31B-200 (2) File#MP-2016-0097
APPLICANT/CONTACT PERSON SMITH COLLEGE OFFICE OF TREASURER
ADDRESS/PHONE COLLEGE HALL 4
PROPERTY LOCATION 21 HENSHAW AVE
MAP 3 lB PARCEL 200 001 ZONE EU(100)/URC(100)/
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-CONVERT TO OFFICE BUILDING
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owned Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
VORMATION 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
Permit from Elm Street Commission Permit DPW Storm Water Management
Signature of Building Official Date /f I )
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.
RECEIVED
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File No. t-97
ZONING PERMIT APPLICATION(00.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $30 filing fee (check or money order)payable to the
I I City of Northampton 11 /t
1. Name of Applicant: THE TzUGlEEs OF THE SMITI4 COLLEGE
Address:C/0 FQ.aI LIii ES MG-HT, ..`.21n kJE'I� 1ST.Telephone: #13. 585. 2.424
2. Owner of Property: CAME N mil-WAFT-014
rt4Mprod
Address: SAME. Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: 21 4ENS4At&l AVE
Parcel Id: Zoning Map# 3 libParcel# 2OO District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THEBUILDING DEPARTMENT)E-7
5. Existing Use of Structure/Property: SI t tG(_E RKAI-4 �s-( ESIDEf.1
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
CONIVE2T To OFFICE &IILD 1.1G Fob., 2ELOCS ED
KaNti rJIST1TUTE_ SM IT4( COI,A..E GE_.
7. Attached Plans: Sketch Plan X Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW X YES
IF YES: enter Book Page and/or Document#
`,
9.Does the site contain a brook, body of water or wetlands? NO y 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\FOR4S\origina1Building-juspect or\Zoning-Pcniit-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 X
IF YES, describe size, type and location:
11. Wilt the construction activity disturb (clearing, grading, excavation, or filling) oyer 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
'JJ ' B_2 oo for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size t 3 770, 1317760
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear /4/'—
Building Height
2 SToe.Y 2 S1oa..`-f
Building Square Footage
2,583 2,583
%Open Space: (Lot area
minus building B paved 85 % 95
ro
parking
#of Parking Spaces
2
It of Loading Docks
N/A. ki
Ful: N/A- N(votume & location)
/A-
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my6knowledge. �J
Date: . UP' Applicant's Signature ( (lq,�Gi( /+LL(.ir
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\Documents\FORMS\origin\Building-Inspector\ oning-Permit-Application-passive.doc 8/4/2004
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