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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 z ,-- 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.