18C-176 (3) ,
File No.
//71 •
r, 474
Pl or print all in formation and return this form to the Build
Inspector' Office with the Z ing fee (check or money order) payable to the
City ofNorthampton
•
1. Name of Applicant: f�l / Cv1Q r C �/ Ct e S C e
Address: 7 7 I /3` -r df (CG( Telephone: 3 4/ 7?-92- �
2. Owner of Property: SLIM e
Address: Telephone:
3. Status of Applicant: Owner ✓ Contract Pur Lessee Other (explain)
4. Job Location, ` 7 7 L/ /3�r 419 e ". £ ( .chaser
- 7
i
-, -77.------- .....* , a. ... ! _.s"
5 Existing Use' of Structure /Property: 6a g e Q /1d C a S r[ e 6 y rry( S�f>p
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
l o f_ %?eeJ C r a / z . C v e e 44 r r d4 frcM 1 4 ides €sC ► s tiny I , /cbirc
Y 4.is9G(atIOIYL Gut �QDD " 1 - , Ve ATA (i 3T6 (1
T. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed. Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site?
NO
YES
DONT KNOW IF YES, date issued:
- 1FYES: was tie 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?
Ne t o be obtained Obtained ,date issued:
(Forrfl £ rrtinucs ETrt er-Side)
V4/2004
W:1I7ocuments\FORIv1S10 �inaI�BuiZdin�- Inspector\Zoning- Permit- Application- passive.doc
I t
i r
File # MP- 2010 -0049
APPLICANT /CONTACT PERSON JAESCKE RICHARD E & SANDRA H
ADDRESS/PHONE 774 BRIDGE RD (413) 584 -7898 ()
PROPERTY LOCATION 774 BRIDGE RD
NIA 8C PARCEL ,170 Ql , ONE S 1 )/ P
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
(ZONING FORM�ILLED OUT v ✓JT �
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - 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 PR5ENTED:
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
L- P / ermit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
c7e- 3 /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.