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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
Frontage • NJA tp,,. N/A N/A
Front:
Setbacks: Side: L: R: ;: L :. R:
Rear:
Height
% Open Space:
(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: 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.
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City of Northampton
-- - q Massachusetts , E ,
r DEPAR2NT OF BUILDING INSPECTIONS ¢
a i i' 212 M ' n treat • Municipal Building
°. A , 7 • se No thampton, MA 01060 j ti '� '
INSPECTOR DLE - Or BUi
MA �� -+.,
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check # ? '
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: U d,'fM es 4 P1 Zola 7
' j . .._.
Address: .4 424 /ry1'7�r _�� & & Telephone: -* 7196
2. Owner of Property: ` - .5 A.,7#r C'.
Address: Telephone:
3. Status of Applicant: owner Contractor
4. Structure Location: 1, e
Parcel ID: Zoning Map # Parcel # istrict(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: ✓" Multifamily: Commercial: ,
6. Description of Proposed Structure:
Shed under 200 sq. ft. V Freestanding Deck under 200 sq. ft. Other (describe)
7. Attached Plans: Sketch Plan ✓. Site Plan Plot Plan
8. Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW YES
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
•
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File # MP- 2012 -0140
APPLICANT /CONTACT PERSON DOSTAL JAMES M & NANCY L D i
ADDRESS /PHONE 624 RYAN RD
PROPERTY LOCATION 624 RYAN RD
MAP 28 PARCEL 051 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid ii
Buildin_ Permit Filled out r�'�JAiz Pre
Fee Paid
Typeof Construction: 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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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 Peimit from CB Architecture Committee
Permit from Street C. 'ssion „ Permit DPW Storm Water Management
r
Signature of :wilding 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.