17A-157 (4) File #3 Z `v K
APPLICANT/CONTACT PERSON:DOSTAL ERIC D&ELENA L CIAMPA
61 FOX FARMS RD FLORENCE, MA 01062
PROPERTY LOCATION 61 FOX FARMS RD
MAP:LOT 17A-157-001 ZONE URA
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Building Permit Filled out
Fee Paid $30.00
Type of Construction: ADD 12'X24'X15'MODULAR BACKYARD STUDIO WITH l/2 BATH & 3'HIGH
CRAWL SPACE
New Construction
Non Structural Renovations 77 (4
Addition to Existing
Accessory Structure V�/
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:
)C Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER:§
Intermediate Project: Site Plan AND/OR SpecialPermit 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
OtherPermits Required:
Curb Cut from DPW Wa ter Av a ila b ility 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
Demolition Delay
t: ,
Sigr(ature of Building Official b 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 Office of
Planning&Development for more information.
p 15�- L ; O Qd 1oT S�aG : .
Gib✓ a*,, to : oily it&
a Ott-
i' ' r'Lill File No. 3
�� J -11
u 'kONING PERMIT APPLICATION (§io.2)
- I Please type or print all information and return this form to the Building
Inspector's Office with the $30 filing fee (check or money order)payable to the
City of Northampton
L
1.-. Name of Applicant: EIevl a C I am f
Address: Ca FP x' ✓w►S Rd • 01U(22- Telephone: S - 100
2. Owner of Property: S cwit. cooLt [r // kic Do - C i t; -?--1 r�3q 1
i�T
Address: e, Telephone: SI/MI-
3. Status of Applicant: Owner k/ Contract Purchaser Lessee Other (explain)
4. Job Location:
Parcel Id: Zoning Map#)1 167-00 I Parcel# District(s): U IZA
In Elm Street District In Central Business District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property: • of 12gat 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
YN SIG
12- I x A+' x I s J rn t.l o/ baG v 4 c-Ii-t'o w Jk.ai7i-
(— i'�,d l r '' h' �c s
7. Attached Plans: Sketch Plan V Site Plan _ Engineered/Surveyed Plans
8. Has a Special Permit/Variance/Finding ever been issued for/on the site?
NO I DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds? N/h_
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 DO7------N'T KNOW YES
IF YES, has a permit been or need to be obtained from the Conservation Commission? N/
Needs to be obtained Obtained , date issued:
(Form Continues On Other Side)
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: 14/A
Are there any proposed changes to or additions of signs intended for the property? YES NO
IF YES, describe size, type and location: Ar A
11. Will the construction activity disturb (clearing, grading, excavation, or filling) ove 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
/ t ij
EXISTING rr PROPOSED REQUIRED BY
y ciapAc ( F ZONING
Lot Size --8 4 002
2
FrontageqtY 1 Iv - .' „b
Setbacks Front 1
Side L: R: L: ((JJ('Jj I R: /Lo
L: C R:ifirotRear.- ) t 6 I i
i ,/
Building Height /5- /
Building Square Footage 440 p
e ,
%Open Space: (lot area
minus building Et paved V-%
0parking S
#of Parking Spaces
#of Loading Docks
0
Fill: /�j
(volume Et location) l�
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: if Qft el ,..., Applicant's Signature s(.1/ .,091 ,1\__
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:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004