38B-311 i
10. Do any signs exist on the property? YES NO li
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO 1/
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 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 ' Y
Lot Size
/69//7� �/ .::.
Frontage
Setbacks Front 4 4 1
Side L: R: L: / 5 R: /5 , L i R:' 15"
Rear 2 61 J !:' W.
Building Height
3C'
..
Building Square Footage �'
2 DD
% Open Space: (lot area
minus building & paved 8 g / � 'r_ ' .1 - _ . -
parking "` i
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location)
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
my know ledge. /
Date: e 2 Applicant's Signature Ae
i
d
NOTE: Issuance of a zoning permit does not relieve an applicant's bur en 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.
WADocumentsWORMSIoriginal1Buil ding- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004
nrlr`� i.`
9 LJUJ
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___j \ File No. l Pio 91
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-- - , 'P... Mi P , Ic. '. oo 0 f i
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 ofNorthampton
1 . Name of Applicant: ' ' / I 7L 't A !V
Address: 1 / v t 7 - r Telephone: 5 a ' J /‘/ 0
2. Owner of Property: 1 &-2t/ ' 7 A /t/ /
Address: ` / 1 Telephone: 6 00
3. Status of Applicant: Owner V Contract Purchaser Lessee Other (explain)
4. Job Location: Z D �� /f/ �X 7 .* L71— tT/2 7 `j 7
a: ff
M2 r
A s 7 � ," y ® i A i l l IF. ' a Vie °a , c , , =' 4 C ' 0 .-'4 .' s � " ` ' w' X-
5. Existing Use of Stpueto"re/ roperty:� 7�6 / a -- iti-7 - 11 v A7 z,
6. Description of Proposed Use /Work/Project /Occupation: (Use additional sheets if necessary):
i/Zpp 5 , 5 A 7 P 5 iL1 4 s77 Pm iti
7. Attached Plans: Sketch Plan / Site Plan / Engineered /Surveyed Plans
eUG(i c'??
8. Has a Special Permit /Variance / indin ver been issued for /on the site? - 4 -- 7) An't I a f / e/11
NO __ DONT KNOW l/ 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 _ y 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\ FORMS\ original \Building- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004
File # MP- 2010 -0027
APPLICANT /CONTACT PERSON FIEMAN BENJAMIN
ADDRESS /PHONE 54 FORT STREET 0 586 -9610 0
PROPERTY LOCATION FORT ST
MAP 38B PARCEL 311 001 ZONE SC(35)/URB(65)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT` Q 7*L5 - Fee Paid , °� •
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - 2 FAMILY
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 ACTIO HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRES ED:
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 Stre Commission Permit DPW Storm Water Management
,7 440
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.
r
File # MP- 2010 -0027
APPLICANT /CONTACT PERSON FIEMAN BENJAMIN
ADDRESS /PHONE 54 FORT STREET 0 586 -9610 ()
PROPERTY# OCATION FORT ST ,
A ' i RC _ I IsLI *N . I L', /
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FI LED OUT 1"�
Tee ras
Building Permit Filled out
Fee Paid
Tvpeof Construction: ZPA - 2 FAMILY
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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
� / 7
Permit from Elm Street �i.mmission Permit DPW Storm Water Management '`
Signature of Bui ding 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.