31A-114 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 pi
IF YES, describe size, type and location: i L : At'./] VU . i c,J 2: ' S t 'i Q )
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 REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage Z J 00 �,� 3�
% Open Space: (lot area
minus building ft paved
parking
# of Parking Spaces
# of Loading Docks
0
Fill:
(volume � location) 0
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: (� Applicant's Signature i( eerfiz
NOTE: Issuance of a zoning permit does not relieve an a plicant's burden to comply with all zoning
requirements and obtain all required permits from the Board of Health, Conservation Conuniission,
Historic and Architectural Boards, Department of Public Works and other applicable permit gran tin
authorities.
8/4/2004
W:\ Documents\ FORMS\ original \Building- Inspector\Zoning- Permit - Application- passive.doc
File No.
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
1. Name of Applicant: #1((i
'
'i
Address: 10 ( � { 1 ) t 1 Telephone: L, (3 5 F 4 _. 0 p S J{ D G
2. Owner of Property: � ,� AI 'CAA kJ ' ,. t , r
Address: 1 1 D �� Q 1L 64 Telephone: 13 g u S0 g
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: Lip \1 e--(1v yVM S
In ttm Street Distract iEn Central Base s 1hstract
. „°r.ix�Y . U Q a N, ; B1Tllj��N'C�PATMEI�NT} <'' c mss.
5. Existing Use of Structure /Property: f i\tqa-rj C011(u s�s rc 1 c
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
o
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
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 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)
8/4/2004
W: \Documents\FORMS \original \Building- Inspector\Zoning- Permit- Application- passive.doc
rzCl.cIvcu ma
•
" 2 8 2011 v--tv 1 0/79 P O _
Date Filed File No ./,
R rr• OM OFFICE /OCCUPATION (510.2 & 11.11)
Wit . e Building Inspector
Name of Applicant: Ke((iA
Address: j Q jer1A0A Tel 1•13. 5 F35lI3
2. Owner o Pro erty: •tk1) �
f
Address: X14 \I ertkoA Telepho SSA{ 85y -
3. Status of Applicant: Owner Contract Purchaser Lessee
Other (explain:
4. Parcel Identification: Map , Parcel -D
Zoning District(s) (include overlays)
Street Address WO Q,11A0tit _ •
5. • Narrative Desciption of 1 Proposed H me Office: (Us additional sheets
if necessary) 1'� ��cin� t - t CO t11 + tACt1 0 s ' io OC 4'
6. Is this a legal resi ntial building ?. 4 NO
7_ Will there be an e p /owner who doesn't live in the home ►to NO
8_ Will you ever see c lents or customers at your site? A NO
How .often ,1( co ( 9
For what purposes P. -re,ok n)
9. Will there be any signs for the Home Office? • NO
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? YES g
11_ Will there be any outdoor storage of materials? YES
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)? CP NO
If NO explain:
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 civil actions_ .
Date: �� 2 - k( Applicant's Signature: • Aj,14/
wr
- - - - - - - - - - THIS SECTION FOR OFFICIAL USE ONLY: _________
NLY: - - - - - - - - -
Approved as presented /based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF Tnls YEAR AND MUST TaEN BE RENEWED
Denied as presented - -- Reason: -
Signature of Building Inspector Date
NOTE iwasnos of a perrnit does not roifovo an applicant's bc:rden to comply with aft zoning raquiraments and obtain all roquirod pro mitt=
from tho U. acrd of Haatth, Consarvatlon Cornrnlczion, Dopartmertt of Public Works and othar appiicabia porrnit granting authoritios.
File # MP -2011 -0080
APPLICANT /CONTACT PERSON COFFEY KELLY
ADDRESS/PHONE 40 VERNON ST (413) 584 -8548 0
PROPERTY LOCATION 40 VERNON ST
MAP 31A PARCEL 114 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 1J / � �S
Fee Paid
Tvpeof Construction: HOME OFF/REG - PERSONAL TRAINING STUDIO
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 PREST
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: § /o. / --
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
,filar 1/
Signature of Building Official Date f
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.