ZPA Acc AptFile # MP-2020-0033
APPLICANT/CONTACT PERSON BLAKESLEY DARLENE
ADDRESS/PHONE 19 WINCHESTER TERR
PROPERTY LOCATION BURTS PIT RD
MAP 36 PARCEL 039 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildin Permit Filled out
Fee Paid
TypeofConstruction: ZPA -BUILD A 864 SQ FT DETACHED ACCESSORY DWELLING WITH FRONTAGE
ON BURTS PIT RD
New Construction
Non Structural interior renovations
Addition to Existino
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:§ __________ _
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 -------
Permit from Elm Street Commission ---____ Permit DPW Storm Water Management
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applic.ant'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 ofMGL 40A. Contact the Office of
Planning & Development for more information.
X
350-8.8 Driveway
X
350-10.10 Accessory Apt
X
11/27/19
3. Status of Applicant: Owner _x __ Contract Purchaser ___ Lessee. ___ Other (explain}, ____ _
4. Job Location: Burts Pit Road Map 36 Lot 39
5. Existing Use of Structure/Property: __ N_on_e_v_a_c_a_n_t_L_o_t _________________ _
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7.
This property owner owns the dwelling at 19 Winchester Terrace Map 36 Lot 44 and also owns the
vacant lot behind the Winchester Terrace dwelling Map 36 Lot 39 that has frontage on Burts Pit Road.
The property owner would like to build an 864 Sq Ft detached accessory dwelling on the lot with '
frontage on Burts Pit Road. We understand we will need a permit for the driveway on Burts Pit Road.
Attached Plans: Sketch Plan X Site Plan Engineered/Surveyed Plans ___ _
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
X NO ___ _ 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# ______ _
9.Does the site contain a brook, body of water or wetlands? NO __ X_ DON'T KNOW __ _ YES __
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs t.o be obtained ____ _ Obtained _____ , date issued: _______ _
(form Continues On Other Side)
' DCBLAKtSL.e'f i 4 @_ (iM.Al~,C0¥1A
W:\Documcnts\FORMS\original\Building-lnspector\Zoning-Pennit-Application-passive.doc 8/4/2004
10. Do any signs exist on the property? YES ___ _ NO X
IF YES, describe size, type and location: ----------------------------
YES ___ NO __ _ Are there any proposed changes to or additions of signs intended for the property?
IF YES, describe size, type and location: ---------------------------
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES___ NO X ---
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
D tm epa1· ent
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
6000 SqFt
Frontage
60 Feet
Setbacks Front 25 Feet
Side L: R: L: 18Ft R: 18Ft L: R:
Rear 39 Feet
Building Height '.
One Story
r
Building Square Footage --
·•
864 SqFt · ... ,_
'r ,
% Open Space: (lot area -.. . . .
minus building & paved 75.6% parking -
# of Parking Spaces .
. . Two -,: ·•
# of Loading Docks ' None ,,
'
Fill: N/A (volume & location) ,.-.
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. ,/)
Date: 1/Uif-/;t_ Applicant's Signature /.j.,,,~ C, ~
NOTE: lssuanf e 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:\Docurnents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passivc.doc 8/4/2004
SKETCH/AREA TABLE ADDENDUM
Property Address Burts Pit Accessory Dwelling
City Northampton State MA Zip .. Borrower
Lender/Client
Appraiser Name
Map 36 Lot 44
60.0'
Map 36 Lot 39
Rear Setback 39'
Side Setback 18' Ranch Style Home Side Setback 18'
0 24 x36 0 ~ 664 SqFt §
~ Driveway
• ,:, Setback 25' ~
60.0' Scale 1~ • 25'
Burts Pit Road
Northampton Appraisal Associates APEX SOFTWARE 800-858-9958 Apx7200-w Apex2
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