33 Cfld Rd ZPAFile#MP-2020-0013 0
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APPLICANT/CONTACT PERSON ROGERS DONALD&DEBBRA Q
ADDRESS/PHONE 450 SPRING S ( 45--7462 ()
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PROPERTY LOCATION 450 SPRING ST
t e'lQ7rr'T 1 US
MAP 16A PARCEL 012 001 ZONE URA(100)/Go`L (t6 putt
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT 1t '
Fee Paid
Buildin Permit Filled out pi
Fee Paid
T3peof Construction: ZPA-MODULAR HOUSE
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
ATION PRESENTED: N jINF j Af P to v6 o , NEbb 5pprovedAdditionalpermitsrequired(see below) W A` CP_ S6 vJ6(C. ) D Rig vFW
PLANNING BOARD PERMIT REQUIRED UNDER: § APQ N au% NLkrvt13Egppo
Intermediate Project : Site Plan AND/OR Special Permit with Site Plan pv
k-
Mayor Project: Site Plan AND/OR Special Permit with Site Plan V `
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW t/ Water Availability Sewer Availability ASb
Septic Approval Board of Health Well Water Potability Board of Health
cev6ao
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
l NAM!)
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.
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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File No.
ZONING PERMIT APPLICATION (310.2)
ale e or print all information and return this form to the Building
vInect Office with the X30 filing fee (check or money order)payable to the
Comity of Northampton
1. Name of A plicant: t)IE Q_( :ll4000 a,A ll S
Address: s Telephone: (o '3 ,2 a
r
2. Owner of Property: 4 .
W-c r S-Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location:
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:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
yyADA C-Aciz, t\L&Y P--
C C-1
d(-%u a
7. Attached Plans: Sketch Plan f/ Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NOy 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)
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W:\Doocuuments\FORMS\original\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. 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
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
j s-6—
Setbacks Front L c) I
Side L: R: L: 1 6— ' R: 13o L: R:
Rear I
Building Height
Building Square Footage
Open Space: (lot area
minus building ft paved
parking
of Parking Spaces h
of Loading Docks
o
Fill:
volume Ft location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: C{ I (Q I I Applicant's Signaturg L
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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