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25A-052 (2) � �� '� a.. � � � � � � �� `� � �` � cr � `� � � �� c� �c '�- �y �\ r `� V a . �• �� .......... (bi r),7 C�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 l/ IF YES, describe size, type and location: 11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Tfzis cohnnn:reserved for use by tlee B•eriiciing Department TING PROPOSED nor. .. Lot Size .Frontage Setbacks Front Side L: R: L: R: Rear Building Height G. Building Square Footage - *.�.�. All %Open Space: (tot area - minis btnlding&paved parking #of Parking Spaces #of Loading Docks Fill: il (volume Et location) _- 12. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: '71 d16' Applicant's Signature NOTE:Issuance of a zoning-permit does not relieve an applicant's bar en to comply-A ith all zoning requirements and obtain al> required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Deparbnent of Public vJorii s and other applicable permit granting-authorities. ODD pdf . i i i File Nof �,��..� V 2pp� �_______ �'lease a oriprint all ia€©rmation and return G Cr I'D DE",e'c o s cf� th the $.t 5 f Hng fee (c�Ceck or mo ey N � ° ' able to the City o/fNo�rthamptort 1. Name of Applicant: �j� /�� Address: g � ST , � 5%// ii�fl�/r/ Telephone: S�� 7-7 y 2. Owner of Property: %Tf/ zl-d z'!�—lti Address: Telephoner 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) 4. Job Location: NW 5C1 26417 C/i/j�,�/ 011 -5 4&2 5XL O� ��/� ff�/ P(�. z . 5. Existing,Use of Structure/Property: 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): Amw d0aw 61V 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 ��` 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/of 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) File#MP-2005-0019 APPLICANT/CONTACT PERSON Richard Labombard ADDRESS/PHONE 119 Park St (413)527-7427 PROPERTY LOCATION 49 HUBBARD AVE MAP 25A PARCEL 052 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM ILLED OUT Fee ai Building Permit Filled out Fee Paid Typeof Construction: ZPA-REPLACE GRADE LEVEL DOOR WBULKHEAD ON BLOCK FOUNDATION New Construction Non Structural interior renovations Addition to Existing Accessory Structure Buildin¢Plans Included: Owner/Statement or License 3 sets of Plans/Plot Plan THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INFORMATION PRESENTED: Approved Additional permits required(see below) PLANNING BOARD PERMIT REQUIRED UNDER: § Intermediate Project: Site Plan AND/OR Spei Major Project: Site Plan AND/OR Spa ZONING BOARD PERMIT REQUIRED UNDER: § Finding Special Permit Received&Recorded at Registry of Deeds I Other Permits Required: Curb Cut from DPW Water Availability -Z � Septic Approval Board of Health Well A Permit from Conservation Commission Pei Permit from Elm Street Commission 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.