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29-351(1) M MORTGAGE LOAN INSPECTION Sv.S.T�-cr To ��S'FMFi✓T.S `To nn.ON`s E r 3 6�cZ LO RA.vG� 1 2 9'9> �1us-r, �, I hereby report that Elie premises shown on this plan is not located within a Flood zard Area as shown on Department of H.U.D. Federal Insurance Administration Maps, Community Nu er 250167-0001A _ Identificati to A it 3 8 E` By! IE SPRINGFIELD INSTITUTION FOR SAVINGS OWNER RONALD J. & LOUISE A. BUSHEY AE FLRST AMERICAN TITLE INS. CO - ONLY L TON, 40 AUSTIN CIRCLE To the best of my knowledge, informa- NORTHAMPTON, MASS. i and belief, I hereby report that I Al 8� `.. �,, � .:,.'r:�� } � ,,reTiii ses and that tills •,..yar IER HUrre`�i`LEY,�iR.Ek ASSOCIATES, INC. ction plat shows the improvement or SURVEYORS •ENGINEERS .PIANNERs cements as located on the premises de- 125PLEASANT STREET P.O. BOX 568 �d, that the improvement or improve- NORTHAMPTON, MASSACHUSETTS 01060 are entirely within lot lines , and here are no encroachments upon the SCALE, ;es described by the improvement or fements of any adjoining premises , t1��" 1 as indicated. I further report that DOUGLAS p DATE, are no easements of record affecting W. H 1 No. 28M act shown hereon, except as noted. NJ o. 28088 �i�l✓ Arc/sitR�� JOB NO._ NT IS FOR IDENTIFICATION PURPOSES . ONLY AND DOES NOT CONSTITUTE A PROPERTY ;zl inl/Kv $'too m 3 c Z ., z Z _ v � -- m Zoning _ Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MA'P'S. 1 q Additions APPLICa ATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. 2. Owner's name 7NA�\L� �S� Address 3. Builder's name V-Qy,�" ��`���Y�� Address��Sst Q Mass.Construction Supervisor's License Ng_ ExpirAbon Date 4. Addition L�rv>L> 5. Alteration 6. New Porch 7. Is existing building to be demolished? S. Repair after the fire 9. Garage No.of cars Size 10. Method of heatingF 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost:- 6 t t The undersigned ifies that the above statements are true to the best of his, h, knowledge an be • SU � Sign ure of responsible is nt Remarks f I i , i i I i i � i � I i i j i i I .W ` o N� C� • * ' � ', •� 0" C. G " � � �� � � v � '2 a � _ __ - _- — � --- �� � t�� 1�� � � - -� � \➢ I N= - - --� l � --� -'-L-� � y o_ � � �P� 1 �_ h L .'-'�--�� \ t 1N � t � � � � � I '\ N � � G � -- - l_ �_l, �I r` Z- �,' �I J ' r � � � � -, �� � � i s � � I i i f j I � , i � N G (� �l cp C 1 `� r o f � � � Y . . . . i N .` :. ' � N � r . � J � � s. � 1 A -}� -r I! 1 � � � �° � � c , Y ��- r �` � -_ —� `9 � � , ..—cv � � y .� !f _fit._ �� �w � -o � � L �,� � � ; G` f �1,'�`� `�;i' i �i i -.--------,--- ----- ' -�'I----- -----__-_- --- i � ` .! � I '� f (� ��- - --_..� � ' ' � � � �� I,, � � � ,+ . :; �� ----..__ ______ ___ 1 �� { � � , �_ t� � � � -- .-__-___ . ____-------..___..�---__----__-__._..___�_ G �� � - � � ' �. 1..------_ ---__._--______-_ ., _ . ., -- � } � _ 11 ,.____-__. ______ --__-_ I___ I� � (�; i o_ 4 i�- ------------- li; i . ( �. � � ,— ------ {� � i � ;a v i � __ _ �: � ; �, �,� �- U � /, �' � �-�' � �� �� O _ -�_ � �� � -y- a� � .� � -a O � � a� � � � `� � � �� � a, a • Og tKAMP�O , (rz r of 'N art11 iiiptol � 6 �asartcilnsrtia DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Bui Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCH AFMAVIT (licenseeJpermittee> with a principal place of business/residence at: (Phone#} (street/city(statrhip) do hereby certify, under the pains and penalties of pegJury, that ( ) I am an employer providing the following worker's romper is=on coverage for my employees worlang on this job: (Insurance Company) (Policy Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner circle one) and have hired the contractors listed below who have the following worker's mpensation policies: (Name of Contractor) (Insurance Company/Policy N (Expiration Date) (Name of Contractor) (Insurance Company/Policy Numbe ) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Numbe ) (Expiration Date) (Name of Contractor) (Insurance Company/Policy N ) (Expiration