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LOCUS REFERENCE: 104 ,
BOOK 6346 PAGE 233 S
PLAN BOOK 28 PAGE 5
SUBJECT TO WATER LINE EASEMENT fr
IN BOOK 1562 PAGE 295 004,0
To:MORGAN STANLEY PRIVATE BANK. NA
OWNER: DICK LARSON
AND: FIRST AMERICAN 1111 E INS. CO.
AVADHAN LARSON
I hereby report that the premises shown on this plan are LOCATION: 28 GLEASON ROAD
not located within a Flood Hazard Area as shown on the NORTHAMPTON, MASSACHUSETTS
Federal Emergency Management Agency's Flood
Insurance Rate Map,
Community No. 250167 -0002A HOLMBERG & HOWE, INC.
Effective Date APRIL 3, 1978 PROFESSIONAL LAND SURVEYORS & CIVIL ENGINEERS
87 UNION STREET, EASTHAMPTON MA 01027 -0945
I also report, to the best of my knowledge, information 37 DAMON POND ROAD, CHESTERFIELD MA 01012 - 0176
and belief that this inspection plan shows the 73 PRINCETON STREET, NORTH CHELMSFORD, MA 01863
improvement or improvements as located on the premises
described, that the improvements are entirely within lot SCALE:
lines, and that there are no encroachments upon the
1" = 40
premises described by the improvement or improvements
of any adjoining premises, except as noted. I further
report that there are no easements of record affecting the DATE:
tract shown hereon, except as noted - FEBRUARY 27, 2012
JOB NUMBER:
�`�� 12 -014
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DAY- TIMERS RE -ORDER • CIS'.) 429001 or K (Sr.) 411855 • MADE iR U.SA
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9. ALL INFORMATION. MUST BE COMPLETED: PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage N/A N/A N/A
Front:
Setbacks:
Side: L: R: L: R:
Rear:
Height
% Open Space:
(Lot area minus bldg and
Paved parking)
10. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: 1 1 P0117- APPLICANT'S SIGNATURE Sfrhe 3
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities.
City of Northampton
�
° Massachusetts fg�
,„ j f r `M1Jw DEPARTMENT OF BUILDING INSPECTIONS
,, 212 Main Street • Municipal Buildin 41,
"- Northampton, MA 01060
INSPECTOR •
ACCESSORY STRUCTURE PERMIT APP ► IC A T IO N ' 2012
DEPT. OF BUILDI . s 01 o
(For freestanding structures less than 200 sq. ft., at least 5 feet • •• "'` : er structure)
Permit Fee: $25.00 Check #
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ?tjxbQ1 J • K, 11
Address: G leconI.) Rol Telephone: S08 (0q 1 4 L
2. Owner of Property: 1'�
+
Address: l �Ali'PvvGriC \ c1 ikht) ))1A Telephone: SO Q p ( (vi Er
3. Status of Applicant: x Owner Contractor
4. Structure Location: �Q,CC
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: ■ Multifamily: Commercial:
6. Description of Proposed Structure:
One Story Shed under 200 sq. ft.: A, Freestanding Deck under 200 s . ft., less than 30" above grade:
Other (describe): /°2 /
7. Attached Plans: Sketch Plan yl Site Plan Plot Plan
8. Does the site contain a brook, body of water or wetlands? NO • A 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
CONTINUED ON NEXT PAGE
File # MP -2012 -0108
APPLICANT /CONTACT PERSON KELLY BARBARA J
ADDRESS/PHONE 4 CHILLMARK RD (508) 641 -4958 Q Ott
PROPERTY LOCATION 28 GLEASON RD
MAP 18C PARCEL 093 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT !
Fee Paid 7; 1 q C .,-
Building Permit Filled out
Fee Paid
Typeof Construction: 12 X 16 SHED
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
IN RMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : §
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
CX ---- / t"----'1L—C g (i21(.-
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.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.