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IDENTIFICATION - To be completed by all applicants Name Mailing address — Number, street, city, and State ZIP code Tel. No. I' Owner or Cooley Dickinson 30 Locust St 01060 584-4090 Lessee Hospital n r f r Builder's N xc1J -t 1. r i �� �''�. CJ� _��� f �<}� If�--a_ ../ r� �. License No. J Contractor � I?21Z, 3. Architect or Engineer I hereby certify that the proposed work is authorized by the owner of record and that I have been authorized by the owner to make this application as his authorized agent and we agree to conform to all applicable laws of this jurisdiction. Sign tur f applicant Address Application date 30 Locust St. 4/30/87 00 NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD - For office use Plans Review Required Check Plan Review Date Plans By Date Plans By Notes Fee Started Approved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Date Permit or Approval Check Obtained Number By Permit or Approval Check Obttaitned Number By BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GRADING USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building FOR DEPARTMENT USE ONLY Permit number Building e �y 19 7 Use Group Permit issued V{i(/�+ 7 IF Building Fire Grading Permit Fee $ (vS Jv�[_J .0 V Live Loading Certificate of Occupancy $ Occupancy Load Approved Drain Tile $ Plan Review Fee $ TITLE „ CITY OF NORTHAMPTON .� MASSACHUSETTS $ OFFICE of the INSPECTOR of BUILDINGS $ e Pa B ��� ,yT g Plot APPLICATION FOR INSPECTOR ZONING PERMIT AND BUILDING PERMIT z IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, and IX. O 1 ZONING URB-2 AT (LOCATION) 30 Locust Street (Cooley Dickinson Hospital) DISTRICT LOCATION (NO.) (STREET) OF BETWEEN AND BUILDING CROSS STREET) iCROSS STREET) LOT 12.6 acres SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking” most recent use m M 1 [7] New building Residential Nonresidential 20 Addition(1/ residential, enter number 12 One family 18 Amusement, recreational of new housing units added, if any, 13 Two or more Family — Enter 19 Church, other religious in Part D, number of units— — — — 3 Alteration (SSee e 2 above) —)- 20 Industrial 14 Transient hotel, motel, 21 Parking garage 4 Repair, replacement or dormitory — Enter number 5 ❑ Wrecking (If multifamily residential, of units ——————— — 22 �� Service station, repair garage enter number of units in building in 15 Garage 23 Hospital, institutional Part D, 13) ❑ 16 Carport 24 n Office, bank, professional 60 Moving (relocation) 17 Other — Speci/y 25 Public utility 7 D Foundation only 26 School, library, other educational B. OWNERSHIP 27 Stores, mercantile 8 [# Private (individual, corporation, 28 ❑ Tonks, towers nonprofit institution, etc.) 29❑ Other — Specify 9 0 Public (Federal, State, or local government) C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, e.g., food processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement,,,,,,,,,,,,,,,, 128,000 school, secondary school, college, parochial school, parking garage for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost a. Electrical....................... 52,000 Relocation of Hospital Recovery Room and b. Plumbing ...................... 14 000 new Surgical Day Care area. c. Heating, air conditioning.......... 17,000 d. Other(elevator, etc.)............. 11. TOTAL COST OF IMPROVEMENT $ 211 ,000 III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip to IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 1 30❑ Masonry (wall bearing) 40:K{ Public or private company 48. Number of stories.............. 31 Wood frame 41 El Private (septic tank, etc.) 49. Total square feet of floor area, all floors, based on exterior 4 050 32 Structural steel dimensions ..................... 33 X: Reinforced concrete H. TYPE OF WATER SUPPLY Kr l Public or private company 50. Total land area, sq. ft. 12•.6•ac. 548,856 34 0 Other — Specify 42 43 ❑ Private (well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES 51. Enclosed ....................... F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 35 E5� Gas Will there be central air 52. Outdoors........................ 570 36 ❑ Oil conditioning? L. RESIDENTIAL BUILDINGS ONLY 37 Electricity 44 [a Yes 45 ( No 53. Number of bedrooms.............. 38 Coal 39 Other — Specify wood Will there be an elevotorP Full.......... 54. Number of 46 F� Yes 47 In No bathrooms Partial........ DEPT:OF BUILDING INSPECTIONS BUILDING �O a 212 Main Street 'Q 5 ' Northampton, MA 01060 PERMIT as 23B - 46 VALIDATION DATE April 2Q 19 PIT NO. 241 APPLICANT F.J. Mac Innis ADDRESS 3(�ozcu�s StreERMet (NO.) (STREET) (CONTR'S LICENSE) PERMIT TO Alteration (_) STORY Hospital NUMBER OF (TYPE OF IMPROVEMENT) NO. (PROPOSED USE) DWELLING UNITS AT (LOCATION) 30 Locust Street/Cooley Dickinson Hospital ZONING URB DISTR ICT (NO.) (STREET) BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE BUILDING IS TO BE FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: permit of relocate hospital recovery room and new surgical day care area VOLUME 4.050 sQ. ft. ESTIMATED COST $ 211 ,000.00 FEEMIT $ 580.00 (CUBIC/SQUARE FEET) OWNER Cooley Dickinson Hospital (J/,��► Gr"�� /} ' ADDRESS 30 Locust Street BYILDIN�^ WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINK - ASSESSORS COPY p0-1-Irp