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PermitApplication_Linda Manor, LLCPermit Application Todav's Date- 02/27/2013 Owner Applicant Linda Manor, LLC Chakalos Investments - John Chakalos, President 349 Haydenville Rd. 52 Overlook dr. Leeds, Massachusetts 01053 Windsor, Connecticut 06095 860 - 688 -5994 JCCInvestments@aol.com City of Northampton department: No Work Location Information How many lots involved in the project: 2 Map / Block / Lots of all lots in project: 06 / 055 / 001 Deed Book of all lots in project: Bk. 5934, Pg. 19; Bk. 2257, Pg. 288; Bk. 1622, Pg. 118 Project work address: 349 HAYDENVILLE RD City / State / Zip: Leeds 01053 Zoning District: SR Application for following Permit Types ❑ Planning Bd. Special Permit w/ Site Plan ❑ Planning Bd. Special Permit w/ MAJOR Site Plan NO Special Permit ❑ Administrative Site Plan Review ❑ Planning Bd. Major Site Plan Approval (No Special Permit), including 40R projects ❑ Subdivision Preliminary ❑ Planning Bd. Special Permit w/ Site Plan for flag lots ❑ Planning Bd. Site Plan (NO Special Permit) ❑X Approval Not Required Plans ❑ Subdivision Definitive with Preliminary Approved ❑ Subdivision Definitive with no Preliminary Approved ❑ Zoning Board Special Permit ❑ Appeal of Building Commissioner - Zoning ❑ Variance ❑ Historic District Determination of Non - Applicability ❑ Historic District (Elm St) Determination of Appropriateness ❑ Subdivision Definitive Amendment ❑ Zoning Board Finding ❑ Comprehensive Permit (40B) ❑ Demolition (Demolition Delav) ❑ Central Business Architecture ❑ West Street Architecture ❑ Wetlands Notice of Intent IF ONLY local ❑ Wetlands Notice of Intent IF state wetlands wetlands 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Wetlands Certificate of Compliance reauest 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Wetlands Request for Determination OR ❑ Wetlands Amendment or Resource Delineation extension Total Fee Amount: $250.00 Existing Use Nursing Home / Extended Care Facility Planned Use Nursing Home / Extended Care Facility Detailed Project Information Number of Plan Pages:1 Special Permit Description: ANR plan. Approval Not Required Description: Swap parcels of land between Linda Manor, LLC and Tuperkeizsis properties to allow for creation of new facility. Files Uploaded: Approval Not Required: Autocad: CHAKALOS- TUPERANR2012vers2000.dwg Tiff or PDF: CHAKALOS- TUPERANR2012 ANRl.pdf By typing my name in the signature box, I certify that all the information above is accurate to the best of my knowledge, I am the property owner or have permission from the property owner to apply for this permit. I also grant permission to the City of Northampton to inspect the proposed work Signature: Randall E. Izer Date Signed: 02/27/2013 210 Main St., Rm. 11, City Hall, Northampton, MA 01060 (413) 587 -1262 Fee Information Approval Not Required Plans - $250 /plan page $250