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PermitApplication_City of NorthamptonPermit Application Todav's Date- 09/27/2012 Owner Applicant City of Northampton City of Northampton Planning and Development 210 Main Street 210 Main Street Northampton, Massachusetts 01060 Northampton, Massachusetts 01060 413 -587 -1265 WFeiden@Northamptonma.gov City of Northampton department: Yes Work Location Information How many lots involved in the project: 2 Map / Block / Lots of all lots in project: 13 / 048 / 001 Deed Book of all lots in project: B. 7330, P. 239 Project work address: 21 HATFIELD RD City/ State/ Zip: Northampton 01060 Zoning District: SR Application for following Permit Types ❑ Planning Bd. Special Permit w/ Site Plan ❑ Planning Bd. Special Permit w/ MAJOR Site Plan NO Special Permit ❑ Administrative Site Plan Review ❑ Planning Bd. Major Site Plan Approval (No Special Permit), including 40R projects ❑ Subdivision Preliminary ❑ Planning Bd. Special Permit w/ Site Plan for flag lots ❑ Planning Bd. Site Plan (NO Special Permit) ❑X Approval Not Required Plans ❑ Subdivision Definitive with Preliminary Approved ❑ Subdivision Definitive with no Preliminary Approved ❑ Zoning Board Special Permit ❑ Appeal of Building Commissioner - Zoning ❑ Variance ❑ Historic District Determination of Non - Applicability ❑ Historic District (Elm St) Determination of Appropriateness ❑ Subdivision Definitive Amendment ❑ Zoning Board Finding ❑ Comprehensive Permit (40B) ❑ Demolition (Demolition Delav) ❑ Central Business Architecture ❑ West Street Architecture ❑ Wetlands Notice of Intent IF ONLY local ❑ Wetlands Notice of Intent IF state wetlands wetlands 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Wetlands Certificate of Compliance reauest 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Wetlands Request for Determination OR ❑ Wetlands Amendment or Resource Delineation extension Fee Information Total Fee Amount: $0.00 Existing Use Abandoned house and property Planned Use House lot in front, conservation land in back Detailed Project Information Number of Plan Pages:1 Special Permit Description: Not applicable, this is an ANR Approval Not Required Description: Included Files Uploaded: By typing my name in the signature box, I certify that all the information above is accurate to the best of my knowledge, I am the property owner or have permission from the property owner to apply for this permit. I also grant permission to the City of Northampton to inspect the proposed work Signature: Wayne Feiden Date Signed: 09/27/2012 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262