23B-046 (3) • •
- 10. Do any siocs exist on the properry? YES NO
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED
Lot Size I
Frontage
Setbacks Front
Side L: R: L: R: t R
Rear
Building Height
Building Square Footage I
Open Space: (lot area I - -
minus building & paved J
barking I f
of Parking Spaces I
# of Loading Docks
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
•
/Date: Applicant's Signature _.�� — � 4 i e
NOTE: Iss -ante o 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,
Historic and Architectural Boards, Department of Public Works and other applicable permit zranting
authorities.
w:', riot; rnens ,FCiRMSbrzma\aai:dinz- -s::est_ 2s-r per n- zoiimnon- pamve.doc 8/4/2004
is 25, 00 /tent ,
File No.
.___
r-t - ',7 : f -A-1. .„-- - . = - -- - - - - - '
i _,-_-_-_-;::-. : - - -r-t --- '- -t. -=AP-Pi.
l , __. _____________-____ ___-______,____ .__„_,.....,:,_:._, - , --.....,
PIease type or print all \information and return this form to the Building
Inspector's Office " ,check or money order) payable to the
City of Northampton
dr U i 'c
Name of a ficant: �^ - v: ,
/Addr 7 0 G).�CAf- j ' L12.""
Owner of Properly: Ii € /4 "I. r
A Per`y: —
Address: ,O i; {-i '`"� ' i Telephone: 5 �-- ` 271/
3. Stet-is of Applicant: Owner Contract Purchaser Lessee / Other (explain) /'iC' Co
`��
74. Job Location: I t.f�'��'i4.ff , - :: -��,K,r (""'.
-,mac 6 d T� S7° ','F
.., Y T�'� ..• i T3aCG` ___ = fir -°_: ,, ,. -- �- -
" � - - � — _:-:cam : ; fi ' ` �z
7 t oe
Existing Use of Structure /Property: A4 f ice, ('! e- k (en / rt
LIST EVENT
• H Of-4e- ter J 107
5. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
V LIST DATES OF EVENT"
NO OF /SIZES OF TENTS' X 1/ 0
WHEN TENTS READY FOR INSPECTION)
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special Permit/Variance /Findingg ever been issued for /on the site?
NO DON'T KNOW V YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Cons Commission?
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
W: ,roc.,:.. t, =FOP_IvIS ti-; a sis - in --- -- Zo ni n g -a -- rvii at; or.- pZSive_doc &/4/ 2004
7
(
30 LOCUST ST BP- 2009 -1000
GIS #: COMMONWEALTH OF MASSACHUSETTS
Map:Block: 23B - 046 CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: Tents BUILDING PERMIT
Permit # BP- 2009 -1000
Project # JS- 2009 - 000388
Est. Cost:
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:5/28/2009 0:00:00
TO PERFORM THE FOLLOWING WORK:ERECT 20 X 40 TENT 6/4/09 - 1 DENNISTON PL
- MIDWIFE CTR
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:
Date Paid: Amount:
Building 5/28/2009 0:00:00 $25.00
212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272
Building Commissioner - Anthony Patillo