38B-183 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 NO
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) ov9r 1 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
for use by the Building
Department
EXISTING PROPOSED fie a . B
Lot Size
3Z_
\ Frontage ,,�
Setbacks Front /6t /i '
Side L: . R: 71 L: !f R: e s-- L:. R :.
Rear 70 ' 26—
Building Height i
Z S ZS
Building Square Footage
% Open Space: (lot area 1
6 4
minus building & paved RHO ).3 8b 16
parking
# of Parking Spaces
Lf
# 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: XV) / 1 2 L
Applicant's S' nature (nu� MI • a•�' Ii_
1 PP SA
nature
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 ArchitecturarBoards, Department of Public Works and other applicable permit granting
authorities.
W :\Documents\FORMSbriginal \Building- InspectorlZoning- Permit - Application- passive.doc 8/4/2004
File No. /V 0//
-• • 777":777' I
Please tree or print all information and return this form to the Building
,
Inspector's OlOce with the $15 filing fee (check or money order) payable to the
City ofNorthampton
rl (
1. Name of Applicant: ,‘ 3--( 1 .
) ‘?Cr
Address:2 26. („/?1/' Lizdc
, SI , L i. Oa 1,,eikiL Telephone: 7 IL) "Th
i ry
2. Owner of Property:
-
Address: ' Telephone:
3. Status of Applicant: Owner Contract Purchaser I Lessee Other (explain)
4. Job Location: -1 /
• ,„
-
5. Existing Use of Structure/Property: I /\..1(
6. )'
Description of Proposed Use/Work/Project/Occupation: (Use addition& sheets if necessary .
• c • • j 1 C , C 1
t
7. Attached Plans: Sketch Plan 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 DON'T KNOW YES
IF YES. enter Book Page and/or Document #
9.Does the site contain a brook, body of water or wetlands? NO V DONT KNOW YES
IF YES, has a permit been or need to beobtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
4 (Form Continues On Other Side)
WADocuments\FORMS\original\Building-Inspector\Zoning-Permit-APPlication-Passive.doc 8/4/2004
•
File # MP- 2011 -0067
APPLICANT /CONTACT PERSON SMITH CATHERINE H
ADDRESS/PHONE 226 COOPER LN (413) 625 -2408 Q
PROPERTY LOCATION 27 FORT ST
MAP 38B PARCEL 183 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
- ZONING RM FILLED OUT `�
Fee Paid . (fJ!
Building Permit Filled out
Fee Paid
Tvpeof Construction: ZPA - DEMO & BUILD NEW HOUSE
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 PRESFTED:
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
L. D ✓LE teW ICI.
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.