32C-067 (3) •
BP-2008-0597
GIS#: COMMONWEALTH OF MASSACHUSETTS
11011111- CITY OF NORTHAMPTON
Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS
Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A)
Category: BUILDING PERMIT
Permit# BP-2008-0597
Project# JS-2008-000926
Est. Cost: $2300.00
Fee: $50.00 PERMISSION IS HEREBY GRANTED TO:
Const. Class: Contractor: License:
Use Group: TYPROWICZ HOME IMPROVEMENT INC 093516
Lot Size(sq. ft.): 30666.24 Owner: MAPLEWOOD SHOPS INC
Zoning: CB Applicant: TYPROWICZ HOME IMPROVEMENT INC
AT: 2 CONZ ST - UNIT 60 & 64
Applicant Address: Phone: Insurance:
417 SPRINGFIELD ST SUITE 210 (413) 789-6702
WC
AGAWAMMA01001 ISSUED ON:12/28/2007 0:00:00
TO PERFORM THE FOLLOWING WORK:SEPARATE 1 UNIT INTO 2, MOVE BATHROOM
DOOR (FORMER CAFE LEBANON SPACE
POST THIS CARD SO IT IS VISIBLE FROM THE STREET
Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector
Underground: Service: Meter:
Footings:
Rough: Rough: House# Foundation:
Driveway Final:
Final: Final:
Rough Frame:
Gas: Fire Department Fireplace/Chimney:
Rough: Oil: Insulation:
Final: Smoke: Final:
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Certificate of Occupancy Signature:
FeeType: Date Paid: Amount:
Building 12/28/2007 0:00:00 $50.001662
212 Main Street,Phone(413)587-1240,Fax: (413) 587-1272
Building Commissioner-Anthony Patillo
File#BP-2008-0597
APPLICANT/CONTACT PERSON TYPROWICZ HOME IMPROVEMENT INC
ADDRESS/PHONE 417 SPRINGFIELD ST SUITE 210 AGAWAM (413)789-6702
PROPERTY LOCATION 2 CONZ ST-UNIT 60&64
MAP 32C PARCEL 067 001 ZONE CB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out S$lad ��/ �
Fee Paid /1Q
Typeof Construction: SEPARATE 1 UNIT INTO 2,MOVE BATHROOM DOOR(FORMER CAFÉ LEBANON
SPACE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Statement or License 093516
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF ATION 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
Demolition Delay
lL
Signature of BuildingOfficial Date
g
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 Office of
Planning&Development for more information.
• Versionl.7 Commercial Building Permit May 15. 2000
Department use only
City of Northampton Status of Permit:
Building Department Curb Cut/Driveway Permit
212 Main Street Sewer/Septic Availability
Room 100 Water/Well Availability
Northampton, MA 01060 Two Sets of Structural Plans
phone 413-587-1240 Fax 413-587-1272 Plot/Site Plans
Other Specify
APPLICATION TO CONSTRUCT,REPAIR,RENOVATE, CHANGE THB USE OR, OCCUPANCY OF,OR DEMOLISH ANY BUILDING
OTHER THAN A ONE OR TWO FAMILY DWELLING
SECTION 1 -SITE INFORMATION DEC 2
This section to be completed by office
1.1 Property Address: •
.2- ChZ. Vet (GCS 'E• Map • i''; st n ,s Lot Unit
--ap g.aet.0 Zone Overlay District
Elm St.District CB District
SECTION 2-PR TY OWNERSHI UTHORIZ T
2.1 Owner of Recor
Y'(1 a IAILw0c1a Vlo ^ q amines �Q---
Name(P O Q. Curr nt Mailing Address:
. Q rIUU
Signature Telephone l ` -� ��
2.2 Authorized Aqe t
--�`lQ`"t"'kcz. � rnp , �nL� 1-1i1 sQ-C-A Ay.),uoo.m,
M .
