23B-046 (136) 3-APR-1999 09:44:59 Hampshire County Registry of Deeds Receipt No: 103464
Marianne L. Donohue, Register of Deeds
33 King Street
Northampton, MA 01060-3298
Name: NORTHAMPTON FIRE DEPARTMENT Addr: 60 MASONIC STREET
NORTHAMPTON, MA 01060
Receipt Type: OR
Payment
Total Pages: 0007 Fees Taxes
Fee: $ 13.00 Cash: $ 13.00 $ 0.00
Tax: $ 0.00 Check: $ 0.00 $ 0.00
Misc: $ 0.00 Charge: $ 0.00
Charge Code:
Comment: SPECIAL PERMIT/SITE PLAN APPROVAL-30 LOCUST STREET N'TON
Receipted By: BETH Status: PAID
DOCUMENTS: 990010651 to 990010651
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Type Page Doc Mref Consider$ Record Fee Excise Tax Stat Misc Fee Record Date Document# Book/No./Page Status
---- ---- --- ---- ----------- ----------- ----------- ---- ----------- ----------------- --------- -------------- ------
IIS3 007 0001 0000 0.00 13.00 0.00 0.00 13-APR-1999 09:44 990010651 OR /5660/0224 INIT
Page 0001 of 0001
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 19 Additions
APPLICATION FOR PERMIT TO ALTER Repair
4 r
Garage
1. Location Cooley Dickinson Hospital Lot No.
2. Owner'sname Cooley Dickinson Hospital Address30 Locust St. Northampton, MA 01061
3. Builder's name Address
Mass.Construction Supervisor's License No. Expiration Date
4. Addition Adding small tower structure to roof of building.
5. Alteration
6. New Porch
7. Is existing building to be demolished?
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating
11. Distance to lot lines
12. Type of roof
13. Siding house
14. Estimated cost:
The undersigned certifies that the above statcmcnts are true to the best of his.
knowledge and belief.
Signature of responsible app,icant
Remarks
APR 1 4199q
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. • ,_,.,,.,;..w:,.,,.s,,�,,e.,,,::..,.,.«..a.. a s s n ch ns c t to
m DEPARTMENT OF BUILDING INSPECTIONS
212 Main Street ' Municipal Building
Northampton, Mass. 01060
WORICER'S CO-PTUENSA`ITON INSURANCE rlrFLDAVrr
Connecticut Radio, Inc.
(li cease'"/pe rmi ttee}
with a principal place of busiuess/residence at:
1208 Cromwell Ave. Rocky Hill Ct- 06067 (phone#) 860-563-4867
(str�ilci ty/statf:/ri p)
do hereby certify, under the pains and penalties of pemily, that:
O I am an employer providing the following worker's compensation coverage for my
employees working on this)ob:
(Insurance Company) (Policy Number) (Expiration Date)
(X) I am a sole proprietor, general contractor or homeowner (circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
C.I.S 660 -283Xg36L1 -PA98 51-)
(Name of Contractor) (Insurance Cornpany/Poticy Number) (EYpirntion Date)
(Name of Contractor) (Iasurant~ Company/Poticy Number) (E),piration Date)
(Name of Contractor) (Ituuranct- CompanyRolicy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(atrncht UkHo"thci if noccnuy to iochsdc iafvcruaboo prrta.iuing to all 000tractors)
O I am a sole proprietor and have no one working for me..
( ) X am a home owner performing all the work myself.
NOTE:please be awarc this wbilo hocncoknm wbo ccoploy persom to do mn;Mmlncc constxw600 or repair work on a dwelling of
not mOcO than thrnO unite iu which the bomoowncr resides or cc the grounds appurtenant tharto ara not gcocrnlly oxoidcrcd to be
anployesa under tbo worker`s 0omp=m4cn Act application try a homeowner for a lieevse cc permit may evidcux tho
10911 ctatut of an omployor under tho Wor$oes CompcoaA ion Act
I unduitand that a oopy of this rtstcmcm may bu forwardod to tbo Dcyartmc of 1.awbial Attidmb Ofr'.of rmur*noo for th-
covcrx verification and that failure to secure oovaxp tusdcr saetion 25 A of MOL 152 can lead to tbd imposition of--Baal pcaaltic
ooati.st*mg of a Sic bf up to S 4500.00 an&oc impcisommcai of tip to one Y=and civil prstaltics in the form of a Stop Work Omer aid a
film 0(5100.00 Idly cPn d
For dry=tW'-"cal ciao only
Permit Number
Signahtrc cf Ltocuscr1Permtittce
10. Do any signs exist on the property? YES NO X
IF YES,describe size,type and location:_ The job location is the roof of the
Hospital where no signs are located.
