31A-179 (10) File 4 MP-2019-0051
APPLICANT/CONTACT PERSON LOCKWOOD ALLISON
ADDRESS/PHONE 19 WASHINGTON AVE
PROPERTY LOCATION 19 WASHINGTON AVE
MAP 31A PARCEL 179 001 ZONE URBO00V
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION-CHECKLIST
ENCLOSE REQUIRED DATE
Z N G FORM FILLED OUT
Fee Paid
Buildiraz Permit Filled out
Fee Paid
TvoeofConstruction: ZPA-ADD ADDITION TO EXISTING HOUSE,ADD DETACHED GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessary 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
INFSIRMATION PRESENTED: INCUS
✓APQ
pproved Additional permits required(see below) dpipep qA P AGE
SET 6Ac.IcS
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 a
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
—3I(Y 401
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.
RECEIVED
MAR 1 2 2019
File No.
ZONING PE"ITAPPLICATION(§io:2 ,.PF .,IONS
please type or print all information and return this form to the Bu mg
Inspector's Office witten(h the $30filing fee (check or money order)payable to the
{ City ofNorthamp-{ton `�
1. Name of Applicant: f "� //dZl/�-� LOLL
/1 1
Address: /0087 C, �,NC/L ZX 62n Telephone:
2. Owner of Property: %B 0 -1�c s(.gl�otn.5 �- r"1t1 tZr A+y -1Z/o}�L
Address: Iq lV4S4{'1lJlr- /05� Ayc Telephone: �1 r 0-1 1
3. Status of Applicant: Owner Contract Purchaser ✓ Lessee Other(explain)_
4. Job Location: Iq WA-KH1NF'7od Avg.. IJoeTt+le--,nTa,J 01mo
Parcel ld:is Zoning Map# ISI/I Parcel# / 79 District(s):
In Elm Street District In Central:Business District
(TO BE FILLED IN BY THE BUILDING.DEPARTMENT)
5. Existing Use of Structure/Property: Re S (Z7 f f'r1 I--
b. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
nn Gtr r`r t
17 T 6H GD
7. Attached Plans: Sketch Plan V Site Plan Engineered/Surveyed Plans
8. Has a Special P ni /Variance/Finding ever been issued for/on the site?
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#
S.Does the site contain a brook, body of water or wetlands? NO :ZDONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained /� aYI
,, date issued:
[; �t
Shashoua,mtcha�l � rYll 'W (Form Continues On other Side)
W.DommmrsTO"Sb gmaMuilding-Inspecto Zo,ng-Pem,it-Applicafion-passive.doc tl 8/4/2009
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 NOy
IF YES, describe size, type and location:
11. Will the construction activity disturb lclearing, grading, excavation, or fitting)aver cre 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
Departrnent
EXISTING PROPOSED REQUIRED BY
Lot Size ZONING
I I i-1 ov � l I , K �o �'
Frontage
� 6S � �C7
Setbacks Front
Side L: I > y R: Jf / L: r R: s L: I S ' R: l s
Rear
6.31?
Building Height ,
Building Square Footage 00
% Open Space: (lot area �� �� �Q yDyo
minus building & paved 6
parking
N of Parking Spaces ' 1
N of Loading Docks
Fill: —�
ly me B location) D D
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. G
Date: I 1 } 1 I -1 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.
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