Name(Print) Current Mailing Address:
Signature 0,AA Telephone
SECTION 3-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be Official Use Only
completed by permit applicant
1. Building (a) Building Permit Fee
2. Electrical
(b) Estimated Total Cost of
Construction from (6)
3. Plumbing Building Permit Fee
4. Mechanical(HVAC)
5. Fire Protection
6. Total=(1 +2+3 +4+5) Check Number /6,G 9- 1/4.5i5
This Section For Official Use Only
Building Permit Number Date
Issued
Signature:
Building Commissioner/Inspector of Buildings Date
.
Versionl.7 Commercial Building Permit May 15,2000
SECTION 4-CONSTRUCTION SERVICES FOR PROJECTS LESS THAN 35,000
CUBIC FEET OF ENCLOSED SPACE
Interior Alterations ❑ Existing Wall Signs 0 Demolition 0 Repairs 0 Additions 1S3 Accessory Building 0
Exterior Alteration ❑ Existing Ground Sign❑ New Signs❑ Roofing❑ Change of Use❑ Other❑
Brief Description Enter a brief description here.
Of Proposed Work: f, \ —�
` q Qrcel-q-- 0 wz \3yits \v`}v !_W‹) kO•se._i r Wok. Yv\,
SECTION 5-USE GROUP AND CONSTRUCTION TYPE ' ock%it 'ram •Pe.TO'Q_
USE GROUP(Check as applicable) CONSTRUCTION TYPE
A Assembly ❑ I A-1 0 A-2 0 A-3 0 1A I 0
A-4 ❑ A-5 ❑ 1 _1 B 0
B Business 0 2A 0
E Educational ❑ 2B 0
F Factory 0 F-1 0 F-2 0 I 2C ❑
H High Hazard 0 3A 0
I Institutional ❑ 1-1 0 1-2 0 1-3 ❑ 3B 0
M Mercantile ❑ 4 ❑
R Residential 0 R-1 ❑ R-2 ❑ R-3 ❑ 5A I 0
S Storage 0 S-1 ❑ S-2 0 5B ❑
U Utility ❑ Specify'
M Mixed Use ❑ Specify:
S Special Use ❑ Specify:
COMPLETE THIS SECTION IF EXISTING BUILDING UNDERGOING RENOVATIONS,ADDITIONS AND/OR CHANGE IN USE
Existing Use Group: _._....__ _ ._ ..._: Proposed Use Group:
Existing Hazard Index 780 CMR 34): .__, ,.__ Proposed Hazard Index 780 CMR 34):
SECTION 6 BUILDING HEIGHT AND AREA
BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION OFFICE USE ONLY
Floor Area per Floor(sf)
._ ,
1st 1st
2nd 2nd
_ __. 3'd
3rd _________ ___ ____ _.
to —
4t"
Total Area (sf) Total Proposed New Construction sf)
Total Height(ft)
Total Height ft
7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewa Disposal System:
Public Private ❑ Zone Outside Flood Zone❑ Municipal.. ] On site disposal system❑
Version 1.7 Commercial Building Permit May 15, 2000
8. NORTHAMPTON ZONING
Existing Proposed Required by Zoning
This column to be tilled in by
Building Department
Lot Size
Frontage
Setbacks Front
Side L: R: L: R:
Rear
Building ITeight
Bldg. Square Footage
Open Space Footage
(Lot area minus bldg&paved
parking)
#of Parking Spaces
Fill:
(volume&Location)
A. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO 0 DONT KNOW v` YES 0
IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO 0 DONT KNOW 0 YES 0
IF YES: enter Book Page and/or Document tt
B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (3 YES 0
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained , Date Issued:
C. Do any signs exist on the property? YES NO 0
IF YES, describe size, type and location:
D. Are there any proposed changes to or additions of signs intended for the property? YES 0 NO s
IF YES, describe size, type and location:
E. Will the construction activity disturb(clearing, grading, excavation, or filling)over 1 acre or is it part of a common plan
that will disturb over 1 acre? YES 0 NO
IF YES,then a Northampton Storm Water Management Permit from the DPW is required.
