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10. Do any signs exist on the property? YES NO V
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO V
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling) over cre 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
4
Lot Size
113 X '18o s 44-144,
Frontage
l ? 3 S 44-wt e
Setbacks Front 167
Side L: (p 2.. R: $ O L: R: R:
_
Rear 3 Go
Building Height {2 ,,
Building Square Footage
2%e0 1/
% Open Space: (lot area
minus building & paved � , .�
parking
# of Parking Spaces te
# 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.
Date: Z' jj Applicant's Signature 'l G7'ic.1 6-4
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
gP PP PY 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\ origin (\Building - Inspector\Zoning - Permit - Application - passive.doc 8/4/2004
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_ Please - type or print all information and return t hi s s form t o the Building
Inspector's Office with the $15 filing fee (check or money order) payable to the
City ofNorthampton
1. Name of Applicant: A .. y & P ",,Q. --
Address: Lf 1'$ (L Telephone: 4 £3 6/s SSZ 2—
2. Owner of Property: // r/
Address: 1/ Telephone: le //
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
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4. Job Location: 5 4-1
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5. Existing Use of Structure /Property: A-v' 4- .s 4-1. o't f 6
6. Description of Proposed Use /Work/Project/Occupation: (Use additional sheets if necessa ):
C.r4 a, - Lr v i s° �o�� r o,• L c ova
7. Attached Plans: Sketch Plan Y Site Plan Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site? ci
NO V 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 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 $f
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File # MP- 2011 - 0026
APPLICANT /CONTACT PERSON PAYNE ANDREW C & LORETTA M KANE
ADDRESS/PHONE 470 BRIDGE RD (413) 695 -8564 ()
PROPERTY LOCATION 470 BRIDGE RD
MAP 17B VARCEL 006 001 ZONE RR(100) //RI
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONN FORM FILLED OUT
77e —
Building Permit Filled out
Fee Paid
Typeof Construction:_ZPA - DET ACCESSORY APARTMENT
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 PRES 14TED:
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: § 350 - la( 0 CB)
Finding Special Permit 1,7 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
g17-5/ 10
Signaf Building 0 ficial 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.