39-060 (31) atwood dr zoning permit appl'
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~~ .File No.,~-'!- ~d q ~b ~~~ ~iav ~ 7 ~~~~ ..
Please type or print all information and return this form to. the Building' ' -
Inspector's Office tivith the $15~lingfee (check ormor~eyorde~ p~,~aBY~ to the
City ofNorthampton
1. Name of Applicant: L ~ y~ .- C~d /~ J ~ '`f t~i~!C~~'~~,51~ «I~..
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Address: fC~~ ~5r~i[~P ~~ /1.~,~~'~i/~T/~i~_Telephone: ~~~~~ GYv' ~~~G
2. Owner of Property: ~e;/`~ uJ'etO ~+%I-S.~c ~C
~ ,~u~ ~~ ,ro 7y'~ - 7 ~/- 72 C6
. ~ Address: -, L~t3 l.l~, ~ v~-rl;-yr~~~I ~~~k ~Wu t~'~,/.~ ,arA Telephone:
3. Status of Applicant: Onwner Contract Purchaser Lessee~_ Other (explain)
4. Jab Location: /-~-~"wu u,Y ~/`,/1/~ fV~r~~,.., ~)Z,y f~t+.~3
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6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan ~ Engineered/Surveyed Plans _~
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW ~ YES IF YES, date issued:
1F 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
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained
Obtained ,date issued:
YES
(Form Continues On Other Side)
bV:`Documents`~FOIZVIS' originahBuilding-InspectorZoning-Permi[--~peiication-passive.doc 3'~'hC~t~`I
5. ~ Existing Use of Structure/Property: ~'~CL J U~.tle.~'
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10. Do any signs exist on the property?
,;:,
IF ?F,~S, describe size, type and location:
YES NO '~'~
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Are there any proposed changes to or additions of signs intended for the property?
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 Lam-'
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 ase by the Building
Department
EXISTING
PROPOSED L ~:.~ ~ REQ~Ea=&Y
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~`arinrrs''
Lot Size
Frontage
Setbacks Front
Side
Rear
L:~ R:
L: R:
~1_: ~'
Building Height
Building Square Footage
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% Open Space: (lot area
minus building & paved
arkin _
..
# of Parking Spaces
# 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 Sign ture -
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to cflmply 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 granting
authorities.
YES NO ~
3isi?OQ~
`N Documrnrs~FOCLbIS'ori~inal`Buildin~ Inspector'Zonin~ Permit-iapplication-passive.doc