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10. 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 ci-7a 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 --f-�
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 PROPISED °REQiJIl l)BY
ZOI�FIPtG
Lot Size
Frontage
Setbacks Front �
Side L: /! R: G 7, L: // r R: /0 R: ��
Rear —� r
Building Height
Building Square Footage
%Open Space: (lot area
minus building& paved '
parking1
#of Parking Spaces
v Z
#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. r
Date: tV '' Applicant's Signature
r,. 11
-NQTE^Issuance of a�flninQ permit does not relieve an a licant's burden to comply with all zoning
-- --z.equirements--and-obtain all-required-permi sfr-ta> tlie--&oard of Heal ,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W:Documents,FORMS'on_inal`,Buildin,--InspectorZoninS Permit-Application-passive.doc 314i1_004
r'
20 i File No.
Y00 all information and return this form to the Building
-�a pec#Qr's fl!c' � the $15 ding fee (check or money order)payable to the
City ofNorthampton
1. Name of Applicant: C �^c�w"� ^r� '' �-r"��•_�. I�l`�,r�" h
ice'- S o
Address: � � .�� Telephone: 5 5
,s
2. Owner of Property: ''��^
Address: Lam'
�.,. ,-,v � .,5 'Telephone:
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location:
ParceF:Fot ZaorngMap# PareeF# TIC �8 DEStFct(s
��. . 3istric ..
Frt ECrrt Street fltstztct -. Fn CentraF Brss�e�ess
- - '` :, .� . '=�'Cf1:BE�FEfLEEl.EF�f.B��FiEBUFLaFktFO../DEPt�R�IItFEMC�=
5. Existing Use of Structure/Property: S ---
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
L 1 y
7. Attached Plans: Sketch Plan Site Plan _ Engineered/Surveyed Plans
8. 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 X YES
IF YES: enter Book Page and/or Document#
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?
Needs to be obtained Obtained date issued:
(Form Continues On Other Side)
W:DocunenLs,FOR.CIS'.on_inai`Buiidin_-Inspector,Zonin_-Permit-Appiicatiou-passive.doc 1'4/2004
File t MP-2008-0062
APPLICANT,/CONTACT PERSON KENDRICK GRAND J
ADDRESSIPHONE 48 WALNUT ST (413)584-2119()
PR
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
,i2 NING FO ILLED OUT �/ y�/{',�
Fee ai
Buildi ig Permit Filled out
Fee Paid
Typeof Construction: ZPA-ADD 2ND FLR PORCH
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
jT F LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
O 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
Pemut fro Elm Street Co ion Permit DPW Storm Water anagement
L Ltd Z3
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.