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10. Do any signs exist on the property? YES NO C/
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO C--
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 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. ALI. ! NFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot ifJ(
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
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: 0 ,r t1
/ C) Applicants Signature / - (
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with . 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 - Inspector\Zoning - Permit - Application - passive.doc 8/4/2004
r
File No. -
Please type or print all information and return this
is form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
/� City of Northampton
1
1. Name of Applicant: C h ri. 5 "t(c)p/ X 1 -6 p A z---
Address: e 95 C S 1 r rc Telephone: CP ( 1 '1r
2. Owner of Property: ®0 4 0 tO AI O• • [ Z
Address: c (0 5 I • Telephone: ,(e T l
3. Status of Applicant: Owner Contract Purchaser Lessee //Other (explain)
4. Job Location: VitlieTil Ain Pt - 6 1 C 11:-4
F*arceF Id Zaning iA p#.,-i3 '. P'arcel Di trrct
fn Elms Sfree Drstcrct In Central Business Dis rret
(PTO BE FILLED. Ili BYa THEE BUI LD:ING, DEPART iIENTko ,. , ....
5. Existing Use of Structure /Property: 4(C) FS ' (00- 1 At 5
vOR 5
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
A cycr6 . r Ff D L 00 L1)110 131 - tin AL
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ev 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 Obtained , date issued:
(Form Continues On Other Side)
W:\Documents \FORMS \original\ Building - Inspector\Zoning - Permit- Application- passive.doc 8/4/2004
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Date Filed T : ti k "- File No. /
;,
REGISTRATION_ 0.TSHO OFFICE /OCCUPATION ( §10.2 .& 11.11)
' e Building Inspector
,' , , -]
_
1. Name of App icant WON ' ! 1-6-Lo /Ix z____
Address: , (, l it ,, 16K' j,.. Telephone: viff „ arkr
2. Owner of Property: b, t ♦ hi //SOU r u / 6
Address: •" i a, li, j , Telephone: 1
3. Status of Applicant: Owner l/ Contract Purchaser Lessee -
Other (explain: : [J/ Cy''<' L E.j )
4. Parcel Identification: Map # , Parcel f ,
Zoning District(s) (include overlays)
Street Address 1 MU,:
5.. Narrative Description of Proposed Home Office: (Use additional sheets
if necessary) pietyc F -3 Toc.at i w V S ("' W C 1 ">< - 1t� Tim IL
• Li • : " r lip k • if It ■ 14- At v . ..... 41/1/• •
O (' e p Ek.)l;'E f y s
' 6_ Is this a legal residential building? • N
: 7. Will there be an employee /owner who doesn't live in the home NO
8. Will you ever see clients or customers at you site? ES NO
Bow often 05 n r 037 Ro.tv'( (7'L
For what purposes g ‘ (0-r
9 . Will there be any sins for the Home .Office? YES f.1v
10. Will there be any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale,, or any
display of goods on premises? ..,,,
11..Will there be any outdoor storage of materials? •
12. Will your use be totally within a building and not cause any
outward manifestation (including traffic generation, parking
congestion, noise, air pollution, and materials storage)? NO
If NQ explain: P i <, . p ytaUaLL (o T _
13. Attach Plans (if applicable)
14. Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non - criminal fines and
criminal and ivil actions.
Date: 1 014 , 7 1 0 Applicant's Signature: �� ��� A %
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented /based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF THIS YEAR AND MUST THEN BE RENEWED
Denied as presented - -- Reason:
Signature of Building Inspector Date
NOTE: isauanca of a permit does not re an applicant's burden to compty with all zoning requirements and obtain all required permits
from tho Board of Heath, Conservation Commission, Department of pubiic Works and other appik *bta permft granting authorities.
File # MP- 2011 -0053
APPLICANT /CONTACT PERSON BEDNARZ CHRISTOPHER
ADDRESS/PHONE 256C STATE ST (413) 327 -2778 ()
PROPERTY LOC c .1 M
witmpoacti, 12 001 ZONE URC(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
Tvpeof Construction: HOME OFF /OCC - BICYCLE TOURING
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 Additional permits required (see below) AS ' rtit fr c t
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: § yco - 1 0 ` v- ) 3 GO 2, i
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
/r /q/16
Signature of Building Official 5-67 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.