18D-055 (12) 10. Do any signs exist on the property? YES NO
IF YES, describe size, ty e and location: D r7 C� j� \
- - i l
Are there any proposed changes to or additions of signs intended for the property? YES NO y'
IF YES, describe size, type and location:
11. Will the construction activity disturb (clearing, grading, excavation, or filling)overt 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
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED 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 Et paved
parking
#of Parking Spaces
#of Loading Docks
Fill:
(volume Et location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: (93-23-- Applicant's Signature
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 ADocuments\FORMS\original\Building-InspectorVoning-Permit-Application-passive.doc 8/4/2004
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
�� File No. lap—15
252015 !1`
ZONING PERMIT APPLICATION
Electric, Piu;Z PLEASE TYPE OR PRINT ALL INFORMATION
NorthamptonMg07p6E f1Ons
1. a nt: W
Address: ` e-e^Lc' ;4e$ `t> Telephone:
2. Owner of Property: M fi tT fil)EV
Address: � ��s I� �SI��ephone: / j - 23 6 [
3. Status of Applicant: Owner Contract Purchaser 'Lessee
^Other(explain):
4. Job Location:I qj �t
Parcel ID: Zoning Map# Parcel# District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: b 1- l ''- UNS-<:f—
6. Description of Proposed UseNVork/Project/Occupation:(Use additional sheets if necessary)
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Speci I Permit/Variance/Finding ever 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?
NO DON'T KNOW YES
IF YES: Enter: Book Page and/or Document#
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?
Needs to be obtained Obtained ,Date issued
10. Do any signs exist on the property? YES ✓ NO
IF YES: Describe the size,type and location: U ��� �'✓`~'
Are there any proposed changes to,or additions of,signs intended for the property? YES/'U,-"-
, NO
IF YES: Describe the size,type and location:
dzi-21W
Page 2of3
File#MP-2015-0068
APPLICANT/CONTACT PERSON BEWRY OWEN
ADDRESS/PHONE 38 GREENLEAVES DR (413)387-0600 Q
PROPERTY LOCATION 141 D DAMON RD
MAP 1813 PARCEL 055 001 ZONE GB(100)/URA(0)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: ZPA-SERVICE ON SUNDAYS&BIBLE STUDIES ONCE A WEEK
New Construction
Non Structural interior renovations
Addition to Existing
AccessoKy 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:
tfjApproved 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 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
'7
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.
141D DAMON RD MP-2015-0068
COMMONWEALTH OF MASSACHUSETTS
CITY OF NORTHAMPTON
GIS 8953
�Map�, 18D _
Block _ 055
Lot: 001 ,. ZONING PERMIT
Permit: ZONING PERMIT APPLI APPLICATION PERMIT
Category: Zoning Permit
Permit# MP-2015-006$ PERMISSION IS HEREBY GRANTED TO:
Project# JS-2015.001729
Est. Cost: Contractor: License: Expires:
Fee Charged:$15.00 Homeowner as Contractor
Balance Due.$,00 Owner: BOYLE RICHARD R
#of Fixtures Applicant: BEWRY OWEN
DigSafe# AT: 141D DAMON RD
UseGroup
ConstClass
ISSUED ON: 06-Apr-2015 AMENDED ON.• EXPIRES ON.•
TO PERFORM THE FOLLOWING WORK:
ZPA-SERVICE ON SUNDAYS&BIBLE STUDIES ONCE A WEEK
THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF
ANY OF ITS RULES AND REGULATIONS.
Signature:
Fee Type: Receipt No: Date Paid: Check No: Amount:
Zoning Permit Application REC-2015-004748 25-Mar-15 MO $15.00
212 Main Street,Phone:(413)587-1240,Fax:(413)587-1272,Email:lhasbrouck @ northamptonma.gov
GeoTMS®2015 Des Lauriers Municipal Solutions,Inc.