35-270 (16) sewage disposal facilities
water supply facilities
B_g, Existing&proposed:
landscaping,trees and plantings(size&type of plantings)
stone walls,
buffers and/or fencing:
B-9. Signs-existing and proposed:
Location
dimensions/height
color and illumination—
B-10. Provisions for refuse removal,with facilities for screening of refuse when appropriate:
FOR MAJOR PROJECTS-ONLY:
B-11. An erosion control plan and other measures taken to protect natural resources&water supplies:
C. estimated daily and peak hour vehicles trips generated by the proposed use,traffic patterns for vehicles and
pedestrians showing adequate access to and from the site, and adequate vehicular and pedestrian circulation
within the site.
Site Plans submitted for major projects shall be prepared and stamped by a:
Registered Architect, Landscape Architect, or Professional Engineer
9
SITE PLAN REQUIREMENTS
REQUEST FOR WAIVERS APPLICATION
The application MUST include a site plan containing the information listed below.The Planning Board
may waive the submission of any of the required information, if the Applicant submits this form with a
written explanation on why a waiver would be appropriate. To request a waiver on any required
information, circle the item number and fill.in the reason for the request. Use additional sheets if
necessary.
A. Locus plan
B. Site plan(s)at a scale of 1"=40' or greater
B-1. Name and address of the owner and the developer, name of project,date and scale plans:
B-2. Plan showing Location and boundaries of.
- the lot
- adjacent streets or ways
- all properties and owners within 300 feet
- all zoning districts within 300 feet
B-3. Existing and proposed:
-buildings
-setbacks from property lines
-building elevations
-all exterior entrances and exits
(elevation plans for all exterior facades structures are encouraged)
B-4. Present&proposed use of
the land
buildings:
B-5. Existing and proposed topography (for inter iediate projects the permit granting authority may accept
generalized topography instead of requiring contour lines):
- at hvo foot contour intervals
- showing wetlands,streams,surface water bodies
- showing drainage swales and floodplains:
- showing unique natural land features
B-6. Location of:
- parking& loading areas
- public&private ways
- driveways,walkways
- access&egress points
- proposed surfacing:
B-7. Location and description of:
- all stormwater drainage/detention facilities
water quality structures
public&private utilities/easements
8
G. Explain how the requested use will promote City planning objectives to the extent possible and will not
adversely effect those objectives,defined in City master study plans(Open Space and Recreation Plan;
Northampton State Hospital Rezoning Plan;and Downtown Northampton:Today,Tomorrow and the
Future).
9. I certify that the information contained herein is true and accurate to the best of my knowledge. The
undersigned owner(s)grant the Planning Board permission to enter the property to review this
application.
Date: Applicant's Signature:
Date: Owner's Signature:
(If not the same as applicant's)
MAJORPROJECTS MUST ALSO COMPLETE THE FOLLOWING MAJOR PROJECT APPROVAL
CRITERIA:
Does the project incorporate 3 foot sumps into the storm water control system? Yes No
(IF NO, explain why)
Will the project discharge stormwater into the City's storm drainage system? Yes No
(IF NO,answer the following:)
Do the drainage calculations submitted demonstrate that the project has been designed so that there is no
increase in peak flows from pre- to post-development conditions during the: 1, 2, or 10 year Soil
Conservation Service design storm? Yes No
(IF NO,explain why)
Will all the runoff from a 4110 inch rainstorm (first flush) be detained on-site for an average of 6
hours? Yes No
(IF NO,explain why)
Is the applicant requesting a reduction in the parking requirements?
Yes No
If yes,what steps have been taken to reduce the need for parking, and number of trips per day?
7
How does the project meet the special requirements?(Use additional sheets if necessary)
F. State how the project meets the following technical performance standards:
I. Curb cuts are minimized:
Check off all that apply to the project:
use of a common driveway for access to more than one business
use of an existing side street use of a looped service road
2. Does the project require more than one driveway cut?
NO YES(if yes,explain why)
3. Are pedestrian,bicycle and vehicular traffic separated on-site?
YES NO(if no,explain why)
FOR PROJECTS THAT REQUIRE INTERMEDIATE SITE PLAN APPROVAL, ONLY, SIGN
APPLICATION AND END HERE.
9. I certify that the information contained herein is true and accurate to the best of my knowledge.The
undersigned owner(s) grant Planning Board permission to enter the property to review this
application.
