39A-020 (12) File iF MP-2018-0057
APPLICANT/CONTACT PERSON STEPHEN D ROSS
ADDRESS'PHONE 36 SERVICE CENTER RD (413)584-1224()
PROPERTY LOCATION 118 CONZ ST
MAP 39A PARCEL 020 001 ZONE GB(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-ADD 8X10 VESTIBULE AT REAR EGRESS
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 J,/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
ZONINGBOA REQUIRED UNDER: §J
i
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 Gom Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
1�
Signature of Building Official Dale ,
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.Conmcl the Office of
Planning&Development for more information.
Ht�tivtu
MAY - 1 21118
Yy -005'7 File No.
ZONING PERMIT ADPL
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
City of Northampton 7
1. Name of Applicant: �'P-Tkl / ��Y-�w -� �cn��At rr rt / "-m! Q 1y N Ki r ciS
Address: 1 ( S Lot-2— ST Telephone: bi 4-- k L7 4- - C�sw ,a
2. Owner of Property: Qf"` Y lcKN `I-4
Address: Y Isc^, &k �LNkG6 502A(`-Yo1'-- Vt0 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee L-1/other (explain)
4. Job Location: W6 6 (ONz- eo
Parcel Id: Zoning Map# ✓ / Parcel# asO District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: M VO t [.R1'k— fj I/, PB "I"L
6. Description of Proposed Use/Work/Project/Occupation: (Use additional-sheets if necessary):
A-lb () VI X I o f V P5 1-11% l 6 A ' 9,FC-" rif,"Ss
7. Attached Plans: Sketch Plan Site Plan J Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever Issued for/on the site?
NO DON'T KNOW=ES IF YES, date issued:
IF YES: Was the permit recorded at the Re 'stry 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 7ZDON7 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)
iA Ducumeno FORMSorieinal\Building-Inspecmr6oningPem,it-Application-passive doc 8321xW
10. Do any signs exist on the property? YES V 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. Wit the construction activity disturb (clearing, grading, excavation, or fitting) over 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.eseroed
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size �j lFl`�ll'3 `Y NO LF}�,VCi�
Frontage
110,32 No U{�.}-FGE
Setbacks Front
Side L: 1 -3t� R: 10�-6`t L: I' -z R. 181 (o° L: R:
Rear ct 2 _(vl
Building Heigh[
ZA ' —Ot1 hdo GI�#NGE
Building Square Footage � C,I
%Open Space: (lot area
minus building R paved
parking
#of Parking Spaces
3fo+ � hcc��,161.E No ca-1a+1�F
#of Loading Docks
Fill: _
(volume B location) _
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 5 l Applicant's Sigq uo
v �
NOTE:Issuance of a zoning permit does not relieve 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.
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