25A-188 (23) File#MP-2019-0038
APPLICANT/CONTACT PERSON HERIRAGE HEMP LLC
ADDRESS/PHONE
PROPERTY LOCATION 99 INDUSTRIAL DR
MAP 25A PARCEL 188 001 ZONE GI001)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
r
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-INSTALL AND OPERATE BOTANICAL EXTRACTION SYSTEM FOR
RECOVERY OF BENEFICIAL CANNABINOIDS FROM INDUSTRIAL HEMP USING ALCOHOL-BASED
SYSTEM
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
INFO ATION 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 from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
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41 R
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.
I RECEIVED .
NOV - 9 2018
File No. MP- 1q- 3i I I i
ZA.JZtJl1.7 V PERMIT APP.ICAPO DING INSPECTIONS
Please type or print all information and return this formto e
Inspector's Office with the$30 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: W QJ�l <--e��� �. �.t- -► r
Address: L1,4,t &4,1
Telephone:-W 1�
2. Owner of Prperty: QNB Sal P�/IST 14 L
Address K qq 10 Tete%one: q1-5- -1� 0'110&k)�,qA)
3. Statusof Applicant: Owner Contract Purchaser LesseOther(explain)
4. Job Location: "IVl ��Y�t�
Parcet Id: Zoning Map# a67 Parcel# j District(s):
In Elm Street District In Central Business District-
(TO BE FILLED 1N (BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: h *-VS, Gtet4V
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance inding 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:\Documents\FORMS\original\Building-inspector\Zoning-Permit-Application-passive.doc 8/4/2004
10. Do any signs exist on theproperty? NO
/
IF YES, describe size, type and location: S l �St✓�i� �0 �' ������ r/ �� �
o�o r-S r�,
Are there any proposed changes to or additions of signs intended for the property? YES NO '
IF YES, describe size, type and location:
11. ill the construction activity disturb (clearing, grading, excavation, or filling)over 1 acre or is it part of a corn
plan evelopment that witl disturb over 1 acre? YES NO
IF YES, then a rthampton Storm Water Management Permit from XOFORMATION
12. ALL INFORMATION MUST BE PLETED, or PERMIT CAN BE DENIED DUE TO mn reserved
y the Buildingent
EXISTNk REQUERED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R• L: R. L: R:
Rear
Building Height
Building Square Footage
%Open Space: (1.9earea
minus building paved
parking
#of Parki Spaces
#o oading Docks
Fill:
(volume li location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
+
Date: '�'' I U Applicant's Signature [�
NOTE:Issuance of a zoning permit does not relieve 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.
W:\Documcnts\FORMS\original\Building-inspcctor\Zoning-Pctmit-Application-passive.doc 8/4/2004
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