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10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: V)PoI / 7e
d` 3 5 �f�RJ s -r� y s i t�1�S 5 �11✓S LiA��s
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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 filling) 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 ItEQi1II�ED BI'
Lot Size
Frontage
+f:
Setbacks Front ja 0 .-r-
Side L• R: L• R: R:
Rear ('O FT-
Building Height
Building Square Footage
01-cl" sg- =
%Open Space: (lot area twX
minus building &paved
parking / / 000
#of Parking Spaces
#of Loading Docks Q
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 3Z 18— Applicant's Signature
NOTE:Issuance of a zoning Permit does not r ' e 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:\DocumentsTORMSI original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
C, ltn f 'LL_
4
M A 1 8 2099
g File No.
FT, Zo
Plea e'tjpe-orprint all information and return this form to the Building
Inspector's Office with the $15 filling fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: A Cot Vj S
Address: 6,57EgFkt-V:�� r-D , (BEDS f-,jA Telephone: 6L 1 3)
2. Owner of Property:
Address: G.lfviz� �� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: �� �J£S \AA?-,?%Z)T---J �. (jtT.(o�� �2���lFn�',��uy MA
4
5. Existing Use of Structure/Property: 3�/ X 6,47ZA
R 4.(Z),, MCcam' 5M?_A(�E 1W 0 641V Z)SLPtf S_ M,117ZZ►AL-
oFFtc.€ /fNP
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
C c7N-n Iy 6z) y 5 CR,-)
061 i(,6 - C t)i4Z6WE C>L-. *J 62- t..7c,-) _o �;E Lads-,N!, TttE
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ver been issued for/on the site?
NO_.T. DONT 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 date issued:
(Form Continues On Other Side)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/42004
rr
File#MP-2009-0074
APPLICANT/CONTACT PERSON JACOB SCHRADER
ADDRESS/PHONE 112 Chestfield Road (413)575-1426()
PROPERTY LO(—TION 383 WESTHAMPTONII
1
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM LLED OUT r_ r
Fee ai J
Building,Permit Filled out
Fee Paid
Tyueof Construction: ZPA-CONTINUED USE
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
INFO,RMATION 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* 1 t
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
4AW 70 Brt
Permit from Conservation Com rnission Permit from CB Architecture Committee
Permit from Elm Street ommission Permit DPW Storm Water Management
Signature of 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 IIealth,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.