22B-041 (7) 12/12/2013 12:14 14135871272 NT114 BLD DEPT PAGE 02/02
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—Nfo—��
IF YES, describe size,type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) acre or Is it part of a common
plan of development that will disturb over 1 acre? YES . NO -2�
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 rescryed
for rice by the hruHdtqg
EXISTiIVG PROPOSED REQUMED BY
Zoilasr-
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: W
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building &paved
arkinq
#of Parking Spaces
#of Loading Docks
Fill:
(volume&location)
13. Certification: I hereby certify that the information contained herein is true and Accurate to the best of
my kno e.I d9
e",
Date; ?/ �� � ._ Applicant's Signatur
NOTE:rssuance of a zoning permit does not relieve an applicant's burden to comply wilth aLU zoning
requirements And obtain all required permits from the Board of Han1th,Conservation Commission,
1-Ustoric and ArcWtectur4 Boards,Department of Public Works and othar applicable permit granting
autho.1rities.
-Pamive.ftc 8/41004
12/12/2013 12:14 14135871272 11TON BLD DEFT PAGE 01/02
r V
\� - 7� ,---� ,File 1'Ta.
ONIN
Please type or print all information and return this form to the Building
Inspector's Office Wth the $15fxlfngfee (check or money4rder)payable to the
City ofNorthamlpton
11 Name of Applicant: I � �U
113J T- z
Address: Telephone: -- —
2. Owner of Property PL 1-
Address: f,)! Telephone:
3. Status of Applicant: Owner Contract Purchaser�.,._Lessee V Other (explain)
4, job Location: O[� 2
Parse! Id: Zoning lutap# Parcels pistriCt(s):
to rn Street t3isirfct_ In Central RusinessSDistrict
f 1
7l7 BE F'I'LLED IN BY'THE UILl INN DEPARTMENT) .
5, Existing Use of StnuctUre/Property=
G. Description of Proposed Use/Work/Project/Ocsupation: (Use additional sheets if necessary):
�'��'��� ll f�//✓�� �hS���r� �i��tia iffi ��'/�� J�C� t,�✓,� St�ry/'rte
�l(��e 7�7� r,.�,��n y �)<!? rl��i �� <ica�✓ fy<ai;�i�L�' ��G v At /2;c°tlf/o�)�S
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
g. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW %/ YES ___.__ IF YES, date issued:
IF Y'ES: Was the permit recorded at the Registry of Deeds?
NO _ DONT KNOW YES
IF YES: enter Dook Page and/or Document#
4.Does the site contain a brook, body of water or wetlands? NO ,. DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained date issued:
(Form GontInues On Other Side)
tiV:�DaoumontslYOkMSVoriginati$uildittg•Btspectorl oitittg•�'zunit-Ap�1}1C3t1011'p4RSIVE.�6C 8/412004
File#MP-2014-0057
APPLICANT/CONTACT PERSON LIU JINHAI
ADDRESS/PHONE 4110 BOWNE ST APT 5U (646)641-5421 ()
PROPERTY LOCATION 176 PINE ST
MAP 22B PARCEL 041 001 ZONE NB(100/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildine Permit Filled out
Fee Paid
Typeof Construction: ZPA-MASSAGE THERAPY
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
dZ
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.
176 PINE ST MP-2014-0057
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 8976 I
Map: '22B
Block:- 041 ZONING PERMIT
Lot: 001 it: ;ZONG
Perm , IN PERMIT APPLI
LI
_ - - __- ----____-� APPLICATION PERMIT
!Category: ;Zoning Permit
Permit# IMP 2014 0057 ---_ - PERMISSION IS HEREBY GRANTED TO:
Project# JS-2014-001273
- _- - - - -�Contractor: License: Expires:
.Est. Cost:
- -- _ Homeo
-
Fee Charged:'$15.00 �mer as Contractor
'Balance Due:i$00 Owner: PUN FAMILY LLC
#of Fixtures:' Applicant: LIU JINHAI
DigSafe# _.�AT. 176 PINE ST
- -
UseGroup
ConstClass
ISSUED ON. 03-Jan-2014 AMENDED ON. EXPIRES ON.
TO PERFORM THE FOLLOWING WORK:
ZPA-MASSAGE THERAPY
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Zoning Permit Application REC-2014-002603 20-Dec-13 208 $15.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:ihasbrouck@northamptoama.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.