30 Hawthorne ZPA Home Occupation 7-15-11-----
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File # MP~2012-0008
APPLICANT/CONTACT PERSON SAMOLEWICZ JENNIFER A & STEVEN
ADDRESSIPHONE 30 HAWTHORNE TERR
PROPERTY LOCATION 30 HAWTHORNE TER
MAP 43 PARCEL 156 001 ZONE SR{lOO)//WSP II
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ii""oNrNG FORM FILLED OUT ueeNd tJ:; 1.:?1 ;; ~IS.dO
Building Pennit Filled out
Fee Paid
Typeof Construction: ZPA HAIR SALON
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets ofPlans / Plot Plan
THE FOLLOWING~CTN HAS BEEN TAKEN ON TIllS APPLICATION BASED ON
INFORMATION PRE NTED:
__Approved __Additional pennits required (see below)
PLANNING BOARD PERMIT REQl.TIRED UNDER: § ________
Intermediate Project : ___Site Plan AND/OR'--__Special Pennit with Site Plan
Major Project: Site Plan AND/OR Special Permit with Site Plan
ZONINGBOARDPERMITREQUIREDUNDER:§_350-10.f2.. J TAf3l..6 Of tlS€
Finding____ Special Pennit c/' Variance*
___Received & Recorded at Registry ofDeeds ProofEnclosed_____
__Other Pennits Required:
___Curb Cut from DPW ___Water Availability ___,Sewer Availability
___Septic Approval Board ofHealth ____Well Water Potability Board ofHealth
Pennit from Conservation Commission Permit from CB Architecture Committee
___,Pennit from Elm Street Commission ____Pennit DPW Storm Water Management
SignafiL~fficlal Date I Ie ofBuilding
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 the Office of
Planning & Development for more information.
RECEIVED
Please type or print all information and return this form to the Building
Inspector's Office with the $1sfilingfee (check or money order) payable to the
City ofNorthampton
1. Name of Applicant: Jennifer A. Samolewicz
Address: 30 Hawthorne Terrace. Florence. MA Telephone: 413-586-2133
2. OWner of Property: Steven E. Samolewicz and Jennifer A. Samolewicz
Address:__......:S::.:a::.::m::.::e:......;::a=-s.....:a::.::b:.,:o;...;;,v..::::;e__________Telephone: 4\~ S~d--\~3
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (exptain),_____
4. Job Location: '50 t+PrvJf\;orY\£ ~vlfrt.e I \==-\orev'\ce jffio;".
5. Existing Use of StructureIProperty:___-=.!R:.::::e.=!.s==i~d.:::.en~t.:::.~::!·a=.:l=---'s""'i!::.t.n~go..=l.."e'---'l:f~a~m'-=i-=l.;t..y__________
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
.
\/\
77. Attached Plans~ Sketch Plan Site Plan Engineered ISurveyed Plans ___
8. Has a 7 permitlVariance/Find.ing 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 ____
Book _____IF YES: enter Page _____ andlor 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: HCL~ 11'1'3
(Form Continues On Other Side)
W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/412004
YES ____10. Do any signs exist on the property? NO ./
IF YES, describe size, type and location:_________________________
---7"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) ovey1 acre or is it part of a common
plan of deveLopment that will disturb over 1 acre? YES___ NO _V__
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
Lot Size
Frontage
Setbacks Front
Side
Rear
Building Height
Bljilding Square Footage
% ppen Space: (lot area
minus building 8: paved
parking
# of Parking Spaces
# of Loading Docks
Fill:
(volume 8: location)
EXISTING
L: R:
PROPOSED
\.04 A-c.-v£ <;
0 0 '1/_
L: 15 R:
'"6.'l---~ -.j..q:<
This column reserved
for use by the Building
D'epartment
REQUIRED BY
ZONING
L: R:
.'
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Da'.: ,1161'\
NOTE: Issuance ofa zoning permit does not re . applic burden to comply with all zoning
requirements and obtain all required permits from the Board ofHealth, Conservation Commission, Hi~toric and Architectural Boards, Department ofPublic Works and other applicable permit granting
authorities.
