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PermitApplication_Kubosiak Brothers LLCPermit Application Todav's Date- 02/20/2013 Owner Applicant Kubosiak Brothers LLC Kubosiak Brothers LLC 248 Coles Meadow Road 248 Coles Meadow Road Northampton, Massachusetts 01060 Northampton, Massachusetts 01060 413 -584 -3079 patmelnik@gmail.com City of Northampton department: No Work Location Information How many lots involved in the project: 1 Map / Block / Lots of all lots in project: 08 / 067 / 067 Deed Book of all lots in project: Book 10849 Page 76 Project work address: 0 COLES MEADOW RD City/ State/ Zip: Northampton 01060 Zoning District: RR 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 Total Fee Amount: $250.00 Existing Use Vacant Land - Recreational Planned Use Vacant Land - Recreational Detailed Project Information Number of Plan Pages:1 Special Permit Description: Plan is agreed upon out parcel for sale to City Approval Not Required Description: Plan is agreed upon out parcel for sale to City Files Uploaded: Supporting Information: Description of Plan.docx Plan Sheets: Final Plan.pdf Approval Not Required: Tiff or PDF: Final Plan.pdf 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: Patrick Melnik Attorney for Applicant Date Signed: 02/20/2013 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Fee Information Approval Not Required Plans - $250 /plan page $250