43-156 e e
File # MP- 2012 -0008
APPLICANT /CONTACT PERSON SAMOLEWICZ JENNIFER A & STEVEN
ADDRESS/PHONE 30 HAWTHORNE TERR
PROPERTY LOCATION 30 HAWTHORNE TER
MAP 43 PARCEL 156 001 ZONE SR(100) //WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ING FORM FILLED OUT
ee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA HAIR SALON
New Construction
Non Structural interior renovations
Addition to Existin
Accessory Structure
Buildine Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRE ED:
P'
Approved 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: § 350 — 0• i2 - rA(3Lc Of u SE
Finding Special Permit i� 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
_7 5
Signa a of Building fficial 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.
• RECEIVED
is 201 File No.
DE INSF NG .PERMIT AP'PL�CATION (Y 0.2)
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: Jennifer A. Samolewicz
Address: 30 Hawthorne Terrace, Florence, MA Telephone: 413- 586 -2133
2. Owner of Property: Steven E. Samolewicz and Jennifer A. Samolewicz
Address: Same as above Telephone: ` 1 l 6 b C�,�
d
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location: S n 4 O ✓ }/� T,� f�p �l()�,/�CP,
5
Parcel: Id: Zoning Map # "" Parcel# 1 5. D�stnct s
1).
i In E:lm Street In Central Business'District
(TO BE FILLEDIN BY;,THE BUILDING °DEPARTMENT)`'
5. Existing Use of Structure /Property: _ Residential—single family
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 Spec' Permit /Variance /Finding ever been issued for /on the site?
NO 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 DON'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? c�
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
W: \Documents\FORMS \original \Building- Inspector\Zoning -Per ;nit - Application- passive.doc 8/4/2004
f
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) ove 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
Dep artment
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front ro
Side L: R: L: 65 R: ' S L: R:
Rear ( ( a
Building Height
Building Square Footage
% Open Space: (lot area
minus building Et paved
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: �CJ Applicant's Signature
NOTE: Issuance of a zoning permit does not re '& applica ' 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
File No
R Date Filed
I '
I REGISTRATION OF HOME OFFICE /OCCUPATION ( 510.2 & 11_11)
With the Building Inspector .
1. Name of - Applicant:
Jennifer A. Samolewicz
Address: 30 Hawthorne Terrace, Florence Telephone: 586 -2133 or 584 -563
Steven E. Samolewicz and Jennifer A. Samolewicz
2. Owner of Property:
Address: 30 Hawthorne Terrace, F orence Telephone: 586
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain: )
4. Parcel Identification: Map 43 Parcel r 156 ,
Zoning District(s) - (include overlays) SR /WSP II
Street Address 30 Hawthorne Terrace, Florence, MA.
5. Narrative Description of Proposed Home Office: (Use additional sheets_
if necessary) hair salon
6. Is this a legal residential building ?. YE.
_
7- Will there be an employee /owner who doesn't live in the home YESC� .
8.. Will you ever see clients or customers at _your site? YE NO
How often daily
For what purposes cosmetol and hair servic
9. Will there be any signs for the Home Office? YES hTO
1o Will there be any goods sold from the premises . or any sale of
goods stored on premises, either retail or winolesale, or
display of goods on premises? QD NO
11. Will there be any outdoor storage of .materials ?' YES �O
12. Will your use be totally within a building and not cause any
outward manifestation (including traffic generation; parking
congestion, noise, air pollution, and materials storage)? ES NO
If NO explain:
13. Attach Plans (if applicable)
14. Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non - criminal fines and
criminal and civil actions_
Date: July 15, 2011 Applicant's Signature:
- THIS SECTION FOR OFFICIP.L - USz - Y: - - - - - - -
-Approved as 'presented /based on information presented
APPROV.A - L .EgPIRES ON DECEMBER 3Z O THIS YEAR AND MUST THEN BE RENEWED
Denied as presented - -- Reason: -
Signature of Building Inspector Date
NOTE: L.=:anco of a psr-ut doer not rollovo an appllc -ril'a fxsden to oompfy wfth all zoning r�irotnanty arrd obtain all roqulrod porn =
from the l oard of Hoatth, Cote =aivatlon CommIzzlon, Department of Publle WC-4i= and oL`tor appllcahle pomft grarting authorftl—
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