35-255 (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 NO Lf
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 wilt disturb over 1 acre? YES NO _L,-
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 REQUIRED BY
ZONING''
Lot Size
ZS t S� S•F• Zs� S`13 S.F.
Frontage
Setbacks Front
Side L: R: L: R: L: ' R.
Rear
Building Height
Building Square Footage
%Open Space: (tot area
minus building Ft paved SG(3 S.� opt 5�T3 parking
#of Parking Spaces
#of Loading Docks
i�
Fill:
(volume Ft location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 8 Z 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
l , pG File No x _
3.
Please type or print all information and return this form to the Building
Inspector's Office with the X15 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: C r'k O` T)G(ty-yriewl- Oy CoeoC W02\,/S
Address: t25 I_DC0 Stf<-',V-",, voirlwplPi4at01ATeLephone: 413` SYL/670
2. Owner of Property: C I T `1 i la Y hi-ro 0
Address: QT (,0 CV S% S 1 a��t.C11D�1}r'4MCI-ON4l7 fi Telephone: q/3 -5-U- 1570
3. Status of Applicant: Owner Is' Contract Purchaser Lessee Other (explain)
4. Job Location: rk_f'ta
76E E, "5 rE *�x {s 1 �. €' €EE's a
MIN
EE L �i tn1ap#� � a � '. �Y'�e�fi a�INC,
.�� tEU "}
h
5. Existing Use of Structure/Property: POTg6l.1r2 WYV 1<<Z S I OAR'&C- 1 JJht1( 1FQ Q
C l i`I OF r.1�CLi���Y►,P�akv�s �VY�T CL SyS►`�
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
_ cogs,�X(W c,K T rl wa-lr;(L gior mr► s 11)nne- W saxi,e
V-00 VeIW 1 oG 4L�ISl tW6-- SiQa04G- i4r4c,.
7. Attached Plans: Sketch Plan Site Plan L--- Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO ]� DONT KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained date issued:
(Form Continues On Other Side)
W:\Docwnents\FORMS\original\Buil ding-Inspector\Zoning-Permit-Application-passive.doe 8/4/2004
File#MP-2007-0021
APPLICANT/CONTACT PERSON Northampton Department of Public Works
ADDRESS/PHONE 125 LOCUST ST (413) 587-1570 Q
iwom I�3 } C ._WTI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FI ED OUT
—0—
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-REPLACE WATER STORAGE TANK WITH TALLER
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 PRESPX ED:
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 Street Co on
A9
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.