31A-228 (11) File #20
APPLICANT/CONTACT PERSON:SETERDAHL, MARY B. &PETER
28 HARRISON AVE NORTHAMPTON, MA 01060
PROPERTY LOCATION 28 HARRISON AVE
MAP:LOT 31A-228-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $30.00
Type of Construction: ZPA -GARAGE TO WORK/ART STUDIO
New Construction
Non Structural Renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
Driveway Grade%
THE F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION
PRES ED:
Approved Additional permits required(see below) For all projects that need additional reviews E;v41 .E
as checked below,please see the Office of Planning& Su sta inability Permit page or scan here i t-t ' .1
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
/ii_ 3- i7-Za2Li
Signature of Builing 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.
Itiq
File No. Q
oF�r 20(9I
ZONING PERMIT APPLICATION (356,4u•. / '
Please type in this fillable PDF or print and hand-write all information arti',61-efurr to
the Building Inspector at the Building Department (212 Main St.) with the $30 filing-fe'e by
check and money order (payable to the City of Northampton) or credit card (in person only).
1
1. Name of Applicant: P Nrt r e����0-4 Email: ee+c+- $ c)14-q�a inn'‘C, 444
Address: 2 ? 14-✓vti'-3 �'� /'r"C Telephone: 4f 3 Z Z_Z 1 5-S
2. Owner of Property: �'t �� JS <"�0` "� � `A 4
Address: Z J S lam" Telephone:
3. Status of Applicant: Owner klEl Contract Purchaser ❑ Lessee ❑ Other (explain)
k4e\f, ^ ../"N
4. Job Location: Z L
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: 2 G'` ' q ors o--�/-
6. 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/Findingl ever been issued for/on the site?L NO H DON'T KNOW J YES LJ IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW ❑ YES ❑
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO 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)
6/7/2023
10. Do any signs exist on the property? YES NO El
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO LI
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
I
plan of development that will disturb over 1 acre? YES I 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 Dept.only.
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
%Open Space:
(lot area minus building It
paved parking)
#of Parking Spaces
#of Loading Docks
Fill:
(volume if location)
Driveway Grade%
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge.
L
Date: ' Z 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, Historical Commission and Architectural
Boards, Department of Public Works and other applicable permit granting authorities.
6/7/2023
Ipe -t r S e�-� G t. �'