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10. Do any signs exist on the property? YES NO
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. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
-�s'� c5c,
Frontage I
Setbacks Front 3ju
Side L: S7S R: d lSv L: R: L: R:
Rear (46-0
Building Height
Building Square Footage
% Open Space: (lot area
minus building ft paved pa rltin
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et location)
12. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: � a0 Z d 0"� Applicant's Signat re � -
NOTE:Issuance of a zoning permit does not reli 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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File TNo. ■/�/
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In
10PT F I pri t all information and return this form to the Building
the$io.filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: 6�C{A- —ARJ n)
Address: 677 &YziS PF- 90 Telephone: 5cf
2. Owner of Property: fi��U h s J c tf (-:'P4 f'�
Address: y 191 (mot) Telephone:__
3. Status of Applicant: Owner '1 Contract Purchaser Lessee Other (explain)
4. Job Location: L-77 Aue:E5
VIN
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K
Ce Id ZOD�I�$ PaTCej> DrStt5
-
h Etrn�S eet'Dfs ct ��- fin Cen ral Busrnes District �
-(TO,BE;;FJLLED IN BY7 IE�BOILD(NG_DEPAl
......;
5. Existing Use of Structure/Property: L0i
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans x
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ^ DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetlands? NO 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:
(Form Continues On Other Side)
the#MP-2003-0032
APPLICANT/CONTACT PERSON BRIN JOSEPH V&PATRICIA C
ADDRESS/PHONE 677 BURTS PIT RD
PROPERTY LOCATION 677 BURTS PIT RD
MAP 29 PARCEL 476 001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tyneof Construction: CREATE TWO FLAG LOTS
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included: /jt,LC�� LRN
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRES�TED:
Approved . Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § &.
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan G�fjT/NCO
Major Project: Site Plan AND/OR Special Permit with Site Plan F[,AG co
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 Co 'ssion
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.