38C-020 (9) 10. Do any signs exist on the property? YES X NO
IF YES, describe size, type and location: FCRMEJ CAP /LLAJz S /fil ON POST' , 1
ST2FE T To REM A tn.) 4v N - vv L TTFT}21 /lrr 01 AIE2S' PlZh poser
51C 1JACrF Pa- 61(-44 A-LEIDr APPr24
Are there any proposed changes to or additions of signs r quie for the property? YES NO
PIo.Eaa. vAL�t c,Z6 $ r tPopcowS Si tr.)Alc S 1D now THey HM/
IF YES, describe size, type and Location. HA � pry h
11. Will the construction activity disturb (clearing, grading, excavation, or filling) fiver 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO ,A
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
/2 9 4C/2 ,6'S / 2 d',4 c,��s
Frontage
ca 2 Pr 63 2 fr
Setbacks Front
Side L: R: L: R: L R:
Rear /46. G HkN
Building Height
2 y ''
Building Square Footage
/S; o9'y 471 /S, o7y0
% Open Space: (lot area CJ
minus building Et paved 7Li c D 7 / co
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume £t location) i"� A/4
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: I Applicant s Signature 3 G4���
NOTE: Issuance of a zoning permit does not relieve an ap 'cant's burd 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. g -91
ZONING PEIVIIIT . !!PLI A-T,lON; "•
Please type or print all information and return this fo ; . ': t :I •
Inspector's Office with the $15 filing fee (check or money • er) pay • • - e
City of Northampton
11.11.2 81
S 10 . E
1. Name of Applicant: /•10�1A s A►. � N Ea.
NG
,,rr O1A0/04,o NO•� . a oN , 1NSPE
Address: /9� fIt,1s'INT ST 5OITT2OZ I NOQT1tAM miv, /it bT A Telephone: I. 2 b _ •
2. Owner of Property: NI C 15g Try t. .
Address:gCric./f vim LANE:' 7- frkiTTN 44 0loll Telephone: 813.5 27 - 5 7 d /
3. Status of Applicant: Owner Contract Purchaser Lessee V Other (explain) A -tnT.E -
4. Job Location: 3 ?5 SouTM � 1")e-E , / dieThift-nArroty , (r.A Ot °co
Parcel Id. Zoning Map# Parcel# Distrlct(s)•
r •
In Elm Street District In Central Business District
{TO. BE FILLED IN E Y Th1 <BUILDING DEPARTMENT) :. .
5. Existing Use of Structure /Property: s/AC4r.tT' P
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
HALF of xi5nrvef l'ult..-bkOcr To Ho uSE USED G l� E4c.;E,QSHt p
1MlcK ( D ` $ , • OTHER- /4A-LFF 14)E PI SE ! R o Ss Fcr
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 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)
W FORMS\ original \Building- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004
File # MP- 2013 -0091
APPLICANT /CONTACT PERSON Thomas Douglas
ADDRESS/PHONE 196 PLEASANT ST (413) 585 -0641
PROPERTY LOCATION 375 SOUTH ST
MAP 38C PARCEL 020 001 ZONE URB(100)/WP(6)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT , f , n '`/
Fee Paid L f O y r Ju
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - PIONEER VALLEY CROSSFIT
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: § 3 , 9 3 (A) l /
Finding V 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
113
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.