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YES NO X IF YES, describe size, type and location: 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 (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 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 8, 1 Do E3 bD Q) (,° , Frontage Setbacks Front 0 .4- Side L: R: 1�..� L: 2$ (fl R: 5. L: ' ,�✓ R: Rear / S � ,' `t ^ j Building Height lDD 1 3o Building Square Footage f3 `1 2 oa a % Open Space: (lot area minus parking wilding Er paved BA- % l s ` e /. §D e # of Parking Spaces # of Loading Docks 0 0 Fill: (volume a location) 0 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: GP, 1 2I 2 o I z Applicant's Signa - 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- Inspecter\Zoning- Permit - Application- passive.doc 8/4/2004 t r JUN 9 2012 DEPT. OF BULL), S a3 iNSPECTIGNS File No. �Am � �Atn I G 'ER11 I AP LIGATIO § 0,.2) Plea type or print all information and return this form to the Building Inspector's Office with the $15 fil fee (check or money order) payable to the • City of Northampton 1. Name of Applicant: C' • a. t_\ Address: 4 4 e- Telephone: t�c� n 2. Owner of Property: l • ■ C. c e \ ink S R"y v -i ' Address: 4& L;,>< C_c3\ Nve. Telephone: 3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain) 4. Job Location: �.Pat ;In Elm_Street'District In Cent Distri (TO BE; FILLEDI NN-By THE:BUILDING 5. Existing Use of Structure /Property: Sk 6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary): �e<1IY�n \, iD� bit PXIST csHr∎ l� n i_ ot�c,.c\ r�� net-a a►.�\\. %,,2 7. Attached Plans: Sketch Plan Site Plan )( Engineered /Surveyed Plans 8. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO g 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 X 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) 'Docents�FOF.r S \origina0,Buiiding- I.:spector ---:- g= ner-. it- .ipj.:ic:.tio:.- t.assi�e.doc 8/4/2004 nm Zow.,�y File # BP- 2012 -1133 APPLICANT /CONTACT PERSON SPINK MICHAEL J & THUY T NGUYEN f � ADDRESS/PHONE 44 LINCOLN AVE NORTHAMPTON 1) V G. P� PROPERTY LOCATION 44 LINCOLN AVE MAP 25C PARCEL 091 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: 6 PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid 10 L? (i /f Cr? ' Building Permit Filled out Fee Paid Tvpeof Construction: Demo & build SFH 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 0ESENTED: • Approved V 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 RMIT REQUIRED UNDER: § 3Dd i � St e�Gt ,�U ti [v�..P/LL l�-� f� � k) 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 • •. 'tion De ay Sign. e 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 ofMGL 40A. Contact Office of Planning & Development for more information.