36-206 (12) File H MP-2019-0020
APPLICANT/CONTACT PERSON MATTHEW WEST
ADDRESS/PHONE P O BOX 235 (413)588-4231
PROPERTY LOCATION 59 W INTERBERRY IN
MAP 36 PARCEL 206 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
N SED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Tvoeof Construction ZPA-24X12 POOL HOUSE WITH 1/2 BATH
New Construction
Non Structural interior renovations
Addition m Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License
3 sets of Plans/Plat 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: §
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: 3
Finding Special Permit Variance'
Received&Recorded at Registry of Deeds Proof Enclosed
_Other Permits Required:
Cub Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health welf Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
r
j
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.
a Variances are granted only to those applicants who meet the strict standards of MGL 40A.Contact the Office of
Planning&Development for more information.
. ... . _ . . .._.
ZONING PERMIT APPLICATI
Please-type or print an information and'returh'th
Inspector's Office with the$30fi1ing fee (check or money order)payable to the
MJ
1�v 1 t ttg of ivortnampron
i. Name of Applicant: i"1/,Tl 4NrC'L
Address: a0 Abd rr��Z�S (To h LX43d , � o 13 LI( 1 Telephone: 913 �8 q Z3
L. UWner of Property: ' oy J- - —s Ma"(s')a-'r-(Jf- A"
_ Wo va
Address: 51 � T
`tt3 21''1 ?Lill
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) CO-Ar-1,
S, W,Ny{r6err7 Imo . L i loYchc� MAI
Parcelld: Zoning Map# Parcel# '24 Cf District(s):
In Elm Street District In Central Business District
5. Existing Use of Structure/Property: rules.t)2,x) I77rA
6. Description of Proposed Use/Work/Proiect/O Dation: '(Use adltt:al sheets rt necessarvl:
24' k 12 0ni 4ar._ �ool he �s� I Sts so ��� ie)t'ft-)
). 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#
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , date issued:
/ (Form Cantlnuee On Other Side)
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W\ uments\FORMSbngioal\Building-Imp toN ping-Permit-AM[icadon-p sive.dac W412M4
10. Do any signs exist on the property? YES NO /\
IF YES, describe size, type and location: T
Are there any proposed changes to or additions of signs intended for the property? YES NO–X—
IF YES, describe size, type and location:
11. Will the construction activity disturb(clearing, grading, excavation, or filling)avQr 1 acre or is it part of a common
plan or aevewpment mat wnr aismro over I acre: wtS— Nu �
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
for use by the Building
rtment
EXISTING PROPOSED REQUIRED BY
11 t ZONING
Lot Size
Frontage J 171-
�35
Setbacks Front 90l
Side L: R: L: 381 R: )tot L: R:
(tear 2l'
Building Height
/ZI
Building Square Footage
%Open Space: (lot area
minus building B paved `I o 8� e
parkin
#of Parking Spaces
Z U
Fill: 6 C.
(volume& location)
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
My��agqnowleage.
Date: Applicant's Signature
NOTE:Issuance of a wring permit does not relieve an applicant's burden to comply with all zoning
a.acn..d nbtn:o nri.o....:.c.d..a....:m f—tbo R—A-fn—ttb !`n.,ca.n.nN....r'n......:ca:....
Historic and Architectural Boards,Department of Public Works and other applicable permit granting
authorities.
W1Documenls/FORMSbngiwlV3uilding-IsssputoNnnivg-Penoit-Application-passiveda 8/42006