Loading...
42-112 (2) g l 12 v�vs art of &-C 9 I /41,4 Sa79- 4/ 9v c- I 1. trii t Re, a04 • • . ( 7 0 - 4 4 I e Il 1 1 e� 'Zoo /3// I0 mss: 7 e— We, i�.s Gt�'� �.- J avi /97 G 9'e YY� i �} 7r/ i2Q .1.20 c,.si; .rte. . Y.".• .��oir2L"�Yc t �Jr� 0.-"ele 2 a a - <S,�.-1 G ds 5ree p_ 10. Do any signs exist on the property? YES NO ✓ IF YES, describe size, type and location: i Are there any proposed changes to or additions of signs intended for the property? YES ✓ NO i IF YES, describe size, type and location: ✓ X / & % 7 ' ?42 O 22" /7--'54" 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 l/ 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: f Rear r '' Building Height :: �,f Building Square Footage / r' % Open Space: (lot area °� minus building Et paved parking `. # of Parking Spaces 7 , # of Loading D , . \ 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: ✓/ C '�' �( 7 Applicant's Signature _ .=. _ . �. , ..✓� i ----- 1 — _ NOTE: Issuance of a zoning permit does not relieve an appl' . it's burden to comply with all zoning requirements and obtain all required permits from i e 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. / 3 .5 7 ZONING PERMIT APPLICATION 010.2) 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: /J/9/Q 3 "a09/5 - 4/40veE "-5// rrh y /01/- Address: 69S � Telephone: , � enitc 2. Owner of Property: ' 7 / 17 1 #'94 7 IVA. % 4 Lf , <', R '9'f Address: `G'6 i9n'1P1 v2 If Telephone: //'a" 6-3-/- 79 3. Status of Applicant: Owner k Contract Purchaser Lessee Other (explain) 4. Job Location: r. Parcel Id: Zoning Map# Parcel# District(s): In Elm Street District In Central Business District (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property: e /Y! 6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary): Od 1'll°s.1 ,F;11).1- FL / -11)E-. 7. Attached P s: Sketch Plan / Site Plan Engineered /Surveyed Plans 8. Has a Special Permit 'ance /Finding ever been issued for /on the site? - NO DONT KNO YES IF YES, dat- 'ssued: IF YES: Was the permit recorded at - Registry of Deeds? NO DONT KNOW YES IF YES: enter Book P. and /or Document # 9.Does the site contain a brook, body of water or . ds? NO DONT KNOW YES IF YES, has a permit been or nee : - obtained from the Conservati • Commission? i ' � Needs to be obtained Obtained date issued: Form Continues On Other Side) W:\Documents \FORMS \original \Buil ding - Inspector\ Zoning - Permit- Application - passive.doc 8/4/2004 File # MP- 2013 -0059 APPLICANT /CONTACT PERSON LABARGE RICHARD J & MARIANNE L ADDRESS/PHONE 698 WESTHAMPTON RD (413) 586 -1011 () PROPERTY LOCATION 698 WESTHAMPTON RD MAP 42 PARCEL 112 001 ZONE THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out 0 760 Fee Paid Typeof Construction: ZPA - SURVEYOR OFFICE 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) 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 Street Commission Permit DPW Storm Water Management !(/F /ice 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.