35-206 (3) i
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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. Will the construction activity disturb (clearing, grading, excavation, or filling)ove/'T acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO ��//
IF YES, then a Northampton Storm Water Management Permit from the DPW is required.
12. 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 ( a ';-3 -53
Frontage
1,2s
Setbacks Front '
Y
3o (a t1
Side L: . R: 'CG L: R: L: R: /O
S_
Rear T f� f o
�v
Building Height /
Building Square Footage
i;
%Open Space: (lot area
minus building Et paved o�
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicants Signature
NOTE:Issuance of a zoning permit does not relie appli burden to comply with all zoning
requirements and obtain all required per ' from th oard of Health,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
NOV - 9 2004 File No.
M-1-1 filt P RMIT APPLICATION 01 o.2)
Pl al l information and return this form to the Building
I� $15 filing fee (check or money order)payable to the
Ci of Northampton
1. Name of Applicant: `�'a50�\ e
Address: 1 L 3,j r =� Telephone:
2. Owner of Property:
r <
Address: \ L I �1 �ir CYO Telephone:
3. Status of Applicant: Owner Contract Purchaser Less e Other (explain)
4. Job Location:
Parcel Id: Zoning Map# ��' Parcel# n2067 District(s):
In Elm Street District In Central Business District
TO BE FILLS IN BY TOE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: Y lt;'�1 ck
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
v s e
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNOW z 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 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)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Applieation-passive.doc 8/4/2004
File#MP-2005-0065
APPLICANT/CONTACT PERSON LAVALLEE JASON
ADDRESS/PHONE 1244 BURTS PIT RD (413)586-7877 Q
PROPERTY LOCATION 1244 BURTS PIT RD
MAP 35 PARCEL 20 0001 ZONE SR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ONING FORM LLED OUT r 4,',—
Building_Permit Filled out
Fee Paid
Typeof Construction: ZPA-CONSTRUCT ATT GARAGE
New Construction
Non Structural interior renovations
Addition to Existina
Accessory Structure
Building Plans Included•
Owner/Statement or License
3 sets of Plans/Plot Plan
bNJ
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLI0 _.A09W "
INFORMATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § �� S 11,=17
Intermediate Project: Site Plan AND/OR Special Per ��'�J � (u ('�3 o(ry
Major Project: Site Plan AND/OR Special Pe �/
ZONING BOARD PERMIT REQUIRED UNDER: § (VI�( �
Finding Special Permit Varian( S
Received&Recorded at Registry of Deeds Proof E
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 Commission
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.