49-003 (2) File /t MP- 2011 -0003
APPLICANT /CONTACT PERSON City of Northampton DPW
ADDRESS/PHONE 125 Locust St (413) 587 -1570 0
PROPERTY LOCATION 238 GLENDALE RD
MAP 49 PARCEL 003 001 ZONE SR(100) //WP/WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
/ 1AIRMII MO LED OUT
Fee 'air
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - DEMOLISH DWELLING,GARAGE & BARN
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved L /fCdditional permits required (see below)
PLANNING BOARD PERMIT REQUIRED U D R: 5
Intermediate Project : Site Plan AND /OR Special Permit with Site Plan
Major Project: Site Plan AND /OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance* _
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 Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
-7119it 6
yELIVI
Signature of 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.
the strict of MGT 40A. Contact the Office of
* Variances are granted only to those applicants who meet uic ��..�� „u......�,.:, ....•.
Planning & Development for more information.
File No. in Pt/ -3
ZONING .PERMIT APPLICATION (§10 2)
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City ofNorthampton r, 0 '
1. Name of Applicant:
— 64 IAJA 2 n 5- N I/l JuvZ P P t.) 4a1 G V Cr Sad
Address: /631- L CAA-ST Telephoner ? - i S 7
2. Owner of Property: C rry 6 i K 'J At' cJ
Address: CIA i Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) L/
4. Job Location: 6- e--E ALE Rd A t
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property: S) /LI Z fJt \ \ L1 , D "`°EZ L).
KcNWs E.`1 1 1 4 G,y f psi T cf D i u L3 ! -
s
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
D M ot 11 %✓Eu..4 .A/ G.-, 6-A fz-Ace 17F3 if R.-00
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 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 V
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained / Obtained , date issued:
y cJ � r > J / C-/ rF5` ET fi ' (Form Continues On Other Side)
P r\ as zs F
W :1 Documents \FORMS \ori ginallBuilding- Inspector AZoning- Permit- Application- passive.doc 8/4 2004
10. Do any signs exist on the property? 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 REQUIRED BY
ZONING
Lot Size
/ 41 - A c v h,ro CtiikArGE
Frontage .74-) 1/\ C4.1A10;E:
c2 —
Setbacks Front - 7 ÷.
Side L: R: t F62, L. ARC. R: L: R:
Rear
a le° Aft2
Building Height
ignAsE „1- 0 FT
&AR I I,- 1 1—
Building Square Footage
i //CO S o
P.-A( 1 5r
% Open Space: (lot area fs ,
minus building a paved q 7 / 1 0
parking 7
# of Parking Spaces
# of Loading Docks
N.A •
Fill: *--- CAA YDS
(volume Et location) ep cior
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: ./ Applicant's Signature
NOTE: Issuance of 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 granting
authorities.
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