23D-103 (4) r ;;, re, I I �R : 1
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I r . , 1 i FILE I 2
L_____ll JUN LL 7 l997 Y
.. ._APP.LICANT/ N ACT PERSON: — 'PT �i r �n u p /
PROPERTY LOCATION: �`�
,(�MAP c_22 3 P PARCEL: /O3 ZONE ,aii--
i'HIS SECTION FOR-OFFICIAL USE ONLY:
PERMIT APPLICATION CAF,CKLIST
ENCLOSED REQUIRED DATE
ZONING FORM I LE1D OTTT
gPPi �
Building Permit Finest nut
Fee Paid
Type of Cnnctrrirtinn•
New Cnnctrnrtinn
Remodeling Tnterinr
Additinn to Existing
Arreccnry Stnrrture
Building Plane Tnrliuded•
Owner/flrrnpant Statement nr Licence 1/
3 Sets of Plane /Plnt Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented
Denied as presented:
( Special Permit and/or Site Plan Requ• ed under: §
•
PLANNIN
G BOARD -- ZONING BOARD
Received & Recorded at Registry of Deeds Proof Enclosed
Finding Required under:§ w/ZONING BOARD OF APPEALS
Received & Recorded at Registry of Deeds Proof Enclosed
Variance Required under: §a, D w/ZONING BOARD OF APPEALS -5 Off' 3• h�-�' cede.
y
e•C Chi n a_4 J - zev-,,,,cb (!-GIC Ice OW IrQ,1
Received& Recorded aT Registry of Deeds Prof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval-Bd of Health Well Water Potability-Bd Health
lPerruit from Conservatio ommission
Signa.e for D e
NOTE:issuenoe of a zoning permit does not relieve en epplloente burden to oompty with all
_ zoning requirements end obtain all required permits from the Board of Health, Conservation
Commission, Department of Public, Works and other applioable permit granting authorities.
t_-
)` JUN 2 11997
File No.
I)EPT OF BUILDING INSPECTIONS
/ 4251 1
NORTHAMPTON.MA A 01060
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
( Name of Applicant: KCert , Hruby
Address: 23 � I Ue wit—,A�'�`f f Telephone: 1f —/*OS
— .
6AOwner of Property: An J Ih"i vUt A Address:kg I d ($h0- I t 41U 1 NI 0/O'3f Telephone: (4)3)2-4 —1Z31
3. Status of Applicant: Owner Contract Purchaser d Lessee
Other(explain): (�,�
4. Job Location: id 23 1 �I/ 4
Parcel Id: Zoning Map# 2340 Parcel# (,t7f/03 District(s): ..,...46,---b---
(TO BE FILLED IN BY THE UILING DDEPAR/ TMENT)
5. Existing Use of Structure/Property (-SI ( rex/L
6. Description of Prpposed Use/Work/Project/Occupationi: (Upe additional lhpets if necessa
/ Jo a 0 A rb CQ- Pil /Py � pnof h 'a7 , e'vQAP ce 7. Attached Plans: ✓ Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
Has a Special PermitNariance/Finding ever been issued for/on the site?
NO V DON'T KNOW 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#
Does the site contain a brook, body of water or wetlands? NO V DON'T 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)
f
10. Do any signs exist on the property? YES NO 1
IF YES,describe size,type and location:
Are there any proposed changes to or additions of signs intended for the property?YES N/ // NO
IF YES,describe size,type and location: 50 l - 1 x 4fltGx@ lix ovi
ii,VI.Q., i p r
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This column to be filled in
by the Building Department
I !Required I
Existing Proposed By Zoning
Lot size ) chile
Frontage lvo dtie
Setbacks - frnnt Aft 4010
eritti do L: ►Jc R: WC
v-i wb-\‘‘,kA IOC
a� �r+� � I) bltutt-
Bu 1
Bic 1/41°\A- kA i;)ufrilteth(y•— Or:
%C WW1)
NC
-- .pf Parking Spaces t _q � ��/ Li
fof Loading Docks t
0 U
Fill:
(vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and ccurate to the best of my knowledg
/
DATE: - C 2 9) APPLICANT'S SIGNATURE l,l'M
A
NOTE: Issuan a of a zoning permit does not relieve an applioenes burden to mply witilt-ell
zoning requirements and obtain all required permits from the Board of Healt , Conservation
Commission, Department of Publio Works and other applioable permit granting authorities.
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