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10., Do any signs exist on the property? YES NO.
IF YES, describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO V
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO
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 �tEt2T733.3 '
diLot Size ,, - .
Frontage
Setbacks Front
Side L R: L: R: L_ :::. _R.
Rear ; r
Building Height
:• ding Square Foo .:r O. 59CA IC
,1111.-1 . Laa!' !, Sta rt 2 #,,--4/
4 Open Space: (lot areas Q � �'/ /C{ �2 .., ,.-- :Y:� :k a<
Minus building &paved t .
parkin. 7Z7�/�.( 2 ) �' 4'5 2 CATS 9 , - .. .. . ..
arking Spaces /Je�'re '- - - - -
YL :i
i curs 3 Co Z cam, ` ... . . • •
tt of Loading Docks
.---EiilL
(volume& location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. . -
Date: 19/1
�Z°/Z 6/3 Applicant's Signature ��Z `a ,....3
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\originanBuilding Inspectof Zoning-Permit-Application-passive-doe S/4/2004
RECEIVED
to t 12013 I ynD) 3-./3 3
�... file No.
Pt-441-1. -F xa*cy s.�.ea;c.K .R+iw►'n v.sv�.arss C: 'a.vr:�r.�a�.�c ua� � m "5=-�m ♦ 1 ,ri. ���
'r� ''rr.'e p' '�. ` '. F'�- „ .�.+. �. "' a �'. ay*t i.�5,
PIease type or print all info on and return this form to the Building
Inspector's Office with th 15 filing e (check or money order)payable to the
1 yol• ortharnpton
1. Name of Applicant: 7o 61(/ Aer - •
� � .7 — (7
Address: �S /T�?��2( �� �ld� 0 Telephone: y� �� .
2. • Owner Of Property': Plr V/V. �o.Se k)�--`��e�
Telephone:•i& t'Address: hi,z,n_.( a.�
Status of Applicant: O. .ner tract ti �c-i,asor 1 ncccc?'. . Other (explain) -
... J7LL's Ot .:�}1tFLaut. �..+ve etyma Cieu �� - -
4. Job Location: /L / / 7 ? Ado 0/.060
�`�a°'r,� •��-- i� �`^^�;s'..� '�. '"t_r."�'._ "may A 'a
-`-�` ' �' .'�a-�• F '�""S""� '.a �-.- .-i, .:�c..^ --'"--� Z y-
-
•
I Elm.'$tFee t :et r�a- Lirr 3LYeSSr ti15LT �`� � � S z'�¢
NOROAR1"•NI£NR ,..> 1`75 ,.`4
5. Existing Use of Structure/Property: /ref
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/ p-
'a - • l(/ L 2 tze�-�/e ee.��lrfV� k.•(�1
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a,Spe cial Permit/Variance/Finding ever been issued for/on the site?
/
NO t/ DONT 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_\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 814/2004
File#MP-2013-0133
APPLICANT/CONTACT PERSON ROSENBERGER DAVID W&VANNAK SAING ROSENBERGER
ADDRESS/PHONE 55 HATFIELD ST (413)584-7617()
PROPERTY LOCATION 55 HATFIELD ST
MAP 18C PARCEL 053 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Lii,i 1/ ( ' f b
Fee Paid `�``
Tvpeof Construction: ZPA-2 ADDITIONAL PARKING SPACES
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 PREySEENTED:
Approved V Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § g-1
Intermediate Project: V 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
ate_
6( 7 I3
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.