21 Belmont Demo Application, File # MP- 2011 -0091
APPLICANT /CONTACT PERSON Trustees of Smith College
ADDRESS/PHONE 126 West Street (413) 585 -2424 ()
PROPERTY LOCATION 21 BELMONT AVE
MAP 31D PARCEL 041 001 ZONE URM001 / /EU
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
E C _E _Q U E
MAY 2 7 2011
DEPT OF PLANNING
NORTHAMPTON, MA 01060
ENCLOSED REQUIRED DATE
Building Permit Filled out
Fee Paid
Tyieof Construction• ZPA - DEMOLISH BUILDING & MULTI BAY GARAGE
New Construction
Non Structural interior renovations
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 t/ 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
rmit from Elm Street Commission
Q E 1-145 i u R-► C 1 1"
1.
Signature of Building Official
Permit from CB Architecture Committee
Permit DPW Storm Water Management
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 the Office of
Planning & Development for more information.
Please type or print all information and return this form to the Building
Inspector's Office with the X15 filing fee (check or money order) payable to the
City of Northampton g
1. Name of Applicant: T-4� TPUGTF ES ®F T4F— �MIT9-6 CA)-.l EGsE
Address: I2- Lo elephone:
2. Owner of Property:
Address: ' Telephone:
3. Status of Applicant: Owner X Contract Purchaser Lessee Other (explain)
4. Job Location: Z1
. P.>EL" CD PT )N-V - Rt LIl =. K1b?-T4 &MP'T®t , MA
Parcel Id' Zoning Map# I ' Parcel# 4 D�strrct(s�
LnElm ":Streetbstrlct 1n,rrentralBusJnessD�strct
JOSE FfL:LED (N B;YTHE.BUiLD{�lG DEPARTMENT-)
5, Existing Use of Structure /Property: TA F— RO LD 6 RIG i s C, u P-zE: jTL A. M uc u qI
6. Description of Proposed Use /Work /Project /Occupation: (Use additional sheets if necessary):
DENoU - iwi , BU ILlJIt & A.L.OQ& W IT4 V E. MULTI - Bt, , (
G APUGE W, LL B E RE:-MOVE-Q - TWa L&NAD u.I Ga C.OwVc - RTE ®
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 DONT KNOW X 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)
W: \Documents \FORMS \original\Building - Inspector\ Zoning - Permit- Application- passive.doe 8/412004
10.1 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 fitting) 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
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. _
Date 2:� • 2 b 1 0 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:\ Docutuents\ FORIv, S\ originalSuilding- Inspector\Zoning- Permit - Application- passive.doe 8/4/2004
EXISTING
PROPOSED
REQUIRED. ,.:....
ZONING
Lot Size
Frontage
Setbacks Front
Side
L: R:
L: R:
L; R:
Rear
Building Height
Building Square Footage
Open Space: (lot area
minus building & paved
p arking__. - -.._ _._ _... _._ _ . _ _
...._... ___..... .. ..__. -._.
_... -. _...... _._ __._.. _.
_...._
# of Parking Spaces
# of Loading Docks
Fill:
(volume ft location)
m]
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge. _
Date 2:� • 2 b 1 0 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:\ Docutuents\ FORIv, S\ originalSuilding- Inspector\Zoning- Permit - Application- passive.doe 8/4/2004
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