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Zoning Permit Application 4.14.21W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 File No.__________ ZONING PERMIT APPLICATION (§10.2) Please type or print all information and return this form to the Building Inspector’s Office with the $15 filing fee (check or money order) payable to the City of Northampton 1. Name of Applicant:______________________________________________________________________________ Address:___________________________________________________Telephone:____________________________ 2. Owner of Property:_______________________________________________________________________________ Address:___________________________________________________Telephone:_____________________________ 3.Status of Applicant: Owner _______ Contract Purchaser _______ Lessee_______ Other (explain)_____________ 4. Job Location:_____________________________________________________________________________________ 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:___________________________________________________________________ _________________________________________________________________________________________________ 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): _________________________________________________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ 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 __________ DON'T KNOW ___________ 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 _______ 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) Peter Flinker (413) 687-3184 Peter and Stephanie Flinker 502 Haydenville Rd., Leeds, MA 01053 502 Haydenville Road, Leeds, MA 01053 (413) 687-3184 502 Haydenville Road, Leeds, MA 01053 006 RR 6 X with an addition between 2009 and 2015. A certificate of occupancy was issued in March 2015. Single Family Residential: the original farmhouse was expanded Conversion of existing single family home into a two family dwelling, with renovations to the original structure including new kitchen and reconfigured baths. X X X Yes 2008 W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 10. Do any signs exist on the property? YES __________ NO ___________ IF YES, describe size, type and location:______________________________________________________________ _________________________________________________________________________________________________ _________________________________________________________________________________________________ Are there any proposed changes to or additions of signs intended for the property? YES ________NO________ IF YES, describe size, type and location:_______________________________________________________________ 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 DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUIRED BY ZONING Lot Size Frontage Setbacks Front Side Rear L: R: L: R: L: R: Building Height Building Square Footage % Open Space: (lot area minus building & paved parking # of Parking Spaces # 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: ______________________ 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. No No 3.74 Acres 180' 3.74 Acres April 14, 2021 180' None None 4 4 54' 36' 480' 36' None None 4944 (gross) (no impervious other than building footprint) 159,660 s.f. 125'125' 54' 480' 2900 (rear unit) 2034 (front unit) 159,660 s.f. 30'30'