23A-089 File ft MP-2018-0055
APPLICANT/CONTACT PERSON WEST JUDITH A&CATHERINE H
ADDRESS/PHONE 1I PLYMOUTH AVE
PROPERTY LOCATION I1 PLYMOUIIT AVE
N1AP23A PARCEL 089 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction: ZPA-OFFICE FOR MY BUSINESS/PERSONAL HOME-THERE WILL BE NO WORK
PERFORMED FROM MY HOUSE OUST PAPERWORK)NO CUSTOMERS
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Building Plans Included:
Owned Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO}iMATION 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: §
FindingSpecial 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
�—�`y!P/�er�mit from Elm Street Commission Permit DPW Storm Water Management
Signature�B ldmg Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply withal]zoning
requirements and obtain all required permits from Board of Health,Conservation Commission,Department
of public works and other applicable permit granting authorities.
i Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact the Office of
Planning&Development for more information.
2APR 4
File No. r rn n_ ir 9 56
ZONING PERMIT AM t (§10.2)
Please type or print all information and return this form to the Building
Inspector's Office with the$30lalingfee (check or money order)payable to the
(City of/Northampton
1. Name of Applicant: � CCA \jyte-S'C
Address: uylcI4T�At=&, Oc "CL Telephone:
2. Owner of Property: _ 21C_[n I?
Address: \\ QWlWl"� \ ALIC. Telephone:
i
3. Status of Applicant: Owner ��Contract Purchaser Lessee Other(explain)
4. Job Location:- Y j A
Parcel ld: Zoning Map# o-1 24 Parcel# Q District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: `!�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
—1L12iLLQ.,1��VVl4 �SI VY G.�S / 72Y:bN4 ' �✓l�c(� �t
kYa-fG wl`� y\G t.+�oc Ru-(vr4sk c �(oYH 04-mf VLPOA2V KC:) CCop(le
7. Attached Plans: J Sketciwlan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO vl� DONT KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
w.vIMcumen 1FORMS4&i 1%RuOdingJJ-Inspecu,iJnning-Penni-Applirntion-pa�nvedo 8/4nW4
�V'v14i f ; (Jy�W�$�S� r7 Vs'Mil 1.Lo vvt
10. Do any signs exist on 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 N0A—,-*�
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading excavation,or filling)over 1 ire 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
BX/STING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Z �(y
Building Square Footage
1 ,(j�3z-
�4
%Open Space: (lot area
minus building rt paved
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume& location)
13. Certification: I hereby certify that the information contain d herein is true and accurate to the best of
my knowledge.
Date: 2 Applicant's Signature 1-
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:AD) uincntdFORMS'original,Building-Irupecw 9,,—,N—I-Apph.ti,—,—,c&, 8/4/2N4