00 Glendale 42-167 ZPA 2020W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/20 04
File No.__________
ZONING PERMIT APPLICATION (§10.2)
Please type or print all information and return this form to the Building
Inspector’s Office with the $15 filing fee (check or money order) payable to the
City of Northampton
1. Name of Applicant:____Carolyn Misch, Assistant Director Office of Planning & Sustainability____________________
Address:____210 Main St, Room 11 Northampton MA__________Telephone:______413-587-1287_______________
2. Owner of Property:___City of Northampton Office of Planning & Sustainability______________________________
Address:__SAME________________________________Telephone:_______SAME______________
3.Status of Applicant: Owner _X_ Contract Purchaser _______ Lessee_______ Other (explain)_____________
4. Job Location:___________Glendale Road (abutting #24)_ADDRESS TO BE ASSIGNED_____________________
Parcel Id: Zoning Map#__42______ Parcel#__167_______ District(s):_____WSP___________
In Elm Street District In Central Business District___________
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5.Existing Use of Structure/Property:_______Vacant Flag Lot approved in 2003_______________________________
_________________________________________________________________________________________________
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
_________________________________________________________________________________________________
_________Confirm allowed use of lot for Single Family Home_______________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
7.Attached Plans: Sketch Plan ___________ Site Plan ______ Engineered/Surveyed Plans _X__
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO __________ DON'T KNOW ___________ YES ____X___ IF YES, date issued:__Jan, 2003 Comprehensive Permit_
IF YES: Was the permit recorded at the Registry of Deeds?
NO __________ DON'T KNOW ___________ YES __X_
IF YES: enter Book _7133___ Page _23_ and/or Document # _________________
9. Does the site contain a brook, body of water or wetlands? NO _X___ 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)
30
Approved as a Buildable Lot 05/14/2020Needs Driveway permit, water and sewer/septic availability
Louis Hasbrouck
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/20 04
10. Do any signs exist on the property? YES __________ NO ____X___
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 X
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 1.587 ACRES
Frontage 123'
Setbacks Front
Side
Rear
L: R:
L: R:
L: R:
Building Height
Building Square Footage
% Open Space: (lot area
minus building & paved
parking
# of Parking Spaces 2
# of Loading Docks
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date:______________________ 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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