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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 N/A N/A
Front: �0
Setbacks:
Side: L: L R: 7 L: R:
Rear: t
Height
% 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:v APPLICANT'S SIGNATURE
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all:equired permits from the Conservation CgWmission, Department of Public Works and other
applicable permit granting authorities.
City of Northampton
Massachusetts
� JS
t' DEP TMENT OF BUILDING INSPECTIONS
2 2014
y 2 Main Street • Municipal Building
I Northampton, MA 01060 s�t� g t11
INSPEC OR
Elecirlc P • '.: lions
ACCESSORY STRUCTURE PERMIT APPLICATION
(For freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
Permit Fee: $25.00 Check# /??b
h� \ `PLEASES TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: �� �Wf'j� Telephone:Cu��
2. Owner of Property: �j 7 /
Address: ''✓ S W J Telephone:(4(1) 1- J - 19' 6
3. Status of Applicant: Owner Contractor
4. Structure Location:
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family:_ X__ Multifamily: Commercial:
6. Description of Proposed Structure: V
One Story Shed under 200 sq.ft.: Freestanding Deck under 200 sq.ft., less than 30"above grade:
Other(describe):
7. Attached Plans: Sketch Plan Site PlOx— Plot Plan
8. Does the site contain a brook, body of water or wetlands? NOS DON'T KNOW YES
IF YES: Has a permit been,or need to be,obtained from the Conservation Commission? N A
Needs to be obtained Obtained , Date issued
CONTINUED ON NEXT PAGE
File#MP-2015-0001
APPLICANT/CONTACT PERSON DERSHAM DAVID H&MOLLY A WATKINS
ADDRESS/PHONE 16 SWAN ST (413)923-1860 Q
PROPERTY LOCATION 16 SWAN ST
MAP 25A PARCEL 040 001 ZONE URB(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out n [
Fee Paid
Typeof Construction: ZPA-ERECT 6 X 12 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
INF¢RMATION PRESENTED:
V 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 Permit DPW Storm Water Management
Signature of Building O icial 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.
16 SWAN ST MP-2015-0001
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS# _.- 4261
Map: 25A
Block 040 _ ZONING PERMIT
Lot: 001 .�.
Permit: ZONING PERMIT APPLI
Category: APPLICATION PERMIT
Category: shed i
Permit# MP-2015-0001 - PERMISSION IS HEREBY GRANTED TO:
Project-# _JS-2015-00.0022 _
Est.Cost: Contractor: License: Expires:
Fee Charged:$25.00 Homeowner as Contractor
Balance Due:$.00 Owner: DERSHAM DAVID H&MOLLY A WATKINS
of Fixtures Applicant. DERSHAM DAVID H&MOLLY A WATKINS
DigSafe`# AT: 16 SWAN ST
UseGroup
ConstClass
ISSUED ON. 03-Jul-2014 AMENDED ON: EXPIRES ON.
TO PERFORM THE FOLLOWING WORK.
ZPA-ERECT 6 X 12 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-2015-000045 02-Jul-14 MO $25.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @northamptonma.gov
GeoTMS®2014 Des Lauriers Municipal Solutions,Inc.