25-017 (4) 10. Do any signs exist nn 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) ovP,r 1 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 :.REQI7Il2ED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: G G L- R:
Rear
�U
Building Height -
tJ
Building Square Footage
16� f
%Open Space: (lot area
minus building & paved
parkin
#of Parking Spaces
#of Loading Docks
Fill:
(volume& location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. f
Date: to ), Applicant's Signature
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,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
iTr:`,Documents\FORYIS\original\Buildina-Inspector\Zoning-Permit-AapIiration-passive.doc 314!2004
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File No l i
ZONING JJ 'R�VLIT'A�°'PJ ,ICA3IOIr►T [ Z}. rs� j
Please type or print all information and return thislorm to the Building._.
Inspector's Office with the $'15Wilingfee (check or money order)payable to the
City ofNorth.-3mpton
1. Name of Applicant:-19A C a r1j,
:C
Address: ( u�='s �� �� —Telephone: �
2, Owner of Property: 1 Yl 'f i" ? r ,s,F V,
Address: 3d Iz uS e l � d Telephone: r q S
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location:
Parcel Id. Zoning Maps r Parcel# District(s): W '✓'
In Elm Street District In Central Business District
(TO BE FELLED IN BY THE BUILDING DE/PARTMENT)
5. Existing Use of Structure/Property: 1�-�'� � i�'� t ( ( S��K Le e-, f
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
' jS /C irate c}
7. Attached Plans: Sketch Plan Site Plan CIC Engineered/Surveyed Plans
B. Has a Speci Permit/Variance/Finding ever been issued for/on the site?
NO DONT 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 n
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? &1e,
Needs to be obtained
Obtained , date issued:
,Form Continues On Other Side)
W:,Documents\r`OR-\4Sbriginal\Buildin-.-Inspector,Zonine-Pennit-Application-passive.doc 8/4.•'200=
File#MP-2005-0095
APPLICANT/CONTACT PERSON MCCUTCHEON DAVID J
ADDRESS/PHONE 263 SYLVESTER RD (413)587-4570 Q
PROPERTY LOCATICiN NORTHERN AVE
MAP 25C PARCEL 017 001 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM F LLED OUT
OWV
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA- 1 1/2 20 X 20 STORAGE STRUCTURE
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan
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 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.