175 Jackson ZPA MP-2020-0057PROPERTY LOCATION 175 JACKSON ST
MAP 24A PARCEL 043 001 ZONE URB(99Z
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Buildinp,Permit Filled out
Fee Paid
Typeof Construction: ZPA-ADD 2 MULTIFAMILY 2 UNIT DWELLINGS,NEW 4 CAR GARAGE WITH
APARTMENT ABOVE
New Construction
Non Structural interior renovations
Addition to Existing
Accesso 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: R
Approved Additional permits required(see below) rAK( 0 u$it
PLANNING BOARD PERMIT REQUIRED UNDER: § Q Jf' Srk plczy,/N
Intermediate Project: S. 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 Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Zf Z7 2,0
Signature of Building Official 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 $30 filing fee (check or money order)payable to the
City of Northampton
L a `
I l
A.. r ame iQ Applicant: I (r 1'1 V Cl I C'(
Addre Fa i C- 1&1 1 ke l I I Telephone: I 13 - 53-7 - 97 e
2. Owne roperty: Cl P 1 s, 1 0.V e
00
A ress: C-i-en Va l { d q hna Z o n
Telephone:
7 F a
L l
3. Status of AplAwwC Qvmer, V Caritract Purchaser Lessee Other (expiaim),
4. Job Location: 1 `7 J I-C)- C, ceA- N (Sr k G rv,) 12 0 n
Parcel Id: Zoning Map# Parcel# District(s):
In Elm Street District In Central Business District
TO BE FILLED IN BY THE
1BUILDING
DEPARTMENT)
5. Existing Use of Structure/Property: 2e.5" A
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
Add fwt-, v10rum • 2
C-11CA, _ W IN a
1 GG ca.r,c tr r' cy--< rL
7. Attached Plans: Sketch Plan V Site Plan Engineered/Surveyed Plans
S. Has a Special Fermin/VariancefFbi i:ing ever been issued:for/on,the site?'
NO V/ DONT KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DONT KNOW YES
IF YES: -enter Book Page / and/or Document#
g.Does the site contain a brook, body of water 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:
ICA R,6 LA v "I"-f ^ (-7MA r` ' (o /L,'L
Form Continues On Other Side)
W\Documents\FORMS\original\Building-InspectorVoning Permit-Appiication-passive.doe 8!4/2004
Are there any proposed changes tor 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 WFORMAMON MUST SE 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
G,r C
t7 i
I
rJ
Frontage
Setbacks Front S 1- V a r ,es S-ec S I
1
Side L: q 0'4- R: Zf 5 + L: R: L: R:
Rear f-
B Wing i*ight
Building Square Footage L,)r 2 Q
c 5 ' cAbrvi
0*5
I ncl C C
Open Space: (lot area
q
G
minus building Et paved
parking
of Parking Spaces e
of Loading Docks
C 0
Fill:
volume Et location) C
13. Certification: I hereby certify that the information contained herein is true and accurate to the best of
my knowledge.
Date:1 I .Z"' AppbcarA's S*wture \6:L--
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:1Documerns\FORMS\original\Building4nspector\Zotung-PermitAppliratina-passive.doe 3/4,2004
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NAPIMw LOCUS REFERENCE
KAREN S.LBVERDIERE
BOOK 11495 PAGE 289
MAP 24A-043
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See our website for larger copies of this plan–www.the.homestore.com. Plans may show optional
features, such as garages, porches, roof dormers, gable returns, decorative moldings, & chimneys.
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