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LITHO IN USA N.E. 81.1.1#00INT t2774* • . 1
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10. Do any signs exist on the property? YES NO X
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) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO V
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 col umn reserv
for use by the Building
Department
EXISTING PROPOSED E i,! g ,
Lot Size —, �
yF
' 7
Frontage
1 3o Ft
Setbacks Front fit- 9\c.� J Ce, ?ion-
r _
Side L: R: L: R: 1...
Rear
Building Height _
Building Square Footage
r 1 811 5 r d)1 � 0 �D') ,
Yr
% Open Space: (lot area 4 Yw k w�
minus building & paved ' l � / 73 s ,� hj '7 Q S� st, A , h
parking
# of Parking Spaces (� ( ��, �� �.,
1
# 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. 1
Date: Oa_ I 0 1 1 Applicant's Signature �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\Buil ding- 1nspector\Zoning- Permit - Application- passive.doc 8/4/2004
L- i H 1 It-
i : - 9 201 File No. 10Pn 70 ff" { � a d } f Y- l �7 f u' , f F " J 7 P l o- n ` J ^` y ' . , r S ri
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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: , . . w � 13 - 601-/
Address: �r ' AG„ SA- Tel ephone: 6-1 �� a2o
2. Owner of Property: v o o ' ► '� kA A.,
Address: -_ C■` -P_ Telephone: Set c _-
3. Status of Applicant: Owner X Contract Purchaser Lessee p Other (explain)
Job Location:
166 5,,k1, ,, S. �'04 ∎ 1
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p '"vr Y z x I i e ,.t. t r -7 f K t .� -^f f f t-. s - Yak- „,. 1
:17 , -: ' ` ,� t. ^t _ r- r i ! � ' -- i-, o a n .. f. f ` pa ` '
a� t � � � s h " ' -,-11 _.v 3 � r.� e' t a 1 t wv �e er -u tiw!�
' mot , - , S t �m - _ .,,ro;1fl- .. 4 t r4 -, 4 L.,„,,,, ! `4,4'.. ',1,',,-,, ,... f " " .,.. "', ..�. u.w�,,. - �"u. i „ �x t�^i"'ii,,
5. Existing Use of Structure /Property: S 'r ii t._. .fCk� ,
6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary):
■ a. b. -^^ : Cat • 0,. _
7. Attached Plans: Sketch Plan _ Y_[�_ Site Plan )( Engineered /Surveyed Plans
8. Has a Special Permit/Variance /Finding ever been issued for /on the site
NO — DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES _____41t.__-
IF YES: enter Book Page and /or Document #
9. Does the site contain a brook, body of water or wetlands? NO )c DON'T KNOW 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 8/4/7004
•
File # MP-2011-0070 likt59.1 y E4 fO ( 2°35 )
APPLICANT /CONTACT PERSON HEXDALL AARON ��i�� �,
ADDRESS/PHONE 168 SOUTH MAIN ST (646) 209 -2037 0
PROPERTY LOCATION 168 SOUTH MAIN ST N6Gb
MAP 23A PARCEL 110 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ILLED OUT atD.v dic
ee raia (p
Building Permit Filled out
Fee Paid
T \peof Construction:_ZPA - REAR 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 ACTI N HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRE TED:
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 o
ZONING BOARD PERMIT REQUIRED UNDER: § arD J 9.3 C(6 (J)
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
c -% l 3 131 II
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.