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23D-037 (4)
V 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Are there any proposed changes to or additions of signs intended for the property? YES 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 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 IL�QC-UT`� This column reserved for use by the Building Department EXISTING PROPOSED REQUMD BY ZONING Lot Size Frontage Setbacks Front Side L: R: L: R: L: R: Rear Building Height Building Square Footage %Open Space: (lot area minus building & paved parking__ #of Parking Spaces #of Loading Docks Fill: (volume & location) 13. Certification: I hereby certify that the information contained erein is true and accurate to the best of my knowledge. Dat��Ll'K� i� Applicant's Signature Zj NOTE: Issuance of a zoning permit does not rel' ve an applicant's burden to comply with all zoning requirements and obtain all required p mits from the Board of Health,Conservation Commission, Historic and Architectural Boards,De artment of Public'Works and other applicable permit granting authorities. W:\Documents\FORMS\origins]\Building-inspector\Zoning-Permit-Application-passive.doc 8/412004 l --� File No. EleClri Z'PI'h�:f` ERMIT APPLICATION:f,§10.2) lease 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 1. Name of Applicant: CA~bl(-C C�-�o-�) r'�tin 4/ Address: 11 6A -k,�-D 02�dnC�c�� AiA 0106 2 Telephone:q'�- 2. Owner of Property: 0-cfc-ra — Address: CG' _ Telephone: 1 -j- S� S / 01 3. Status of Applicant: Owner V Contract Purchaser Lessee Other (explain) 4. Job Location: ©� �`> ��� ��-��'tCr"-�� �''�� °l �� Z 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: D�—NG,,,(- a'CC vPc C-'b S C-C-7- tC3�1— C- s- � &' 14---b I ti--H 11 L 0,4 tr'C.,,11 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): P���c=�,7 „mac- �� 7-`T �+-('r�.2•��--�- '7� ©�C-�'.�z- 1b41 ,oC�/Z�r 7, i e urveye a No /"`r'l C�9 C— C 6f-A ^--C_e 8. Has a Special Permit/Variance/Finding eve r been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? Pa e en ��- 9.Does the site contain a brook, body of water or wetlands? NO ✓ DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? �Jeeds-te-�e-ett�airred Obtained �a*e is�ded• (Form Continues On Other Side) W:\Documents\FORMSIorigina]\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 File#MP-2014-0112 u 0 APPLICANT/CONTACT PERSON FOGELSON JONATHAN 41 �I V (� ADDRESS/PHONE 11 ORMAND DR (413)585-5965 Q F A PROPERTY LOCATION 11 ORMOND DR �;. (c ►'� �, MAP 23D PARCEL 037 001 ZONE URB(100)/ L T'YFE THIS SECTION FOR OFFICIAL USE ONLY: F�; �� H v � ' 's�I PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid / Building Permit Filled out Fee Paid Typeof Construction: ZPA-DAYCARE New Construction Non Structural interior renovations Addition to Existing Accessoa 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: ` ©PC-F�A eS f l/ Approved Additional permits required(see below) R� t�� ] A` t l�t i J /1 PLANNING BOARD PERMIT REQUIRED UNDER: "I—I( R1 A p pru j&i, Intermediate Project :_ b!�-�Site n ND/O R Special Permit with Site Plan Major Project: n 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 Water Potability Board of Health Permit from Conservation Commission Permit from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 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.