10-007 y
File # MP- 2012 - 0009 ` r-AV
APPLICANT /CONTACT PERSON BRANDT ROBERT & JOAN SWERDLOW- BRANDT
ADDRESS/PHONE 200 AUDUBON RD
PROPERTY LOCATION 200 AUDUBON RD
MAP 10 PARCEL 007 001 ZONE RR(100 //WSP
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
N1NG FORM FILLED OUT
ee Paid 0 Q R1 � F J E �� 0 4� 4-
Building Permit Filled out f
Fee Paid S 0 6D P6e,W`7
Tvpeof Construction: 10 x 12 Shed
New Construction
Non Structural interior renovations
Addition to Existing
Accessoly 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
INFgIMATION 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 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.
10, Do any signs exist on the property? YES NO
IF YES, describe size, type and location: -' )
•1t
Are there any proposed changes to or additions of signs intended for the property? YES NO X
IF YES, describe size, type and location:
11. Will the construction activity disturb rlearino aradinn excavation�or fillin l over 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 ' ' REQ.L1IIiD' `
Lot Size
Frontage
Setbacks Front
Side L: `��� R: j � L: R: L R:
Rear
Building Height
Building Square Footage
% Open Space: (lot area
minus building & paved
parking'
# of Parking Spaces ATP
# of Loading Docks
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
C� f
Date: 7 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 p assive.doc
8/4/2004