42-007�6R, C) File # MP- 2011 -0060 f D I l
APPLICANT /CONTACT PERSON ALTHOFF JONATHAN J
ADDRESS/PHONE 291 WEST FARMS RD (413) 584 -3567 -0
PROPERTY LOC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FO ILLED OUT i
T ee Paid �7`�
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - ENLARGE BARN
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:
Approved V 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* t
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 Elm Street Commission
Signature of Building Official
Permit from CB Architecture Committee
Permit DPW Storm Water Management
12,
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.
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
, x45
`,elf Ga IJ
7. Attached Plans: Sketch Plan v Site Plan Engineered /Surveyed Plans
8. _ Has a Special Permit/Variance /Finding ever been issued for /on the site?
NO DON'T 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 01-� 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)
W:\Documents\FORMS\original \Building- Inspector\Zoning- Permit - Application- passive.doc 8/4!2004
10. Do any signs exist on the pro ert 7 YES NO
P Y
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 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.
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.
W:1Documents\FDRMS\originalSuil ding- Inspector\Zoning- Permit - Application - passive.doc 8/42004
ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
This plat is
information,
changes as a
construction
PLAN FOR MORTGAGE PURPOSES ONLY
compiled from other plans, deedimensions and other sources of
is not to be construed as an accurate survey, and is subject to
more accurate survey may disclose. Not to be used for
planning, construction layout or recording purposes.
v
-J
�v
'
�1
� f
f
ta d
.3'
V j
llpl
,�O U
to
i
f �
Property Reference: /���i'�i5i /
2 County
Deed Bk. $Sc� Pg. , Plan Bk. — Pg. —
Land Ct. Cert I Plan 1
•30vl itko(y
Owner:
Address: 4/ // 577
Date: �4 ,3 O S
D. L. BEAN, INC.
LAND CONSULTANTS
Forty Sdwol Street Westfield, Mass. 01085
V1 of 441r
s
DAVID �
L. m
BEAN _
9 #29280
� E �
F N
�ND SURY0
To the Family Choice
and theFirst American Title Insurance Corp.
To the best of my knowledge, information
and belief, I hereby report that I have
examined the premises and that this
inspection plat shows the buildings as
located on the premises described, that the
buildings are entirely within lot lines,
an tat there are no encroachments upon
the premises described by buildings of any
adjoining premises, except as indicated.
I further report that to the best of my
knowledge there are no visible easements of
record affecting the tract shown hereon,
except as noted. I further certify that
this property is not located in the
established ood hazard area.
NN
IkA
12
0
A
a
v.n
m
H
N
9
NA
1i AY E P
it
.J000
AA
. ^;`.: