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-10" Do any signs exist on the property? YES NO v
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 constriction activity disturb (clearing, grading, excavation, or filling) ove 1 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
ZWs column reseed
for use by the Buildiggo
Deuartment
EXLSTING PROPOSED3
Lot Size coo LJ GC C
Frontage 7,-�o E, +
;,
Setbacks Front Jd�
Side L- ���' R: L: ( �:� R: �o' !�/ # l->✓
Rear
Building Height / ao 2
Building Square Footage
Open Space: (lot area
minus building& paved
parking 3
°r C er fAiei«1
#of Parking Spaces
#of Loading Docks f—
Fill:
(volume & location)
-13. -Certffca-tioh: I hereby certify teat the information contained herein is true and accurate to the best of
my knowledge.
Darn: � Applicant's Signature J/.�,
NOTE: Issuane/of a zoning permit does not relieve an applicant's burden to comply with all zonin.-
requirements and obtain all required permits from the Board of Health, Conservation Commission.
Historic and A chitectural Boards.Depar=ent of Public Work and otlber applicable permit ara-iLLn�
authoriz=es.
r.n
APO,
print aU information and return this form to the Bundina,
hi!sp e c t o r!s 0 f H'c e vvi th the $15 f1ling fee (check or m on ey order-)payable to the
-npton
I Name of Applicant: -rvier I-,:;x e c2A"
r r!2�r u,"ut f Pic,
Address: 7 5(-J1oc21 t)j re')e, Gr.q6y41WR3phone: -L.17- eO-3Y
2. Owner of Property:_ t3c m.,de-4 c- C.) ;bl vx
Address: 11c) �J '. lhc-ui5 6 If C --v kodLoelorl Telephone:------
3. Stags of Applicant: Owner - Contract Purchaser Lessee O`er er (explain)CDj'i4r-'j0'(-
4. Job Location 1 to odl"'04"
S. Existing Use oflStructure/Proper-ty:— (7?j&(-A6'e �210 rEabc-
0
6. D tion o, Proposed Use,,)Nork/P,-oject,C)ccLipatio,-i: (Use additional steets if necessary):
2" rl--� 'T A D f-r J) /e CA 1�5
!a C v f�. -
\j"\ C' b"' Lw' iLi Ltll___,t?, fj4er-j 01-, OV
A�WI�L2 IT I
g�k C\V'vx�"- kc- #U-%'d T VA LA t-c- -k-jo L" 4 e w c ce-J,
\J v / -
,-)A-fkAJLf-r5 PE i !.elf Ai&r-.( Would Oil - e-x(r-1:J �04 I\h k.r4"'-tlf'
7. Attached.Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
S. Has a Special Pem-ti✓Variance/Finding ever been issued for/on the site-,
NO DON7 KNOW� YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON7 KNOW L11 YES
IF YES. enter Book Pap and/or Document
9.Does the site contain a brook, body of water or wetlands? NO DON7 KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be-obtalnedi Ob-nined date issued:
(20= Continues On D�ter side",
—1 -r— M2
File"MP-2008-0063
APPLICANT/CONTACT PERSON TYLER BERGERON
ADDRESS/PHONE 7 SCHOOL ST (413)427-8034 O
PROPER"T
M �
........ ..
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: ZPA-REPLACE 1 STORY GARAGE W/1 1/2 STORY DET
GARAGE/STUDIO/STORAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessoly 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: § �• 35-0 /. 3 c",)
AAIAR
Finding Special Permit Variance*
s-19-eprdc
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
Signature of Buil ng 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.