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
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