Date) (attach additioml sheet ifnaarsuy to include iafontution pertaining to all coatractota) ( ) I am a sole proprietor and have no one working for me. (v% Y am a home owner performing all the work myself. NOTE:please be aware that while homeowncra who employ p==to do maintenance ion or repair work on a dwelling of not more than three units in which the homeowner resides or on the grounds appurterc aai an not gcrxrstly Wondered to be employ=under the worker's oompeasation Act(GL152,ss 1(5)),application by a homeowix r for a Gecue or permit may evidcnoc the legal dab=of an employer under the,Workees Compemation Act. I una W.And that a copy of this uatemem may be forwarded to the Dtpwtmc of Jd,,u al Atcideate Offioo of In%Avmoe for the ooverago verification and that failure to sewn coverage under section 25A of MGL 152 car lead to tba imposition of criminal Penalties ooasisting of a fine of up to S1,500.00 and/or imprisot maxi of up to one yt a and civil cs in the form of a Stop Work Order and a fins of 5100.00 a day aaainA ma Sign r , day of 199 7 Fir a �y P t Number � Lot Sipature of Li 'tt:,ee 9� °8 Grif r of 'Nor#llally foil r a yNSB ACI�11SfI�H is s� DEPARTMENT OF BUILDITjG INSPECTIONS - INSPECTOR 212 Main Street ' Municipal Building ' n Northampton, Mass. 01060 HOMEOWNER LICENSE EXEMPTION h (Please Print) DATE• D JOB LOCATION- (Map) (Parcel) (S division) HOMEOWNER: 14co (Name & Address ) (Home Phone ) (Work Phone ) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( 1 )or two (2) fami l ie and to allow such homeowner to engage an individual for hire who does not possess a , license, provided that the owner acts as su ervis r. CMR780 Section 109. 1 . 1 DEFINITION OF HOMEOWNER: Person( s) who own a parcel of land on which he/she resides or intends to reside, on wh ch there is, or is intended to be , a one or two family dwelling, a tacked or detached structures accessory to such use and/or farm struc ures . A person who constructs more than one home in a two-year p riod shall not be considered a homeowner. Such "homeowner" shall su mit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work p erformed under the buildin permit. As acting Construction Supervisor your presence on the job site will be required from time to time , during and upon completion of the work for which this permit is issued. Also be advised that with reference to chapter 152 (Workers ' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person( s ) you hird to perform work for you under this permit . The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, ity of Northampton Ordinances , State and Local Zoning Laws , and State of Massachusetts General Laws Annotated HOMEOWNER SIGNATUREL� BUILDING PERMIT # _ y FILE I U V l `- 60 APPLICANT/CONTACT PERSON: ,a,_Z a Jr �43 y�/ ADDRESS/PHONE: ' PROPERTY LOCATION: MAP_ PARCEL: Z0N _ ` THIS SECTION FOR_OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FULED 011T - Fee Paid 0 0 lRemndelin2 Interior Arre_ssfn::VStrurfi re THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: Approved as presented/based on information presented Denied as presented: Special Permit and/or Site Plan Required under: § /� �y�' /0•0 /� '7 �iP • y ) _PLANNING BOARD ZONING BOARD Received &Recorded at Registry of Deeds Proof Enclosed Finding Required under: § )Y/ZONING BOARD OF APPFAT S Received& Recorded at Registry of Deeds Prc Variance Required under: § w/ZONING B t � , Received &Recorded at Registry of Deeds Proo i Other Permits Required: Curb Cut from DPW Water Availability co` Septic Approval-Bd of Health Well Water Potability !Permit from Conservatio mmiss'o Signature of Building Insp or NOTE:1"uanoe of in zoning permit does not relieve an ap,r_...... zoning requirements and obtain all required permits from the oard of Health, Conservation Commissfon, Department of Publio Wades and other applioabld permit granting authorities. 