32A-154 6 Strong Ave 2013-07-18RECEIVED
',,' .$ICATION;(§l()~2)"
Please type or p' :' ,~'mmlih d return this form to the Building
Inspector's Office withitlJ,e $15 flling fee (check ormoneyorder) payable to the
: City ofNorthampton
1. Name of APplicant:_ Ga.~ J Ca.ra {?ertrJall :5.tr Qt?cY: Ave LiC
Address: /JJ. CiliA/a. /ds i<Lwesij,a.oy t~"Telephone: ""/ /? -~.t9 ~ C-j 5""'(; 8'
2. Owner of Property: 51 radiJ. AlL'::: L.L C. Ca.cal" G,:'5? Uoltl.at?
Address: O!Z c:L"'t'a.ccd<ii Ul.;,.Le>tkao/f ,n Telephone: tfZ'.k ~5"39 -,-/Sq(5
3. Status of Applicant: Owner ./ Contract Purchaser Other (explain)_____
4.
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Parc~I#-,"',_'_"..;..'___','Olstrlct(s):_'_-.:.,...,--_~___
" :. , . " . .
'In E'I~ StreetOhitrict " In Central Busil1essOistrict ~ "", ' ' ," (t6 'BE .FILLED IN BYTHE BUILDlNG'DEPARTMENn ,'-'--,-,--"
5. Existing Use of Structure/Property: Res fa. u carl r
6. Description of Proposed Use/WorklPrQjectlOccupation: (Use additional sheets if necessary):
7.
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO ____ DON'T KNOW .....X'-"'--__ YES ____ IF YES, date
IF YES: Was the permit recorded at the Registry of Deeds?
NO ____ DON'T KNOW _X--=---__ YES ____
IF YES: enter Book __---:-_ Page ____ and/or Document # ______
9.Does the site contain a brook, body of water or wetlands? NO X 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)
81412004W:\Documents\FORMS\Original\BuildingcInspector\Zoning-Pennit-Application-passive.doc
"-..
10. Do any signs exist on the property? YES __X.:..-''..;,.:;','_ NO __-+-_
IF YES, describe size, type and 10canon: _____________--,-_...2...._________
Are there any proposed changes to or additions of signs intended for the property? YES ___,NO X
IF YES, describe size, type and 10CaW)n:,_________________________
11. Will 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 DEI\lIED DUE TO LACK OF INFORMATION
This column reserved
for use bytheBuilding
Department
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size (-~ ~ ----'\
Frontage ---...
Setbacks Front
Side
Rear
~< ~
L: 0 R: ()
()
L: R: L: R:
Building Height ( r.3 / 12 ,
-Footager 1500 / 0 (pl.) 11
L/%Open Space: (lot area '\..,
minus building & paved ~ '--0'-MltJ
# of Parking Spaces 2
# of Loading Docks ~ ~ ~
Fill:
(volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: 7 II zll '$ I I
Applicant's Signature --0.4';Z~r&;fL~'.F-h/Jt,'&Et2:1!t.---
NOTE: Issuance ofa zoning permit does not relieve an a c burden to comply with all zoning
requirements and obtain all required permits fr the ard ofHealth, Conservation Commission,
Historic and Architectural Boards, Departme ofPublic Works and other applicable permit granting
authorities.
81412004W:\Documents\FORMS\Original\BuiJding-Inspector\Zoning-Permit-Application-passive.doc
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