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10. Do any signs ebst 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. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This C01-W= to be f3.21.a3 is
by tha Bail,ding DDepazt�ent
Required
Existing Proposed By Zoning
Lot size 1 3C60-1 �p 0
3 X07, c
Frontage ' S I 36
Setbacks
- side L:, ' _R: 10' L: 7 R: 10' 3c)
- rear 1001 100
Building height 17' I
Bldg Square foots 045E 11 SQu
r2 AMW Ff f ' }-
%Open Space:
T10 W/6 '3
Lot area minus bldg 6 t
&paned parking)
# of Parking spaces 6
#tof Loading Docks
Fill:
vol-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: 2 Z9 f q T , APPLICANT's SIGNATURE a
NOTE: Issuanoa of a zoning permit does not relieve an applioanrs burde to comply Wltb-all
zoning requirements and obtain all required permits from the Board of Healthr Conservtstion
Commission, Department of Public Works and other applicable permit granting authorities.
FILE #
i
V
FEB 2 4 2004 File No� Q�
ZONINO PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: NI II (ha d i Nf ct4he.l- 46a(.t
Address: O(A t ,gCLD KH P t(V f— Telephone:
2. Owner of Property:_ 3 A cy)e—
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: id q ial r"ri (c) o n j: T (/r�rP v'V P
Parcel Id: Zoning Map#---?— /
Parcel# `7' istrict(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMEN
5. Existing Use of Structure/Property
� ate. � r �i Tina
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
7. Attached Plans: ✓ Sketch Plan Site Plan Engineered/Surveyed Plans
Answers to the following 2 questions may be obtained by checking with the Building Dept or Planning Department Files.
8. Has a Special PermiUVariance/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)
File#MP-2004-0101 0 1400&-ft.
APPLICANT/CONTACT PERSON BOULEY MICHAEL C&HEATHER M
ADDRESS/PHONE 269 RYAN RD Q 584-6400 Q
PROPERTY LOCATION 269 RYAN RD / n
MAP 29 PARCEL 142 DO 1 ZONE URA/1,(�to r
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FIL ED OUT
wilding Permit Filled out
Fee Paid
T_meof Construction: ZPA-ATTACHED 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 PRE RNiTED:
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: § �,. Z AOer--s do Y
Finding Special Permit Variance* �7—
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
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.