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25-017 (4) 10. Do any signs exist nn 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) ovP,r 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 column reserved for use by the Building Department EXISTING PROPOSED :.REQI7Il2ED BY ZONING Lot Size Frontage Setbacks Front Side L: R: L: R: G G L- R: Rear �U Building Height - tJ Building Square Footage 16� f %Open Space: (lot area minus building & paved parkin #of Parking Spaces #of Loading Docks Fill: (volume& location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. f Date: to ), Applicant's Signature NOTE:Issuance of a zoning permit does not relieve 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. iTr:`,Documents\FORYIS\original\Buildina-Inspector\Zoning-Permit-AapIiration-passive.doc 314!2004 F}. j 9""25A-147 25A-150\ 25C-1 Z 5A-14 151 \� 25C-44 X 25C 3 r -4.t. r /2SC-; / 25C-34 �. N", / 1 25c-2$ �.. � ERN r V 25C-2' \ / 7 \ j \ / t,SC \ 14 z5e-25 �.v�\ /25r--26 � ,� 25C-74i `\ \ , i IJ , z5C-267 v /25:-22 / f \ 25C-23 f \ \ �ko `� 25( -1 Z \ \ \� •�\ \25C- E .N. 5 \ / IN `N. 1 C-!�? '� 25 Ems' A' \\� /l 25C-4 ; ` \ ECEL �� D� F c File No l i ZONING JJ 'R�VLIT'A�°'PJ ,ICA3IOIr►T [ Z}. rs� j Please type or print all information and return thislorm to the Building._. Inspector's Office with the $'15Wilingfee (check or money order)payable to the City ofNorth.-3mpton 1. Name of Applicant:-19A C a r1j, :C Address: ( u�='s �� �� —Telephone: � 2, Owner of Property: 1 Yl 'f i" ? r ,s,F V, Address: 3d Iz uS e l � d Telephone: r q S 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) 4. Job Location: Parcel Id. Zoning Maps r Parcel# District(s): W '✓' In Elm Street District In Central Business District (TO BE FELLED IN BY THE BUILDING DE/PARTMENT) 5. Existing Use of Structure/Property: 1�-�'� � i�'� t ( ( S��K Le e-, f 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): ' jS /C irate c} 7. Attached Plans: Sketch Plan Site Plan CIC Engineered/Surveyed Plans B. Has a Speci 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 DON'T KNOW YES IF YES: enter Book Page and/or Document n 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? &1e, Needs to be obtained Obtained , date issued: ,Form Continues On Other Side) W:,Documents\r`OR-\4Sbriginal\Buildin-.-Inspector,Zonine-Pennit-Application-passive.doc 8/4.•'200= File#MP-2005-0095 APPLICANT/CONTACT PERSON MCCUTCHEON DAVID J ADDRESS/PHONE 263 SYLVESTER RD (413)587-4570 Q PROPERTY LOCATICiN NORTHERN AVE MAP 25C PARCEL 017 001 ZONE URB THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM F LLED OUT OWV Building Permit Filled out Fee Paid Typeof Construction: ZPA- 1 1/2 20 X 20 STORAGE STRUCTURE New Construction Non Structural interior renovations Addition to Existin 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: 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 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.