23A-085 File q MP-2019-0005
APPLICANT/CONTACT PERSON BELISARIO BURI
ADDRESS/PHONE 31 EXETER ST (413)222-2914
PROPERTY LOCATION 3 MAIN ST
MAP 23A PARCEL 085 001 ZONE GBUNk
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED O
Fee Paid �1
Building Permit Filled ou
Fee Paid
Tvueof Construction: CHANGE OF USE FROM COMMERCIAL RETAIL ASSEMBLY USE
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�OLLOWENG ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFf/RMATION PRESENTED:
((//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 hem CB Architecture Committee
e it from Elm Street Commission Permit DPW Storm Water Management
Sign o Buildi g //�/r/,1 Da[
ua
Note: Issnce of a Zo4dug permit dues not relieve a applicant's burden to comply with all voting
requirements and obtain all required permits from Board of Health,Conservation Commission,
Department of public works and other applicable permit granting authorities.
s Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning&Development for more information.
File No.
ZONING PERMITAPPLICATION Oio.a)
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, �.�'�"
Address: J 1 C X a IJy S I Telephone: y J — L — 7 r///z/,
2. Owner of Property:
Address: `r I�Y '�C 2 Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee_Other (explain) W 1+l D
4. Job Location:
Sujjnir �{er
017
Parcel ld: Zoning Map# 1'7 Parcel# l./D� District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: 171
6. DT!9n ion of Pro osed a/Work/Pr jec /Occu ation: (U additional sheets if necessary):
r r i u a 4.sern-G u sa
o(oli/ ro 1 Mah, 0 D
r�aa nr ager �i'o o� S-'Udprr un� lahu � /dDU
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 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)
W 8/412004
10. Do any signs exist on the property? YES NO
IF YES, describe size,type and location: �'L.til f'ltY i Ny�LUs
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 J
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
TONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building Et paved
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume ft location)
13. Certification: I hereby certify that the information contained her is true and accurate to the best of
my knowledge. j \
Date: � � / l Applicant's Signature
NOTE:Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
requirements and obtain aD required permits from the Board of Health,Conservation Commission,
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W'.IDocumenvsTORMs%original'Building-InspectodZoning-PenNi-Applicarion-passive.doc 9142004