W:\Documents\FORMS\original\Building-Inspector\Zoning-Pennit-Application-passive.doc 8/412004
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FiJ-e No.·Date Filed~_________________
:r3,r:REGISTRAT::r:ON OF HOME GF:E:ICE/OCCUPATIO¥ (§~O. 2 &: ~~. ~~)I with t:he Building Inspector .
I 1. N~e of ~plic~t:__J~e~n_·n_i_f_e_r__A~,~·~s_a_m_o~l_e_w~1_c_z___~~~~~~~~~~r=~~~~
Address: 30 Hawthorne Terrace, Florence Tel~phone: ·586.-2133, or 584 5636
j Steven E. Samolewicz and Jen~ifer A. Samolewicz2. O~~er of'propertY:_'~~~'~~~M1~~~__~__~~~~~~~-'~~~~___~~__Addres~.: 30 Hawthorne· Terrace, Florenc.e TelephoDe:__5_8_6_-_2_1_3_3_____
J .
3. Status of Applicant:~OWlfer contract Purchaser Lessee
other (expl·ain:_______________---:__·)
4. Parcel .rdentificat~on: H<;I.p i!-43 , Parcel -# '156
Zoning District(s)· (incJ-ude overlays)_....:S:..:R..:.I-.:-w~S-P-I-I----'-----_:_~-~"'-:-=~
··Street· Address·3Q··-HawthoT"ne-Te·r-T"ac~:>· Flo-rence,·'MA··
5 •. Narrative Des~ription o"f Proposed Home Office: (Use additional sheets'·
'if necessary) hair salon
Is .this a legal residential b~ilding? . @~
Will there be an employee/owne:r who doesn't l.iv.e in the home YES <....1I9/
Will you ev~:r:-.see clients or customers at your site? @ NO,How often . '.daily
.For what purposes c;osmetology and hal..r serVl.ces
·9. Will there be any 5fignS for the Hom.e: Office? '" YES:. @
10. Will there' be any· goods sold from the premises'or any sale qf ','"
g?o"ds stored'.on preinises!. ~ither retail or wholesale, or. anYr-\
d~splay of goods on prem~ses? .. ~NO
11-Will there be any outdo.or storage of iuaterials?' ... YES ®
12. Wi1;l your use bet'otally witl:J.in a buiJ;ding·and not ca",:!se any
outward.manife~tati,ol}-(iTl.clud~ng ,traffic g.e~erationi ~arkingr.::--._\
congest1.on, n01.se,· a1.r pollut1.on, and mater1.als storage)? ~NO'
If NO eXplain: ------------~------~--~~~----~------~-----
13. Attach Plans (if appl~ic~ble)
14. Certif·icatl.on: I hereby certify that. the information contained herein
is true and accurate. .I understand that if p.ny infornation is. incQrrect,
my pennit is, null and void an'd I may be liable for non-criminal fines and criminal and'<:;iviI actions.' , '. .. .'
Date: July 15, 2011 .. Applic'mt's s~gnature:~ ~~
------THIS SECTION FOR oFFIcr];..L-UB~------. -
.
__}.pproved as'pr~sented/based on information presented
APPRO"V]l..L .EXPIRES ON DECE:l:'..BER .3~ OF TJIIB YEAR AND HUST TEEN BE RENEWED
Denied'as pre~ented---Reasoh:
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Signature of Building Inspector
NOTE: E=.:cnoQ at .. p<H"mtt do-not rol\ov.o l!.n apprI=."rlr" oord.m to com?!"! with "n zoning rvquln:ltIlont:t 4r.<! obU!n 41[ r...,:rulro-d porm~
from trw B=rd of Ho,,~ Com;.Qrw".o.tlon CommIssIon. DOPl1rtmont of PublIc Week: "nd ot"l~r "ppll=.bl... pormft gr4ntlng ltuthorltlo:s:.
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