05-059 (8) File N MP-2017-0001
APPLICANT/CONTACT PERSON NEW SOME BARRETT&ELIZABETH V IZENTIN
ADDRESS/PHONE 341 AUDUBON RD (413)727-3835 ()
PROPERTY LOCATION 341 AUDUBON RD
MAP 05 PARCEL 059 001 ZONE RR(94)/WP(15)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORty1,FILLED OUT
Fee Paid 7-s0 !T/. D.
Building Permit Filled out
Fee Paid
Tvoeof Construction: ZPA-PERSONAL ART STUDIO ABOVE THE GARAGE-KIDS SUMMER CAMP
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 f N F°17-D14141101" ' '1"."4-• Li C{N SE
PLANNING BOARD PERMIT REQUIRED UNDER: § CfRNllf-y G+tIL0 ARE)e�
ICO
Intermediate Project : Site Plan AND/OR Special Permit with Site Plan Lik FPOI�.`7 GP
Major Project: Site Plan AND/OR _Special Permit with Site Plan 02
ZONING BOARD PERMIT REQUIRED UNDER: § 350- 10tp�
Finding Special Permit_(/ Variance" FA
350 - 10
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
77;1/6
Signaure 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 40k Contact the Office of
Planning&Development for more information.
File No.
ZONING FERMI" ' .)_PLICATION(gxa2) r
Please type or print T. inform:-ton . . d return this form to the Brrflr'ntig
Inspector's Office with tL• 5NMI-Ingfee Zaecld or money order)payable to the
.Q..anCarafthampton
b 1. Name of Applicant: 21 ' n
f � —1 r,
Address: 31I �l(A 7Ic
Of ROO(t LEEP5 Telephone: CLIA / ? f - ,.Br1.3�
h`T
2. Owner of PropertY:�s 7'� Z/ti-(1� V 1./-'�,(l-1 �} , . 504-1342
. .,��•��e i �-� l., 2
?
Address: 4( U. .(.( (-)0())1(-)0())1R Telephone: a� r ,4X.9
3. Status of Applicant: Owner \--P.'''. Contract Purchaser Lessee Other(explain)
4. Job Location: _ �I r\ R _+-, OR PGG 5_,........ /. {�
Parcel Id: Zoning Map# 1 Parcel# 05 "{
Distrftf{s)i iS C
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING [DEPARTMENT)
5. Existing Use of Structure/Property: 4<2.5^Cseni`i ._
6. Descriptions} of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
gar
uaII c 4d5Ez,Qe53- (a
+17' cap^4 u)'i f (on *COK5 cora 2 wed '( 5dinreg-
-- NOON
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 Regstry 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 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 konbnues On Other Side)
Ju
\WttjohumentstFORMS o mawud' °r-' m_ •cm i p i i amu ax i tl&N]D04
.ro n 4
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 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
EXISTING I PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
%Open Space: Not area
minus building & paved
parking
#of Parking Spaces
#of Loading Docks
Fig:
(volume & 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
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.
WADocumexsCORMSIonginal8Buuding-I specror8Zmigg-Permit-Application-passive.doc 8/4/2004