10. Do any signs exist on the property? YES NO I, 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 002uma to be filled in by the 8ni1din9r Department Required Existing Proposed By Zoning Lot size /3 �, �, ! v co Frontage Setbacks r � - side L• R: L:'L/ R:3,_ J - rear / Building height Bldg Square footage %Open Space:- I `7 a ell 2 o 3 �- 9 - (Lot area minus bldg &paved parking) -7 ng) 3U� �- v �- # .pf "Parking spaces rof Loading Docks Fill: 4vo1-ume--& location} 13 . Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: - APPLICANT's SIGNATURE }' NOTE: Issuanoe of a zoning permit does not relieve an applicant's burden to oom wlt ill zoning requirements and obtain all required permits from the Board of Health, Conservatlor. Commission, Department of Publio Works and other applicable permit granting nuthorltles. .. FILE # r' • File No. ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: Address: 4?J � _���t V\�' _ _Telephone: 2. Owner of Property: N��Q `CtJSly� Address: CjT1 Gl il. Telephone: 5�� l�f 3. Status of Applicant: _Owner Contract Purchaser Lessee Other (exxpll2in):__ _ 4. Job Location: ��7�/ � . 7 Parcel Id: Zoning Map# Parcel# District(s): � (TO BE FILLED IN BY THE BUILDING DEPARTMENT 5. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): f .� C� ) ..A do 7. Attached Plans: — Sketch Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 8. Has a Special Permit/Vadance/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 KNOWS 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) s[y l5 U G FILE # t ? C. ,U1 6�eert ,NTACT PERSON: 1ro2�=G4) se DEPT ' I ti 'E:.1 PROPERTY L. CATION: MAP PARCEL:_ '.; / ZONE C"r� THIS SECTION FOR-OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONTNG FORM FUJIM OUT Fee Paid Fee Pnirl Tyne of Cnnstriirtion- (��1 �ri rl i t i nit n��Y1SftI1��— THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION: Approved as presentedfbased on information presented Denied as presented: LA GUV q Special Permit and/or Site Plan Required under: § O0•/�1 b 1 ,__PLANNING BOARD ZONING BOARD l 3 ?V-.tc.4r.A a Received & Recorded at Registry of Deeds Proof Enclosed -/ls� < t.✓�S2cv b� U < Finding Required under: § )N,/"ZONING BOARD OF APPEALS Received & Recorded at Registry of Deeds Proof Enclosed_ Variance Required under: § w/ZONING BOARD OF APPEALS Received & Recorded at Registry of Deeds Proof Enclosed __ Other Permits Required: Curb Cut from DPW Water Availability Server Availability Septic Approval-Bd of Health Well Water Potability-Bd Health Permit from Conservation ommission f Signat o r D to NOTE: Issuanoe o a zoning permit does not relieve an applionnt's burden to oomply with ali zoning requirements and obtain =11 required permits from the Board of Health, Conservation Commission, Department of Publio Works and other npplioable permit granting authorltles. a > lot a _ o > 0-► m Zoning Miscellaneous Additions,Repairs,Alterations,etc. Tel.No. Alterations NORTHAMPTON, MASS. 1 q Additions a APPLICATION FOR PERMIT TO ALTER Repair Garage 1. Location Lot No. 2. Owner's name �N \�> ` _ Address Lf U 3. Builder's name NPr�n '� u`�t�`C�� Address h.) ti\� Mass.Construction Supervisor's License N . Expiration Date 4. Addition L�,V� 5. Alteration 6. New Porch 7. Is existing building to be demolished? 8. Repair after the fire 9. Garage No.of cars Size 10. Method of heating Z1 S 11. Distance to lot lines 12. Type of roof 13. Siding house 14. Estimated cost- W o l i The undersigned ifies that the above statements are true to the best of his, her knowledge an be slgn are of responsible is W Remarks W�c`� i. c.�t•�, \'J4�e- � �'ittAMP�. - z � 6 ,�lasaachtrsctfs m DEPARTMENT OF BUILDING INSPECTIONS 212 Main Street ' Municipal Building Northampton, Mass. 01060 WORKER'S COMPENSATION INSURANCE AFFIDAVIT (licensee/permittee) with a principal place of business/residence at: , e? �� ��!� ��c►1�r.