25A-129 (8) E� The
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The Procedural And Technical Standards For-The Practice Of land D 9
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Ways Shown Are Those Of Public Or Private Ways Already Established Constructed Improvements,Natural Features,Observable Monuments,Obtainable Plans And 0 Handhole a, Gas Valve Planning
a F I And That No New Lines For The Division Of Existing Ownership,Or New p Land Surveying
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! v� y 5.All Improvements Shown Hereon Have Been Spatially Fixed To A Locatlonal Tolerance Of Not O Light Pole,Double C. Drain Manhole
/ �ryJ 4- More Than 1/lOth Of The Plan Scale.Positional Tolerance Does Not Exceed Allowable Standards. O Electric Handhole . Post/Bollard
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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 size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) o_ver 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO ,,�
t
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 REQUIRED BY
Lot Size ZONING
Frontage BB
Setbacks Front
Side L: (l ` R: (9 L: / R: Z 1 L: R:
Rear -7 '
Building Height r
Building Square Footage Z-7 Z SF
%Open Space: (lot area
minus building Et paved
parking
#of Parking Spaces
#of Loading Docks
Q �
Fill:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
1
Date: Applicant's Signature --- _ _-
NOTE:Issuance of a zoning permit does not relieve ap�icant'b rden to comply with all zoning
requirements and obtain all required permits from the Board of Health,Conservation Commission,
Historic and Architectural Boards,Department of PuWc Works and other applicable permit granting
authorities.
W:\Documents\FORMS\original\Buil ding-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
All Y - 7
File No.
North;:rnp NG PERMIT APPLICATION (§10.2)
ton,�iN.
Please type or print all information and return this form to the Building
Inspector's Office with the $15,filing,fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: �?%-a rr'2.,c� ° �4' ZL) P
Address: lq' 6t=- P Qt=�telephone: Q5Z^7t�c�
2. Owner of Property:
Address: �cl 1�hQT Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: (q F�A�C \�-
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: <'-)t rJ C LL$ `—{r�Y
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
_t=om c
`i Y- C, L-.7;-1
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 DON'T KNOW K " YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW 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:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doe 8/4/2004
Ll
File#MP-2015-0079
APPLICANT/CONTACT PERSON Berkshire Design Group
ADDRESS/PHONE DO NOT USE THIS ONE f
ti
PROPERTY LOCATION 69 DAY AVE
MAP 25A PARCEL 129 001 ZONE URB000)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out r � ,
Fee Paid /
Tvoeof Construction: ZPA-DEMO EXISTING STRUCTURES&CONSTRUCT 3 SFH
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 PRESENTED:
Approved Additional permits required(see below)
PLANNING BOARD PERM T 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 Ehn Street Commission Permit DPW Storm Water Management
C>�-- y
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.