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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:
11. Will the construction activity disturb (clearing, grading, excavation, or fitting)over 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
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIItED BY
ZONING
Lot Size p f _ 3 7
Frontage 0 0 o
Setbacks Front -I- S00 jrj�,
Side L:f/00 R: S0 t L: R: L: R=
d
Rear `
Building Height ,L
Building Square Footage
%Open Space: (lot area
minus building Et paved -1 /00 7
parking
#of Parking Spaces
#of Loading Docks
Fill: Ill we,- /tom 1",
(volume£t location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicant's Signature ,
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\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
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!LIT
Please type or print all information and return this form to the Building
Inspector's office with the $15filingfee (check or money order)payable to the
City ofNorthampton
Address: 3-5-/ eZ,e 'It' Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location:
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
6. Description ofProposed Use/VYork/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan jl� Site Plan Engineered/Surveyed Plans
8. Has aSpecial Finding ever been issued for/on the site?
NO____-___ DONTKNOVY � YES________-- |F YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO ________ DONTKNOW ___-__ YES
IF YES: enter Book - Page __--_ and/or Document#
9.Does the site contain a brook, body of water nrwetlands? NO DONTKNOVV __-__-_ YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
.�
Needs tobeobtained Obtained . date issued:
(Form Continues on Other Side)
w:\Dvmmenm\FooMmvzigival\ammmg-ImpeuvmZouiug-peroit-xmxicmim*passme.wc ~.^~_
File#MP-2008-0085
APPLICANT/CONTACT PERSON City of Northampton-Office of Planning&Development
ADDRESS/PHONE 210 Main Street ( ) 587-1265()
ROPERTY L
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORNVFILLED OUT /"I f
eeF_ g_� y r L.L�
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-DEMOLISH ALL STRUCTURES ON PROPERTY
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 PfLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I ATION PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project : Site Plan AND/OR Special Permit with Site Plan A-6
Major Project: Site Plan AND/OR Special Permit with Site Plan ��G r
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 ssion Permit DPW Storm Water Management
11Z12otoS
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.