Version1.7 Commercial Building Permit May 15,2000
SECTION 9-PROFESSIONAL DESIGN AND CONSTRUCTION SERVICES-FOR BUILDINGS AND STRUCTURES SUBJECT TO
CONSTRUCTION CONTROL PURSUANT TO 780 CMR 116(CONTAINING MORE THAN 35,000 C.F.OF ENCLOSED SPACE)
9.1 Registered Architect:
Not Applicable ❑
Name(Registrant):
Registration Number
Address
Expiration Date
Signature Telephone
9.2 Registered Professional Engineer(s):
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Name Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
9.3 General Contractor
�P t C W t cz VIP v"r`Q- Not Applicable ❑
Company Name:
n—cpin pcowlc
Responsible In Charge of Construction
Address
L��3-1c c tD Da-
Sign re Telephone
• Versionl.7 Commercial Building Permit May 15, 2000
SECTION 10-STRUCTURAL PEER REVIEW(780 CMR 110.11)
Independent Structural Engineering Structural Peer Review Required Yes 0 No ( I
SECTION 11 -OWNER AUTHORIZATION -TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, \\* "fr ,as Owner of the subject property
-= eby authorize p tclw 1CZ �\' .-3-W+ c \J-Z-v ' i J-f i C • to
.n m ehalf, in all matters relative to work authorized by this building permit application. 1 0
Signature of Owner D to
—s —
I, J CDe u,.)t<-�iTic)E-C;t1,J1c,-r_ •�c�r�swN�� M t IN ,as Owner/Authorized
Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge
and belief.
Signed under the pains and penalties of perjury.
Jo e.._ \ \A Qrc w“.. z
Prin Name
IV\ ! 7fay I0 11
Signs re of Owner/Agent Da e
SECTION 12-CONSTRUCTION SERVICES I
10.1 Licensed Construction Supervisor: Not Applicable 0
Name of License Holder: ,C/V.$11 . _rn. -zi RtGW_Ici t 1 35I
License Number
9 4 Soo Pcm-kit-t ,,. gym, t 0IOC I Ids('idii0(1
A.,.ress Expiraate
Sig,:ture Telephone
SECTION 13-WORKERS'COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c. 152,§25C(6))
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed Affidavit Attached Yes No 0
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
-a� 600 Washington Street
. Boston, !vL4 02111
� www.mass.gov/dia
-Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ADolicant Information Please Print Legibly
flame (Business/Organization/Individual):1y9poLsv4CZ. m.L- -LJY1Qcove..Y{119 v j..r1 C.
Address: 4 11 59%-t r t1.p ST. Su cre al()
City/State/Zip: Aga k:c{m i VAA O l oc,I Phone.: 1 I -^i g e‘ 70,E
Are you an employer?Check the appropriate box: Type of project(required):
1.[ I am a employer with 3
employees(full and/or part-time).*
4. ❑ I am a general contractor and I
have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner listed on the attached sheet 7. 1 Remodeling.
ship and have no e_.�Ie;Tees These sub-contractors have. g. Demolition
working. for me in any capacity.acit employees and have workers'
p + 9. ❑Building.addition
[No workers'comp.insurance comp.insurance.:
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself. [No workers'comp. right of exemption per MGLc. 152,§1(4), and we have no
12.❑Roof repairs
insurance required]t
employees.[No workers' 13.❑ Other
comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating atrh
:Contractors that check this box must it-irbed an additional sheet showing the name of the sub-coatractors and state whether or not those entities have
employees. If the sub-contractors have enmloyees,they must provide their workers'comp.policy number.
I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site
information. ii
Insurance Company Name: Gc ,,t+C, `Jtbh J.ft5' ,
Policy#or Self-ins. Lic. #: 1,3 C. <1;2%4 `_ S Expiration Date: 3 faolog
Job Site Address: ri2T, V1111.leC{(G'j City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of c im n:ll penalties of a
fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby rtify under the pains and pennlries of perjury that the information provided above is true and correct.
Signature: tAp4()Z5 Date: I Z"o2 , • C
-
Phone#: LI) S _7 S 1 —�7O)
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector
6.Other - -
Contact Person: Phone
I Si) N
S
Typrowicz Home Improvement,Inc.
