12-033 (3) Stephen Petegorsky 172 North Farms Rd. Florence, MA 01062 413.584.0999
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9. ALL INFORMATION MUST BE COMPLETED:PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled h by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage WA WA 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: 6/2/773 APPLICANT'S SIGNATURE Adir
NOTE:Issuance of a permit does not relieve an applcant'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.
04YNAPTp City of Northampton ..-.- _
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Massachusetts A!, *'`- <e c.
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: 1 4 DEPARTMENT OF BUILDING INSPE f IONS R E C E I iV/ g
212 Main Street • Municipal Bui din •`'
°"".0 Northampton, MA 01060 JUN INSPECTOR 2 l 2013
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DEPT.OF BUF DWG IiN. C- O ,
ACCESSORY STRUCTURE PER , -." '1• • ` a -
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check#404,_
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: -:-S i.e. r ke yl ?e-1'r 6 n(ZJ)C y
Address: ` 1 2-- / - p 4L P R � ('Telephone: Y [
o ✓,� lri..0 L� . Tele hone: ���/—0
2. Owner of Property: 4,-+e,01^.C✓l * C 1 1 Z-ec Ine t1 Pe:--fP ej p psi(,
Address: 7 2_ NOg._-L1 rte' f Telephone: < 3I me 7 j 7
XOwner Contractor
4. Structure Location:
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: Multifamily: Commercial:
6. Description of Proposed Structure:
One Story Shed under 200 sq.ft.: Freestanding� Freestanding Deck under 200 sq.ft., less than 30"above grade:
Other(describe): 16 6 ' I o- S),>!ef
7. Attached Plans: Sketch Plan Site Plan Plot Plan
8. Does the site contain a brook, body of water or wetlnds? NO DON'T KNOW YES f�
IF YES: Has a permit been,or need to be,obtained from the Conservation Commission? n� 11�(q- ?' f fkf
Needs to be obtained Obtained , Date issued
✓">`. 1 4 e(
CONTINUED ON NEXT PAGE
File#MP-2013-0134
APPLICANT/CONTACT PERSON PETEGORSKY STEPHEN&ELIZABETH M PETEGORSKY
ADDRESS/PHONE 172 NORTH FARMS RD (413) 584-0999 0
PROPERTY LOCATION 172 NORTH FARMS RD
MAP 12 PARCEL 033 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA- 10 X 12 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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION PRESENTED:
V App1roved 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
i
d -e.:43
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.