32A-202 (2) File #41
APPLICANT/CONTACT PERSON:BERCUVITZ, DEBRA T.
41 WARNER ST FLORENCE, MA 01062
PROPERTY LOCATION 59 PHILLIPS PL
MAP:LOT 32A-202-001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $30.00
Type of Construction: ZPA -CHANGE DWELLING TO 2 UNITS
New Construction
Non Structural Renovations
Addition to Existing S1231
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
j( Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR SpecialPenni With Site Plan
Major Project: Site Plan AND/OR SpecialPenni With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received&Recorded at Registry of Deeds Proof Enclosed
Other Perm its Required:
Curb Cut from DPW Water Availability 'ewerAvailability
Septic Approval Board of Health _ Well Water Potabilit Board of Health
Permit from Conservation Commission Permit from CB • chitecture Committee
Permit from Elm Street Commission Permit DPW Sto Water Management
Demolition Delay
I
di ; .$ i ii7)2b dr
Sign ture of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to co ply with all zoning
requirements and obtain all required permits from Board of Health, Consery tion Commission,Department
of public works and other applicable permit granting authorities.
*Variances are granted only to those applicants who meet the strict standards of GL 40A.Contact Office of
Planning&Development for more information.
File No. l
ZONING PERMIT APPLICATION (§l o.2)
Please type or print all information and return this form to the Building
Inspector's Office with the $30 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applican _ �b 1PC� g, C-U V ( !{
_
Address: . _ pp__ / Telephone._ __ __
2. Owner of Property:1)e l�r'C� t o✓c( ) V_1 (72-
Address:1 I Icloor 0 Q ✓ S-( flor-c 17)C'--2 Telephone: e--)—i ' 9 S. ' `0q 6 CI
3. Status of Applicant: Owner Contract��I�� P rc aser Lessee Other (explain)
4. Job Location: ill S c-e— ilbritA CA 1/ / b—h
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:
nA tA l't - L)PI ii)- d<.,.., , orG7s
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
C\I CW1 O L) 5 -e_ = Pence.) z- ___ (1--(
., vivt e\''S
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 DON'T KNOW (2 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 91N, 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 Continues On Other Side)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
1
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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 fillin v 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
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear
Building Height
Building Square Footage
%Open Space: (lot area
minus building Et paved
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. , n
Date: ft( ZZ Applicant's Signature V
NOTE: Issuance of a zoning permit does not relieve 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.
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
—NOTE—
THIS PLAT IS COMPILED FROM DEEDS, PLANS AND OTHER SOURCES AND IS NOT
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS NOT GUARANTEED.
LOCATION OF FENCES ON OR NEAR BOUNDARY LINES
IS NOT VERIFIED BY THIS INSPECTION.
NOTE:
PROPERTY LINES SHOWN ARE APPROXIMATE, A NOTE:
FULL FIELD SURVEY IS REQUIRED TO SUBJECT TO AND TOGETHER
ACCURATELY DETERMINE THEIR LOCATION. WITH EASEMENTS AND RIGHTS
OF WAYS OF RECORD.
89'± +
///// 75.08'±
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90'±
PHILLIPS PLACE
TO:
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT I HAVE EXAMINED THE PREMISES AND BASED ON EXISTING
MONUMENTATION ALL VISIBLE EASEMENTS, ENCROACHMENTS AND (BUILDINGS ARE LOCATED ON
THE GROUND AS SHOWN AND THAT THE BUILDINGS ARE ENTIRELY WITHIN THE LOT LINES,
EXCEPT AS NOTED. I FURTHER REPORT THAT THE PROPERTY IS NOT LOCATED WITHIN
A FLOOD PRONE AREA AS SHOWN ON FEDERAL FLOOD INSURANCE MAPS FOR
COMMUNITY #250167
—NOTE—
SURVEYOR: THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
AND DOES NOT CONSTITUTE A PROPERTY SURVEY
—MORTGAG
INSPECTION PLAT—
(v,„;-k
Sgcti NORTHAMPTON,N MASSACHUSETTS
RANDALL � PREPARED FOR
o IZER N DEBRA T. BERCUVITZ ET AL
i�35032 SCALE: 1"=40' DECEMBER 27, 2021
�9yo vct HAROLD L. EATON AND ASSOCIATES, INC.
uR REGISTERED PROFESSIONAL LAND SURVEYORS
235 RUSSELL STREET — HADLEY — MASSACHUSETTS