ZPA Demo 2013-01-04File # MP-2013-0067
APPLICANT/CONTACT PERSON OBER JEREMY D
ADDRESS/PHONE 8 HOCKANUM RD #14 (413)658-7583()
PROPERTY LOCATION 23 FAIR ST
MAP 25C PARCEL 255 001 ZONE SC(L On/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Building Permit Filled out 7r f
Fee Paid
Typeof Construction: ZPA - DEMO 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 ON HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P ENTED:
-1S
Approved A ditional 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
rksla le[42 1 -1071 1 1 9 1.3, W 3 IN 'i 1 6 1
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 Pen from CB Architecture Committee
� ermit from Elm Street Commission Permit DPW Storm Water Management
� fT
Signature of Bu i l ding O
�f� 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 MOIL 40A. Contact the Office of
Planning & Development for more information.
JAN - 3 2013 ,
P - /3 -67
PERMITAPPLICATION(§10.2) 11
Please type or print all information and return this form to the Building
Inspector's Office with the $15fi ling fee (check Or money order) payable to the
City of Northampton
1 Name of Applicant: C) � - Q- r
Address: _—Telephone: 41 G &I
2. Owner of Property:
Address: WCX_Nr_inV.... rj A IX k L A - 7 3 n
qjj
3. Status of Applicant: Owner Contract Purchaser Lessee— Other (explain
" D * 1 4;� —
4. Job Location: a r Sl rl
Parcel Id. Zoning Map# Parcel# J District(s):— no
In Elm Street District In Central Business - District
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/ Property: P—e & t AQVce Z
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 Y DONT KNOW YES IF YES, date issued:
IF YES: 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 of water or wetlands? NO DON7 KNOW —
IF YES, has a permit been or need to be obtained from the Conservation Commission?
RM
Needs to be obtained Obtained date issued:-
(Form Continues On Other Side)
W:\Documents\FORMS\origin"udding-Inspector\Zoning-Pemiit-Applic4tion-passive.doc 81412004
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?
IF YES, describe size, type and
YES NO
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
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date: Applicant's Signature (J `►
NOTE: Issuance of a zoning permit does not relieve 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
EXISTING
PROPOSED
REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side
L: 1 R: 1
L: I R: t9 '
L: R:
Rear
Building Height
® l
3
Building Square Footage
% Open Space: (lot area
minus building ft paved
®
parking
# of Parking Spaces
, r
t
# of Loading Docks
Fill:
Q
(volume R 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 (J `►
NOTE: Issuance of a zoning permit does not relieve 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