32C-215 (5) 2'/2 STORY
IN HOUSE
52 zk
SOURCE ONE FIR
A140 THE
owi19dges inforrncsiic n and bolic-if, I i or4ptby repart that I ho
located rrt
the, prerni,ses demcf-ibecilp that
"Ouchm,Onts upon the prom;ue-9 do!sicribed by this Jmpr-z,>vmvr
I*r"onts of record aff4!3cting the tract sihowrt here_m0ti, excel
pr"rnisen ghown on this Flan I't; not located WiWin a
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10. Do any signs exist Dn 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:
11. Will the construction activity disturb (clearing, grading, excavation, or-filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO _ r
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
De aztment
E)CISTING PROPOSEDD �
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: /D
Rear
Building Height
Building Square Footage _
%Open Space: (lot area
minus building&paved v
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume& location)
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
i
Date: /L — Applicant's Signature— All 6
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\orie naMuilding-Inspector\Zoning-Pemit-Application-passive.doc 8/4/2004
JUN - 9 2005 JUL i ? 2005 1 File No VA,
p_,A RPLI A TION § 10.2
w,lr�mplete thins form` your corrrp to-� n the free Adobe PDF Reader
gyp:%/www.adobe.com/products/acrobat/readstep2.html). Print the completed form, sign it,
and return it to the Building Inspector's Office together with the $15 filing fee (check or
money order) payable to the City of Northampton.
1. Name of Applicant: -� O ✓1 " C�.1C�C��
Address: 7Q �1C7 lJ 5 r ( j4 y fUl4
3 'v City: � ��(�-� State: Zip: O10fn0
Telephone: C41 `J� C�
2. Owner of Property:
Address: 7 � l�5( City: /�'�� ���e''� state: /cam Zip: 0�6,
Telephoner z✓ S�� ��
3. Status of Applicant:
Owner & Contract Purchaser 0 Lessee 0 Other (explain)
4. Job Location: V t9-111 L /Vp/rkK7At P -ror-', Town: If d r
Parcel Id: Zoning Map# Parcel# l6, District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessa
y�,
7. Attached Plans: Sketch Plan T Site Plan 0 Engineered/Surveyed Plans DQ
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DON'T KNOW Q YES (�) IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DON"T KNOW 0 YES IF YES: Book Page and/ Document#
or
9. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW 0 YES
IF YES, does a permit need to be obtained or has a permit been obtained from the Conservation Commission?
A permit needs to be obtained 0 A permit has been obtained 0. and was issued:
OOO.pdf
File#MP-2005-0136
APPLICANT/CONTACT PERSON BOUCHER JOHN J SR
ADDRESS/PHONE P O BOX 1672 (413)586-9320 Q
PROPERTY LOCATION 37 HOLYOKE ST
MAP 32C PARCEL 215 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ILLED OUT
`'F'e�Pai
Building Permit Filled out
Fee Paid
Meof Construction: ZPA-CONSTRUCT 2ND FLR DECK
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 PRESET ED:
Approved dditional 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
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
11,41 1230<0
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.
a
File#MP-2005-0136
APPLICANT/CONTACT PERSON BOUCHER JOHN J SR
ADDRESS/PHONE P O BOX 1672 (413)586-9320()
PROPERTY LOCATION 37 HOLYOKE ST
MAP 32C PARCEL 215 001 ZONE URC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ING FORM ILLED OUT
ee Faict
Building Permit Filled out
Fee Paid
T_ypeof Construction: ZPA-CONSTRUCT 2ND FLR DECK
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 F LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INY9rRMATION 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 Stre ommission
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.