25C-205 ! ,
ti
RECEIVED
mAR 1 7 2011
. File No. /A 51), 77
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Please type o 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
� Cit ofNorthampton
1. Name of Applicant: M 6 4 y / " c/ V e- /'? Q./
Address: 20 i—r rid/et? 51 /U'4 ILI Telephone 5) 3Y/ ^ /577
2. - Owner of Property: 5 4 e'le
Address: r Telephone:
3. Status of Applicant: Owner N/ Contract Purchaser Lessee Other (explain)
4. Job Location: 2 0 L f dam? Si
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5. Existing Use of Structure /Property:
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
Piety/7 ovse_ 14 r ac1c yarb1 /ox /2 1 4 1 1 / ' p 4
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Findin er been issued for /on the site?
NO DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at th Registry of Deeds?
NO DON'T KNOW at
YES
IF YES: enter Book Page and /or Document #
9.Does the site contain a brook, body of water or wetlands? NO 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
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1 0, Do any signs exist on the property? YES NO iliocilaJqtrAif
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 filling) over 1 re 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
fift for use by the Building
D us e Department
EXISTING O POSED REQUIRED BY
ZONING
Lot Size Sq 6 — 5 vos,O I
Frontage a
E
Setbacks Front J 7
�
Side L: R: L: 6- 1 R: 1 0 L R:
Rear
q
Building Height 1)
Building Square Footage )
j O2. 9 )20 32- I5Z
% Open Space: (lot area
minus building & paved c 0 7
parking
# of Parking Spaces
2.
# of Loading Docks
Fill:
(volume & location) u 0
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 3/! i / / Applicant's Signature
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all z g
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
THIS PLAT IS COMPILED FROM DEEDS, PLAtsIS AND OTHER SOURCES AsU NVD
TO BE CONSTRUED AS AN ACCURATE SURVEY AND IS NOT TO BE RECORDED.
BUILDING LOCATION ACCURACY IS N•T ' ,UARANTEED T / !
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0: FLORENCE SAVINGS BANK &
FIRST AMERICAN TITLE INSURANCE COMPANY
TO THE BEST OF MY INFORMATION, KNOWLEDGE AND BELIEF
I HEREBY REPORT THAT 1 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. 1 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: t, THIS PLAT FOR MORTGAGE LOAN PURPOSES ONLY
< AND_ DOES NOT CONSTITUTE A PROPERTY SURVEY
MORTGAGE LOAN INSPECTII ► - .,
4 OF Atilk '
NORTHAMPTON, MASSACHUSETTS
RANDAU. PREPARED FOR
IZER w CHRISTINE J. BELL
` � SCALE: 1"=20 1 t, JULY 12. 20
' sub HAROLD L. EATON AND ASSOCIATES, iNG.
REGISTERED PROFESSIONAL LAND SURVEYORS
�.
,t.