23C-069 (3) 9. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size .
Frontage N/A NIA NIA
. ,Front:'
Setbacks:
L: R: . L: R-
-a-r-:*
Height
o Open Space:
(Lot area minus bldg and
Paved parking)
10. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge._
DATE: APPLICANT'S SIGNATURE
NOTE:Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities:
uj-ry or Norrnampron
:. -�.
}: Massachusetts `.
DEPARTMENT OF BUILDING INSPECTIONS �` r
- Y 212 Main Street • Municipal Building
Northampton, MA 01060 std
INSPECTOR
ACCESS ORYSTRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check # 5
PLEASE TYPE OR PRINT ALL INFORMATION
9. Name of Applicant: �� iii> %
Address: /�� ��/iSS � z 11enr,� Telephone:
2. Owner of Property:/er xi-- ✓c'h� /
Address: /2 Telephone:
3. . Status of Applicant:_/Owner Contractor
4. Structure Location: LQncer c•-f /iSS klzlk ) it'I1l z"
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: ✓ Multifamily: Commercial:
6. Description of Proposed Structure:
Shed under 200 sq.ft."•" ✓ Freestanding Deck under 200 sq.ft. Other(describe)
�KZ4
7. Attached Plans: Sketch Plan :✓ Site Plan Plot Plan
B. Does the site contain a brook,body of water or wetlands? NO 11 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 7 {M
. 0 c o-4 c h
CONTINUED ON NE
� .
File#MP-2014-0091
APPLICANT/CONTACT PERSON JONES WILLIAM P&BARBARA A&STEPHEN JONES&M W JONES
ADDRESSIPHONE 118 BLISS ST
PROPERTY LOCATION 118 BLISS ST
MAP 23C PARCEL 069 001 ZONE URA(100)/WSP(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA- 10 X 16 SHED
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
INFOIWATION PRESENTED:
pproved 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 Commission 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 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.
118 BLISS ST MP-2014-0091
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS#: 3133
Map: 23C
Lot: 069 ZONING PERMIT
Lot: ____- -- 001 —
Permit: ZONING PERMIT APPLI APPLICATION PERMIT
Category: shed
Permit# MP-2014-0091 PERMISSION IS HEREB Y GRANTED TO:
Project# JS-2014-001911
Est.Cost: Contractor: License: Expires:
Fee Charged;$25.00 Homeowner as Contractor
Balance Due:$.00 Owner: JONES WILLIAM P&BARBARA A& STEPHEN JONES&M W JONES
#of Fixtures _Applicant: JONES WILLIAM P&BARBARA A&STEPHEN JONES&M W JONE
DigSafe# i `AT: 118 BLISS ST
UseGrou_p _
ConstClass
ISSUED ON: 01-May-2014 AMENDED ON: EXPIRES ON:
TO PERFORM THE FOLLOWING WORK:
ZPA- 10 X 16 SHED
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:
shed REC-2014-006303 30-Apr-14 4505 $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @ northamptonma.gov
GeoTMSO 2014 Des Lauriers Municipal Solutions,Inc.