15B-032 (9)R 7P AMPTON
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TO BE CoNYEYED BY iti6 �ps8 3p,
CITY OF NOR7HAMP70AI moo,
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P47RICK J. MEL.NIK
N AL.ICSE. MELNIK ��c --It-
IV, u /0.3467 ACRES
".k LAND OF
PATRICK T MELNIK ,
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10. Do any signs exist on the property? YES NO ✓X
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property?
IF YES, describe size, type and location:
YES NO '-"\
11. Will the construction activity disturb (clearing, grading, excavation, or filling) oXr 1 acre or is it part of a common
plan of development that wall disturb over 1 acre? YES NO J�
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
/ 0, �(7 4C/.,*-r
/D.21-) . e Ay-t
Frontage
I V 6
9 q 6
Setbacks Front
57V
5-0
Side
L: ibd R:
L: S-" R: �f�
L: R:
Rear
D
0
Building Height
Building Square Footage
! y UD
y 6 o
% Open Space: (lot area
minus building Et
paved
parkin
# of Parking Spaces
# of Loading Docks
V
0
Fill:
0
U
(volume Et location)
13. Certification: 1 hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicant's Signature
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
go.31* File No. /'yyr � P-Jd -73
Please type or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City of Northampton
1. Name of Applicant: PTA r K f ,,rt Al r l+it
Address: 2 N C ��rt"�- eL� ��� Telephone: S`P d 7 S-0
2. Owner of Property: 44-rx iu
Address: 1) C fie rTt ti 4.0 C j0 Telephone:
3. Status of Applicant:
4. Job Location:
Owner Contract Purchaser
1) (Nt trgti "GW /�-p AJ
�L/essee
Other (explain)
Parcel Id: ,', Zoning Map# Parcel# District(s)':
In Elm Street District, In CentralBusiness District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: C, r�pL 7 /a^+ N Na-v4 -e
b. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7.
8
Z�J 1-4 Or, ✓at o, c f0 Z.on AlaLl U.o' �A4aw '.
3 l,✓ r trees, (✓ A- lke,.T ✓,f4 �^7' ND., It e4llt4
Attached Plans: Sketch Plan _ Site Plan Engineered/Surveyed Plans
Has a Special Permit/Variance/Finding ever been issued for/on the situ
NO X 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 t wetlands? NO �_ 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)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
File # MP-2012-0073
APPLICANT/CONTACT PERSON MELNIK PATRICK J & ALICE E TRUSTEES
ADDRESS/PHONE 311 CHESTERFIELD RD (413) 584-6750 Q
PROPERTY LOCATION 311 CHESTERFIELD RD
MAP 15B PARCEL 032 001 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildiniz Permit Filled out
Fee Paid
TWeof Construction: ZPA - GROUND PHOTOVOLTAIC PANELS
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 ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P N fED:
Approved " Additional permits required (see below) N D D
PLANNING BOARD PERMIT REQUIRED UNDER: § S TR 6 LE U S E SC G
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 Elm Street Commission
Signature of Building Official
Permit from CB Architecture Committee
Permit DPW Storm Water Management
2 9 ri
Date
Note: Issuance of a Zoning permit does not relieve a applicant'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 of MGL 40A. Contact the Office of
Planning & Development for more information.