31D-166 (6) 4
10. Do any signs exist on the property? YES 'L NO
IF YES, describe size, type and location: VkArlf4LC 5k(' Ni '?(Z c
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 / J
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
(C_..7?) for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size e i) ro ¢1, po
Frontage
o 1 0
Setbacks Front -1 t) 1 0
Side L: 3 cD R: ZOO L: ID D R: Zoo L: R:
Rear k5 D 15 D
Building Height 1° t 10 1
IT)boo
Building Square Footage
Open Space: (lot area � A !�
minus building Et paved l9l� 1) CD O qv
parking
#of Parking Spaces
#of Loading Docks 1
Fill: 0 0
(volume ft location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
1
Date: .2 .cb Applicant's Signature 11` `b`(L�6ott- 6 S��I S
NOTE:Issuance of a zoning permit does not relic e an :ppli ant' burden to comply with all zoning
requirements and obtain all required permits from th�Bo rd of Health,Conservation Commission,
Historic and Architectural Boards,Department of Publi orks and other applicable permit granting
authorities.
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
AUG _ 22013 g7P �_
�� File No. 5---°Z g-
prp,OF BU'_U}IJu ItvSP�CTIONS
H NORTH ''r i oiv,„A ZOING PERMIT APPLICATION (00.2)
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 ofNo Northampton
1. Name of Applicant: v cc A 'c ' 1Oa/tvc� f ) c a ocn A
L., 5 2A)tGlE5
Address: tJ ot-A v • t A� j Telephone: 5(61. ��Pb
,
2. Owner of Property: Q\ ()' �ORA�Ak'r
Address: (.S AV`'` \ Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain)
4. Job Location: A \ oc VO5,C-.." 1 ILIA ` `AkvA ' .
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
`
5. Existing Use of Structure/Property: ' SM4 ASS gLI <INLk V(
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
AN Z S Q t N li\ KC-k '1(1-r& r 6C-A 'S 00 i ACC Roo
V 'c- S Iz s 5 '\ Q- t,at-lS _ ,,��,,��`` ''
7. Attached Plans: Sketch Plan Site Plan ngineered/S rveyed Plans � Ml�"'
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?NO 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)
WADocuments\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
File#MP-2014-0022
APPLICANT/CONTACT PERSON CITY OF NORTHAMPTON CENTRAL SERVICES
ADDRESS/PHONE Memorial Hall (413)587-1260()
PROPERTY LOCATION 274 MAIN ST
MAP 31D PARCEL 166 001 ZONE CB(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out 614"Fee Paid
Typeof Construction: ZPA-REPLACE 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 ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION PRESENTED:
Approved (/Additional peinrits 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: §
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 er Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
67Z-- / 22-/3
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.