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ANR application Lori Derouin Boggy Meadow RoadPermit Application Today's Date: 06/10/2015 Owner Applicant Lori Derouin Northampton Planning and Sustainability 612 Bridge Road 210 Main Street, Room 11 Northampton, MA 01060 Northampton, MA 01060 413 -587 -1265 wfeiden@northamptonma.gov City of Northampton department: Y Work Location Information How many lots involved in the project: 1 Map / Block / Lots of all lots in project: 17B / 003 / 001 Deed Book of all lots in project: B9539, p245 Project work address: 0 BOGGY MEADOWS RD City / State / Zip: Northampton 01060 Zoning District: RR Application for following Permit Types ❑Planning Bd. Special Permit w/ Site Plan ❑Planning Bd. Special Permit w/ MAJOR Site Plan ❑Administrative Site Plan Review ❑Planning Bd. Major Site Plan or 40R Approval (No Special Permit) ❑Subdivision Preliminary ❑Subdivision Definitive IF NO Preliminary ❑Zoning Board Special Permit ❑Appeal of Building Commissioner - Zoning ❑Variance ❑Historic District Determination of Non - Applicability ❑Historic District (Elm St) Determination of Appropriateness ❑West Street Architecture ❑Wetlands Notice of Intent, Abbreviated NOI or ANRAD, IF state wetlands ❑Wetlands Request for Determination OR Resource Delineation ❑Wetlands Certificate of Compliance request ❑Planning Bd. Special Permit w/ Site Plan for flag lots ❑Planning Bd. Site Plan (NO Special Permit) ®Approval Not Required Plans ❑Subdivision Definitive IF Preliminary approved ❑Subdivision Definitive Amendment ❑Zoning Board Finding ❑Comprehensive Permit ❑Demolition (Demolition Delay) ❑Central Business Architecture ❑Wetlands Notice of Intent IF ONLY local wetlands ❑Wetlands Amendment ❑Wetlands extension 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Fee Information Total fee amount: Existing Use Beaver Pond Planned Use Conservation Area Detailed Project Information Number of Plan Pages: 1 Special Permit Description: Not applicable Approval Not Required Description: Included Files Uploaded: Supporting Information: Comprehensive (40b): Drainage Information: Traffic Information: Plan Sheets: Wetlands Information: Approval Not Required: Autocad: Tiff or PDF: Historic Information: $ 0.00 By typing my name in the signature box, I certify that all the information above is accurate to the best of my knowledge, I am the property owner or have permission from the property owner to apply for this permit. I also grant permission to the City of Northampton to inspect the proposed work Signature: Wayne Feiden Date Signed: 06/10/2015 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262