23A-079 (26) File#MP-1999-0048
APPLICANT/CONTACT PERSON George Falk
ADDRESS/PHONE 586-0320
PROPERTY LOCATION 41 MAIN ST(REAR)
MAP 23A PARCEL 079 ZONFIej
THIS SECTION FOR OFFICIAL USE ON Y:
PERMIT APPLICATION CHECKLIS
ENCLOSED REQUIRED DATE
ZONING FO FILLED OUT
ai
Building Permit Filled out e �6v-ate Zz .�� .���' 'ISO
Fee Paid
Type of Construction:
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/Occupant Statement or License#
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
Denied as presented:
Special Permit and/or Site Plan Required under: §
PLANNING BOARD ZONING BOARD
Received&Recorded at Registry of Deeds Proof Enclosed
Finding Required under: § w/ZONING BOARD OF APPEALS
Received&Recorded at Registry of Deeds Proof Enclosed
Variance Required under: § w/ZONING BOARD OF APPEALS
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
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden o comply with all zoning
requirements and obtain all required permits from Board of Health,Co nervation Commission,Department
of public works and other applicable permit granting authorities.
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ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: L tS' • ThL
K
Address: C1 / Alt( ir( 'P--lCrUtc.Q- � )Telephone: " // u VC-031,0
2. Owner of Property: /Vitt, d ae.. -F-
-ik
'i R
Address: / 1'1 Q f X FJO(&h C Q. Telephone: J O 6 03 Z d
3. Status of Applicant: V Owner Contract Purchaser Lessee
Other
(explain):► /
4. Job Location: 7�[/ ,'+/A i (i ' FIttfth(2- �t•
Parcel Id: Zoning Map# R 3 A Parcel# 9 1 District(s): CIE
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property dfi(e- .--altOd.
6. Description ohProposed Use/Work/Project/Occupation: (Use additional sheets if necessary): •
9cao s . `G En vlatre u. . I4uQL ,cr►L "ram t
el;r...el Ieo reV (ldl(ct * Sracc/,Q
7. Attached Plans: Sketch Plan V 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 PermitNariance/Finding ever been issued for/on the site?be
NO DON'T KNOW ✓ YES IF YES,date issued:
IF YES: Was the permit recorded at the Registry of Deeds? 4,+
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 f 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)
0. Do anysigns exist on the property? YES ✓ NO
1
IF YES, describe size,type and location: (: Rc
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 column to ba filled in
by tha Building Department
(Required
Existing Proposed By Zoning
Lot size o4,o t S�ha.2.
Frontage I I
Setbacks - frnnt '�f U/ ' t'h S•ok
- side L:o-rl R:o•ti L: R:
- rear 1
v
Building height i,f _ d 6.5
Bldg Square footage , 600 Lati pt eg
%Open Space: ( oI•.&- elitiVtl
(Lot area minus bldg Q.Llc,
&pawed parking)
�ca.vT 13t tt.y • - -
# of Parking Spaces 11
' •
V ``
it fof Loading Docks Q
Fill: �`\
(volume-& location) V .)
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge. •
DATE: APPLICANT'S SIGNATURE
NOTE: issuanoe of a zoning permit does not relieve an appiioent's burden to oompty with all
zoning requirements end obtain all required permits from the Board of Health. Conservation
Commission. Department of Publio Works end other applloable permit granting authorities.
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Reference No: MP-1999-0048
Department:
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Zoning Permit Application REC-1999-001400
Paid By: Paid in Full On:
George Falk Thu Nov 19,1998
Received By: Check No:
Linda Lapointe 5522
TREASURER'S COPY Amount: $5.00
Reference No: MP-1999-0048
Department:
Building, Electrical & Mechanical Permits
Fee Type: Receipt No:
Zoning Permit Application REC-1999-001400
Paid By: Paid in Full On:
George Falk Thu Nov 19,1998
Received By: Check No:
Linda Lapointe 5522
DEPARTMENT'S COPY Amount: $5.00
Reference No: MP-1999-0048
Department:
Building, Electrical & Mechanical Permits •
Fee Type: Receipt No:
Zoning Permit Application REC-1999-001400
Paid By: Paid in Full On:
George Falk. Thu Nov 19,1998
Received By: Check No:
Linda Lapointe 5522
CUSTOMER'S COPY Amount: $5.00
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