29-295 (5) MORTGAGE LOAN INSPECTION
\ ` LOCUS REFERENCE
1 BOOK 7391 PAGE 320
13g PLAN BOOK 74 PAGE 66
SiB SECT TO AN EASEMENT TO
NEM EMXAAV TEL. 6 TEL. CO.
x \ SEE BOOK 1552 PAGE 373.
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GUN BARREL FOUND T+/-'OFF
10. Do any signs exist on the property? YES NO V-
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) over 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 REQUIRED BY
ZONING
Lot Size �1
4�
Frontage
Setbacks Front 7�p �-F �I._ �Q-�� 41-
Side R: L: 1,3-�k fi/- R: L: R:
Rear �0 R ff (/-
Building Height
2DD 4/- 41-
Building Square Footage / 0 19 Z�
%Open Space: (lot area ll�
minus building F± paved yQp�
parking
#of Parking Spaces
#of Loading Docks /v
/A
Fill:
(volume Ft location) /1 /t 0
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: I,\\, \ 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.
W:Oocuments\FORMS\original\Building-Inspector\Zonine Permit-Application-passive.doc 8/4/2004
I � I
FEB ( °
File No. jf
E'ec `r NA 11,)-3°ZONING PERMIT APPLICATION (§10.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: Gyl! I'C)/�_S
Address: 27 T. oca pr- l orcv.ac ✓✓{ 010(17- Telephone: !?Z3-:?gl-36Zci
2. Owner of Property::5�i yy_V,.a-j% t Cp C�,v LA,
Address: 2� encc�sA� �r (—�or vv� �e /t L4 CSto�ZTelephone:jf/f'K�/'36z4
3. Status of Applicant: Owner ✓ Contract Purchaser Lessee Other (explain)
4. Job Location: Z ���cast l7� Flo{���-i Z- Q b 16 U Z
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BEI FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:
— � �i✓%rty /�/tea
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
r-A C04'-/ivt -6 Nr� n 5�"d zevz
tICi Y(C,�( , al ror?a/ SfGI I�'e -4 � /w►�� � V C3
7. Attached Plans: Sketch Plan t/ Site Plan Engineered/Surveyed Plans
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 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-Application-passive.doc 8/4/2004
File#MP-2015-0061
APPLICANT/CONTACT PERSON HICKS GARY J& SHANNON HALABOV
ADDRESS/PHONE 27 PENCASAL DR
PROPERTY LOCATION 27 PENCASAL DR
MAP 29 PARCEL 295 001 ZONE
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: ZPA-ADD 2ND FLR Q BEDRMS,2 BATHROOMS)
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 BASED ON
INFORMATION PRESENT
Approved ditional 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: § �� , Si,.) S r � // -k q1C Or
Finding !Z� 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
it lrn Street Permit DPW Storm Water Management
Sig re o Buildinffficielf 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.