Date: Applicant's Signature:
Date: Owner's Signature:
(If not the same as applicant's)
FOR PROJECTS.THAT>REQUIRE A SPECIAL PERMIT..OR WHICH ARE A MAJOR PROJECT,
appl icants'NIUST also'complete the following:
F. Explain why the requested use will:
not unduly impair the integrity or character of the district or adjoining zones:
not be detrimental to the health,morals or general welfare:
be in harmony with the general purpose and intent of the Ordinance:
6
B. How will the requested use promote the convenience and safety of pedestrian movement within the site and
on adjacent streets?
How will the project minimize traffic impacts on the streets and roads in the area?
Where is the location of driveway openings in relation to traffic and adjacent streets?
What features have been incorporated into the.design to allow for:
access by emergency vehicles:
the safe and convenient arrangement of parking and loading spaces:
provisions for persons with disabilities:
C. How will the proposed use promote a harmonious relationship of structures and open spaces to:
the natural landscape:
to existing buildings:
other community assets in the area:
D. What measures are being taken that show the use will not overload the City's resources, including:
water supply and distribution system:
sanitary sewage and storm water collection and treatment systems:
fire protection,streets and schools:
How will the proposed project mitigate any adverse impacts on the City's resources,as listed
above?
E. List the section(s)of the Zoning Ordinance that states what special regulations are required for the
proposed project (flag lot,common drive, lot size averaging,etc.)
5
CITY OF NORTHAMPTON
PLANNING BOARD APPLICATION FOR:
1. Type:of Project: SITE PLAN APPROVAL
Intermediate Project(Site Plan)
Major Project(Site Plan Special Permit)
OR SPECIAL PERNUT:
Intermediate Project(with Site Plan Approval)
Major Project(Site Plan Special Permit)
2. Permit is requested under Zoning Ordinance: Section: Page: -
3. Applicant's Name:
Address: Telephone:
4. Parcel Identification: Zoning Map# Parcel# Zoning District:
Street Address:
5. Status of Applicant: Owner Contract Purchaser Lessee
Other ;(explain)
6. Property Owner:
Address: Telephone:
7. Describe Proposed Work/Project: (Use additional sheets if necessary):
Has the following information been included in the application? Site/Plot Plan
List of requested waivers Fee Signed/Denied Zoning Permit Application
3. Site Plan and Special Permit Approval Criteria.(If any permit criteria does not apply,explain why)
Use additional sheets if necessary. Assistance for completing this information is available through
the Office of Planning&Development.
A. How will the requested use protect adjoining premises against seriously detrimental uses?
How will the project provide for:
surface water drainage:
sound and sight buffers:
the preservation of views,light and air:
4
FILING INSTRUCTIONS:
1. Take the original and 14 copies of the application, to the City Clerk's Office. The Clerk
will keep the original and date stamp one complete copy of the application.
2. File the remaining 14 copies of the application at the Office of Planning & Development,
and pay the filing fee.
WHAT HAPPENS AFTER YOU HAVE FILED YOUR APPLICATION?
1. Once a completed application has been filed, we will schedule a Public Hearing for the
next available agenda of the Planning Board, notify your abutters and place a legal ad in
a local paper to appear a minimum of two (2) weeks prior to the hearing date.
2. The public hearing is conducted, applicant must be present, and if all information is
complete, the hearing is closed.
3. Once the hearing is closed,the Board has up to 90 days to make a decision on the permit.
(Planning Board rarely takes that long)
4. Once a decision is made, then the Board has ninety (90) days from the date that the
hearing was closed, to file the decision with the City Clerk's Office. Applicant receives a
copy of fhe decision.
5. After the decision has been filed with the City Clerk's Office, a twenty (20) day appeal
period begins.
6. Once the twenty (20) day appeal period passes, (without an appeal being filed) the
applicant must pick up a Certified copy of the decision from the City Clerk's Office and
record it at the Registry of Deeds. Permit is not valid until recorded at Registry of
Deeds.
7. Proof that the decision has been filed at the Registry of Deeds must be brought to the
Building Department, before a Building Permit will be issued.
The short time frame for issuing a Special Permit, Site Plan Approval, or a Site Plan
Special Permit is two (2) to three (3) months. The long time frame is four (4) to six (6)
months.
3
6. Fill in the property owner's name, or state: "Same as above" if the owner is the applicant.
7. Give a detailed description of the proposed work/project. Use additional sheets, if required.
Check-off if a Sketch Plan or Site/Plot Plan and a list of requested waivers has been included
with the application.
