25A-196 ._____ —\ z -vK I, l v7o��i
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m
Il
o "-"11 File 0.,�
'0 ZONING PERMIT APPLICATION (§i 0.2)
o° N P1 type or print all information and return this form to the Building�
Inure Office with the $30 filing fee (check or money order)payable to the
'sm N' if`!, City of Northampton
0 0 .� f
FP . Name of A piicant: , .i 8 di ill i f !' '(f .6 .C. I
/.14 0/02.8
Address: /0 it.."1 i'1 . due . E., L , Aot rA t� Telephone: 6W/3 ) 6 3 —6 0 84--
2. Owner of Property: /3ft 1.S,4 Af'+ 19. Z.�C7ApieLalti7#? i'
Address: if Si rt1 3I4m VC of t'� i,lepho c�
� � �A�t Telephone: �'�,r/��STY" 917
3. Status of Applicant: Owner Contract Purchaser I1" Lessee Other(explain)
4. Job Location: Lc�7 —2. ?Sit e,Z 144! AR istio ktris.44 {19 t../e G b
Parcel Id: Zoning Map# a`7 A Parcel# 1 q (461 District(s): C....4.5 1
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
;
5. Existing Use of Structure/Property: ee1i- 13 c,'.'/ �f ';.. 7 - o ,fr el Q
ay 712e C, ,).4 ,...., i'lloyeri,A14,fie;RO'NV A 401.i :V 734./W
b. Description of Proposed se/Work/Project/Occupation: (Use additional sheets if necessary):
"re; C072,577eldtr / q tilCrr.,L, . Ali"'.f4,
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 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 L------' 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:U)ocuments\10122 1Sbrigina1\Building-lnspectar\Zoning-Pennit-Application-passive.doe 8/4/2O04
10. Do any signs exist on the property? YES NO Z
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NOS
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 for 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 colunm reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size / �_,,,,?
Frontage �/j
Setbacks Front e)
Side L: R: L: I S5' R: 9 L: R:
Rear ?6) I
Building Height /
Building Square Footage
/i 73 0
%Open Space: (lot area
minus building & paved
parking '
# of Parking Spaces
3
#of Loading Docks
Fill:
(volume & location) _'
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: ,`�G�-� Applicant's Signature
f
NOTE:Issuance of a zoning permit does not reliev applicant's burden to comply w. all zoning
requirements and obtain all required permi om the Board of Health,Conse ration Commission,
Historic and Architectural Boards,Department of Public Works and other ap icable permit granting
authorities.
W:U3ocuments\FORMS\original\Building-Inspector\Zoning-Pemtit-Application-passive.doc 8/4/2004