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38D-038 9. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This column to be filled in by the Building Department. Existing Proposed Required by Zoning Lot Size I 0 Frontage N/A N/A N/A ( a Front: Setbacks: Side: I - L: R: L: R: Rear: P" c) Height % Open Space: 1 Vrid(- (Lot area minus bldg and Paved parking) 10. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. DATE: .1 /..).7 7/ a APPLICANT'S SIGNATURE NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits from the Conservation Commission, Department of Public Works and other applicable permit granting authorities. i , q / .--.- p I, h ' I ---- - - --- ( il ... City of Northampton Massachusetts t. F -- - " DEP TMENT OF BUILDING INSPECTIONS` � ` 212 Main Street • Municipal Building ,�<< M MAR 2 7 2012 Northampton, nom, 01060 4,V INSPEC OR DEPT. OF BU DIN NO - STRUCTURE PERMIT APPLICATION (For freestanding structures less than 200 sq. ft, at least 5 feet from any other structure) Permit Fee: $25.00 Check # 5 PLEASE TYPE OR PRINT ALL INFORMATION , 1. Name of Applicant: n C Gki Address: )4C r)( Telephone: S t 03/ 2. Owner of Property: ; Ct ve-1 ' n C. (Don Address: S < Telephone: Sc N 4— 3. Status of Applicant: ? Owner Contractor 4. Structure Location: 13 H ri c 1 Parcel ID: Zoning Map # Parcel # District(s) (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Use of Property: Single Two Family: /r Multifamily: Commercial: 6. Description of Proposed Structure: Shed under 200 sq. ft. X Freestanding Deck under 200 sq. ft. Other (describe) p 7. Attached Plans: Sketch Plan X Site Plan Plot Plan � b(ck c,C)i 8. Does the site contain a brook, body of water or wetlands? NO X DON'T KNOW YES L � l IF YES: Has a permit been, or need to be, obtained from the Conservation Commission? Needs to be obtained Obtained , Date issued CONTINUED ON NEXT PAGE File # MP- 2012 -0094 APPLICANT /CONTACT PERSON CLOONAN JACQUELIN ANN ADDRESS/PHONE 43 HARLOW AVE (413) 586 -0315 Q PROPERTY LOCATION 43 HARLOW AVE MAP 38D PARCEL 038 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid '5Y1 Building Permit Filled out Fee Paid Typeof Construction: ZPA - 8 X14 SHED 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 Ir dMATION 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 Permit from Elm Street Commission Permit DPW Storm Water Management ! /2,5 Signature of Building Official Date ll 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.