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31B-159 (9)
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'i -,11:-,1 :',:-.I.:,,,,4,,,,',:..i,;.:••,'-',4,,,k4)--..-."- , P' t • 1■::''', i.'11',•",,, 4 1,1- 'a °t_ l', '•,"11;,!11:1'.., '411.11„ tt ; -;'.".,,''‘ 14' '' ,,,,7„--."4, .1,,.°. - ,..,°;.;.".-1 1, 1° .,,t.• 1. 11 t •1' 1- -'11., 1 , , " 1.,, ,, -4 •',- ,,,.!: , :::-.,--°:, '•••t‘i "'..-lit ...., r, - .. • ., . . . . . i. iJ .., ,,i` r"; , -it ,• ',,,,,,!:;-'i. ::'• ' : ,. •). '; ' - 'fl*,*:',,;':e • 7 : . 4k . 1 . • , 10, Do any signs exist on the property? YES NO S '„ 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 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 EXISTING PROPOSED` =a te, a 0 ;1 IAt Size j, s mo w.., 7 Frontage . Setbacks Front Side L: R: L: R: R: Rear Building Height Building Square Footage % Open Space: (lot area , aKC,i „,,.„ " F4 3 .a ; minus building & paved .. L K �fM1, j la{ 'Y ) parking # of Parking Spaces # of Loading Docks Fill: (volume & location) 13. Certification: I hereby certify that the information contained herein is e and accurate to the best of my knowledge. h / 1 Date: (� w Applicant's Signature S i (a1A/V7t7 ,, 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:1Documents\FORMSbriginal \Building - Inspector\Zoning - Permit - Application- passive.doc 8/4/2 • File No./'I 1 y f 4 .l. _._. ,.non....... , ..... ....- ,.. ._ -,. ro .- ..,, ' __ .. _ .. . ..., .d ,... .... ___-_ ,.- .u....w. ,.. ,..u. - . , : .:., 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 of Northampton ' EV' 0 Cr' NI 617'11/4-3 M ('S 1. Name of Applicant: Address 3 EL • � � A/154/71/1“4 /71/1“49/ -6/J Telephone: -C 7 3 t C7 ©t6we� nn n 2. Ow - ner of Property: a, � Ck rrrteu C e S i ) t'r d , At Lbw rove vt 5D le- 1( / S�7rz.ct /E�t U SE_ Address: 65 i ft (.1", i- 5f. 1 5PAN‘ . � Telephone: 7 5c 4-( � ltoS - 3175" 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) �t'A5� q � 4. Job Location: (01 k � C M — S KO ( (t) 1 Tb✓1J ( f -t g 0 1 O to P4 CH ' f Yt a&f /2 .e. ,... s t r w x 4 i ,r ti. r. .,.., .,-- _ , n ..__ t . '.:. 1 „. „� } t n, ,',, w.— . „: .m. ..” .,-.: .u: I --4 5. Existing Use of Structure /Property: V ACA N r ---- 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans .5"U ,yn S(a)S ¶O( NISIC12.CAI., c,o1/ 8. Has a Special Permit/Variance /Finding ever been issued for /on the site? NO X DON'T 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 )4 DONT KNOW .-YES---- ~ IF YES, has a permit been or need to be obtained from the Conservation Commission ? Needs to be obtained Obtained , dat tssued: 1 (Form Continues On Other Side) WADocuments\FORMS\origina [Building- 1uspector\Zoning- Permit - Application- passive.doc 8/4/2004 • File # MP- 2010 -0090 APPLICANT /CONTACT PERSON CONNORS JOHN REV ADDRESS/PHONE 3 ELM ST (413) 584 -7310 0 PROPERTY LOCATION 101, KING ST .< MAP "Irrnt 1 ZONE URC(10Q1/ • THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE (CONING FORM31,LED OUT �, '/i 9 01/6"-- r ee Paid Building Permit Filled out Fee Paid Tvpeof Construction: ZPA - DEMOLISH STRUCTURE 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 PRES),ITED: Approved lAdditional permits required (see below) PLANNING BOARD PERMIT REQUIRED UNDER : § 161- 3 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 i _ 1)6 OJT p6LA ggg 6 Signature of gilding Offi 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.