JFK ZPA 2015-12-21File# MP-2016-0055
APPLICANT/CONTACT PERSON NORTHAMPTON CITY OF J F KENNEDY SCHOOL
ADDRESS/PHONE 210 MAIN ST
PROPERTY LOCATION 100 BRIDGE RD
MAP 16B PARCEL 003 001 ZONE URA(l00)/RI(81)/WSP(44)1SR(O)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT a:;; --o-
Typeof Construction: ZPA -36 X 60 MODULAR BLDG FOR RECREATION OFFICE SPACE
New Construction
Owner/ Statement or License
3 sets of Plans I Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PR~ENTED:
__ Approved _· _Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: § 3_fd -l l I L. ~ m -U ff
Intermediate Project : V 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
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 ofMGL 40A. Contact the Office of
Planning & Development for more information.
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Please type or print all information and return this form to the Building
Inspector's Office with the $30fi.lingfee (check or money order) payable to the
City of Northampton
1. Name of Applicant:(;~\ of: \JOK\\AW\r\H I \/¢~k '$~(kl)~ \' . \
Mdress: 2Ao 't"\f\!·\~· )~Ol\?ZrI&u&'rt:{)\)JJr Telephone: 6~1· \'2,(D6
2. ONner of A-operty: (j\ t'\ ~ · Nb~\lt\lP1 \ ~.
3. S:atus of Applicant: ONner ...,_· __ Contract F\Jrchaser ___ Lessee ___ Other (explain) ____ _
4. Job Location: \l]) ~4~ '\2:t).
5. Existing Use of S:ructure/ A-operty: '"'S;f .:'(.. \J.J...\ ~~ \1¢> ~CJrtQl)l..,
6. Description of A-oposed Use/ Work/ A-oject/ O:;cupation: (Use additional sheets if necessary):
LWj~'1fu.:\t, A. i ~'llD6 M.oou.uL 12\A \Lt),~ \&t!tt tr!\kmtt~~ t&\U..
~ ~1b0 ~ ~ Q;t"M\ 'PAIX.-":>"', ~ ~f1t. -fc,(\-l1\f1t\(t; ~ r~.. ·
7. Attached Aans: &etch Aan Ste Aan &lgineered/ SJrveyed A ans __ _
8. Has a ~ecial Perm;t/ Variance/ Ft ng ever been i S!Ued for/ on the Ste?
NO IXJNT KNON IF YES, date isrued: ______ _
IF YESc Was the permit recorded$ the Registry of C>aeds?
NO IXJNT KNON YES ___ _
IF YES: enter l?ook Page ____ and/ or Cbcument # _____ _
9.D>es the site contain a brook, body of water or wetlands? NO ~ IXJNT !<NON __ _ YES __ _
IF YES, has a permit been or need to be obtained from the Cbnservation Cbmmission?
Needs to be obtained ___ _ Obtained-----·' date isrued: ______ _
(Form Continues 0, Other Sde)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
10. D::l any signs exist on the property? YES ___ _ NO ___ _
11.
12.
IF~ describe size, type and
Are there any proposed changes to or additions of signs intended for the property? YES ___ NO __ _
Will the construction activity disturb ( clearing, grading, excavation, or fillin~r 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO F-
IF YES, then a Northampton S:orm Water l'Vanagement Permit from the a::w is required.
ALL INFORMATION MUSf BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION
Lot Size
Frontage
Setbacks Front
Side
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building & paved
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location)
EXISTING
L: R:
· This column reserved
for use by the Building
De artment
PROPOSED
R: \5
13. Certification: I hereby certify that the informati n contained herein is true and accurate to the best of
my knowledge.
Date: \\.\9 ,\5 \ ( \
Applicant's Si!J"latur
NOTE: Issuance of a zoning permit does not re t's burden to comply with all zoning
ard of Health, Conservation Commission,
Works and other applicable permit granting
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004