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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