41-032 Steven Willner 3059318083 p.2
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
W YES, describe size, type and location:
11. Wilt the construction activity disturb (clearing, grading, excav Lion, or filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES / NO
W 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 colwnn reserved
far use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
55.4 A4 vA14av5 ; sii pud
Frontage
83e' r v*Asol/5 j SEE PiAwi
Setbacks Front
I
Side I- NIA R: L: N/A It L: R:
Rear
Building (Height NIA
N�
Building Square Footage -
tvlA MA
16 Open Space: (lot area
minus building & paved 659'0 ovGltsc.c.
Me "•
parking p9 wc-41 P 0. s.
# of Parking Spaces
M'A AlIA
# of Loading Dodos
NIA N/A •
Fill:
(volume & location) NIA NIA
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: /0/22r / /0 Applicant's Signature ft .
NOTE: Issuance of* zoning permit does not tefieve an applicant's burden to comply with an zoning
requirements and obtain all requir permits from the Board dof Health, Conservation Commission,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W:1 DocwnentAFORMAoriginaltBuilding- lnspectDnoning- Pcrnrit- Applirauon- passive.doc 8//4/2004
Steven Willner 3059318083 p.1
- 2 2010 File /OM
•:ZO GPE.RRMIT'APPLICA ON(lo.2)
Please type or prim 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: .. Tes.se.pi WIUI4Eg Flo -CHI geeK,141ge. pe544,3 cw.co P
Address: 4 Al.L& Pt-. NDl- TuAtAP[b. olobe Telephone: '113 - 6W - 70 0 0
2. Owner of Property: _ f PST L 1- C
Address: 111-Z1 ak.eeiss tL. FDREst HIS ay' Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) r4frArE/2
4. Job Location: WeSTVI A MQi'•o.4 ! 61 -EAPAL czpS . (1! It-632
` Parcel Id :: ZonSi2 Parcels District s
EliilsStreet;District. In Central Business �1lsbncf
CT6,15t fl>:LEf];IN 13Y THE BUjLDING UEpARTh1EN'h
5. Existing Use of Structure/Property: JAt a,JT l of
6. Description of Proposed Use/Work /Project /Occupation: (Use additional sheets if necessary):
QE�ir+trh st.16 r uk.I.0Otrlk SfEldtkt. fteotn KGQO ES'TS pie Dm.% s*Ac.E
>i' $. 5 a8QI4 1 51-o4 (350 -10•) Ag40 LAPP raw/4%10A Foe f£ :rove-gp PhEAS1.r.VtL
RectuieE,Kep rs -6.3c) : 6 #4F-AIL selfAcK. fine. ioTS t I go' VF.Pftl 'F+R LOS l - 2
7. Attached Plans: Sketch Plan Site Plan ✓ Engineered /surveyed Plans
B. 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 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?
Needs to be obtained NIA Obtained , date issued:
(Form Continues On Other Side)
W: 1Documcnts \FORMSloriginaleuilding- 3aspect iManing-Pennit- Application- passirc.doc 5/42004
4
File # MP- 2011 -0054
APPLICANT /CONTACT PERSON Berkshire Design Group
ADDRESS/PHONE 4 Allen Place (413) 582 -7000
PROPERTY - r t • t N RD
5 ,i= }fi}
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
(2 FORIFILLED OUT 9 s `S
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - SUBDIVISION
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 PRESENTED:
Approved V Additional permits required (see below) �°�
PLANNING BOARD PERMIT REQUIRED UNDER : § /u o il A mad d J 6 Fib I P.- �` }d ' Gii /
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
4110
Si e 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.