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LOWS DEFERENCE
Book 4468 Page 287 `
see also: '
Pian Book 42 Page 33
Book 270 Pages 190 4.191
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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, descrihp ci-7a, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) ve ,1 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
13. Certification: I hereby certify that the informationntai ed herein is rue an accur to to the best of
my knowledge. '%
Date: " Applicant's Signature (f 1AC'
_..-N-`aTE-lsng permit does not relieve an applicant's burden to comply with all zoning
------regmrernerrts-and-obtain-all-r�d-per-units-from-the-Board-ofHealth Conservation Commission,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W: Docaments',FGR.�vIS'original`Bwiding-Inspector Zoning -Permit AppiicaEon-passive.doc &4i-'004
EXISTL" iG
PROPOSED
REQUMED BY
ZONING
Lot Size
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1�MIE
Frontage
C c.rL(�(?- i3OT
_ 17�l�i�2
, Z62 G (L
Setbacks Front
13J
Side
L: R:
L: R:
r R:
Rear
Building Height
1 -2ii i
/ 1
351
Building Square Footage
c/ 2Y�O�S
C•
I xLiS Z LOOT -S
� t,.r� � i'TI GIC�t3
% Open Space: (lot area
S
minus building &paved
v4�
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume & location)
13. Certification: I hereby certify that the informationntai ed herein is rue an accur to to the best of
my knowledge. '%
Date: " Applicant's Signature (f 1AC'
_..-N-`aTE-lsng permit does not relieve an applicant's burden to comply with all zoning
------regmrernerrts-and-obtain-all-r�d-per-units-from-the-Board-ofHealth Conservation Commission,
Historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities.
W: Docaments',FGR.�vIS'original`Bwiding-Inspector Zoning -Permit AppiicaEon-passive.doc &4i-'004
1.
2.
3.
4.
Pieasel .pe, or p # all, information and return this form to the Building
Ips 2e i6r's Off e:.'iih-th� $15 fl-13ng- fee (check or money order) payable to the
Name of Applicant:_ l� `' 1 � � � 1�-- Cl e Uv \ 2 �j � � � -.-x-.>Address Z !oE �� Telephone: �� S 0�
i
Owner of Property:'1
Address: -_ 'Telephone: -
Status
Telephone:Status of Applicant: Owner_ Contract Purchaser Lessee Other (explain)
Job Location: �; P( 4 -A
5. Existing Use of Structure/Property:
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
S 6- i o jr L' v4' i iv L. 1� 0 icitcc
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 _X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW
YES
IF YES: enter Book Page and/or Document
9.Does the site contain a brook, body of water or wetlands? NO DON'T KNOW
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained
YES
Obtained date issued:
(Form Continues On Other Side)
W:`Documents', FO R-MS'ori,-mai,Building- Ins pectorZonin_-Per.nit-application-passive.doc 3,4i_004
File # MP -2008-0077
APPLICANT/CONTACT PERSON RAPTELIS NICHOLAS SCOTT
ADDRESS.!PHONE 236 BRIDGE ST (413) 586-5106 O
Moo -follow
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Building Permit Filled out
Fee Paid
Tyneof Construction:_ZPA - STUDIO/LIVING SPACE
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
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: § A%�/J
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW
Septic Approval Board of Health
Water Availability Sewer Availability
Permit from Conservation Commission
Well Water Potability Board of Health
Permit from CB Architecture Committee
Permit from Elm Street Co ssion Permit DPW Storm Water Manage ent
X00
Signa re 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.
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