Planning Board reserves the right to postpone or continue any hearing if the Board determines that
adequate detail has not been submitted with the application (i.e. location of buildings, signs,
parking spaces, etc).
Planning Board also reserves the right to decline consideration of any new information submitted
for the first time at the public hearing and which was not available for public consideration, prior
to the hearing.
p
how the proposed work/ roJect meets the 8. Answer the questions on p p ) approval criteria.Use
additional sheets, if required.
9. Sign and date the application and complete the following pages as per instructions.
STREAIGILINING THEITERMIT PROCESS:
It is highly recommended that the applicant review the completed application with the Senior
Planner,prior to making the required number of copies and filing the application. Doing this will
help identify any additional information which should be included, and could prevent the public
hearing from being continued for lack of information. An appointment can be scheduled by
calling the Office of Planning&Development at : (413) 587-1266.
SUBMITTAL>RE QUIRENTENT S:
ALL APPLICATIONS MUST BE COLLATED AND STAPLED IN 15 COMPLETE PACKAGES.
The following information must be included in the submittal for Site Plan Approval, a Special Permit,
and/or a Site Plan Special Permit:
* The completed application and 15 collated copies of all information (including the
signed, dated and denied Zoning Permit Application - "Z-Form" and any additional
information the applicant wishes to submit) attached to EACII copy of the application.
If there are blueprints, the application must include 6 full sets of blueprints, the
remaining 9 copies may be reduced copies of the original prints. Please attach a folded
copy of the blueprints to EACH copy of the application.
* If the property abuts or is within 300 feet of the City boundary,you must
get abutters list from the neighboring Town's Assessor.
* The Filing Fee: $150.00 for Intermediate Projects or$300.00 for Major Projects.
Note: For fee purposes a flag lot is now included as a Major Project.
2
CITY OF NORTHAMPTON
APPLICATION FOR A
PLANNING 'BOARD-SPECIAL PERMIT & SITE PLAN APPROVAL PERMIT 6/99
A SEPARATE APPLICATION MUST BE FILED FOR EACH PERMIT REQUESTED
PLEASE PRINT OR TYPE ALL INFORMATION
PERMIT INSTRUCTIONS:
1. Check off the Type of permit:
Information can be obtained from the Zoning Permit Application denial, the Building
Department and/or the Office of Planning & Development (OPD).
Intermediate Projects:
- New construction or additions of between 2,000 and 4,999 square feet of gross floor area
(excluding single family homes and agricultural uses).
- Projects which require 6-9 additional parking spaces.
- Projects which require a Special Permit or Site Plan Approval, do not qualify as a Major
Project, and are not a sign.
- Projects which require Site Plan Approval, and do not require a Special Permit.
Planned Village Projects which require Site Plan Approval and are not a Major Project.
Major Projects:
New construction or additions of 5,000 square feet or more of gross floor area.
- Commercial Parking lots and parking garages
Except for the CBD,establishments selling foods prepared on the premises where
consumption is primarily off the premises and retail establishments selling principally
convenience goods.
- Automobile service stations
Projects which require 10 or more additional parking spaces.
Rural Residential Incentive and Planned Business Park projects.
2. Fill in the specific section and page of the Zoning Ordinance,that shows why the Special Permit
is required.This information can be obtained from the Zoning Permit Application denial, the
Building Department or from OPD.
3. Fill in the applicant's name,address and phone number.
4. Fill in the parcel's Zoning Map&Parcel ID, and zoning district(s), including any overlay
districts. Information can be obtained from the Zoning Permit Application denial, the
Building Department and/or the Office of Planning & Development (OPD).
5. Check off the status of the applicant.
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10. Do any signs exist on the property? YES r' 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 MOST BE COMPLETED, or PERMIT CAN BE DENIED DOE TO
LACK OF INFORMATION.
This color to be filled in
by the B=ld=g Depart—nt
Required
Existing Proposed By Zoning
Lot size ( 7 Y-3
Frontage 70
Setbacks
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of -Parking spaces
# of Loading Docks _ y
Fill:
{vol-ume--& location)
1
13 . Certification: I hereby certify that the information contained herein
is true;aa'd accurate to the best of my kno ledge.
DATE: (� < � APPLICANTs SIGNATURE
NOTE: lasu nf as zoning permit does not relieve an appii ant's burden to comply with all
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission, Department of Public Works 0114 other applicable permit granting authorities.
