10-002 File 4 MP-2016-0084
APPLICANT/CONTACT PERSON PALCHES JAKE
ADDRESS/PHONE 401 KENNEDY RD (617)843-6001 O
PROPERTY LOCATION 401 KENNEDY RD
MAP 10 PARCEL 002 001 ZONE RR(100)/WSP(100)
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid __.
Building Pen-nit Filled out
Fee Paid
Typeof Construction: ZPA-CONTRUCT 24 X 12 DET ACCESSORY APARTMENT
New Construction
Non Structural interior renovations
Addition to Existin
Accesso Structure
Buildine 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 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: §. 5 C7 /0 , (Z'
FCC t,�,u
Finding Special Permit Y 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
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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.
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Please type or, prirnt all infarrnatulan =.Ld return tl-Lis form, to the ET—THdinC7
1. Name of Applicant:
— Ownerof Pr-,—'':
Address: �phone
/
3. Status of Applicant: Owner `/' Contract Purchaser Lessee Other (explain
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4. JobLocatnn
Parcel ld:, Zoning Map#
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE B UILDING DEPARTMENT)
^ `
I Existing Use ufStructure/Property:
6. Description of Propc��p!-Uiej46rk7-Prc)lec�/-6cc'up' 'ti6_n.' (Use additional sheets if necessary):
'
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7. Attached Plans: Sketch Plan Site Plan }' En8neered/SumeyedPlans
8. Has aSpecial Perm it/Vahance/Fin ding everbeen issuedfor/on the site?
NODON'T KNOW ��_ YE3 /FYES, date issued:
IF YES: Was the permit recorded at theRegistry ofDeeds?
NO DON'T KNOW �� YES
IF YES: enter Book Pageand/or DocumenL#
9.Does the site contain a brook, body ofwater orwetlands? NO DONT KNOW _______ YES
IF YES, has a permitb d be obtained from the Conservation Commission?
Needs to beobtained V____ Obtained ' date issued:
(Form Continues onOther Side)
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) over nacre 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 cotumn reserved
for use by the.Building
Department
STING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: .�- R L: P L: R:
` �J
Rear
i
Building Height E
Building Square Footage
Open Space: (lot area + _.
n
minus building Et paved
parking
#of Parking Spaces
#of Loading Docks
Fill: ^•
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
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Date: - ' Applicant's Signature '
NOTE:Issuance of a zoning permit does not relieve an applicant'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.
W:\DocumentsTORMSIoriginallBuilding-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
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