18C-134 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 X
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
EXIS'nNG PROPOSED REQUIRED-$Y
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
•
Building Square Footage I • • • -
% Open Space: (lot area
minus building Et paved
parking
# of Parking Spaces
# of Loading Docks •
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: ! _ Applicant's Signature Vii'- i = ..I
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:\Documents\FORMS \original ]\Building- lnspector\Zoning- Permit Application- passive.doc 8/4/2004
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M•° ! 6 2012
File No. / P1 o) 9 0 _ ;,, AIL aC, SPECTIONS
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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: D — C O � Fjp Rt J i cS L Z
Address: / - ft • 5 LL e. a + G4 k2 -1 elephone:
2. • Owner of Property:_ L ” C. `' % V f "'" ,D ' / -R .5 L LC
Address: v r 1 i i'is. - V elephone: 4 7 L T C C3
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: ( � - 1 cc IV o�T " b : .11 . A 44
A � 4 , �'z a',' 1 `".r i�- 7, c � 1' e S ' .4:1 � ' ` - ∎ � ''r " S Zs c x. . a- ` i,
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5. • ' 'ng Use of Structure /Property: �� s ~' 1\)6 A
& l/t 1 mac -SSE — " 2 OSI D '- AANNA •.
6. Descr yti oposed Ube /Work/Project/Occupation: (Use additional sheets if necessary):
3 1361) CannpAS
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special Permit/Variance /Finding ever been issued for /on the si
NO DON'T KNOW YES IF YES, date. issued:
IF YES: Was the permit recorded at the Registry of Deeds?
N0. _ DONT KNOW YES
IF YES: enter Book Page \ `And /or Document #
/ N
9.Does the site contain a brook, body of water wetlands? NO DON'T KNOW YES
IF YES, has a permit been or nee o be obtained from the Conservation Commission?*
Needs to be obtained , date issued:
, \
(Form Continues On Other Side)
W :\Documents\FORMS \original\Buil ding- Inspector\Zoning- Permit- Application- passive.doc 8/4/2004
File # MP- 2012 -0090
APPLICANT /CONTACT PERSON DU -CON PROPERTIES LLC
ADDRESS /PHONE 111 COTTAGE ST (413) 246 -8082 0
PROPERTY LOCATION 256 JACKSON ST
MAP 18C PARCEL 134 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT ��
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - RESPITE HOME
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
INF,,eiRMATION PRESENTED:
V 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
3/22/1 2 -
Signature of Building I fficial 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.