FILE #
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A-M Y 7
OCT 1 820
File No.
8F Ali_
Z,ONX-NG PERMTT APPLXCA2".I'ON (§10 . 2)
P.LE.A..SE TYPE OR PRINT`ALL INFORMATION
1. Name of Applicant: d/ U t j I __
Address: d - U('u E V 9, (( e e9ejo e:/L' J 9 I�
2. Owner of Property: �� `¢ AKO DG,
Add) - C-)4L r: k f�t lGp�.l G- �2� ]�/� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(/explain):
4. ,lob Location: W i's t
Parcel Id: Zoning Map# Parcel# �U District(s): o
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/VV�pr /Prolgct/Ocpupabon: v(Use adc�Tonal sheets if nepessrA y):
7. Attached Plates: Sketch Plan Site Plan _ Engineered/Surveyed Plans
Answers to the following 2 questions n-wy be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermiVVwiance/Finding ever been issued for/on the site?
NO..--- DON'T KNOVV YES IF YES,date
IF YES: Was th`!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 DON74<-Nt�V YES
IF YES, had a permit been or need to be obtained frorn U,ie Conservation Commission?
4 i
Needs to be obtained Obtained date issued:
(FORM CONTINUe Q[�OTHER SIDE)
File#MP-2001-0043
APPLICANT/CONTACT PERSON David McCutcheon
ADDRESS/PHONE 12 TURKEY HILL RD (413)529-9973
PROPERTY LOCATION WEST FARMS RD
MAP 35 PARCEL 270 ZONE NB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT ONE(3)FAMILY UNITS&REAR BLDG(2)SHOPS&OFFICES(SEE
ATTACHED)
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:
Approved as presented/based on information presented.
V Denied asp sented:
'� S ecial P rmit and/or Site Plan Required under: § /Q -7J•�
p 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 Board of Health Well Water Potability Board of Health
Permit from Conservation Commis 5i,63 Permit from CB Architecture Committee
p Z000
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.
- r
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_---- - -
Off-Street Parking Regulations
Use Number of Off-Sheet Parking Spaces per Unit
[CB requirements are in brackets.
Medical/dentist office building One per each 200 square feet of gross floor area 11.0 per
Ann e feet]
ne per eac i I,
Warehouse or storage establishment One per two employees on the two larg st shifts
combined
Hospital (including offices but excluding medical
offices and uses which are not part of the hospital
definition)
Manufacturing or industrial establishment One per each 500 square feet of gross floor space OR
0.75 per each employee of the combined employment of
the rwo largest successive shifts, whichever is the larger
Business, trade, or industrial school or college rooms One for each 200 square feet of gross floor area in class-
and other teaching rooms, including space for the gymnasiums or
auditorium, whichever has the larger capacity
Country club One for each four regular club members,plus one space
for each employee
YMCA, conununity facility (City building, One per each 400 square feet of'gross floor space Inonel
recreation, etc.)
Libraries and museums One per each 300 square feet of gross floor space (none)
Transportation terminal establishment One for each 50 square feet of gross floor area
Public utility and private power plants One for each 300 square feet for office plus one for 800
square feet for other uses
Funeral parlors One for each four seats
Car washing facility (automatic or conveyor) One per employee plus reservoir spaces equivalent to 5
times the maximum capacity of the facility
Mixed use Sum of various uses computed separately
l'lementary and Junior High School One space for each teacher and employee,plus one space
per each four students, including space for the
gymnasium or the auditorium, whichever has the larger
capacity
A use in any business or industrial district which is None required
temporary and seasonal., in unheated outdoor space
Any use permitted by this Ordinance not interpreted Closest similar use as sliall be determined by the
to be covered by this schedule Building Commissioner
(Amended 3/1/84, 7/19/84, 7/28/86, 7/19/90, 8/15/91, 6/17/93, 7/28/93, 10/6/94, 4/18/96 & 5/7/98)
June 29, 1998 8-3
Off-Street Parking Regulations
Use Number of Off-Street Parking Spaces per Unit
CB Requirements are in brackets
^� Dwelling, one, two,and three family units and Two per unit 11.0 per unit]
` townhouses
Dwelling, multi-family One per 500 square feet of gross floor area,up to a maximum of
two per dwelling unit 11.0 per unit]
Dwelling,multi-family for elderly and people with One-half per dwelling unit
disabilities
Residential component of mixed residential/work One per 500 square feet of gross floor area,up to a maximum of
space two per dwelling unit [1.0 per unit]
Lodging house, fraternities, sororities, and similar One per rental or sleeping unit. Any bedroom or group of two
types of group activities, except dormitories. beds in a single room constitutes a sleeping unit. For lodging
houses only,the Planning Board may issue a Special Permit to
allow a reduction in the required number of parking spaces to one
per every two rental or sleeping units.
