20-002 (2) 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
r_ NO
V"
IF YES, describe size, type and location: ood� SIB K- OK r� E0 a-p
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 _V'
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 artment .
R 515=
EXISTING PROPOSED ` _
Lot Size
65 ages. Sams
Frontage
DO Same
Setbacks Front /o66
6 D p
Side L: R: L: R: L. ft:
Rear
Building Height
Building Square Footage
�? v456 SCk -P
%Open Space: (lot area �^� o/
minus building &paved C/q
parking`F -
#of Parking Spaces
#of Loading Docks
Fill:
_(volume& location)
13. Certification: I hereby certify that the information c ai d 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 a licant's burden to comply with aR 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\oril-rmal\Building-Inspector\Zoning-Permit=Application-passive.doc 8!42004
zk
_ 200n � File No.
:6-
-
DEPj Dt � t aII information and return this form to the Building
"R'�� tor's Office with the $ISfzlingfee (check or money order)payable to the
City ofNortharrrpton
1. Name of Applicant: C fl,.,j C txf
Address:— Q40 QESc TCEFFICL� eo qp Telephone: "�� -- 585 7o 3
2. Owner of Property: Jofl
Address: 940 CSI-E;STE EIELL Telephone:
3. Status of Applicant: Owner I✓ Contract Purchaser Lessee Other (explain)
4. Job Location: St,LF- EM PLOy&-�
5. Existing Use of Structure/Property: K zS I-b E/VC-�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
0PEA) 4- 9P .A-LEIST (A5;YW 2 -M 3 bedrdvrns
J
Z— 3 kq-I-km-m s _ All Corts4i,u(47` ko s u4,, co m el
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 permit 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 y date issued:
(Form Continues On Other Side)
W:1Documentsl FORMSbriQinarauilding-Insp--ctor\Zonin,--Permit-Application-passive.doc 8/4/2004
File#MP-2006-0092
APPLICANT/CONTACT PERSON CLAPP JOHN I&
ADDRESS/PHONE DIANA BOYLE-CLAPP
PROPERTY LOCATION 940 CH LD RD
MAMP„
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM ILLED OUT 4 44,e
Fee ai
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-BED&BREAKFAST
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 PRESF TED:
Approved Additional permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: g � /O
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 Street Co ssion
200
Signature o Building fficial 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.