. Mechanical (HVAC) 5. Fire Protection 6. Total = (1 + 2 + 3 + 4 + 5) --T 6ia Building Permit Number 1.F'.Jss'Ued k Signature: Version 1.7 Commercial Building Permit May 15, 2000 SECTION:4- CONS'1'Rt7CTIO.N SERVICES FOR hROJC CS LESS T13AN 3`5;000 CUBIC FEET OF ENCLOSED . AG.E Interior Alterations 11Kisting Wall Signs ❑ Demolition ❑ Repairs L9' Additions I . AccessoryBuilding ❑ Exterior Alteration' `Existing Groupd•Sign ❑ New Signs ❑ Roofing El Change of Use E] Other, ❑. r Brief Description : Enter. a brief descnphon here. X' a r�"��''`f v{`` ' A✓r 6 Of Proposed Work: C.f',9�! v SECTION 5 - USE GROUP AND` Cm 17, E USE' GROUP (Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 ❑ A-2 ❑ A-3 ❑ 1B a A-4 0 A-5 ❑ B Business 2A ❑ E Educational ❑ 2B ❑ F Factory ❑ F-1 ❑ . F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ Institutional ❑ 1-1 ❑ 1-2 ❑ I-3 ❑ 3B ❑ . M Mercantile ❑ 4 0 R Residential ❑ R-1 E7 R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B U Utility❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: .t�_.::.: ti..•.n COMPLETETHIS SECTIbt4 IF �CISTINC� BUIL lhtC UNDERGX?It�IG RE1Vf?afATfONS AbD1T10f � 1Ni7�Qf� CHA1sCGE Iii USE Existing Use Group: 0 N� 5 5 E Proposed Use Group: 05 7-1 Existing 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) ;t°, x, -`•= f 1 St .( L---792 7�� 1st ..r /—�S �� F • t ' 2nd �+M 2nd rd 3rd 3 -Total Pro • New s Total Area (so �G1 � � P w Construction .�fl Total Height (ft) Total Height ft 7. Water Supply (M.G.L. c. 40, § 54) 7.1Flood Zone Information: 7.3 Sewage Disposal System: Public (�� Private ❑ Zone Outside Flood Zone Municipal 22,ol' On site disposal system[:] -A. Has a Special Permit/Variance/Finding. ever been issued forlon the site? NO 0 DONT KNOW .- YES .-..IF-,YES, date issued; _y IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KN01N� YES _ IF YES: enter Book i Paget_^and/or Document # I I B. Does the site contain a brook, body of water or wetlands? NO DONT 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 17�- IF YES, describe size, type and location:. ) ft,)/ D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO' IF YES, describe size, type and location: j E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1. acre or is it part of a common plan that will disturb over 1 acre? YES n NO'� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Existing .; Proposed ::' • ... ; . . Required by Zoning Ibis column to be filled in by Building Department Lot Size Frontage I. iN 0 G G — Setbacks Front�� Side Ream L:=O / O /i"V �- Building Height NG��G' !al o G ' Bldg: Square Footage % Open Space Footage' (Lot area minus bldg &paved •�arkin % # of Parking Spaces / { j Fill: volume & Location -A. Has a Special Permit/Variance/Finding. ever been issued forlon the site? NO 0 DONT KNOW .- YES .-..IF-,YES, date issued; _y IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KN01N� YES _ IF YES: enter Book i Paget_^and/or Document # I I B. Does the site contain a brook, body of water or wetlands? NO DONT 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 17�- IF YES, describe size, type and location:. ) ft,)/ D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO' IF YES, describe size, type and location: j E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1. acre or is it part of a common plan that will disturb over 1 acre? YES n NO'� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. Version 1.7 Commercial Building Permit May 15, 2000• SECTION: 9- PROFESSIONAL QESIGN AND: CONST RUC i IOt�k'SER�fICES -FOR BEIILQINGS AND STRUCT;U :ES SUBJI=CT.TO CONSTRUCTION CONTROL.:PURS(JkNT I0 €IiJ.CMii 116.;(------ INING. 00fl. AN 3,5..,000 C F. QF ENGLQSED, SPACE) 9.1 Registered Architect: Not Applicable ❑ Name (Registrant): l Registration Number Address 1 Expiration Date Signature Telephone 9:2 Registered Professional Engineer(s): . r 'S Name Area of Responsibility. Address Registration Number _ Signature Telephone Expiration Date _ r Name Area of Responsibility AddressRegistration Number. Signature Telephone Expiration Date Name Area of Responsibility r _ Address _ Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor -Sf v� �a'� 1 �' Not Applicable ❑ Company Name: Responsible In Charge of Construction Address Signature Telephone VersionL7 Commercial Building Permit May 15, 2000 SECTION 1.0 -STRUCTURAL PI=ER': REVIEW (780 CMR' 110 11) , ;•:. A ; Independent Structural Engineering Structural Peer Review Required Yes No SECTION 11 - OWNER AUTHORIZATION "TO'BE!iC,OMPL'ETED ;WHHENI" OWNERS AGENT OR'CONTRACTOR APPLIES FOR BUILDING:iPERMIT l __._..._.._�__._ .. ' .. .� t _i✓ _ . _., as Owner of the subject property hereby authorize -to act on my behalf, in all matters -relative to work authorized by This building permit application. Signature of OwnergrDate 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. Print Name �f,0 /As Signature oT Owner/Agent Date SECTION: 12 -'CONSTRUCTION: SER1fIGES 10.1 Licensed'Constructiori Supervisor. :Not' Applicable. ❑ 'Name of License Holder: ." Lidense Number Address Expiration Date Signature Telephone �hlLi....... . I �.. �� SECTION;'1:3:'�•W:.ORKERS'' CQMPENSA'CION[ WSU4ZAWCAEIQQYL;r(Nf G L,=c ,T5256f�, u u u : n,. Workers Compensation Insurance affidavit must be completed and sub mitted.with this. application. Failure to provide this affidavit will result in the denial of the issuance of the building permit why No Siqned Affidavit Attached Yes.�' The Conainonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations •---F ' 600 Washington Street � Boston, MA 02I1I ' - www.massgov/dig Workers' Compensation Insurance davit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: 42 a/o38 Phone #: Are you an employer? Check the appropriate box: �<am 1V 4. I am a general contractor and I • 1. a. employer with _ empIoyees (fulland/or part-time).* . have hired the sub-caniractors listed on the' attached sheet:; 2. ❑ I am a sole proprietor or partner- These sub -contractors have ship and have no employees working for me in any capacity. employees and -have workers' [No workers' comp. insurance comp. insurance-* 5. We are a corporation and its required.] ,. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL, c. 152, § 1(4), and we have no insurance required:] t employees. [No workers' comm. insurance required.] Type of project (required): 6 Q New construction 8. ❑ Demolition 9. ❑ Building addition 10.r_1 Electrical repairs or additions 11.0 Plumbing repairs or additions 12.[] Roof repairs 13.El Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. tHomeowners who submit -this affidavit indicating they are doing all work and then hire outside contractors must submita new affidavit indicating' such. +'Contractors that check this box -must attached an additional sheet showing the name of the sub -contractors and state.whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers'. comp. policy number. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: — Policy # or -Self -ins. Lid. M WC < 50::P.3 CQ.y 0/A 3 Expiration Date: -%//% Job Site Address: 14�3 GeG-`i� �f City/State/Zip:O/ OG v Attach a copy of the workers' compensation policy declaration page (showing the policy, number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. ZA-- g Date- s a n Date Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector 6. Other Contact Person: Phone #: