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23A-111 (4) -0k File# ZO 2-2--0002 APPLICANT/CONTACT PERSON "Brian It kiRrs—S&1 R►3i.-DNs K,c/De viZI ESE !}Rc i}1 T�GrS ADDRESS/PHONE Zz GRe -d'3T", sPj21 n[&(/61.4, will a/105 413-7'41-52 PROPERTY LOCATION 2 MAI A/51; SRC C M4 MAP .2.31) 'ARCEL 11 1 ZONE 68/1 DD� THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 4t3C 1JnipnQ 21:12Io$112166-a 1 Building Permit Filled out Fee Paid TypeofConstruction: L,M/0G-te-T 03u5 Ifc55 0FFic.6 70 l>8/47-tsr oFp-1c� 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 INFORMATION PRESENTED: X 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 Demolition Delay W i I SiI v ature 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 Office of Planning&Development for more information. I J File o. mP-20 -000 '3 � 00 , elo/wL/ ZONING PERMIT APPLICATION 010.2) P1etise type or print all information and return this form to the Building Inspec is Office with the $30 filing fee (check or money order)payable to the City of Northampton Name of Applicant: \it' }} T-4 � J 1\-t.��` S / t . \i -C-4 t , Address:22- 4 i L.iv, .5? �� = ..12 l' elephone: 13 ' 14 1' 52—(F 5 2. Owner of Property: J Address: Telephone: -� 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) 1+11-fir-1^- r 4. Job Location: i" l i j �-- �-� - Parcel Id: Zoning Map# 23A Parcel# 1 1 / District(s): 63F36 00) In Elm Street District In Central Business District 1 (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: � ' f1c-t— b. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 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 DONT KNOW V YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW t YES IF YES: enter Book Page and/or Document# 9.Does the site contain a brook, body of water or wetlands? NO V DON'T 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\origina1\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 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. Witt the construction activity disturb (clearing, grading, excavation, or fitting)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 for use by the Building Department EXISTING PROPOSED REQUIRED BY ZONING Lot Size Frontage „„ 5/ Setbacks Front 1 s Side L: 1 R: Z $.V. L: .51446' R: L: R: Rear Building Height -50 Building Square Footage t -� i �jZ-0 -=- C0 8 41 %Open Space: (tot area 7%, minus building Et paved Act:* 1�' 1.) 4 c, parking #of Parking Spaces I #of Loading Docks Fill: I(volume Et location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date.. 5f / . , .-`f 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:Doctunen s\FORMSIoriginallBuiiding-1nspecto?Zoning-Pcnnit-Application-passive.doc 8412004 50'ESTIMATED PROPERTY LINE 1 EXISTING FENCE I 1 l 1 l 1 i 1 I 1 1 l 1 I 1 1 1 l 1 1 1' 1 1 i ti 1 l� N 1 •1 0 1— EDGE OF FORMER RAMP •1 l v EXISTING RAMP AND 1 '1;1 STAIR TO BE REMOVED 1 j 1 'm 1 1N \ - • ig ` •NEW UP 1 UP'- 1 iy STAIRi 1,i I1 .1 iI H .,L ''; � ° •r-,0- 1 / BREAK RM. 0/-- I X ,1 I l uP » ❑..° Za�� 1 ! laB.. J I 1 x \ I ^4 � \ 1 z rrl — o L C �>! l l © m IN 1 L05L %a • ,1•N1 /, 1 f BDESK I1 TO �rP v I. .r Im I 1 l • 1 UP -) ;I,1 1 31'7• .1 1 PROPOSED NEW PARKING 1'/ (VERIFY) /1 l 1 I 1 l 1 iPROPOSED NEW PARKING 1 1 l 1.1 1 75'ESTIMATED PROPERTY LINE •1 Preliminary Site Plan ' Scale:1"=10'-0• P,o,ec, Dental Office-2 Main St., Florence MA JABLONSKI I DEVRIESE Proposed Site Plan BDV 08.05.21 ARCHITECTS cno Fri•Nam• www.Jdarchitects.com Dr. Deschene 29 Elliot Street I Springfield,MA 01105 I 1":413.747.5285