23B-046 10 Do any signs axis on the property? YES NO
IF YES, -describe Stn. type and location: '
Are there any proposed dzanges to or additions of signs intended for the property? YES ND
i
IF YES, describe siz, type and location:
11. Win the construction activity diistirb (clearing, grading, excavation. or filling) over 1 acre or is it part Of a common
plan of development that will disturb over -1 acre? Y6' NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required. .
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN RE D HIED DUE TO LACK OF INFORMATION
This core r
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ran .- . - c � ... ,
Frontage
Setbacks Front ' ,
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Building Height ,
Building Square Footage
% Open . Space: .(lotarea - . - "
.minus building & paved
Dartiria .
Paf Parking Spacirs .•
' :: i# of Loading Docks .
Flit:
• • Iume & - location _ .
13. Certification: I hereby certify that the information contained berein i true and' accurate to the best of
my knowledge.
/1%W: 7/ Z l i/
Applicant's Si athure -
NOT
NOTE: Lssuance of a zoning permit does not reeve an applicant's bErden to aoarpiy with all xounte •
recroirennenrs and obtain all r pests froartfrel3oardof Health, .e; user ratio= Con:omission,
F 33szoric aaad Asthitectmr"r1 Boards, Devartueat ofPenblic Works add other 'app1mt ble perzait granting
Stitidurri lies.
2002 ZLZTL9SCTt XY3 TT:60 OTOZ /6Z /L0
FE Bit 25. 00 /tent , -
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File No.
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Please type or print informatiOn and return this for:in to the ETTil D diner _
Inspettor'S Office - . - -. - . icheck or money order) payable CO the
_
City of1Vorthampton .
C oo k .; i
/ Name of Applicant: (.. DO I "e- V 1 cit--4ri See) HOC t , /
/Address: 3° Le 4144 S t Si . ve
Telephone: 5- 1 2-- 2-2-
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Ovvner of Propercy: 6.5 ' DI I ki.S Ofri 11$-S
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Addre.ss: Telephone:_____________
. ,
3. Status of Applicant:. Owner Contract Purchaser Lessee Other (explain)
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74. Job Location:. • Ceink4c v..) f - P --04-n ell h , re,
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1. • EXiSting Use of Stnicture/Property:
- .
V LIST EVENT 4 Ret - F
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i ?„10190
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5. Description of Proposed Use/Work/Project/OccupaGon: (the additional sheets if necery):
V - '
LIST DA.TES OF EVENT"
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NO or/SIZES F• TENTS • 30 x Li 0 . '
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I'D .a.Dia %_ : a ISA' I. • PM SA! A
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ttached Plans: Sketch Plan Site Plan Englneerxf/Surveyed Plans
' . . .
B. Has a Special PermiteVariance/Finding ever been issued for/on the site?
. . .
NO DONT KNOW 1.1 YE IF YES, date inued _
•
/F YES: Was the permit recorded at the Registry of Deeds?
' .
' -
. , NO . . DONT KNOW YES
• IF YES: enter Book - Pa9e and/or Document #
9.0oes the site corrtain a brook, body of water or wstards? NO to DONT KNOW YES
IF YES. has a permit been or need to be obtained from the Conservation COrornission?
Needs to be obtained Obtained , date issued: -
(Form C.crir.inues On One Side)
W:.'..r..-...T....z...--2,=;:JADRive 0412!.t04,
• . . . . .
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TO 0 2 ZLZIL8SeTt XV,1 TT:60 0T0Z/6Z/L0
AP LOCUST sT 4 BP- 2011 -0081
GIS #: COMMONWEALTH OF MASSACHUSETTS
p:B1ock: 238 -`cis CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit # BP- 2011 -0081
Project # JS- 2011- 000137
Est. Cost: $0.00
Fee: $25.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: Homeowner as Contractor
Lot Size(sq. ft.): 1325051.64 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning: M(99)/URB(1) / /WP Applicant: COOLEY DICKINSON HOSPITAL INC
AT: 30 LOCUST ST
Applicant Address: Phone: Insurance:
30 LOCUST ST (413) 582 -2216 0
NORTHAMPTONMA01060 ISSUED ON:7/30/2010 0:00:00
TO PERFORM THE FOLLOWING WORK: ERECT 30 X 40 TENT 8/2/10 - CENTER FOR
MIDWIFERY CARE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House # Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace /Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 7/30/2010 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Louis Hasbrouck — Building Commissioner