06-055 (4) •
10. Do any signs exist on the property? YES X NO
IF YES, describe size, type and location:
Welcome to Linda Manor Sign located at Front Entry Drop -Off Circle. Approximate size: 4' -0" High by 5' -0" Wide.
Are there any proposed changes to or additions of signs intended for the property? YES NO X
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 X 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
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size 482,744 S.F. 482,744 S.F.
11.08 Acres 11.08 Acres
Frontage
125.0 Feet 125.0 Feet
Setbacks Front 666 Feet 523 Feet
Side L: 115 Feet R: 94 Feet L: 114 Feet It 94 Feet L: R:
Rear 122 Feet 122 Feet
Building Height < 35 Feet < 35 Feet
Building Square Footage 4
37,660 S.F. 8,929 S.F.
% Open Space: (lot area
minus building Et paved 76.7% 71.2%
parking
# of Parking Spaces
85 Spaces 97 Spaces
# of Loading Docks
1 Loading Dock 1 Loading Dock
Fill: Unknown Unknown
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 40/#14 01 Applicant's Signature dit t• gke e rI' • e
NOTE: Issuance of a zoning permit does not reli e an applicant's burden to comply t 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- inspectorlZoning- Permit - Application- passive.doc 8i4 /2004
C EIVED j
"'3 ail File No. J) �/y
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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: Chakalos Investments, Inc.
Address: 52 Overlook Drive Windsor, CT 06095 Telephone: (860)688 -5994
2. Owner of Property: Chakalos Investments, Inc.
Address: 52 Overlook Drive Windsor, CT 06095 Telephone: (860)688 -5994
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location: 349 Haydenville Road Northampton, MA 01060
i $4te:iim at utt4 l C tofB '"* o. o wz w tA fin..
5. Existing Use of Structure /Property: Extended Care Facility/ Nursing Home
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
Proposed 12 -Bed Addition to Linda Manor Extended Care Facility
and New Rehabilitation Center.
7. Attached Plans: Sketch Plan Site Plan X Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO DONT KNOW YES X IF YES, date issued: 01/06/1988
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES X
IF YES: enter Book 3131 P age 243 and /or Document # 2542
9.Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES X
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
File # MP- 2012 -0045
APPLICANT /CONTACT PERSON ETHEREDGE & STEUER, P.C.
ADDRESS/PHONE 64 GOTHIC ST (413) 584 -1600 Q
PROPERTY LOCATION 349 HAYDENVILLE RD
MAP 06 PARCEL 055 001 ZONE SR(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ) 33 K iS ' j,c, at)
Building Permit Filled out
Fee Paid
Tvpeof Construction: ZPA - 12 BED ADDITION
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 (/Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : § 3S?) - 1 I .3 3SO - TA i3 1_
Intermediate Project : Site Plan AND /OR S ecial 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
4"---4j) /1/10/1/
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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