23A-101File 4 MP -2017-0013
APPLICANT/CONTACT PERSON ATKINS ELAINE C
ADDRESS/PHONE 1 I MANN TERR
PROPERTY LOCATION MANN LEER
Iv1AP23APARCEI.101 001 ZONE IIRB(IOO)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building PLFilled out
Fee Paid
TTt eofConstructiom ZPA -SFH
New Construction
Non Structural interior renovations
Bui di o 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:
'd 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
1 �
J
Signamte 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.
I � _
File No. NN-/ 2" 13
Z ?N . G PERMITAPPLICATION 01o.2)
Please -type -or print all information and return this form to the Building
Inspector's Office with the $30 fling fee (check or money order) payable to the
City of Northampton
1. Name of Applicant
Address: Telephone:
2, Owner
3. States of Applicant: Owner
_ Contract
Purchaser
Lessee
Other (explain)
4. Job Location: lJi' 4 /
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s./: 1.1 ?
w A fr LaG.'-
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Parcel Id: Zoning Toning Map# , Parcel# I -`' r District{s} 1; i '
In Elm Street District In Central Business District _
(TO BE FILI...ED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of StructwelProperty:
6. Description of Proposed Use/ Work/ Prof ect/Occupation: ftlse additional sheets if necessary):
7. Attached Plans: Sketch Plan ___ Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Varcrice./Finding ever been issued foiYon the s0e?
NO �` DON'T KNOW YES IF YES, date
IF YES: Was the permit recorded at the Reglstr/ of Deeds?
NO DONT KNOW YES..._._
IF YES: enter Book Page .and/or Document #
9.0ooez the site contain a brook, body of water or wetlands? NO DONT KNOW YES ^,
IF YES, has a prermit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued: _
� ��.�� L (•� (Form Corhhmns On Other Side)
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10. Do any signs exist on the proper ty? 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. Witt the construction activity disturb fclearina, grading, excavation, or fitting) over t acre or is it part of a common
plan of development that will disturb over i 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
no....n..o..r
i r.XiSTING PROPOSED
REQIIIIiF,D BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L R: L: R:
L: R:
Rear
Building Height
Building Square Foo[age
%Open Space; 717t area
minus building R paved
parking
# of Parking Spaces
# of Loading Ducks
Fill:
(volume it location)
13. Certification: I hereby certify that the information contamga d herein is true and accurate to the best of
my knowledge.
>i
Date LL.c /5 ?°.^ _ Applicant's Signature
i
NOTE: Issuance ofa zoningpermit does not relieve an applicant's burden to comply nth 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.
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