�� ... `M (phone#) (StrCeUCity/StattaP) do hereby certify, under the pains and penalties of perjury, that: ( ) I am an employer providing the following worker's compensation coverage for my employees working on this job: (Insurance Company) (Policy Number) (Expiration Daze) ( ) I am a sole proprietor, general contractor or homeowner(circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Comparry/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poticy Number) (Expiration Date) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (sffadt additional sheet ifnecessa y to include information pataining to all ooatrad4rs) ( ) I am a sole proprietor and have no one working for me. I am a home owner performing all the work myself. NOTE:please be aware that while homeowners who employ persons to do mairae moor,oxmVuction or repair work on a dwelling of not more than throe units is which the homeowner resides or on the grounds appurtennni thereto art not gene roily considered to be employers under the worker's con>Qcasation Act(GL152,ss 1(5)},application by a homeowner for a license or permit may-ideaoe the legal stains of an awloyer under the Workers Compemation Act I undatund that a copy of this rutememt may be forwarded to tbo DVwUnced of Industrial Acci&n&office of Insurance for the coverage verification and that failure to snare coverago under smtoa 25A of MGL 152 can lead to the impoS ioa of criminal penalties consisting of a fmc of up to$1,500.00 and/or of up to one year and civil penalties in the form of a Stop Work Order sad a fma of S100.00 a day against m „Y Sign day of = 1997 For dq=t nWW un�y zrmit Number ap# Lot# Signkure of sWP&iittee Pursuant to Massachusetts General Laws (MGL), Chapter 40A, Section 11, no Special Permit, or any extension,modification or renewal thereof,shall take effect until a copy of the decision bearing the certification of the City Clerk that twenty days have elapsed after the decision has been filed, or if such an appeal has been filed that it has been dismissed or denied, is recorded in the Hampshire County registry of Deeds or Land Court, as applicable and indexed under the name of the owner of record or is recorded and noted on the owner's certificate of title. The fee for such recording or registering shall be paid by the owner or applicant. It is the owner or applicant's responsibility to pick up the certified decision from the City Clerk and record it at the Registry of Deeds. The Northampton Planning Board hereby certifies that a Special Permit with Site Plan Approval has been GRANTED and that copies of this decision and all plans referred to in it have been filed with the Planning Board and the City Clerk. Pursuant to Massachusetts General Laws, Chapter 40A, Section 15, notice is hereby given that this decision is filed with the Northampton City Clerk on the date below. < If anyone wishes to appeal this action, an appeal must be filed pursuant to MGL Chapter 40A, Section 17, with the Hampshire County Superior Court and notice of said appeal filed with the City Clerk within twenty days (20) of the date of that this decision was filed with the City Clerk. Applicant: Ronald J. Bushey-40 Austin Circle DECISION DATE: September 11, 1997 DECISION FILED WITH THE CITY CLERK: October 2, 1997 J • 'S i zo�aadsul $uzpZtng oZZz��d fuou,u�V s ATTACHMENT A SECTION 16 7 ce by ,necial Permit In approving the Special Permit with Site Plan Approval,the Planning Board found: 2. The Special Permit may be issued because the application includes: B. drainage recharge features and provisions to prevent loss of recharge. • " t B. The requested will-promote the convenience and safety of vehicular and pedestrian movement within the site and on adjacent streets and minimize traffic impacts on the streets and roads in the area because it will have no effect on existing traffic or pedestrian movement.:. : C. The requested use will promote a harmonious relationship of structures and open spaces to the natural landscape, existing buildings and other community assets in the area because the addition will have siding to match the existing house. D. The requested use will not have an adverse impact on City services such as the City's water supply and distribution system, sanitary and storm sewage