College dormitories One and one-tenth per two beds
Theater, gymnasium, auditorium, church or similar One for each three seats of total seating capacity [one for each six
place of public assembly, with seating facilities seats]
Automobile retail and service establishment, and One per 1,000 square feet of gross floor space. In the case of
other retail and service establishment utilizing outdoor display areas, one for each 1,000 square feet of lot area in
extensive display areas, either indoor or outdoor. such use.
Hotel, motel, tourist court One for each sleeping room plus one for each 400 square feet of
public meeting area and restaurant space
Drive-in establishment One per 100 square feet of gross floor area
Tourist home/bed and breakfast Two spaces,plus one additional space for each rooming unit
Establishments selling foods prepared on premises, Three for each four seats of seating capacity,plus one for each
where consumption is primarily off the premises 100 square feet of kitchen area and waiting area
Sit-down restaurants, lounges,bars, and nightclubs, Two for each four seats of total seating capacity,plus one per
breakfast facility each 300 square feet of gross kitchen area [one for each four
seats of total seating capacity,plus one per each 500 sq feet of
gross kitchen area]
Commercial,retail and personal service One per each 300 square feet of gross floor area 11.0 per 500 sq.
establishment ft.]
Miscellaneous professional and business offices, One per each 300 square feet of gross floor area 11.0 per 500 sq.
including banks, insurance and real estate ft.]
establishments
June 29, 1998 8-2
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10. Do any signs exist on the property? YES ONO
IF YES, describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES p
IF YES, describe size,type and location:
11 . ALL INFORMATION MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This col=m to be filled in
by the Builfin Departure
Fjoning e d
Existing Proposed
u 0'S;-
Lot size
q34-3
Frontage
Setbacks - frnnt 0-0 0
R. l� 3
- side L: L. � R:�
- rear 0 15 -
Building height
Bldg Square footage q
%Open Space: 13 I -4T(I 0 / Z3
(Lot area minus bldg ��� /7 lL 3 S
&paced parki-2g) �-
3 3
# of -Parking spaces
# of Loading Docks
Fill:
{vol-ume -& location)
13 . Certification: I hereby certify that the information contained herein
is t e nd accurate to the best of my kn e e.
DATE: � d APPLICANT's SIGNATURE
NOTE: Is unn a of a zoning permit does not relieve an appli ants burden to comply Witt)yall
zoning requirements and obtain all required permits from t e Board of Health, Conservation
Commission, Department of Public Works and other applioable permit granting authoritios.
FILE #
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE O RI
/R PNT ALL _INFORMATION
K 1. Name of A plicant: Ct Ci �,J (l
Address: Tu (L Telephone! 5 f 3
2. Owner of Property: Ou a ` 1j 1 /q' \ t 0 U ?`
Address: I�(; ( t I' elep�one:
3. Status of Applicant: Owner ontract Purchaser Lessee
Other(explain):
/ I,
4. Job Location: L(;eS '+g- 9 S
Parcel Id: Zoning Map# � _ Parcel# - 61 District(s): 60 /
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Proj cUOc upation: .(Use additional sheets if necessary):
GlG Kq:Z i Gad t w ,-T�- G 212 Ira
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 rp ON'T KNCl'A' � YES IF YES,date issued:
IF YES: Was t -re corded at the Registry of Deeds?
NO D=KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook, body of water or wetla ds. 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#MP-2001-0046
APPLICANT/CONTACT PERSON David McCutcheon
ADDRESS/PHONE 12 TURKEY HILL RD (413)529-9973
PROPERTY LOCATION WEST FARMS RD
MAP 35 PARCEL 270 ZONE NB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ILLED OUT
ee ai
Building Permit Filled out
Fee Paid l
Typeof Construction: Front Building 66 x 42 ,3 family(I bdrm per),back building 24 x 48 tradesman building
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:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: o)
_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 Board of Health Well Water Potability Board of Health
Permit from Conservation mmission Permit from CB Architecture Committee
Signature of BuildingAfficial 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.