25A-007 File#MP-2019-0003
APPLICANT/CONTACT PERSON MACKIEWICZ JOANNE&DIANE KROK TRUSTEES OF THE JOSEPH P
KROK FUNDING TEL
ADDRESS/PHONE 345 DAMON RD
PROPERTY LOCATION 345 DAMON RD
MAP 25A PARCEL 007 001 ZONE URA(100)/HB(0)/
THIS SECTION FOR OFFICIAL USE ONLY.
PERMIT APPLICATION CHECKLIST
QUIRED DATE
ZONING FORM FILLED OUT ENCLO
Fee Paid
Building Permit Filled out
Fee Paid
Typeof C nstmctiom ZPA-USED CAR LOT
New Construction
Non Structural tenor renovations
Addition to Existing
Accessory Structure
Building Plans Included
Owned Statement or License
3 sets of Plans/Plot Plan
VFOMATION
LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
I PRESENTED:
ved 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/ORSpecial 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
Pefitit our Elm Street Commission Permit DPW Storm Water Management
v �(l
�gnature of Building bffici Dale
Note: Issuance of a Zonin�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.
RECEIVED
File No. JUL - 9 2018
ZONING PERMI'P' o. )
Please type or print all information a e Building
Inspector's Office with the $30fi1ing fee(check or money order)payable to the
City of Northampton
1. Name of Applicant:
,l ,q1— I
Address: I phone: U //_��7-5--2 7
7. Owner of Property: n i l/i G
Address: Telephone:
3. Status of Applicant: Owner�� Contract Purchaser Lessee Other (explain)
4. Job Location: 111
n tni
Parcel Id:_. Zoning.Map# ab /7 "__'Parcel#Q 0 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:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: Sketch Plan Site Plan 1 Engineered/Surveyed Plans
B. 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)
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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) e9 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
Frontage
Setbacks FrIult
Side L: R: L: R>/ L: R:
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building 3 paved
parking
#of Parking Spaces
#of Loaning Docks
Fill:
(volume R location)
13. Certification: I hereby certify that the information contained he� is tr e and accurate to the best of
my knowledge.
L:zDate: I Applicant's Signature/ -- _
NOTE:Issuance of a zoning permit does not reli&e 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. j
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