417 Springfield St
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Grand Total Areas:
4,821.21 SF Walls 1,874.96 SF Ceiling 6,696.18 SF Walls and Ceiling
1,874.96 SF Floor 208.33 SY Flooring 545.83 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 546.25 LF Ceil.Perimeter
1,874.96 Floor Area 2,150.35 Total Area 4,821.21 Interior Wall Area
2,099.33 Exterior Wall Area 235.83 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
Typrowicz Home Improvement,Inc.
417 Springfield St ,
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Existing ,
1 23'6' I
23 m
j16'11' I
�(rn r+-10'3' -� i
En to
CQ1. 1
7
MIME 4arene[II r
20*9' 1-2'1. —
. _13'1' .ON ii
A F2—
7 6'm-�
6 7'—1 6'10' '
F-6'.4' _ "_i - m
J I 6 3' Tm —
cam _ .
1 `32-I -
TI amru n / 1
14'11' 1'� — I 74
15'6'
3' T— i —F-4' . m
, V
F-3'4' T
Moir
n 1
0
F 101sa= --3'11' I
19'6' I —
T
27'6' 15'3' W_
1 20' I 15'9' I 5't
Existing
MAPLEWOOD 12/27/2007 Page: 2
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam, MA 01001
Phone: 413-789-6702
HIC 137179
Existing
1 23'8'
23' --- m
i._ 16:11'
gn
113'3 III
1nt= MIL 1
rn
s goraue(1)
k
2049" k2'10x' o
-
■ 13'1" ri -7' --■
1-2'
liftman D '10^
Salizt
T __ _.R.4*.-- I
--
�'3•
•TEo
1i:r •2"-I
.-..._ — d
I-
n 147"
• . ----1."1.----11.7. Ft" r4
Fa w
1 •
....411" I' ry — '. _---
II
— 1 —I—�' T m
or
w
v V co
1 . 9' ■ 1-3 7"on
-3.4" I.
Rk in1
61
r" 1n 1
Co Q ■3'11"—�
•
EN [V
19'0" I r...
in
in
scene(l). -
,7'6" 15'3"
1 — 20' -•1----- .15'9` I
MAPLEW OOD 12/27/2
4
Typrowicz Home improvement,Inc.
417 Springfield St
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Grand Total Areas:
2,266.16 SF Walls 1,101.23 SF Ceiling 3,367.39 SF Walls and Ceiling
1,101.23 SF Floor 122.36 SY Flooring 280.33 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 259.91 LF Ceil.Perimeter
1,101.23 Floor Area 1,181.28 Total Area 2,266.16 Interior Wall Area
1,507.89 Exterior Wall Area 178.83 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Proposed
1 23'B' I
N ern. l �
. 1
r
{ 23'7 _ram.l
I 131' 7' it 3'2"-I
.7\,,I 9.7.E Bathroom ano
T-? 6'2•� I
,3 r-1 — 7'4•—4
la I1v ; 14'7: 1 ,.—I
7 14'11' I
_3 T
3
Q V
1 1-3'4-.-!
COMIN
o
N 61
19'6' I
Small
'v
l 27'6 f
(mil
I 292 1J
Proposed
• MAPLEWOOD_1 12/27/2007 Page: 2
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam, MA 01001
Phone: 413-789-6702
HIC 137179
Proposed
I
da'ii" 1
23'
it,
io f.,., I
1— l•
L, co w
N
23'7" .-
r---,p, 1
. ____
i>>
6allvuuw -
T
6,4„ I
ul �n i -
.1 i 2• Cal 7
TSmall
rn tr,
,a c,
co. r
a ?4./".
zi,
m A-4'--i
,4 R
I .3.4•.
1-3'4"i+
4
uo u:
i+ in
ui it
w n
1y.b.
