17C-219 (2) ,
a ���
File No. v
r information and return '
Please typ e or p ' ust all orm to th B g
Inspector's Office with the $15 filing fee (check or on der a , , , t e to e
/ ,
City ofNorthampton
i 1. Name of Applicant: tea 6-E ft ! • G 1_,1 l? ),C
_i Address: a 3 ,/ 1(/ /" jar) r 57L Telephone: `Y/ 3 — 3 4 Y /
t 2. Owner of Property: /t r�i . (. + lfv 7 i 4 nom► / C .-/4r—IC
`t Address: r. 3 Q 4 /, ,N4 it S7` Telephone: 9/ 3 '-5" g.1
`` 3. Status of Applicant: Owner V Contract Purchaser Lessee Other (explain)
4. Job Location: O� a 3 �/� " ) S F JO c e n ce
r '
5. Existing Use of Structure /Property: y 1- H i i -, • .� r p r 5S
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): , ,,\
{ / p liAP, o
,4, 6ec) doom t )-- remdeve_ i y'�'r , o
rujA
7, • Attached Plans: Sketch Plan V Site Plan t' Engineered /Surveyed Plans t p59.7. ___
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: iDocuments \FORMSbriginal\Building- Inspector\ Zoning- Permit-Application- passive.doc 4 f' ( S 5 8/4/2004
i K CO.
Y
File # MP- 2011 -0016
APPLICANT /CONTACT PERSON CLARK ROGER P & JULIANNE M
ADDRESS/PHONE 93 ARCH ST
PROPERTY LOCATIO AA14144.1141APLE ST
MAP 17C PARCEL 21; I")/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Fee Paid '_1611'
Buil' ing Permit Filled out
Fee Paid
Typeof Construction: ZPA Pool/Use
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 (/ 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: § 9 e ` 3 , I g.,XFAtid p N N O JCO sJ fo rt %I
/ 5E
Finding i. 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
l i3 . V 10
Signatur f Building O�icial Date
€� g
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.