28-014 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. Will the construction activity disturb (clearing, grading, excavation, or filling) ove 1 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 columm reserved
for use by the Bidlding
De artneen.t
EXISTING PROPOSED REQUIRED-BY
ZONING
Lot Size
Frontage
Setbacks Front jug `lo/
Side L: 5 R: L: �JS_t R: 5� ► L: R:
Rear
Building Height
Building Square Footage
Open Space: (lot area
minus building Et paved r- �•
parking ��
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et location) /
• f
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: �� � / Applicant's Signature /U'1.s'i%` e�
NOTE:Issuance of a zoningpermit does not relieve an applicaldt'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. f
W.\DocumentsTORMSI originallBuDdin,--lnspector�Zoning-Permit-Application-passive.doc 8/4/2004
p �
AM 2.3 2014 '
File No.
Efect c, Plumbin ,&Gas In �
P� print all information and return this form to the Building
Inspector's Office with the $Y5 feling fee (check or money order)payable to the
City of Northampton
1. Name of Appli cant:
_ ''i' � /�>�1
Address :�2-2 5�iW,� ikV 9::'r ri=, is )) ACTelephone: Z fG �Z
2. Owner of Property:_AC41i leek,
Address: S;f?/t'i-e _ Telephone: &5 5M -
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) f4G �F�U �
4. Job Location: Ne,K f �C �I 7
Parce.[ Id Zornng Map# Parcel# _ - D�strlct(s)
_L -
_
- 7n-Elm Street Distract _ =qln Central.Business=Distract-= - =
(TO BEE"FILLED=IN BY7HEEBl7.ILDING_.DEPARTNiENT}
\ - -
5. Existing Use of Structure./Property: V61 CCC(.4/i;4- /C -ft�z O ( 'a"5- 1
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
S. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO f/ 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:1Documents\FOr,MS\original'Buil ding-lnspector\Zoning-Permit-Application-passive.doc 8/4/2004
File#MP-2014-0087
APPLICANT/CONTACT PERSON LAVALLEY MARK
ADDRESS/PHONE 207 SYLVESTER RD (413)695-4782()
PROPERTY LOCATION 249 SYLVESTER RD
MAP 28 PARCEL 014 001 ZONE
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: ZPA-SFH
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 ATION PRESENTED: °
pproved Additional permits required(see below) AffIulv6D t"j:T ti ��Nk�i'T�►J 1 Mfg S
PLANNING BOARD PERMIT REQUIRED UNDER: §
FR�ftc��'J `IS feu rCK���
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan W 6T LA0b-'j" /q Q VrR
ZONING BOARD PERMIT REQUIRED UNDER: § &O'Q y A D NO
36T 6Ac*5 S H��U n/
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Np W
Other Permits Required:
Q N '3��L�C w•� (S1 —.
Curb Cut from DPW Water Availability Sewer Availability
1 J
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
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.