31D-123 (2) l
10. Do any signs exist on the property? YES X NO' ' »'l>
IF YES, describe size, type and location:_ l 5 �� y $ �' �"'t'` l ' ' l CI-)
6 i.. d L'.4.1.- �WC°-"A p i=
1 . xi To 71-EE 6EFtcE 7sO A . H > IC.- * 3 o 'r CAI( S 1 6N ,- ,v 1 E.:
ND O42.1 1 Ac; A. OE ,
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 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO i&
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 .. R BY
IIIIEEN. _. i7
_ — -- _Lot Size _
3 -7 3 9 "cp. FT
• 5 Avy. r a .
_. Frontage
/
67‘42S S,L�LtA . F_
__ - ._ Setbacks Front • j 3' i(
Side L: 3' R: 1 1 L: 5 txu..._ R: 3 - a L R
Rear f . 5
, ,
Building Height �t A%-t 3viw ta 3a' --_ w ceus1 cne,A i - -
(A:;k., g 023'
Building Square Footage = ;._
/ 56c 19C' NottrhigIgtommiximpigpipgi
%Open Space: (lot area
minus building £r paved 3 �o � ?
�
parking
it of Parking Spaces
3 3
# of Loading Docks
_Fill:
(volume Et location) O (3
13: Thereby-certify that the information contained herein is true and accurate to the best of
GL ,.. L ..._
Date: 1 - I Applicant's Signature RC X-
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
requirements and obtain all required per faits from - the Board of Health, Conservation Commission,
historic and Architectural Boards, Department of Public Works and other applicable permit granting
authorities
- W:\Docunients\ FORMS \originht \wilding- Inspector\Zoning- Permit - Application- passive.doc 8/4/2004 . '
r .
„RECEIVED
FEB 6 2012 � ��� 7
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Pleasetype 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 ofNorthampton
1. Name of Applicant: /At el �� i SLL-?
Address: 16,4 ? (() Hest D 1; Def uF / c7/ b to Telephone: 5 ' 6:- -AGM
2. Owner of Property: pl tnpe a e l HATUU-iE 'H > ?LD 51E0
Address: t-( ( —7o µAsa lac . Telephone: 5 5
3. Status of Applicant: Owner K Contract Purchaser Lessee Other (explain)
4. Joh- Location: 75 t- t" f ,A S , iC ST. - :-
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(T -. 3E LLEil l i Y E BOJLD NG EPARTME e .. it .., 4 0 t th ..
5. Existing Use of Structure/Property: r't k)CC= i> Q OC T /qG Z1.7QNE.S
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
CaPcT (c3 c.1 j L? 9b -t.? - rot >Ar-> v _
ex-vpToAc... u> E 5 ,a ti p A w a.,�
7. Attached Plans: Sketch Plan if Site Plan t ,-- Engineered /Surveyed Plans
8. Has a Special Permit /Variance /Finding ever been issued for /on the site? -
NO DONT KNOW YES X IF YES, date issued: 31l
IFYES —mss tFie Perini recorded at the Registry of Deeds?
NO X DONT KNOW YES
IF - Book Page d%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:1 Documents \FORMS\originai\Buiiding - Inspector\Zoning - Permit - Application- passive.doc p 8/4/2004
File # MP- 2012 -0074
APPLICANT /CONTACT PERSON WELTER DIANE J & ALEX GHISELIN
ADDRESS/PHONE 164 RIVERSIDE DR (413) 586 -1849 0
PROPERTY LOCATION 70 - 76 MASONIC ST
MAP 31D PARCEL 123 000 ZONE
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT f i ) � l m � j
Fee Paid ` 7 9&
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA - 12 X 20 2 STORY ADDITION TO EXPAND USE & 2ND FLR FIRE ESCAPE
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 ACT HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P ED:
Approved V Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : § sd — i hvPY I5 -- �
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
c)Zvs— /(2–
Signatu re 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.