23B-046 (178) PERMIT APPLICA ION .,�C.NE K LIST
PAGE PLOT ZONE Wt t1 -3 YES NO DATE
ZONING FORM APPLICATION
2 , PERMIT I
3 . OWNER OCCUPANT STATEMENT Z LICA IF NOL
3 SETS OF
5 . NEW CONSTRUCTION
6 , CURB C
7 WATER
8 , REMODELING
9 , ADDITION
0 , ACCESSORY UC
11 . SIGN / AWNING
0
12 , PERMIT FEE - CHECK ONLY - MONEY-0 DE 4
13 . SPECIAL PERMIT REQUIRED WITH DEED IF APPLICABLE
14 . UNDER SECTION 127 - C R 780
5 . FORM A
16 FILL
COMMENTS-:
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Zoning
Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. 584-4022 Alterations
a NORTHAMPTON, MASS. Dec. 9, 19 94 Additions APPLICATION FOR PERMIT TO ALTER Repair
Garage
1. Location 30 Locust Street Northampton, MA Lot No.
2. Owners name Cooley Dickinson Hospital Corp. Address 30 Locust St. , Northampton
3. Builder's name Aquadro & Cerrut i, Inc. Address P.O. Box 656 Northampton, MA
Mass.Construction Supervisor's License No. 013212 Expiration Date 1995
4. Addition M.R.I. Addition
5. Alteration
6. New Porch
7. Is existing building to be demolished? No
8. Repair after the fire No
9. Garage No No.of cars Size
10. Method of heating Steam supplied from central heating plant
11. Distance to lot lines
12. Type of roof Flat — E.P.D.M. Membrane
13. Siding house
14. Estimated cost:-
$755,000.00 `I
}lj�r The undersigned certifies that the above statements are true to the best of his, her
knowledge and b f.
Signature of re onsible app icant
Remarks
OW` U0
Date Filed /2-/ -9yr File No.
ZONING PERMIT APPLICATION
1 . Name of Applicant: 4
Address: ' r a Telephone: {•' a
2 . Owner of Property:
Address: T c Telephone:6 e-
3 . Status of Applicant: Owner Contract Purchaser
Lessee Other (explain a1Tmk�ln )
4 . Parcel Identification: Zon 'ng Map Sheets` X. � Parcel# (? r
Zofting District(s) (inclu o ys)
Street Address o ,
Required
5.
Existincr Proposed by Zonin
Use of Structure/Property
(if project is only, interior work, skip to #6)
Building height
%Bldg- Coverage (Footprint)
Setbacks - front U
side L: R: jo L: /" '(�j R:
- rear "
Lot size
Frontage.
Floor Area Ratio
oOpen Space (Lot area minus
building and parking)
Parking Spaces
Loading
Signs
Fill (volume & location)
6. Narrative Description of Proposed Work/Project: (Use additional sheets
if necessary) d', TG I-xZS"
G�& 56A-,�f I3Gi�C� c 7'-
t
7. Attached Plans: Sketch Plan Site Plan
8 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my know le e.'
Date:
App Ii cant rs Signature:
THIS SECTION FOR OFFICIAL USE ONLY:
Z� Approved as presented/based on information presented
Denied as presented--Reason:
ecial•' Per it and/or Site Plan Required:
_ ng Re 1 ed: Variance Required:
gnat roe of Build nspector a
NOTE: fssuanoe of a zoning pormit does not relieve an applicant's burden to comply w 0i all zonln requirements and obtain di required pormits
from the Board of Hoaitk conservation commission, Dopadniont of Public Works and oUior applicable permit granting authorities.
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