collection and treatment systems, fire protection, streets and schools. E. The requested use meets all special regulations set forth in the Zoning Ordinance at Section 16.7. (See Attachment A) F. The requested use bears a positive relationship to the public convenience or welfare, and the use will not unduly impair the integrity of character of the district or adjoining zones. The use will not be detrimental to the health,morals, or general welfare, and the use shall be in harmony with the general purpose and intent of the Ordinance. G. The requested use will promote City planning objectives to the extent possible and will not adversely affect those objectives, as defined in City master or study plans adopted under M.G.L. Chapter 41, Section 81-C and D. In reviewing the Site Plan, submitted with the Special Permit, the Planning Boar_d found that the project complied with the following technical performance standards: 1. No new curb cuts are requested. 2. Pedestrian, bicycle and vehicular traffic are separated on site to the extent possible. No conditions were imposed upon the project. 4 City of Northampton, Massachusetts Kqp! Office of Planning and Development y M 11 U TOy City Hall • 210 Main Street Northampton, MA 01060 • (413) 586-6950 1 2 FAX (413) 586-3726 XT •Conservation Commission • Historical Commission • Housing Partnership• Parking Commission GIN • Planning Board •Zoning Board of Appeals �l - DECISION OF NOBTHAMPT0IY-PLANNIlYG-119ARD APPLICANT: Ronald J. Bushey ADDRESS: 40 Austin Circle Florence, MA 01062 OWNER: Ronald J. Bushey ADDRESS: 40 Austin Circle Florence, MA 01062 RE LAND OR BUILDINGS IN NORTHAMPTON A '00 Austin Circle f MAP AND PARCEL NUMBERS: I At a meeting conducted on September 11, 1997, the Northampton Planning Board unanimously �k voted 5:0 to grant the request of Ronald J. Bushey for a SPECIAL PERMIT with Site Plan Approval under the provisions of Section 16.7, 16.9, 10.10 and 10.11 in the Northampton Zoning Ordinance, to utilize a system for artificial recharge of precipitation to allow more than 15% lot coverage in a Water Supply District at 40-Austin-Circle, Planning Board Members present and voting were: Chair Andrew J. Crystal, Jody Blatt, Paul Diemand, Nancy Duseau, and Associate Members Rick Marquis and Sanford Weil;Jr. In Granting the Special Permit with Site Plan Approval, the Planning Board found: A. The requested use protects adjoining premises against seriousiy detrimental uses because the addition is relatively small and complies with all other applicable zoning regulations, except for amount of lot coverage. The requested use provides for surface water drainage by utilizing gutters to collect rain water and direct it toward areas where it can soak into the ground. ORIGINAI- I'RINTFC ON RFCYCL.F)F:•FLR w Ax C LYS N b. Z I i ' i D � c T ! � z ��f, i I i I t I j I i j N * �, F-3 ! i i 1 '-t7> j I II ! is - I 1 h N� MM1 PJ �o y (rlt� of 'Nort4antptait w r = f B �AS4Al�)li8tII8 T DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 " HOMEOWNER LICENSE EXEMPTION (Please Print) DATE• L JOB LOCATION: "?�_ (Map) (Parcel) (S division) HOMEOWNER: N+�A S �S H�� `f� (�v 3I" �-t k= 1'"��� (Name & Address) (Home Phone) (Work Phone ) The current exemption for "homeowners" was extended to include Owner-occupied Dwellings of one ( I )or two (2) families, and to allow such homeowner to engage an individual for hire who does not possess a , license, provided that the owner acts as supervisor. CMR780 Section 109. 1 . 1 DEFINITION OF HOMEOWNER: Person( s ) who own a parcel of land on which he/she resides or intends to reside , on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on.- a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers ' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries .-not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with the State Building Code, City of Northampton Ordinances, State and Local Zoning Laws, and State of Massachusetts General Laws Annotated HOMEOWNER SIGNATURE BUILDING PERMIT # _,,8 10. Do any signs exist on the property? YES NO ,Z 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 color= to be filled in by the Building Department Required Existing Proposed. By Zoning Lot size / 3 O co v Frontage i Setbacks 60 / - side L: R: L: �R: � J - rearr�'t� Building height Bldg Square footage '7 � %O p en Space: - 1 -71 a (Lot a area minus bldg `t q•� ' &paved parking) 3U,;(13 LP 2-7 v �. i# .Pf Parking spaces of Loading Docks Fill: Avol-iime -& location) 13 . Certification: I hereby certify that the i rmaton contained herein G is true and accurate to the best of my k w dge. DATE: 1 nl �C � APPLICANT's SIGNATURE d 4J NOTE: issuanoe of a zoning permit does not relieve an pplioant' bu en to ply witi7.011� zoning requirements and obtain all required permits from the Board of Hea , CO servation Commission, Department of Publio Works and other appliooble permit grants g a thoritie ... ;' FILE # File No. ZONING PERMIT APPLICATION (§I0 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 2SV EyI n Address: qc) _ _Telephone: 2. Owner of Property: =aNr;\'V .C- c4J51 �1 Address: � Telephone: 5-619�-✓` 3. Status of Applicant: _;Owner Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# C;R Cl Parcel# District(s): (TO BE FILLED IN BY THE BUILDING DEPART,EN 5. Existing Use of Structure/Property 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): f A. 7. Attached Plans: — Sketch Plan Site Plan Engineered/Surveyed Plans Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files. 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) FILE # 96 ?`160 APPLICANT/CONTACT PERSON: 93 9z/ ADDRESS/PHONE: "•✓ PROPERTY LOCATION: MAP ? PARCEL:_ THIS SECTION FOR-OFFICIAL USE ONLY PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE 'Ryiildin2 Permit ,4 O Remnd Armq,nry Structure ✓' THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS AP ICATION: Approved as presentedfbased on information presented Denied as presented: XSpecial Permit and/or Site Plan Required under: § ,_PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w/ZONING BOARD OF APPEALS Received& Recorded at Registry of Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water Availability Sewer Availability Septic Approval-Bd of Health Well Water Potability-Bd Health !Permit from Conservatio minis 'o Signature of Building Insp r ate 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. Department of Public Works and other applicable permit granting authorities. LS U U FILE # C fa kc 6 &,jPMkN,i':)NTACT PERSON: C "� --e '� Z, (u?2 'HC NE: DEPT OF BUILDING INSPECTIONS NORTHAMPTON NIA O1G60 y PROPERTY CATION: MAP PARCEL: 5� ZONE e� THIS SECTION FOR-OFFICIAL USE ONLY: PERNIIT APPLICATION CHECKLIST ENCL SED REQUIRED DATE — Fee Paid lRyidding Permit Filled nia New Ct 3 Sets of Plan-, /Pint PInn THE LOWING ACTION HAS BEEN TAKE THIS ON TS AP ICATIOM Approved as presented based on information presented o�/J,// f-ct�N,Q�T/d�l/ � Denied as presented: Special Permit and/or Site Plan Required u der: § PLANNING BOARD ZONING BOARD Received&Recorded at Registry of Deeds Proof Enclosed Finding Required under: § w ZONING BOARD OF APPEALS Received&Recorded at Registry f Deeds Proof Enclosed Variance Required under: § w/ZONING BOARD OF APPEALS Received&Recorded at Registry of Deeds Proof Enclosed Other Permits Required: Curb Cut from DPW Water A vailability Sewer Availability Septic Approval-Bd of Health Well Water Potability-Bd Health Permit from Consery Commission ignature of Building e for Date NOTE: Issuanoe of a zoning permit does not relieve an applioant's burden to oomply with all zoning requirements and obtain all re-quirod permits from the Board of Health, Conservation Commission, Department of Publio Works and other applioable permit granting authorities. ,� °, ..,� �, *� .. ' �,�� �,� ,� � . . � V t �. ��,- .„� � ; .._ _—.�__.,..s �:� .� OLO INI ® Y kD k)Z " N O Olt 4-m OrA 4-) U 04 ra N m Q Q � 0 0 � zW as o i F i s CL O H O i � � 1 N �n ��]] 8 !C 0 Z .� N M Z 0 CLa W o N c� Z a y U