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AP - 2004 File No._igM4
s
.Please type orprint all information and return this form to the Building
Inspector's Office with - the $1.5 filing fee (check or money order) payable to the
, }} City ofNorthampton
1. Name of Applicant: U (=I f d a2 (l 6,2_
Address: 3 2 `A0;l .t S � 4 / 1042 ['NAettPl Oti% Telephone: ,SL Vi (2
2. Owner of Property: KAie. Ai { ur, ,oKR l Ss
Address: °) `) n /'(_ d EAJC ` l .. Telephone: 3 ?3 ' 1 5-I
3. Status of Applicant: Owner // Contract Purchaser Lessee Other (explain) LC r` -eleT 0e2
4. Job Location: `7 r `
9 o oi/1 n. c p K/) ,
. , yam' u .:" c . -' <, s.e ° �. a . 11 0, •'* IL*
"` �. � .� ,. , fi x.,..
5. Existing Use of Structure /Property: .Ci (R / (� L (i
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
•
n
C 'A) - Sr' . V- . v F ICY de t 6 46e
7. Attached Plans: Sketch Plan ite Pla Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW 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 DONT KNOW d YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
1
File # MP- 2004 -0127
APPLICANT /CONTACT PERSON David Fortier
ADDRESS/PHONE 32 Laurel St (413) 586 -8965
PROPERTY LOCATION 770 FLORENCE RD
MAP 37 PARCEL 008 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLE I OUT _
Najd
Building Permit 1 ed out
Fee Paid
Tvpeof Construction: ZPA - CONVERT EXISTING GARAGE TO FAMILY RM & ADD 24 X36 ATT GARAGE
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 PRF�SITED:
Approved a 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
Si °®e
ZONING BOARD PERMIT REQUIRED UNDER: § „ 2.. NBC
Finding Special Permit Variance* .' \ 7 �g
Received & Recorded at Registry of Deeds Proof Enclosed /0/
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 Stree nnnission
2
Signature of Building Official D. e
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.