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NOTES and Data — (For deportment use)
oil
IV. IDENTIFICATION - To be completed by all applicants
Name Mailing address — Number, street, city, and State ZIP code Tel. No.
Cooley Dickinson Locust Street Northampton, MA 01060 584-4090
Owner or
Lessee Hospital
2. Aquadro & Cerruti, Texas Road, Northampton, MA LBcens e'No . 584-4022
Contractor Inc. 013212
3.Architect or Architects Inc. Main Street, Northampton, MA 584-7224
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.
S'gnature a ipplicont 4_ Address Application date
00 NOT WRITE BELOW THIS LINE
V. PLAN REVIEW RECORD - For office use
Plans Review Required Check Plan Review Date Plans By y
Date Plans B Notes
q Fee Started Approved
BUILDING $
PLUMBING $
MECHANICAL $
ELECTRICAL $
OTHER $
VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS
Date Do,e
Permit or ApprovoI Check Obtained Number By Permit or Approval Check 0btta ned 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, Use Group
Permit issued 199-(,-)—QD
Building r Fire Grading
Permit Fee Y-,,,
Live Loading
Certificate of Occupancy $ Occupancy Load
Approved by: ._.
Drain Tile $
Plan Review Fee $
TITLE
CITY OF NORTHAMPTON
MASSACHUSETTS
OFFICE of the INSPECTOR of BUILDINGS
Page Plot APPLICATION FOR
ZONING PERMIT AND
INSPECTOR BUILDING PERMIT
IMPORTANT — Applicant to complete all items in sections: 1, 11, III, IV, and IX. O
ZONING
I• AT (LOCATION) 3n Locust Street Northampton., MA DISTRICT
LOCATION (NO.) (STREET)
OF BETWEEN AND
BUILDING (CROSS STREET) (CROSS STREET)
LOT
SUBDIVISION LOT BLOCK SIZE
V1
11. TYPE AND COST OF BUILDING — All applicants complete Parts A — D -i
A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use m
M
1 D New building Residential Nonresidential
2>< Addition(If residential, enter number 12 One family 18 Amusement, recreational
of new housing units added, if any,
in Past D, 13) 13 Two or more family — Enter 19 Church, other religious
number of units— — — — --> 20 Industrial
3 Alteration (See 2 above) 14 Transient hotel, motel,
21 Parking garage
40 Repair, replacement or dormitory — Enter number
5 ❑ Wrecking (11 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
6 Moving (relocation) Carport ort 24 Office, bank, professional
�
17 0 Other — Specify 25 Public utility
7 Foundation only 26 F__j School, library, other educational
B. OWNERSHIP 27 L:] Stores, mercantile
8 Private (individual, corporation, 28 0 Tanks, towers
nonprofit institution, etc,) 29 D Other — Specify
9 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,,,,,,,,,,,,,,,, 236,000.00 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 By Hospital
a. Electrical.....................
Addition to House ET Scanner
b, Plumbing ....................... 7,000.0 Addition for Outpatient Cardiology
25,000.0
c• Heating, air conditioning..........
d. Other (elevator, etc.).............
11. TOTAL COST OF IMPROVEMENT $ 204,000.0
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
30.X Masonry (wall bearing) 40 Public or private company 48• Number of stories...............
31 Wood frame 41 Private (septic tank, etc.) 49. Total square feet of floor area,
all floors, based on exterior 1600
32 Structural steel dimensions .....................
33❑ Reinforced concrete H. TYPE OF WATER SUPPLY
34 Other — Specify 42;K Public or private company 50. Total land area, sq. ft. ........... 1600
43 L7] Private (well, cistern) K. NUMBER OF OFF-STREET
PARKING SPACES
F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ......................
35 Gas Will there be central air 52. Outdoors........................
conditioning?
36� Oil L. RESIDENTIAL BUILDINGS ONLY
37 l_J Electricity 44X Yes 45 [7]' No 53. Number of bedrooms..............
38 Coal
39 n Other — Specify Will there be an elevator? Full..........
54. Number of
46 l—] Yes 47 X No bathrooms
J — Partial........
DEPT. OPBUILDING INSPECTIONS BUILDING Z° �n
212 Main Street $a
Northampton, MA 01060 PERMIT
23B - 46 VALIDATION
DATE XWUNNUX plan_ 2, 19 27 PERMIT NO. `(::5L-L
APPLICANT AnOadro R Cpruiti ADDRESS NO )TpXas O(STREET) (CON 312
LICENSE)
NUMBER OF
PERMIT TO — ACadlt3Qn (_) STORY DWELLING UNITS
(TYPE OF IMPROVEMENT) N0. PROPOSED USE)
ZONING
AT (LOCATION) Incugt Street/CoGle Dickinson uvCvpioal DISTRICT IIRR
(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:
AREA OR VOLUME ESTIMATED COST $ 204,000.00 FEEMIT $ 816.00
CU 1 /SO A E FEET)
OWNER Cooley Dickinson Hospital
ADDRESS 3 ocust Street, Northampton, Mass. 01060 svI y` ADE T.
WHITE - FILE COPY . GREEN - FIELD COPY • CANARY - APPLICANT COPY • PINKs- ASSESSORS COPY P�Nf'g'P