38B-074 (2) File#MP-2019-0029
APPLICANT/CONTACT PERSON UHLIG 2OBERT P&CYNTHIA tii
ADDRESS/PHONE 221 SOUTH ST (413';584-5078
PROPERTY LOCATION 221 SOUTH ST
MAP 38B PARCEL 074 001 ZONE URB( 00)/
THIS SECTION FOR O'F1C'IA_I,USE ONLY:
PERM I'APPLI ''' T C'KiCKLIST
F, REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZBA--CONSRUCT AR GAFAGE(24X26)WITH STORAGE ABOVE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
T�EE
WING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
ION PRESENTED:
d Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site Pldn AND/OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDE . '4
Finding Special Permit ;:Variance*
Received&Recorded at Registry-o?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
clzl�_' i yAO/I
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.
&7
ZONING PERMIT APPLICATIO (9
Please type or print all information and return this form to the 11ttildi>ng
Inspector's Office with the $30 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant�o )L(l C wn �(,, L1A k 1 G
Address: A,i k Telephoner1 13 -`J 2 m- 60r g
2. Owner of Property: 0-M e
Address:—.9,-),6LrY)e Telephone: S0—me-
3.
—me.3. Status of Applicant: Owner _Contract Purchaser Lessee Other (explain)
4. Job Location: L),-1.
Parcel Id: Zoning Map# �J v Parcel# v 7 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):
(
Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued forr�/on the site? �1
NO 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:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 9i4/2004
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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 NO__,t_
IF YES, describe size, type and location:
11. Witt 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 P_
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
Depay tment
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
'1 r 1V\L
Frontage
Setbacks Front
t
Side L: R: L: S R: SO L: R:
Rear
Building Height '
Building Square Footage
%Open Space: (tot area
minus building ft paved _
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume Ir location)
13. Certification: I hereby certify that the information contained herein is true
and acc ate 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:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
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