31B-194 File#MP-2016-0096 (_f
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APPLICANT/CONTACT PERSON SMITH COLLEGE OFFICE OF TREASURER • K5 L
ADDRESS/PHONE COLLEGE HALL 4 C NFt_o. l,11
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LC If 'a
PROPERTY LOCATION HENSHAW COMPLEX V ifjt
6 t IgA II\
MAP 3IB PARCEL 194 001 ZONE EU(100)/URC(100)/ Q l y
THIS SECTION FOR OFFICIAL USE ONLY: c f I \
PERMIT APPLICATION CHECKLIST fit„l E \/
ENCLOSED REQUIRED DATE 0314
ZONING FORM FILLED OUT (L'
Fee Paid Al 9 4,Rb L
Building Permit Filled out CP
Fee Paid
TypeofConstruction: ZPA-CONVERT UNITS A-D TO OFFICES/MEDIA SERVICES b
New Construction �` �\�,
Non Structural interior renovations a
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 PRESENTED:
Approved ✓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
t/ Permit from Elm Street Commission Permit DPW Storm Water Management
513t I 16
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 40K Contact the Office of
Planning&Development for more information.
File No. 1119-1,79
ZONING PERMIT APPLICATION 0:10-.2)- nrINS
Please type or print all information and return this form to the-Building
Inspector's Office with the$3Of fling fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: TE. TIZUSTE.ES OF 114G_114G_ SMITH CN I FGE_
Address: p�0 rAGILtTIES HGMT , 12J4 IJESTSTTelephone: 4-13 585 2424
2. Owner of Property:SAME. O NAMPTok.1
Address: 5.A.HE-- Telephone:
3. Status of Applicant: Owner1 Contract Purchaser Lessee Other (explain)
4. Job Location: 1-1EtJ&44d COM , �o2MERL-e EaIEDMAIu f}PT. CbHPIE) .
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: DO2MS /QPAIZ,Tj•�E1�1T5
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
COWVEQT UNIT D To CEuTE2, Fot. 1. 1EolAPeolxtcTlola t- CEaUICES_
(
CON1VERK
T NTo FITS AWCP'( OFFICESr
) 1.o[.)(Jel�1 c4;{%}
awl17 C)4Th Elxv. :TAD,
7. Attached Plans: Sketch Plan X Site Plan X Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW X YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW r YES
IF YES: enter Book Page and/or Document it
9.Does the site contain a brook, body of water or wetlands? NO X 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:
(Form Continues On Other Side)
W:Documents\FORMS\origina Wuilding-Inspector\Zoning-Permit-AppGwtion-passivc.doc 8/4/2004
10. Do any signs exist on the property? YES NO X
IF YES, describe size, type and Location:
Are there any proposed changes to or additions of signs intended for the property? YES NOX
IF YES, describe size, type and Location:
11. Wilt 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
This column reserved
for use by the Building
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size ti/a N/a
Frontage
Setbacks Front
Side L: R: L: R: L: R:
Rear tilA kVA.
Building Height
STOrc{ 2 SToeY
Building Square Footage
VAR-le.S VAaIE-S
%Open Space: (lot area q
minus building Et paved I� % 9 O %
parking
#of Parking Spaces#of Loading Docks
N/a (J
Fill: � 11 1
(volume a location) N Os la NOME
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. I//,'[I ,,
Date: 5. 1(o- Ito Applicant's Signature r.64. , I' t ` l.-7 C 4C
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:\Doouments\FORMStoriginallauilding-Inspector[Zoning-Prnnit-Application-passive.doc 8/4/2004
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