T
r---, , _
I 20'2'
Y
WOK
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Grand Total Areas:
2,679.50 SF Walls 772.79 SF Ceiling 3,452.29 SF Walls and Ceiling
772.79 SF Floor 85.87 SY Flooring 282.67 LF Floor Perimeter
0.00 SF Long Wall 0.00 SF Short Wall 291.33 LF Ceil.Perimeter
772.79 Floor Area 844.45 Total Area 2,679.50 Interior Wall Area
1,273.17 Exterior Wall Area 132.67 Exterior Perimeter of
Walls
0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length
0.00 Total Ridge Length 0.00 Total Hip Length
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam,MA 01001
Phone:413-789-6702
HIC 137179
Proposed
I 17'3' I
If J f0.3' ,moo
IIlltlil
_J ,
105-, f
o
1 7'8'. [n
{- 6'
6'10'_F
1
1 co
CDM:hum:e 1 h
v I 15'6'
67
1-3'7'—
T —
gjYYxw I.
1 , 1
Mega 3'11'—1
ev
Z.
en
_ 15'3' . I
I ,5'11'
Proposed
MAPLEWOOD_2 12/27/2007 Page: 2
Typrowicz Home Improvement, Inc.
417 Springfield St
Suite 210
Agawam, MA 01001
Phone: 413-789-6702
HIC 137179
Proposed
17'3"
Ta
"v m
1. 7
•
StorogC{1}
J
1'10fY
O
10 6'10"
Mai `V
M
M
En
. N ➢flan N
N
\ Bathroom I in
1 r`
(rS� I 15 6"
"I
Q]
6,
1-3'7"
fi
. 9y I
�
3'1'1"—1
r
CV
iO
En
■R.1 15'3"
I 15'1 I" I
File#MP-2008-0051
APPLICANT/CONTACT PERSON KELLY MELISSA C
ADDRESS/PHONE 4 CROSBY ST (413)584-6300 O
PROPERTY L '2 C-
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORT FILLED OUT ,/ 4 tE
—Pee Paid 60 0f6
Building Permit Filled out
Fee Paid
Typeof Construction:_ZPA-HAIR SALON
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 FO LOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFO ATION 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 Commissio Permit DPW Storm Water Manage nt
Signature of Building Official 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.
File No.0/`" 1(57
- =-� 6 NRT'AP -- C'_-' _ I Q @ 1 2) - _ -�
Please type°or print all information and return this form to the Building
Inspector's Office with the $15 filing fee (check ormoney order)payable to the
C..ity th-ofNo1 ampton
'--7 1- Name of Applicant: Me 15 S a (. i (Z`�y
Address: Li"' (,' D s �kTl '��e�v� , t�c ;nilo. '--G7 �'�- Ov
2. Owner of Property: 7 \4 P LAW OO D S 440}9 S N LN C-
Address: 7. Co.t Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: }M,A P Cf WOOb S Ho PS ,_ -* 2, Choi,) ST[__
5. Existing Use of Structure/Property: A -3 2f-S L AU ( 'J
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
H 1 C4 SA LO ),J
7. AttaehedPlans: 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 [F YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: enter Book Fr-age and/or Dor-.lment #
9.Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES
IF YES, hag a permit been or need to be obtained from the Conservation Commission?
Needs to be-Obtain-ad 05tairied , date issued:
(Form Continues On Other Side)
VJ:.D----—n-sTODa Sc:zinz.R_.r-t i__e *==, .ovine-P,I-n1;--ppii=ian-D2mive-aoc 8/4r20(k
10. Do any signs exist on the property? YES n ND
IF YES, describe size, type and location:
V14ie--1 out s M51 JCSS ,�1c
� iC�
Are there any proposed changes to or additions of signs intended for the property? YES >\ NO
IF YES, describe size, type and location: N 6w f N
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 --As—
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
S' for use by the Building
Department
i?)ZS T LNG
I PROPOSED _ i3 '
flla'7G:
J Lot Size I
Frontage i f
Setbacks Front i
iSide L: P.: L: R: +.1= R:
i /
it Rear - _
Building Height
[Building Square Footage 1 qqqq
II
+
%Open Space: (lot area
minus building&paved I
parking j
1 4 of Parking Spaces
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-13.- Legrrification;-_I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
'Dane: Applicant's Signature ' iii '/�n/1/l/
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NOTE:Is - e of a zoning permit does--not relieve an applicant's burden to corn
_—_ 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.
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