3 Madison ZPA File#MP-2019-Q96,
APPLICANT/CONTAC=T'PERSON NAGLE DOROTHY C/O ROBERT C NAGLE
ADDRESS/PHONE 3 MADISON AVE
PROPERTY LOCATION 3 MADISON AVE
MAP 38B PARCEL 170 001 ZONE URB(l0U/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT A—PPLICATION CHECKLIST
ENC REQUIRED DATE
ZONING F RM FILLED,OUT
F Fid
Building PprMit Filled out
F e Pqi
Typeof Construction: ZPA-BLIL12ING LOT-SEE AP TION
New CongnLcti.n
Non S tural interior renov tions
Ad iti n to Existing
AccessAccessM Structure
Building Plans Includ d:
Owner/Stat Ment or incense
3 sets of Plans/Plot Plan rn, AN p,
TIDE FOLLOWING ACT ON)ETAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRE NTED: l�
_Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § 3So- YAFW d F U 56
Intermediate Project; Y'-� Site Plan ANTI/OR Special Permit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: § ���>o
Finding_— Special Permit Variance* 3 Q �a \E
Received&Recorded at Registry of Deeds Proof Enclosed �� 1�
ZN vCe,��
Other Permits Required:
Curb Cut from DPW Water Availability _Sewer Availability 0�
Septic Approval Board of health T 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
lw
Sigtigwreof � U ding Qtfcial 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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o File No.
4
b` C'� ONING PERMIT APPLICATION(§1 o.2)
o,- ,ilea ape or print all information and return this form to the Building
z� i
N Insect ,Office with the $30 filing fee (check or money order)payable to the
o m FT"! z o orthampton
00
�1. ,4p licant: IDC C No C�V�' Cr�ll115�G�
Telephone: 4 ?) ,fi g
2. Owner of Property:
Address: Telephone: Loi,;,) ac)2�A]sc
3. Status of Applicant: Owner —Contract Purchaser Lessee Other (explain)
4. Job.Location:,� M01(Q•1-hr) OnA O\
Parcel Id: Zoning Map# Parcel# _District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:S%Jl L:Cn,Lt(x tnnclA>,4�q `Cxal
0 si -p if wl
A
men :59ao 0
6. Description of Propposed Use/Work/Project/Occupation: (Use additional sheets if necessa �
Ina ,ru : 'tom h� ora , t c� z1 c,P 1 Iy b1P r rr��1 A�/t n�
1 On�ytx�- Q l llf X Y2 f Q 1 l n�rt �RY3l�li� V-1 gpezD t (� UJ 1d}� Jill,qP�i( D'l�
Irr�C711�J GYGP er)Q, SQ1I i(w 04f lb4 7� cYrt�!(6ny lr k- ( -C�"1O(Y'9a -0YAR , Or(,3)
l'�Yar nv,)n cofront 6Mixoro ao$g cM )n4,rcz� a(no-h n,l CO,\iciAn Q Slv,ILdvre(s)
bue'-slcc.- the `f"l+-In trNI2 ' be-constct-"ocf r i -Q-f
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO X 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 �XDONT 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 8/4/2004
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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
IF YES, describe size, type and location:
11. Will 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
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
(gyp llv-V -JVST OrN kn`jp�r"-( 0.s It> PD,�,enk-)c-A ue for use by the Building
Of -�h�S (fro QC —eiW�Er Por"--,c jj kj (Y In Department
EXISTING PROPOSEDX REQUIRED BY
ZONING
Lot Size ZZ
Frontage
Setbacks Front
Side L: R: R: L: R:
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building Et paved
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et to tion)
13. Certification: I hereby certify that the information cont ' herein is rue and accurate to the best of
my knowledge.
'�LA • 15 Applicant's Signatur
Date: 5-
NOTE:Issuance of a zoning permit does not relieve an applican ° urden to comply with R zo g
requirements and obtain all required permits from the Board of Health,Conservation mmission,
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