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 #: