31B-167 (13) 4 r ile#MP-2006-0008
APPLICANT/CONTACT PERSON SHEA JOAN L
ADDRESS/PHONE 137 ELM STREET (413)584-5008 O
PROPERTY LOCATION 137 ELM ST
MAP 3113 PARCEL 167 001 ZONE URB HD
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FO FILLED OUT
ee
Buildina Permit Filled out
Fee Paid
Typeof Construction: ZPA-REMOVE EXISTING SUNROOM&REPLACE W/WOOD FRAME FAMILY RM
14 X16
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACT N HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRE NTED:
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 Co sion
Signature offruilding 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.
\Vl {� s
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J►ji L 2 5
.File No. PP
PR�rf
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"` P e 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 ofNorthamp ton
1. Name of Applicant: ` �'t?' 'C� /7 ' -~
Address: 13 7 _��f l'I6Pfft74A14 ' Telephone:3
2. Owner of Property:__
Address Telephone:
3. Status of Applicant: Owner l/ -Contract Purchaser Lessee Other (explain)
4. Job Location: 72 7 17/Alt aQ�
VAN
a-..-,.— ....- ... ..,....._ ..-._ ....,..., .. ..t�:.y Ar'+k rmrdwFA^�rcvvaa3. u+'F4m-'- ..fr._ .-•
5. Existing Use of Structure/Property:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
i
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 DONT KNOW YES
IF YES: enter Book Page and/or Document
9.Does the site contain a brook, body of water or wetlands? NO ,/ . DONT 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-InspectorlZoning-Permit-Application-passive.doc 8/4/2004
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 1 re 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
EXISTING PROPOSED 11F�
Lot Size
Frontage CW
Setbacks Front 20
Side L: R: L: r7R: LLL
Rear
Building Height ~"
Building Square Footage
%Open Space: (lot area
minus building&paved
parking xx _ . li MEW .
#of Parking Spaces
#of Loading Docks
Fill:
(volume& location)
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: f V Applicant's Signature
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with aU zoning
requirements and obtahn 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:\Documents\FORMSloriginal)$wilding-lnspector\Zoning-Permit-Application-passive.doc 8I4J2004
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