31A-309 (9) File e MP-2017-0007
APPLICANT/CONTACT PERSON SHUKLA SUNDEEP
ADDRESS/PHONE 23 FAIR ST (573)673-9164 0
PROPERTY LOCATION 93 VERNON ST
MAP 31A PARCEL 309 001 ZONE URA(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid %k' % 'i✓
Building Permit Filled out _
Fee Paid
Typeof Construction: ZPA-SFH
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
INORMATION 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 Permit DPW Storm Water Management
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.
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scos`l
L' r.,, File Aro / 14 I
Z . '1tTIATG° PERIL PPUCATVV f T ((l a,`x:
Please type!�� or p., rr_t �Ii information and retu,_ s'
tins farm 0.the Br irritn
V' ec'
siteccLG? s c.'.. with the $30 r.Z<tg.['ee (t. Eck ormoney order))ypa cc!e %6 Th?
City ofN„r ha-Leyton
1,
Name of Applicant: c(I,N tO NBc'e ... C >< 'Li
Address: it;>'"1Bi- ..S`1';1-S2N+=IR Telephone: 5 3siCi-7'3 '47
2. Owner of Property: - co. .LIw I'1 (,Vw J „N P4
Address:_., CR/ A Vi=..P-N.?wJ CT- kr szTbgn faro/ Bill-Telephone:
3. Status of Applicant: Owner Contract Purchaser X Lessee Other (explain)
4. Job Location: 5 bl'='i 1 {T 41 Q-'dkhM PtNrI A94 ct
Parcel Id: Zoning Map# IA` Parole (cc)-VP A District(s): y2h LI I")
( - In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: VAC, IVA/T L-�t
6. Description of Proposed Use/Work/Protect/Occupation: (Use additional sheets if necessar)):
DPIinBO? fins; > - l si()inrt-
7. Attached Plans: Sketch Nan Site Plan l/ Engineered/Surveyed Nan:
8, Has a Specal Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW t/ YES IF YES, date issued:
IP YES: Was the permit recorded at the Reentry of Deeds?
NO DONT KNOW YES
IF YES: enter Book _...... Page_../ and/or Document,-
9.Does the site contain a brook, body of water er 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:
(Enrm Continues On Other Side)
that r n&Y.S'ec ,Lute;sSp: :t ' „_: ppi i.n 7i eco S leant
•
10. Do any signs exist on the property? YES NO r/
IF YES,describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NOS
IF YES, describe size, type and location:
11. Will the construction activity disturb (nearing, grading, excavation, or rifling) over acre or is it part of a common
plan of development that will disturb over 1 acre? YESNO
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 INFORMAcolumnTION
reserved
for use by the Building
Department
EflSiLNG PROPOSED REQUIREDGBY
ZONIN
•
Lot Size 'ei i vs YR '1 10 ,2 (f=
Frontage I
Setbacks Front
R: i L: R:
Side L: i ` R: 2 0 L. LS
Rear
Building Height
Buildine Square Footage I C l' <l I✓eIh)
% Open Space: (lot area '
minus building a paved u{‘) - /
parking
IF of Parking Spaces
# of Loading Docks
Fill:
(volume a location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
/
Date: -q(L / I,6 Applicant's Signature
1
SOIL:Issuance of a zoning permit does not relieve a a plicant's burden toith all zoning
requirements and obtain all requiredpermits . om the Board of Health,,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
. ..,•
authorities. f , .. ♦L
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