Zoning Permit Application 4.14.21W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004
File No.__________
ZONING PERMIT APPLICATION (§10.2)
Please type or print all information and return this form to the Building
Inspector’s Office with the $15 filing fee (check or money order) payable to the
City of Northampton
1. Name of Applicant:______________________________________________________________________________
Address:___________________________________________________Telephone:____________________________
2. Owner of Property:_______________________________________________________________________________
Address:___________________________________________________Telephone:_____________________________
3.Status of Applicant: Owner _______ Contract Purchaser _______ Lessee_______ Other (explain)_____________
4. Job Location:_____________________________________________________________________________________
Parcel Id: Zoning Map#_______________ Parcel#_____________ District(s):_____________________
In Elm Street District In Central Business District___________
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property:___________________________________________________________________
_________________________________________________________________________________________________
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 __________ DON'T KNOW ___________ YES ___________ IF YES, date issued:____________________
IF YES: Was the permit recorded at the Registry of Deeds?
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 _______ 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)
Peter Flinker
(413) 687-3184
Peter and Stephanie Flinker
502 Haydenville Rd., Leeds, MA 01053
502 Haydenville Road, Leeds, MA 01053 (413) 687-3184
502 Haydenville Road, Leeds, MA 01053
006 RR 6
X
with an addition between 2009 and 2015. A certificate of occupancy was issued in March 2015.
Single Family Residential: the original farmhouse was expanded
Conversion of existing single family home into a two family dwelling, with renovations to the
original structure including new kitchen and reconfigured baths.
X
X
X
Yes 2008
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:______________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________
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 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
EXISTING PROPOSED REQUIRED BY
ZONING
Lot Size
Frontage
Setbacks Front
Side
Rear
L: R: L: R: L: R:
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 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.
No
No
3.74 Acres
180'
3.74 Acres
April 14, 2021
180'
None
None
4 4
54'
36'
480'
36'
None
None
4944 (gross)
(no impervious other than building footprint)
159,660 s.f.
125'125'
54'
480'
2900 (rear unit)
2034 (front unit)
159,660 s.f.
30'30'