05-001 f' File # MP- 2011 -0028
APPLICANT /CONTACT PERSON MASONIC HEALTH SYSTEM OF MASS
ADDRESS/PHONE 88 MASONIC HOME RD (508) 434 -2262
PROPERTY LOCATION 222 RIVER RD
MAP 05 PARCEL 001 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FO' ► FILLED OUT ,
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Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - DEMO NURSE'S RESIDENCE & WATER TOWER
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan QQ
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON PP P.OU£P 1° V
INFWIATION PRESENTED:
roved Additional permits required (see below) 3 w G L ` E' ` `SS ��
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 Penult 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
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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.
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DEMOLITION REVIEW APPLICATION
Activity Tracking Sheet
Property: Nurse's Quarters at Hampshire Care
Map: 05 Parcel: 001 Year Built: unknown
Address: 222 River Road, Leeds
Received in Building Department: August 31, 2010
Referred from Building Department: September 1, 2010
Action Taken/ Northampton Historical Commission
Action Taken By: Entire Commission
✓ Sub - Committee of the Commission
Commission Designee/ Staff
Date Action Taken: September 15, 2010 Initial Determination
Public Meeting held
Public Hearing Held
Determination Made:
✓ Property has been determined not to be
Significant according to Ordinance definition.
No further action will be taken. Demolition
Permit may be issued.
Property has been determined to be Significant
according to the Ordinance definition and a
Public Hearing has been /will be scheduled.
Demolition Permit may not be
issued at this time.
Public Hearing has been held, Property was
determined Significant but not Preferably
Preserved. No further action will be taken/
Demolition Permit may be issued.
Photo documentation may be required.
Public Hearing has been held. Property has
been deemed to be Preferably Preserved. The
demolition review period has been initiated. No
demolition permit may be issued until the
Historic Commission approves an alternative plan or the
twelve month period concludes.
Alternate plan has been approved/ delay terminated.
Demolition may or may not be approved as part of plan.
Twelve month time period has expired, demolition
Stj 4k- I permt may be issued.
Referred by: Date se [ 5 �t D
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