31B-266 I.
10. Do any signs exist on the property? YES NO
IF YES, describe size, type and location: kiA
Are there any proposed changes to or additions of signs intended for the property? YES NO
f FT) 10,. I > N mot et i1 ti p v P 'r
IF YES, describe size, type and location: rear - 1 . To ' = PLirritikeep L'7 7 ' ?� -'r`
11. Will the construction activity disturb (clearing, grading, excavation, or filling) oyer 1 acre or is it part of a common
plan of development that will disturb over 1 acre? YES NO X
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 REQUIRED BY
ZONING
Lot Size ( fill el 9 F — r
Frontage ''—.6" Al c1� { /�
Setbacks Front if' 43i" / I/. ,"
Side L:Z &' R: I, °i / L: Z; S i R: I , i ' L: R:
Rear 28,.7 Z,0
Building Height 27' 1
Building Square Footage
{ f 9f` 2 2 -13
% Open Space: (lot area
minus building Et paved 7
parking __
# of Parking Spaces
# of Loading Docks
0 0
Fill: O
(volume Ft location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 1' 11 ' 1 1 Applicant's Signature C' f
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 - passive.doc 8/4/2004
,
4 V 1 11'
1 "
411 2 I ft
I File No. / 11 / I 4
.4 Z'O- •
- 1 -6 1W g r RMITAPPLICATION 016 2)
Please type 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 of Northampton
„ e-
1. Name of Applicant: { 1,)() 7
Address: <
Telephone: 1 t '
2. Owner of Property:
—
Address: 5 Mi 5 E1 Telephone: Le/7 — 7 - fi 3-C
3. Status of Applicant: Owner Contract Purchaser Lessee Other (exp(ain)ARI7TZ_7
4. Job Location: & •5r
Parcel Id Zoning Map# Parcel# ° District(s):
in Elm StreeeDistrict Hn Central Business District
1(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: 1 rt4 t_
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
OVAir 1'),r STV-UC-Tv P--r: (am I'Vve Tire— I C fE
Ap-tc4z,_
Ai ),T) I )/,' 7e; rt; 4/..7rAe-Jerz- .57
e. f)r
N E , t A , ) C i p m rk C/1 L R E - "2. t' -
7. Attached Plans: Sketch Plan Site Plan X Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds? •
NO DON'T KNOW X YES
IF YES: enter Book Page and/or Document #
9.Does the site contain a brook, body of water or wetlands? NO I DON'T 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
A ,
File # MP- 2011 -0065
APPLICANT /CONTACT PERSON Thomas Douglas
ADDRESS/PHONE 196 PLEASANT ST (413) 585 -0641
h
PROPERTY LO
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
'� ENCLOSED REQUIRED DATE
L— ONING FOR "� ILLED OUT_ i2 j /15 _
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA- MULTI FAMILY TO COMMERCIAL USE
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 PRE
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 n
ZONING BOARD PERMIT REQUIRED UNDER: § 350 " DIriErJ 2 2' Ss'1 B/�K,
VAl2AANL6 0 2 Woof
Finding Special Permit Variance* -Gym niflati A$L
Received & Recorded at Registry of Deeds Proof Enclosed A ►J A LL'f 1
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health p
Permit from Conservation Commission l/ Permit from CB Architecture Committee s�r
Permit from Elm Street Commission Permit DPW Storm Water Management
/ /2.8/
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.