35-285 (3) 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. 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 3� MED��
a
Frontage
Setbacks Front
Side L: R: L: R: „,
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building Ft paved parking . =
#of Parking Spaces
#of Loading Docks
Fill:
(volume Ft location)
12. Certification: I hereby certify that the information contained herein is tr r6'and to to the best of
my knowledge.
Date: Q'I Applicant's Signature
NOTE:Issuance of a zoning permit does not relieve an plicant'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.
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File No.
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Please type or print all information and return this form to the Building
Inspector's Office with the$15 filing fee (check or money order)payable to the
City of Northampton
x% 1. Name of Applicant: -�° i`�r1 �'V /�'e9, ec—
Address: `� `) �J/�' ' ^'' �1ZPn.t N Telephone:
2. Owner of Property:
Address: A Telephone: C) )3 " �P
3. Status of Applicant: Owner Contract Purchaser Lessee Other(explain) c'✓s
4. Job Location: '� '`�1�/�^r 1�'• n 7 0/ 0 12
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. 5. Existing Use of Structure/Property: i ��' ✓h ,1 t S'��,tiC'
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
—
o 7"x/1 q r e 44 p i'►'t a N
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 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)
ECE WEB .
Date Filed # File No.j"05 dJ
REGI82`RA ®N� n M�. 11 '=CE/OCCUPATION B10-2 & 11_ 11)
With the uilding Inspector
� m tR ,y o �N7cIZ�t�
1. Name of ;Applicant
Address:' Telephone: .�f ►3 5 { 3 7
2_ Owner of Pro rty: m A;Z;>tZre•--,
Address: mf Telephone: 9-1 ►
3 . Status of Applicant: Owner Contract Purchaser Lessee
Other (explain: )
4 . Parcel Identification: Map " ' Parcel J` ,
Zoning District(s) (include overlays)
Street Address
5_ Narrative Description of Propose Hom e 0�;ice: (Use additional sheets
if necessary) a�-ryn �;, DL k
G_ Is this a legal residential building? NO
7 _ Will there be an employee/owner who doesn't live in the home YES (E
8 . - Will you ever see clients or customers at your site? YES }
How often
For what purposes
9 . Will there be any signs for the Home Office? YES TO
10. Will there he any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale, or any
display of goods on premises? YES T
11. Will there be any outdoor storage of materials? YES TO
12 . Will your use be totally within a building and not cause any
outward manifestation (including traffic generation, parking
congestion, noise, air pollution, and materials storage) ? YES NO
If NO explain:
13 . Attach Plans (if applicable)
14 - Certification: I hereby certify that the information c tained herein
is true and accurate. I understand that if any informa 'on incorrect,
my permit is null and void and I may be liable for no cri al fines and
criminal and civil actions.
Y
Date: v-/0 y y Applicant's Signature:
THIS, SECTION FOR OFFICIAL IISE ONLY:
Approved as presented/based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF THIS YEAR AND MUST THEN BE RENEWED
Denied as presented---Reason:
Signature of Building Inspector Date
NOTE:lazuanco of a permit doe:not relieve an applicant'a burden to comply wfth all zoning requirements and obtain all roqulrod permits
from the Board of Health,Consorvatlon Commiszlon, Department of Public Works and other applicable pormtt granting authorltlos_
File#MP-2005-0023
APPLICANT/CONTACT PERSON ANDERSEN ANTHONY
ADDRESS/PHONE 28 SYLVAN LN (413)585-9847 Q
PROPERTY LOCATION 28 SYLVAN LN
MAP 35 PARCEL 285 001 ZONE SR
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: HOME OFF/OCC REG-MORTGAGE BROKER
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
INF9RMATION 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 Street Co sion
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.
28 SWAN LN MP-2005-0023
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 10660
Map: 35
Block: HOME
Lot: 001
Permit: HOME OFFICE/OCC_RE OFFICE/OCC REG
Category: Home Office/Occ Registrat
Permit# W-2005-0023 PERMISSION IS HEREBY GRANTED TO:
Project# JS-2005-0182
Contractor: License:
Est.Cost: $0.00
Fee: $15.00 Homeowner as Contractor
#of Fixtures: Owner: ANDERSEN ANTHONY
Applicant. ANDERSEN ANTHONY
AT. 28 SYLVAN LN
ISSUED ON: 17-Aug-2004 AMENDED ON. EXPIRES ON. 01-Jan-2005
TO PERFORM THE FOLLOWING WORK:
HOME OFF/OCC REG-MORTGAGE BROKER
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Home Office/Occ Registration REC-2005-000491 11-Aug-04 1198 $15.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272
GeoTMS®2004 Des Lauriers Municipal Solutions,Inc.