38A-112 (2) File#MP-2016-0081
APPLICANT/CONTACT PERSON THE COLUMNS AT ROCKWELL PLACE
ADDRESS/PHONE 711 MILL ST SUITE 310
PROPERTY LOCATION VILLAGE HILL RD
MAP 38A PARCEL 112 001 ZONE PV(100)/SG b(81)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-RENOVATE TO CONDOS
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) IV
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
Signat toe of Building`Official Date E
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.
Please type or jp)rLhit all i-n-f or maatlim m, ]T et'LI =-this fTarm to the B rEdftn-
hnLspectar's OfFEce zoith the $30p7L7angfcc (clzi✓ck or nnoney order)pay.n&Ic to the
Cit"
4 Of2vort'"h MPECTI
1. Name of Applicant: 60-k;.%c'h\ 1: ��.1 Yc� (f c�L-40 f1 S (?Z7, V C.-t.4d.t:;Z�-- VUtct--'LL
Address: �� /�+td S Sea``w �1� !/4'�- Telephone: t ��.`7Z
2. Owner of Property: '( t"tyi; �,E ���� 7 1 tv`I S i �--1-01"4C74'�`
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: 3C U; thtk -24WED vc-" t'll`4 L'.:
Parcel Id:. Zoning Map# -J "'lt `�'` Parce[# - District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)'
5. Existing Use of Structure/Property: V Al(�'Vjy
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
/vim' (�Ati`ti2c�rl-t Ke lavt j 2 55 h��Ip`t-c-
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 ✓ 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#
9.Does the site contain a brook, body of water or wetlands? NO i// 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:IDocumentsTORMS\originallBuildino InspectorlZoning-Permit-Application-passive doc 8/4/2004
10. Co any signs exist on the property? YES NO i/
IF YES, describe size, type and location:
y
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: �6e,
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
=S=G PROPOSED REQUIRED BY
ZOI�rING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R.
Rear
Building Height
Building Square Footage
Open Space: (lot area
minus building & paved
parking
# of Parking Spaces
#of Loading Docks
Fill: fy
(volume E location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: ��`' Applicant's Signature
G
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with 0 zoning
requirements and obtain all required permits from the Board of Health, Conservation Commission,
Historic and Archite ctural B o ards,Department of Public Works and other applicable p ermit granting
authorities.
VT:\Docum entsT0RlvISloriginal\Building-Inspector) oning-Permit-Application-passive.doc 8/4/2004
PLAN IT GREEN
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