11C-039 (6) File # MP -2011 -0015
APPLICANT /CONTACT PERSON DONALD P JUDGE
ADDRESS/PHONE 23 East Center St (413) 586 -2597
l IT-I Aff001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
M ZFOMFILLEDOUT ,
Permit Filled out
Fee Paid
Typeof Construction: ZPA Move Garage
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 wA �
INFO TION PRESENTED: Nb"C Ci6 , J PWC—L. !", 1 _
pproved Additional permits required (see below) I ,, r 'T t+ S7"rC—
D116S POT �R.$6
PLANNING BOARD PERMIT REQUIRED UNDER: § PCB 1 SAZ,^/ VTF6
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
ha
Signatur Building Offici 1 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 No.
P gale type or all ormation and return this form to the Building
ctor's Office . - ,_' 15 filingfee (check or money order) payable to the
City ofNorthampton
1. Name of Applicant:
Address: Telephone:
2. Owner of Property: - on ', � � h ► � A [ q
Address: 7 A7� F Q 1 • L..�G�
Tel 68(� A5l /
3. Status of Applicant: Owner j _� Contract Purchaser Lessee Other (explain)
4. Job Location: E - 6U ocr-_ �> L aA -
5. Existing Use of Structure /Property MI LA iSQ
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan ✓ Engineered /Surveyed Plans V
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.Does 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\FORMSbriginal\Building- Inspector\Zoning- Permit - Application- passive.doc 8/4n004
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 N0 L
1t
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. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
u for use by the Building
De en[
EXISTING PROPOSED
Lot Size
Frontage �X iN�
.Cea�l' nn� l et
Setbacks Front
Side L• R: L: R: R:
Rear
Building Height iY1A�N P Zrjg-^ o %At 3
Gn m
Building Square Footage ; ' -
s..
% Open Space: (lot area
minus building &- paved
# of Parking Spaces
# 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 < Z 2 &a /X
NOTE: Issuance of a zoning permit does not relieve an applicant's bur 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:1Dww=tsl FORMS brignW\Euilding- Inspemr\Zonmg- Permit - Application- passive.doc 8 /4/2004