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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
IF YES,describe size,type and location:
Y r. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED
DUE TO LACK OF INFORMATION. This column to be filled in
by the Building Department
EXISTING PROPOSED REQUIIZED BY
Lot Size ✓V L) 4
Frontage [� j
Setbacks Front
Side' L: R• fL: R' rL:^R•
Rear Lj
Building Height
Building Square Footagb `� f
% Open Space: (lot area
m 0 i �
nus building&paved lJ
parking
#of Parking Spaces
#of Loading Docks f
Fill:
(volume&location)
12. Certificati n: I h eby certify that the information contained e � i Ze a accurate to the best of my knowledge.
Date Applicant's Signature `''� (1
NOTE: Issuance of a zoning permit does not relieve an applicant's burden t 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.
3 1 77"
File No.
M` NT VG PERMIT APPLICATION 10.2)
Please type or print all information and return this form to the Building Inspector's Office with the
$10. filing fee (check or money order) payable to the City of Northampton
1. Name of Applicant:
4
Address: aavjelep hone:-
2. Owner of Property: 6 L4L-
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other(ex-plain)
4. Job Location: mil-' A,v, S4-i '
istrict(s):3 .D
Parcel Id: Zoning'Mao#: Parc el# ���d
In.Elm Street District: In Central,Business District
(TO BE FI -L LEDIN BY THE BUILDINGTEPARTMENT)'
:
5. Existing Use of Structure/Property Lt
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
ve w 4*,
eq, Z
V
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 pern-ift recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: enter Book Page and/or Document#
9. Does the site contain a brook,body of water or wetlands? NO DON'T 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)
o
File#MP-2002-0053
APPLICANT/CONTACT PERSON GUTOWSKI PETER A&ELIZABETH O
ADDRESS/PHONE 32 AUSTIN CIR (413)584-7820 Q
PROPERTY
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: REPLACE EXISTING DRIVEWAY&EXTEND 8.5 FEET
New Construction
Non Structural interior renovations
Addition to Existing
AccessoEy 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 Denied
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan OR Special Permit and Site Plan
Major Project: Site Plan OR Special Permit and 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
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.