32C-166 (9) 10. Do any signs exist on the property? YES " NO
IF YES, describe size, type and location: ON W►N ►?d u-'S
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: SEE h 12_4 W Irv& 5
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 5e-
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
1 S f 400 NC - 1 GH Cs6
Frontage
a5' Nc
Setbacks Front NC
Side L: R: L: NG R: NG L: R:
Rear
Building Height
43 FT re Kit26,E NG
Building Square Footage r 04jWIARr
tia" 11 .1.2o sF N
Open Space: (lot area
minus building Et paved G 5 ° /' /UG
parking
# of Parking Spaces
N G
# of Loading Docks O N G
Fill: o NG
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 1 2 • 2 Applicant's Signature ��`'"�'✓I /�
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 : \Documents \FORMS\ original\ Building- Inspector\Zoning- Permit- Application- passive.doc 8/4/2004
File No. /171
3.5
ZONI PERMIT Al C §Z 0.
Please typeor,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 f EO hi4 S t 0V G( 1
Address: 30 01E4 S i Fier kit o t � Telephone: 413 5
786" 6 641
2. Owner of Property: I f L p,12 t G G
Address: 1-04 G re 5't' 4 1 - A)or f a'7k" Telephone: 4 Ci3 5 0641
3. Status of Applicant: Owner > Contract Purchaser Lessee Other (explain) n
4. Job Location: I ct 6 PLEA S 4 r 5
Parcel Id: Zoning a # Parcel# District(s):.
P {s:. }
In Elm Street District In central Business District
(TO BE FILLED - IN'! THE BUILDING DEPARTMENT) _
5. Existing Use of Structure /Property: P V - OFF! GE - !3 Vi Yve S s
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
ENOVAi F t-At T viz- t iNfo - f - o /3 V5/ntes1 (USES
floD!pY FA6ADE A - l 5 t PC G EVE L
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 DON'T KNOW 7C YES IF YES, date issued: _
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW 71- YES
IF YES: enter Book Page and /or Document #
9.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:
(Form Continues On Other Side)
W:\Documents \FORMS\ original \Building- Inspector\Zoning- Permit - Application- passive.doc 5.'4,'.'_00.
File # MP- 2010 -0035
APPLICANT /CONTACT PERSON Thomas Douglas
ADDRESS/PHONE 136 WEST ST (413) 585 -0641
PRQl
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM) O //
LLED OUT >_
Fee Yai
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - RENO BLDG TO BUSINESS USE & MODIFY FRONT FACADE AT 1ST FLR
LEVEL
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 ACTI N HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRES TED:
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 Stre Commission Permit DPW Storm Water na :ement
/ Z® 0
Signature of Building 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.