23A-274 File#MP-2018-0070
APPLICANT/CONTACT PERSON HARR''.. 4GTON MICHAI ,L
ADDRESS/PHONE P O BOX 393
PROPERTY LOCATION 21 MIDDLE ST
MAP 23A PARCEL 274 001 ZONE URB,^81/GB())/
THIS SEC';IOTFOR OFFICI L USE OIC
PERMIT APFLICAW t'HEC51dST
EN CLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
TvoeofConstructiow ZPA-CONVERT UISTIN.Q GARAGE INTO 2 BEDROOM HANDICAP ACCESSIBLE
APARTMENT
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included'
Owner/Statement or License
3 sets of Plans/Plot Plan
n„cre
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED: �9
_Approved _Additional permits required(see below) 'plot Pon
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
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.
� [_ L CUR lQ e5 P6 " V-0J C C TO �5 � /✓1 curl l c l�
P- ig-2Q FileNo. T6 (3oX -3C[ 3
ZONING PERMIT APPLICATION(§102)
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
1. Name of Applicant: M I(zFt /tE i- 1— 0 AiR21 A)C-(T Y
1 M I D D L E 5 T VUO'LTLt" P TM�. (UTele hone: �Y( _-7(97-
Address:
_ p
2. Owner of Property: (c(q+}Fl
(��{ &JO&T-1 S(2t(Y( Ah Tffs4M SWrn6
Address: t'� Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) '7
a. Job Location: 2-1 M(0LI-E6� dd��C—f o4Ul2T(4-0-✓✓� rcA, t& C
. 10
Parcel Mi
Zoning Map# 'I : YtA Parcel# '�-7 District(s):
In Elm Street District in Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: R L( �G
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
lI
CONJE2i C- il5 01MAillp l my*)T
'L & 7" hIG (32t cK SY2JLYu2P
� A0,M 1 Ffk 9T Ee-r s=f G TttL rrr42HC-(=i I i IS
1ci20f 7rt[ P a a P&ery Kf✓�(uc- r,-uGFw �P2ofC�Li"y /LIG �5"`Oc�crt'L
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans I
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW V YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry 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 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)
Wa\Documents\FORMS\oogma Buildmg luspeclor\Zoning-Permit-Application-passivc.doc 8142004
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 i,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
Departnumt
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
qq
Frontage
50-r
Setbacks Front
Side L: CiO + R: xf' L: 40'
R: Yr L: R:
Rear 3Fp55 D(t tv.crJt> A:dS U2 u+tlntvy'
Building Height
3r3 3v
Building Square Footage 1 / v Ws'tP%6 f r
%Open Space: (tot area
minus building fr paved �� 7d -7
parking
#of Parking Spaces
#of Loading Docks 401
Fill:
(volume Et location)
i.
13. Certification: I hereby certify that the information contained herein i true and accurate to the best of
my knowledge.
� lDate: �- � �- —I� Applicant's Signature ? 4
NOTE: Issuance of a zoning permit does not reliev an plicant's burden to comply with all zoning
requirements and obtain all required permits m the Board of Health,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W'Docum ,FOR SbrigmahBuildmg-InspectorVoning-Permit-Application-passive.doc 84,2004