24D-081 (3) File 4 MP-2018-0068
APPLICANT/CONTACT PERSON LIA DON C/O DEALER SERVICES
ADDRESS/PHONE 1055 E 7ERICHO TURNPIKE
PROPERTY LOCATION 171 KING ST
MAP 24D PARCEL 081 001 ZONE HB(1001/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
OSED REQUIRED DATE
Z G F LED T
Fe Paid
BuildingB.ilding Permit Filled o
Fee Paid
Typenf Coastn,rrinn- ZPA-EXTRAPARYINGP&WaEAERSBIP
New Construction
Non Structural interior renovations
Addition to Existina
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: § }461-e.
Intermediate Project: ue Plan AND/OR Special Permit with Site Plan
Major Project: 1, Sitc Plm AND/OR_Special Permit with Site Plan
ZONING BOARD PERMIT REQUIRED UNDER:§
Finding Special Peanit Variance'
Received&Recorded at Registry of Deeds Proof Enclosed
_,Other Permits Required:
_Cub Cm 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
Now: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.
RECEIVED
File Na.
JuN - G PERMIT APPLICATION (§i o.2)
I Please or Print all information and return this form to the Building
°ED##AM1 , e vith the $30 filing fee (check or money order)payable to the
City of Northampton
1. Name of Applicant: �t a//„ j,C�/g, /, �y��
Address:a'1y / + z 0/060 Telephone: 7i.3' �—tunv6
Z. Owner of Property: // Li
Address:—_� s1�A to lephone:
3. Status of Applicant: Owner Contract Purchaser ( Lessee_Other (explain)
4. Job Location: 1,71 ' j q S4 A)o.L' � M 0/0(1')
Parcel Id: Zoning Map# -2-' 0 Parcel# d g/ District(s):
In Elm Street District In Central Business District
(TO BE FILL'E'D IN BY THE BUILDING DEPARTMENT) 7t
U
5. Existing Use of Structure/Property: 0.Atf
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
rk rt po. ;!f cL.L4o i VLLA A "
7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO DONT KNOW I/ YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW _1.� YES
IF YES: enter Book Page and/or Document#
9.Does the site contain a brook, body of water or wetlands? NO =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 Site)
w:\Do<uments\FDRMSbtiBinal\Builtlin6-tnsPecrotlZoning-Pe,mioAPplica,ian-pessivudoc 814nOM
10. Do any signs exist on the property? YES NO V
IF YES, describe size, type and location:
Are there any proposed changes to or additions of signs intended for the property? YES NO1--�
IF YES, describe size, type and location:
ii. Will the construction activity disturb(clearing, grading, excavation, or HUing)Over 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
Deparnninut
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: ilot area
minus building ft paved
Arkin
A of Parking Spaces
u of Loading Docks
Flll:
(volume&location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: (/J 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.\Oocumants\FORMS\onginall wilding-lmctor\Zoning-Permit-Application wivc.dm 8I42W4