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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations
NORTHAMPTON, MASS. 7-7 Ems• 199y Additions
APPLICa ATION FOR PERMIT TO ALTER Repair
Garage
1. Location 30 Locust St , Northampton, MA 01060 Lot No.
2. Owner's name Cooley Dickinson Hospital ' ,Address 30 Locust St.
3. Builder'sname Aquadro & Cerruti, Inc. Address Texas Road
Mass.Construction Supervisor's License No. 069206 Expiration Date 9Ll t 1200 0
4. Addition
5. Alteration X
6. New Porch
7. Is existing building to be demolished? NO
8. Repair after the fire
9. Garage No.of cars Size
10. Method of heating Central St-pqm
11. Distance to lot lines
12. Type of roof EPDM
13. Siding house
14. EstimatedcosL- $2,458,499.00
The un gne ifies that the above statements are true to the best of his, her
knowledge and bel• f
�ua. -
jSignature of responsib e o pican!
Remarks F4-A-SE 00 c
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C'?l assacatcsctia
DEWTMENT OF BUILDING INSPECTIONS
2112 Main Street Municipal Building '
Northampton, Mass. 01060
WORKER'S COMPENSATION INSURANCE AFFIDAVIT
j, Richard D. Manuel, Aquadro & Cerruti, Inc.
(11 censce/perml ttee)
with a principal place of business/residence at:
Texas Rd. , Northampton, MA 01060 (phone#) 413-584-4022
(street/ci ty/statehi p)
do hereby certify, under the pains and penalties of pegury, that:
( ) I am an employer providing the following worker's compensation coverage for my
employees working on this job:
Aquadro Associates PV YBOUB721K164A96 12/31/98
(Inranm Compa ay)
_nl_ (Policy Number) (Expiration Date)
( ) I am a sole proprietor eneral contrracto r homeowner(circle one) and have hired
the contractors listed below who have the following worker's compensation policies:
Alexander Borowski
M.J. Moran WC95625013 10/31/98
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
Field, Eddy & Bulkley
Collins Electric 3BR011522-01 8/1/98
(Name of Contractor) (Insurance Compauy/PaUcy Number) (Expiration Date)
(Name of Contractor) (Insurance Company/PaUcy Number) (Expiration Dale)
(Name of Contractor) (Insurance Company/Policy Number) (Expiration Date)
(nuanh additional short ifnooc=z y to inchido intacroshon pertaining wall oodxadon)
( ) I am a sole proprietor and have no one working for me.
( ) I am a home owner performing all the work myself.
NOTE:pleare be aware dmi while homeowners who employ pewees to do mxintmance,coagnxdoo.or rz pair work on a dwelling of
not more than throe units is which the homeowner rcudes or on the giwuds zppurteaaat iheteto are not generally mandemd to be
employers under the wm iccr oompcnsatien Act(GL152,ss 1(5))�application by a homeowner for a Ike=or permit may cvidcooe the
legal stxhu of an employer under the Workaes Compensation Act
I undmtmd that a copy of this mtcmcat may be forwarded to the Depart naA of Industrial A ocidm&01B00 of lmun 3m for the
covesxge verification and that failure to so=coverage under section 25A of MOL 152 an lead to tbd imQosi -of aiminal penalties
000sistws of a:foe of up to 51,500.00 andfor imprisaamat e of rip to one year and civil pmaltia in the form of a Stop Work Order and:
fine of 5100.00 a.day agsiml the
j For depaat nat"use caly
PcrmitNumber
Wz ZZ 48 ,f Lot#
Li /Permittee
10 Do any signs exist on the property/? YES XX NO
IF YES,describe size,type and location: This permit is for renovation of interior,
there was a new sign provided by the Hospital as part of the new building
Are there any proposed changes to or additions of signs intended for the property/?YES NO
IF YES,describe size,type and location:
11 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colt to be filled im
by the Building Department
Required
Existing Proposed By Zoning
I Lot size
XX N/A
Frontage XX N/A
Setbacks
- side L: R: L: R:
- rear
Building height
±i4' No Change
Bldg Square footage Area effected
±18000sf No Change
%Open Space:
(Lot area minus bldg
&paved parking;
## of -Parking Spaces N/A
# 'of Loading Docks N/A
Fill:
_(volume--& location)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my kno
DATE: Z��Z f Q8 APPLICANT's SIGNATURE
NOTE: Issuanoa of a zoning permit does not relieve ioant's burden to mply with 4111
zoning requirements and obtain all required permits rom the Board of Health, Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
FILE #
FEB 2 7 1998 t�,.
y File No. L3 �JO
' ZING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: Aquadro & Cerruit , Inc . P . O . Box 656 , Texas Rd .
Address: Northampton MA 01060 Telephone: 413-584-4022
2. Owner of Property: Cooley Dickinson Hosptial , 30 Locust St.
Address: Northampton, MA 01060 Telephone: 413-582-2000
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: � � �
Parcel Id: Zoning Map# (--�123 B Parcel#_ _ District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property Hospital
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Medical Services ( same day care and Emergency Dept.)
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/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW ) YES K 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
Renovation On�—
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)
Now
„ i �- - � ' FILE #
i... s /
i
U J FEB 2 7 1998 c
APPLICANT/CONK T PERSON: .elLke, L,aft✓� � /��-
NOR MAMHCA'1111
PROPERTY LOCATION: C'�
MAP PARCEL: ZONE /7)
THIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FULF11) 0111
FPP Paid
Fee Pnifi
ArressnryStrurture
>�
c sibs
cI j G c,
T�iF� LLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION:
Approved as presented based on information presented 1 Tr
Denied as presented: —7,
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding 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-Bd of Health Well Water Potability-Bd Health
it ,C,uas�t-v C 1•n n
Signature of Building t4ector Date
NOTE:Issuanoa of a zoning permit does not relieve an applioant's burden to oompty with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Publio Worica and other applionble permit granting authorttles.
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