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to
& Store Number. 1 '. 57 Ne
Address / / ha& 0 . 66 Title Mediae — Right Left V 'mon _ dBre I w Dedic Height Cleertace AD
City, Mete If/127A , II ViriniiiiiffrA 42 Title Endo* — Right Left Spot' 'w 11) GP dB= ExistingD *diode d Outlet Curb Stope / Bollards g ded /) f
or LITE dlhe Repeat Existing Dedicated Outlet ADA Compliant NO
Store Phone Number Store Manager Name. Exterior Canopy Ft Other Survey Location Score I
Client Dial-up DSL .
Surveyor C WOV/6 Sketch of Interior Exterior SAM."' Ok
Describe Scope of Wort --
IA AV
Date Print Name and Title redbox Location Approved Br
10. Do any signs exist on the property? YES ✓ NO
IF YES, describe size, type and location:
C - D - vt-S. - 00C c
J
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 .acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO tt
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
• 'A Cites 614-e
Frontage J�f�
Setbacks Front
Side L: R: L: R: L: R:
Rear C
Building Height - J
Building Square Footage
% Open Space: (lot area
minus building is paved j
parking
It of Parking Spaces
l Ali r
ft of Loading Docks
c' S ame
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: i I -dal( Applicant's Signature G 13-1/(tha.AA..._.,
NOTE: Issuance of a zoning permit does not relieve an applicant's 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:1Documents\FORMS\ original \Building- lnspector\Zoning- Permit- Application- passive.doc 8/4 /2004
FIECEPIFD
NOV 1 7 2011
DEPT. OF BUILDING INSPECTIONS File No. glover-5
NING PERMIT APPLICATION ( §1o.2)
Please type or print all information and return this form to the Building
Inspector's Office with. the $i5 f ling fee (check or money order) payable to the
City of Northampton
1. Name of Applicant: K d kg
/ D t 12 �// �c lh !f_�1fx 1 R.— Telephone: G 3c, - cf -g5F 1
Address: /;
2. Owner of Property: , �C P c;26(...6
LL
' I Q cal S/ &m / y/Q l� Telephone: 1/ / 4, "' / 7" c/3
Address: � ! ! p � ` 7 ,
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) WV/DC.-
4. Job Location: 3L2(CD ri L'tC) ' 1 /tiOr'fh' p* /1 /OA f)MOO
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property:
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
CAQt,vc_\ iL
7. Attached Plans: Sketch Plan J 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.Does the site contain a brook, body of water or wetlands? NO DONT KNOW V 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\ FORMSb riginal \Building-InspectortZoning - Pettit- Application- passive.doc 8/4/2004
File # MP- 2012 -0051 ��
APPLICANT /CONTACT PERSON REDBOX • ��� t N
ADDRESS/PHONE ONE TOWER LANE, SUITE 900 (630) 824 -8581
PROPERTY LOCATION 366 KING ST C3 C N
MAP 18D PARCEL 047 001 ZONE HB(100)/URB //WP LE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST'
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT /�� 3 �f S
Fee Paid
Building Permit Filled out
Fee Paid
Tvpeof Construction: ZPA - OUTSIDE REDBOX
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
INFATION 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
/ Vi r.
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.