25C-068 (3) d i t,
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10. Do any signs exist on the property? YLS 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) over 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
MSTING PROPOSED sy
Lot Size 77
Frontage �
Setbacks Front j 7 — O''
Side L: 6-,}„R: �p L. R: S d �di
Rear VN
Building Height 5 '
Building Square Footage
I I f� � 5 air-
Open Space: (lot area
minus building & paved
arkinq
V of Parking Spaces I
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.
Date: l Applicant's Signal re a Z (-
NOTE:Issuance of a zoning permit does not relie`re 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 lVarics and other applicable permit granting
authorities.
rr—
7 r f"`-ire No.
PIea per pr or#iation and return this Form to the Building
Inspector's-Office with the S15filingfee (check or money order)payable to the
City of ATorthamp ton
D1. Name of Applicant:_�rr i A Q " �t n ,2 ��(6
`7R,
Address: �- «mil Chi g?Z�et Telephone:
2. Owner of Property: 141.x" 10 ey'A'Q
Address: -1/A0 '1 Telephone:
3. Status of Applicant: Owner ✓ Contract Purchaser Lessee Other (explain)
4. Job Location: ���►?�1 ���`L
w
s
5. Existing Use of Structure/Property: vl%/�lLP ,�s�i!✓i,// !/�(fJ�°
5. Descrip on of Proposed Use/World roject/Occupation:� (Use additional sheets if necessary):
r�eyP _Ao ��y /8x io, 6' A&Z/,( '4zz..Berl /K✓ A-02-
'd ad i�r�i�lr7v�r iS�ov�- orP.c �b�ts ✓ru fiar,6,� Q,ce�
a� i6xi� f ^0q sad�va� 1 0�l8� By��i a,�P.� �.�1,vn 6YaPG✓/��.�/J , aio,� !�
In /�/ L,(vo✓�y,a /��9/r� a�i7'/ONTZ H c�rL�DO.G ///r��7`t.G �/Jd'"11 w .r/�LBI''��d6+�G�K�,
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,� DON'T KNOW 1'ES 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 f
9.Does the site contain a brook, body of vvater or wetian+s? NO DON'T KNOW YES
IF YES, has a permit been or need to be obtained frDm the Conservation Commission?
Needs tD be obtained Obtained date issued:
(FD-rn Continues On Dther Sije)
GO-,i^c_P� is-�?nli�pnr.-Pzs�ne.do S4hp:K
-File#MP-2008-0015
APPLICANT/CONTACT PERSON THOMAS DOLAN
ADDRESS/PHONE=172 SOUTH ST (413)585-0612
l
l:w '
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FI T
Fee Paid it L 7,2k 2711 1
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-ADDITION
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 LLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I I�,FRMATION 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:Stre o
Signature of Building Officiar Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements-and obtain—Al-required permits from-Beard-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.