23D-101 (6) File 1J MP•2019-0068
APPLICANT/CONTACT PERSON SCIACCA JONNA
ADDRESS/PHONE 219 NORTH MAIN ST (413)586-77060
PROPERTY LOCATION 136 HINCKLEY ST
MAP 23D PARCEL 101 001 ZONE URBO 00)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
�N6LQSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fce Paid
Tvoeof Construction: ZPA-BUILD 2ND DWELLING ON BACK OF PROPERTY
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 ACYJON HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PR NTED:
_Approved _Additional permits required(see below)
PLANNING BOARD PERM�REQUIRED UNDER: § TAM 0 F uSE
Intermediate Project /Site Plan AND/ORTSpadal 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
J Permit from Elm(Street Commission Permit DPW Storm Water Management
Signature of Building Official Date
Note: Issuance of Zoning permit does not relieve a applicant's burden to comply with all caning
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.
File No. M P-1q-0 Y -
ZONING PERMIT APPLICATI N
Please type or print all information and return flih fo to the B di g
Inspector's Office with the$30filing fee(check or morri eyri le o t e
City ofNiorthampton
DEPT OF eURDINGINSPECTIONS
1. Name of Applicant: NORTHAMPTON.MA01060
Address: Telephone: Y13 :M' 77 O�a
2. : •T
Address: 136 heAlA �./
Tetephale:y/3 '5O'tn
3. Status of Applicant: OwnerContract Purchaser Lessee_Other(explain)
4. Job Location: / �,/�QIYYIQV 1L
Parcel Id: Zoning Map# d;3-0 Parcel# /0 District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: r�/� IlU d weffl ng ;- --
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
would li& -D build a second dwell;na on ba
clrPa �� Tc2 ne ru home /l
bgSe�?e�t n AO /n / area -Ppr 4 tears - would D(e A0
In riRd7. CO AttachedPlain Sketch Plan rI v Site Plan r JJ /w Engineered/SurveyyeddSPlans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW V/ YES IF YES,date issued:
IF YES: Was the permit recorded atth¢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 Cwtinues 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)over t acre or is it part of a common
plan of development that will disturb over 1 acre? YES_ NO V
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
Ibis column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
l,p;NaC✓e5 113 acres
Frontage o ) Q /
Setbacks Front I
Yt , /
Z� � ° V (J/ Side L:I�� R: j 2 ' L: �)O' R. J p r L: R:
Rear
Building Height / 7'WO 55/0 ry crybx
one
Building Square Footage q01O PIP,0)(
i oos
%Open Space: (lot area
minus building B paved 3/y QC re G r v2 Q c I'e
parking7
K of Parking Spaces
4
If of Loading Docks
Fill:
(volume ft location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my-knoo,vtedge.e.
Date: Applicant's Signature
NOTE:Issuance,of a ening permit does not reli 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.
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