ZPA Demo 2011-01-27File # MP-2011-0067
APPLICANT/CONTACT PERSON SMITH CATHERINE H
ADDRESS/PHONE 226 COOPER LN (413) 625-2408 ()
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
-. 1
Building Permit Filled out
Fee Paid
Tyl2eof Construction: ZPA - DEMO & BUILD NEW HOUSE
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 Pit 7STED:
Approved 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
Septic Approval Board of Health
Water Availability Sewer Availability
Permit from Conservation Commission
Permit from Elm Street Commission
I
Well Water Potability Board of Health
L E "-0 (- Lew YZ-f- U
T I
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.
Inspector's Office with the $15 filing fee (check or money order) payable to the
City ofNorlhampton
1 Name of Applicant:
17
Address,
2. Owner of Property:
Address: Telephone:
3. Status of Applicant: Owner Contract Purchaser Lessee �- Other (explain)
4. Job Location: V
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 DON7 KNOW N% YES IF YES, date issued:
If-YEIS: -.--Was the permit recorded at the Registry of Deeds?
NO DON7 KNOW YES
IF YES enter Book ' Page and/or Document #
9.Does the site contain a brook,' body 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 Side)
W:\Docaments\FQRMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/412004
5. Existing Use of Structure/Property:
i I
10. Do any signs exist on the property? YES
IF YES, describe size, type and location:
NO I/
Are there any proposed changes to or additions of signs intended for the property?
IF YES, describe size, type and location:
YES NO
11. Will the construction activity disturb (clearing, grading, excavation, or filling) oT 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 reser-ved
for use by the Building
De ent
13, Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicant's Sjgnature
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 ArchitecturaYBoards, Department of Public Works and other applicable permit granting
authorities.
W.\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-panive.doc 8/4/2004
EXISTING
PROPOSED
-0
Lot Size
Frontage
Setbacks Front
16,
Side
L: AJO R: 7 1 (
L: If R: tS"
R.
Rear
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 Sjgnature
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 ArchitecturaYBoards, Department of Public Works and other applicable permit granting
authorities.
W.\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-panive.doc 8/4/2004