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'I 0. 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) 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
De artment
EXISTING + PROPOSED
f
PF ,nte e
7,9 '
Front J C/ – O" /,'U,y 2--0
Side L: , „/R: j _O•� L: �o J,, R: a '�� _ �� 1�
Rear $5 U
Building Height
N—URding Square Footage J
i/c?, S r 11 �/d'6 —
%Open Space: (lot.area
minus building& paved
arkinq
n 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. ,,--
Date: ( Applicant's Signa re L AAEA E
NOTE:Issuance of a zoning permit-does rot reliPy e.an aR licant'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.
�T:,Doc�nent�'�^Ori.i5lo-i�na"�u-,:;:.'•i:-_-L-s-ems='��r�x:a_p••.**nt-�aalicatior,-passive.noc S/420(k
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File hro.
M
PIease e r print all information and return this form to the Buildin;
Inspector's-f3�ce witb the x'15 filing fee (check or money order)payable to the
City of ATorthamp ton
I. Name of Applicant: i CA. V"1
Address: 2A, , t, l A-V"-q. Telephone:
2. 0%mer of Property: �I/Aall
Address: c%l4��AP /w �/O� Telephone: 7/3
3. Status of Applicant: Owner v Contract Purchaser Lessee Other (explain)
4. Job Location:
5. Existing Use of Structure/Property:
r
6. Descnp on of Proposed Use,Work roject/Occupation: (Use additional sheets if necessary):
I&- MA�e- ctrl nr o.dc.�J
60 la e,A ?IiOMIPOV %too,% 0.*WA Ire AC_ 4�
0101- AWY Aboo z.+d/7 Vex "em rgJy.ASJFihr d,[r'a 'ww 6vec ,A8eA>>oK,
�� i�'i tiva✓ /l�I v,a .�oi,.a �i�.�/oH � z r.►i/`LDO,L /9�.f�J`r!,e .�'�i w BE�La��✓,�6Pw+,
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_�� 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 f
9.DDes 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?
Needs to be obtained _0-brained date issued:
(Form Iontinues Gil Other Side)
File#MP-2008-0015
APPLICANT/CONTACT PERSON THOMAS DOLAN
ADDRESS/PHONE 172 SOUTH ST (413)585-0612()
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FI ED OUT
ee ai
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 FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRETED:
Approved Additional permits required(see below)
PLANNING BOARD PER1vIIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan
Major Project: Site flan 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 Commis>,Qn
OZ.
Signature of Bui ing 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.