23B-046 (185) pp,, PERMIT APPLICAJION CHECK LIST
PAGE 2-18 PLOT 7� ZONE �� (J--O - YES NO DATE
1 . ZONING FORM APPLICATION L
2 . PERMIT APPLICATION
3 , OWNER OCCU TA E T 4i:CIIF NOT
4 . 3 SETS QF P-���/PLOI--PLAN G�
5 . NEW CONSTRUCTION
6 . CURB CUT
7 . WATER VAI BI T FORMS
, 8 . REMODELING INTERIOR
9 , ADDITIO
10 , ACCESSORY STRUCTURE
11 . SIGN / AWNI
1 2 , PERMIT FEE - CHECK ONLY - MONEY ORDER
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 , UNDER SECTION 127 - CMR 780
15 , FORM A
16 . FILL
COMMENTS :
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 584-4022 Alterations X
a NORTHAMPTON, MASS. July 23 1993 Additions
APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location Cooley Dickinson Hospital 30 Locust Street Northampton, Ma_ Lot No. #46
2. Owner's name Cooley Dickinson Hospital Address 30 Locust Street Northampton
3. Builder's name Aquadro $ Cerruti, Inc. Address 14orthamp on.Ma_
Mass.Construction Supervisor's License No. 013212 Expiration Date 6-30-94
4. Addition N/A
5. Alteration Renovations to the 2nd floor - Med-Surg/Pediatric Unit
6. New Porch N/A
7. Is existing building to be demolished? No
8. Repair after the fire N/A
9. Garage N/A No.of cars N/A Size N/A
10. Method of heating Existing
11. Distance to lot lines N/A
12. Type of roof N/A
13. Siding house N/A
14. Estimated cost:- $452,777.00
The undersigned certifie t the abov ements are true to the best of his, her
kno )edge and belief.
nalu sible appican
Remarks
OR0 01 1-1 Date Filed '7 26
ONING PERMIT APPLICATION (§10 . 2) File No.
I . Name of Applicant ;
Address : �, �.-�, Telephone: -
2 . Owner of Property: �� ,cK►N' ;; q
Address : o�� iz Teleph ne : Z,OCO
3 . Status of Applicant : Owner Contract Purchaser
Lessee Other (explain : �o� )
4 . Parcel Identification: Zoning Map Sheet# 2.36 6arcel#
Zoning District (s) (include o erlay (�,
Street Address p
Required
5 . Existin Proposed by Zoning
Use of Structure/Property
(if project is only interior work, skip to #6)
Building height
%B1dg. Coverage (Footprint)
Setbacks - front
- side L: R: L: R:
- rear
Lot size
Frontage
Floor Area Ratio
%Open Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Descr�tti,,on Proposed Work/Project : (Use additional sheets
E- t — _ _ I4 a ,a
7 . Attached Plans : f Sketch Plan Site Plan
8 . Certification : I hereby certify that the informati contained herein
is true and accurate to the best of nowledge.
Date : Applicant' s S1 1-1
THIS SECTION FOR OFFICIAL USE ONLY:
�' Approved as presented/based on information presented
Denied as presented--Reason :
Special' Permit and/or Site Plan Required :
in ' g Re ired: _ Variance Required :
gnat - e of B ctor ; ate
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation commission, Department of Public Works and other applicable permit granting aulhorilios.
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