17A-226 (4) File#MP-2017-0039
APPLICANT/CONTACT PERSON MALONE PATRICK M&SHERYL A
ADDRESS/PHONE 167 AUDUBON RD (413)584-6679 0
PROPERTY LOCATION 117 LAKE ST
MAP 17A PARCEL 226 001 ZONE URB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid 313Buildin¢Permit Filled out
Fee Paid
Tvpeof Construction: ADDING A GARA TH A 2ND FLOOR LIVING SPACE
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 permits required(see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § - - 'A1CALh ti 7) 7.
Intermediate Project: t/ 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
l --Q t/24/a7
Signature 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.
J;? - 2 2-Ce
JAN 2 4 2th1 C,C �d4
pL— _ File No. 30
"bm'Amr'N'''''ZO'VING PERMIT APPLICATION 010.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $30fiilingfee (check or money order)payable to the
City ofNorthampton
1. Name of Apptitant: *,UQ 1 !C. kt
Address:] 62 RC/fafh o , R
jc/.ie e cis, MR D i c s Telephone: - 5-y c
2. Owner of Property:ThOtrtCShe P, 4l)oLon e_ uPCO)&7 <.grncPrsrny{..
Address: 41 0 Rd, Le,tbs. Ma bLoc d. Telephone: N13 -3-AC ' 4a 09
3. Status of Applicant: Owner /` Contract Purchaser LesseeOther (explain)_,
4. Job Location: IF? Illci ifi e Sl; VJounc¢. Mt n Int;of .........
Parcel Id: Zoning Map# Parcel# District(s):
to Etm Street District In Central Business District
(TO BE FILLED IN BY//THE//BUILDING DEPARTMENT)5. Existing Use of Structure/Property: le<>taci)Adz %.q iCi m i y h o fmLt
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 X DONT KNOW YES _.
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO x 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'}DocumentstFORNISoriginah13uitding-tnspeetor'Zoring-Pemt Apptieazxm-pasthe,doc g1412004
10. Do any signs exist on the property? YES NO X
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO A'
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 PROPOSED REQUIRED BY
ZONING
Lot size 6, "/79 acres 0, 6/79 %Uer
Frontage O S
a
Setbacks Front /U / yof
Side L: :Z R: 20 L: R: /Si L: R:
Rear 2/z 160/
Building Height 3c) / Q S //
Building Square Footage /
2n ss c' 3/6 sf bi
%Open Space: (lot area �+�¢.�� �
minus building& paved ;2o 6..0 ; ac�ss ci 57✓"j� s, Ff
parking
#of Parking Spaces 2 'J
#of Loading Docks /1/4
Fill:
(volume Et Location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge./
Date: /777e7 77 Applicant's Signature l,/T ,//JbxP,
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\original Building-Inspector\Zoning-Pcrmil-Application-passive doc 8/42004
-NOTE-
THIS PLAT IS COMPILED FROM DEEDS. PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED
83331
BOOK 8053, PAGE 98
- BK. 253, PGS. 170-171
LOT #29
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NOTE:
I. SUBJECT TO EASEMENTS AND
RIGHTS OF WAYS OF RECORD.
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82.5'±-
LAKE STREET C?
TO:
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS. ENCROACHMENTS AND BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY 15 NOT LOCATED 'WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
-NOTE-
SURVEYOB✓ I,Q,P C. .L THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
cJ AND DOES NOT CONSTITUTE A PROPERTY SURVEY
-MORTGAGE I DAN INSPECTION PLAT-
rk NORTHAMPTON, MASSACHUSETTS
RAN US PREPARED FOR
IZE z " PATRICK M. & SHERYL A. MALONE
SCALE 1'=4D' OCTOBER 7, 2010
'' HAROLD L. EATON AND ASSOCIATES, INC:
REGIS[LRED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET - HADLEY - MASSACHUSGI is
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