35-223 (6) File#BP-2016-1453
APPLICANT/CONTACT PERSON DUQUETTE CLAUDE D&ANN
ADDRESS/PHONE 42 LADYSLIPPER LN FLORENCE
PROPERTY LOCATION 42 LADYSLIPPER LN
MAP 35 PARCEL 223 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid G1611- l0?? 'q-60
Building Permit Filled out
Fee Paid
Typeof Construction:_12 X 16 SHED
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
INFOR N PRESENTED:
pproved 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
s
-mot .' P-lay
f7%7
Signat - o ::4°017g Ois al 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 Office of
Planning&Development for more information.
i1�ra� iC_ ,
City of Northampton
t ` Massachusetts ,
\.��i.
l :
,Kt h DEPARTMENT OF BUILDING INSPECTIONS �i
ro
?+ 212 Main Street • Municipal Building �'-. lD�
Northampton, MA 01060 srrW 3j�‘^''
1
CD
z
GO
CO 5§
W E3 o
> C-1 z 2
0
'z .- ACCESSORY STRUCTURE PERMIT APPLICATION
W CC = I freestanding structures less than 200 sq. ft., at least 5 feet from any other structure)
L Z Check# /1 23
0
PLEASE TYPE OR PRINT ALL INFORMATION
/'
1. Name of Applicant: l.• L 4 J D i VO0 V TT�.
Address: 14A 1-.1;" ./ SA, t Pc'l2 k- 010,16-- Telephone: 7/3 "..,C8( - h-42.f
2. Owner ofL.Property: C sat 0.0*. 1- 4'Jo.) (>
p (1 J 4,
e i i
Address: 4a. I-lithiS tP:lL C4* _ Telephone: ill 3 --4.Cad- ?irfaj
3. Status of Applicant: K Owner_Contractor
4. Structure Location: R F i}/L Y4-(LA
Parcel ID:Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Use of Property: Single or Two Family: K Multifamily: Commercial:
6. Description of Proposed Structure:
One Story Shed under 200 sq.ft.: Freestanding Deck under 200 sq.ft.,less than 30"above grade:
SIZE OF STRUCTURE: (A FT X 1 Fr
Other(describe):
7. Attached Plans: Sketch Plan Site Plan Plot Plan
8. 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
CONTINUED ON NEXT PAGE
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9. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION.
This column to be filled in by
the Building Department
Existing Proposed Required by Zoning
Lot size
Frontage N/A N/A N/A
Front:
Setbacks: Side:
Rear:
Height
% Open space:
(Lot area minus bldg and
paved parking)
10.Certiflcation: I hereby certify that the information contained herein Is true and accurate to
the best of my knowledge.
DATE: 0/l‘::7' APPLICANT'S SIGNATU E
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements
and obtain all required permits from the Conservation Commission, Department of Public Works and other
applicable permit granting authorities
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