08-009 File # MP- 2010 -0094
APPLICANT /CONTACT PERSON BADER MATTHEW t
ADDRESS/PHONE 844 NORTH KING ST (619) 400 -9001 Q
PROPERTY LOCATION 844 -NORT G t T
MAP 08 PARC1B09 OUl ZONE 9)/RR(41 L
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
,Z6IQ1�1G FORMM ,ED OUT �, ,
1 ..._
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - HOME OFFICE CAR SALES
New Construction
Non Structural interior renovations
Addition to Existin
Accessoly 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
INF"MATION PRESENTED:
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: §
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
C2 4n = 21-�� 6 b 71t 0
Signature of Building O icial 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.
File N
o
4 qtr,'
Please type or print all information and return this form to the Building
Inspector's Office with the $15liling fee (check or money order) payable to the
City ofNorthampton \�
1. Name of Applicant:
Address: O �� f`! - ! Af 010/10 Telephone:
2. Owner of Prooperty: / ,AJ&) �t d G
Address: h f J 6 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: _ GIY/6 aGGlGj� 1
-a r
5. Existing Use of Structure /Property: - -�!v
t
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
: C �
y
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special 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.poes the site contain a brook, body of water or wetlands? NO 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 8/42004
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 _�
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 the Bugding
Zi mint.
EXISTING PROPOSED
Lot Size
Frontage
Setbacks Front
Side L: R: .9D o2 L: 6 3 R: . 6
Rear
Building Height 4, �C?
Building Square Footage 2 2
% Open Space. (lot area ;
minus building & paved
parking/ L✓
# of Parking Spaces 2
# of Loading Docks
Fill:
(volume & location)
13. Certification: .1 hereby certify that the information contained erein is true and accurate to the best
my knowledge.
Date: 4 Y14, 4 r Applicant's Signature -
NOTE: Issuance of a zonirag pe. <iit does not r el a an r nrl_r_rant'g 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