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LOCUS REFERENCE:
BOOK 10822 PAGE 136
PLAN BOOK 50 PAGE 43
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10, Do any signs exist on the property? YES NO . X
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 X
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
Depal CuleriL
EXISTING PROPOSED 4.IiE(D33Y
Lot Size %.,. ... s
Frontage
Setbacks Front
Side I L: R: I L: R: ('±- R•.
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parking w
# of Parking Spaces :V
# 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: / f� / ?_ Applicant's S " a 0 4' /t// zov.. -
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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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
1. Name of Applicant: are- 4cL4 rn5
Address: ? / Ry ar sd, F /n ice tic j/9 Telephone: 5 V — /O coo /ac3•-g-
2. • Owner of Property: u nF /4 ct a rn S
Address: X ev I .- H AL . /ter, t ,1 Le iv (-I Telephone:
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location: k' • l K t i Lc/. / /oieri - c
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5. Existing Use of Structure /Property: p`C�S 'ole;� jai �; /
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
c)/c/ . ✓ e e . • '; in - or A e ' l i 'e h is
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 DONT KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book . Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO e ) DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained r date issued:
(Form Continues On Other Side)
VW:\Documents\FORMS \original \Building- Inspector\Zoning- Permit- Application- passive.doc 8/4/1004
File # MP- 2013 -0025
at< - gocG(e--,
APPLICANT /CONTACT PERSON ADAMS JANE
ADDRESS/PHONE 881 RYAN RD (413) 584 -1080 0
PROPERTY LOCATION 881 RYAN RD
MAP 35 PARCEL 067 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 3007 16
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - REPLACE 11 X 15 SHED W /16 X22
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
INFQMATION 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
•
g(Z-3/12—
Signature of Building Official Date
g g
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.
881 RYAN RD MP- 2013 -0025
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS #: 6884
Map: 35
ZONING PERMIT
Block: 067 -- .
Lot 001 -
'ss
Permit. ZONING PERMIT APPLI ' T E RCEnLENP �� ` APPLICATION PERMIT
Category: Zoning Permit
Permit # MP -2013 -0025 PERMISSION IS HEREBY GRANTED TO:
Project # JS- 2013- 000318
Est. Cost: Contractor: License: Expires:
Fee Charged: $15.00 Homeowner as Contractor
Balance Due: $.00 Owner: ADAMS JANE
# of Fixtures: Applicant: ADAMS JANE
D igSafe # AT: 881 RYAN RD
UseGroup
IConstClass
ISSUED ON: 24- Aug -2012 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ZPA - REPLACE 11 X 15 SHED W /16 X22
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fixtures:
Floor: Type: # of Fixtures Floor: Type: # of Fixtures
Fee Type: Receipt No: Date Paid: Check No: Amount:
Zoning Permit Application REC- 2013 - 000760 21- Aug -12 3482 $15.00
212 Main Street, Phone:(413) 587 -1240, Fax:(413) 587 -1272, Email :lhasbrouck @northamptonma.gov
GeoTMS® 2012 Des Lauriers Municipal Solutions, Inc.