Are there any proposed changes to or additions of signs intended for the property?YES NO_L_
X
IF YES,describe size,type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This cols to ba filled in
by the Building Departmeut
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&palled parking!
# pf -Parking spaces
#- of Loading Docks
Fill:
(volume• & location)
13 . Certification: I hereby certify that the information contained herein
rr is true and accurate to the best of my knowledge.
DATE: - APPLICANT's SIGNATURE
NOTE: issuance of at zoning permit does not relieve an applioant's burden to comply Wit4 4111
zoning requlrements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works and other appliouble permit granting authorities.
FILE #
PpR Q 1999 ,e
Fi l e No wwJl1/
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Connecticut Radio, Inc.
Address: 1208 Cromwell Ave. Rocky Hill, CT 06067 Telephone: 860-563-4867
2. Owner of Property: Cooley Dickinson Hospital
Address:30 Locust St. Northampton, MA 01061 Telephone: 413-582-2312
3. Status of Applicant: Owner X Contract Purchaser Lessee
Other(explain):
4. Job Location: Cooley Dickinson Hospital
Parcel Id: Zoning Map#P 3 :�_ Parcel# Lo District(s):
(f0 BE FILLED IN BY THE UILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occuppbon: (Use additionaal�stt,-ets� necessa4r�wer consists of
This will be Antenna Tower for new ire a p artment.Ra io ys em.
one 9 foot top section plus antenna. Base Plate to be installed in root
Roofers. Engineering to be confirmed by Bill Barry, the chief engineer at the
hospital . fog J�`0.SeP�aL Ihs� !i" ton Scc a4chcj
7. Attached Plans: Sketch Plan _Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special Permit/Vadance/Finding ever been issued for/on the site?
NO DON'T KNOW- X YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW X YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO X DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#BP-1999-0851
APPLICANT/CONTACT PERSON Young Roofing Co Inc-CONNECTICUT RADIO
ADDRESS/PHONE P O Box 56 (413)584-1367 1208 CROMWELL AVE ROCKY HILL CT 06067
PROPERTY LOCATION 30 LOCUST ST
MAP 23B PARCEL 046 ZONE M
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
Tyneof Construction- INS ALL ASE PLATE FOR FIRE DEPT ANTENNA TOWER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building_Plans Included•
Owner/Statement or License 011878
3 sets of Plans/Plot Plan
THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
pproved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
1eceived&Recorded at Registry of Deeds Proof Enclosed
--Fin----diinngg Required under: § _w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservatio ommission
f
Signa Building Official Date
Note:Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
f
30 LOCUST ST BP-1999-0851
GIs#: COMMONWEALTH OF MASSACHUSETTS
Map:Block:23B-046 CITY OF NORTHAMPTON
Lot:-001
Permit: Building
Category:ANTENNA TOWER BUILDING PERMIT
Permit#_ BP-1999-0851
Project# JS-1999-0129
Est. Cost: $600.00
Fee: $0.00 PERMISSION IS HEREBY GRANTED TO:
Const.Class: Contractor., License:
Use Group: Young Roofing Co Inc 011878
Lot Size(sq.ft.): 667077.84 Owner: COOLEY DICKINSON HOSPITAL INC
Zoning:M Applicant: Young Roofing Co Inc
AT: 30 LOCUST ST
Applicant Address: Phone: Insurance:
P O Box 56 (413) 584-1367 Workers Compensation
FLORENCE 01062 ISSUED ON.•4/16/1999 0:00.00
TO PERFORM THE FOLLOWING WORK.-INSTALL BASE PLATE FOR FIRE DEPT ANTENNA
TOWER
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Inspector of Buildings
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
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 si nature•
Fee Type: Receipt No: Date Paid: Check No: Amount:
Building 4/16/1999 0:00:00 $0.00
212 Main Street,Phone(413)587-1240,Fax: (413)587-1272
Building Commissioner-Anthony Patillo