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32A-171 (4) File#MP-2016-0063 APPLICANT/CONTACT PERSON NEW ENGLAND URBAN SENIOR LIVING LLC ADDRESS/PHONE P O BOX 833 (413)519-9265 Q PROPERTY LOCATION 10 HAWLEY ST MAP 32A PARCEL 171 001 ZONE URC000V THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out Fee Paid Typeof Construction: ZPA- INDEPENDENT SR LIVING W/RESTAURANT&RETAIL SPACE 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 PRES NTED: Approved Additional permits required(see below) Joe r�_� y� 9rL PLANNING BOARD PERMIT REQUIRED UNDER: § 350--U ,35 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: § s YO ri-t Finding 1/ Special Permit Variance* J 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 i9 -& Permit from Elm Street Commission t,/"" Permit DPW Storm Water Management f 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. File No.ge —Z 3 ZONING PERMIT APPLICATION( 10.2) Please type or print all information and return this form to the Building Inspector's Office with the X30 filing fee (check or money order)payable to the �pp City of Northampton T. Name of Applicant: I� ���}^}� UrZ�34W L( V rN 6-- L(_ L Address: Fa C36X 3 c-7 , Loin 6 oyimDow M4 0102Aelephone: Si ? gZ 6S 2. Owner of Property: 12a 1k 400 C4Y-a-0Lc C– P C a Ce S�– o1v Address: 36 e�-t I E S I 4G Telephone: 3. Status of Applicant: Owner Contract Purchaser C, _ Lessee Other (explain) 4. Job Location:�(� t'' l►.� 4 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: Y r 61 ai FM� Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): cwt G hed Plans: Sketch Plan Site Plan Engineered/Surveyed Plans 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? Cn NO DON'T KNOW-- z 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 Z 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: (Form Continues On Other Side) W:\Documents\FORMS':original\Building Inspector-,tonin,Pe-Tnit-Application-passive.doc 8/4/2004 10. Doany signs exist onthe property? YES NO IF YES, describe size, type and location: 640-P" 5(60 615 7 &*AD) Are there any proposed changes to or additions of signs intended for the property? YES NO- |FYEI' describe size, type and location: 11. Witt the construction activity disturb (cleahng' grading, ' orfitting) over 1acre orisitpart ofacommon plan ofdevelopment that wilt disturb over Iacre? YES_ NO IF YES, then a Northampton Sb3rnO 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 Departmen EXISTING PROPOSED REQUIRED BY ZONING Lot Size Frontage CHOZC4 LO'C -2,07-q+ Setbacks Fr t 17 A4;� 4 Spr -7 S+� L: R: Rear Building Height Building Square Footage cc�d ZD %Open Space: (lot area minus building 8: paved parking #of Parking Spaces #of Loading Docks 13. Certification: | hereby certify that the information i d/hhereii is true and accurate to thebest of my knowledge. ur Date: � / --/ � Applicant's Signat Nburden comply�Aithall zoning requirements and obtain all required permits from the Board of Health,Conser-vation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting \v:xouuvmenmpon»ua�Ouoinu/uouomu:'mopvumnzuniog-permit-xvvxcm/nn'nnsmn,.oun 8w12004