11C-050 File # MP- 2010 -0010
APPLICANT /CONTACT PERSON CARROLL TRACY J
ADDRESS/PHONE P O BOX 41 (413) 341 -3794 ()
PROPERTY. a .
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ZONING FORM FILLED OUT ENCLOSED REQUIRED DATE
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: HOME OFF /OCC - MASSAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accesso1y Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING AC ON HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INFORMATION P NTED:
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: § V2—
Finding Special Permit Variance* cG t�
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 CoRmssion Permit DPW Storm Water Management
Signature of Building Official Date
Note: Issuance of a Zonino nvrmit nines not relir+vo a applid -unfc hnrrinn to emmnly with all 7nnina
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.
Date Filed �(L(G° 7 File No
R.= GISTRATION OF HOME OFFICE /OCCUIPATION ( 510.2 & 31.11
with the Building Inspector .
. Name of Applicant:
Address: ; tip iv Telephone
2. Owner of Property: 5c`dw�
Address: Telephone:
`^ 3. Status of Applicant : Owner Contract Purchaser Lessee
V
O her (explain:
-- }
4. Parcel Identification: trap ;r Parcel r ,
Zoning Districts) (include over ys)
Street Address -
J Narrative Description of Proposed Home Office: (Use additional sheets
f"
if necess�rY) �v� z c� �r -- a� T ii f- r, ,�
V c� - 5TH i5 f'l i 1 ) Attu-, Ti' V? - n�
5 1C ,'< �cv� �Q✓ a ` Lfn
'tom 'Vic i`
6- Is this a legal residential building? KYE:�) NO
r 7. Will where be an employee/ owner who doesn't live in the home YES �c 'S3
E. Will you ever see clients or customers at your site? ES NO
How of Ca j5 MC 16 AZ Y - >
For what purposes ,;t r
9. Will there be any signs for the Home Office? YES PTO
10. W 11 there be any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale, or any
display of goods on premises? YES 7 0
i1. Will there be any outdoor storage of materials? YES O
12. Will your use be totally within a building and not cause any
outward manifestation (including traffic generation parking
congestion, noise, air pollution, and materials storage) ? YE NO
If NO explain:
13 Attach Plans (if applicable)
14. Certification: I hereby certify that the info �u ati on contained herein
is true and accurate_ .I understand that if any information is incorrect,
my permit is null and void and I may be liable for non- criminal fines and
criminal and civil actions-
Date (2,(�y 5 Appli_cant's Signature: =- .
TEIS SECTION FOR OF_FjCIP_L�IISE ~ ONLY.
Approved as . presented /based on information. presented
APPROYP_I, EXPIRES ON DECE.M RR . 31 OF THIS Y F.AR AND HUST TnEN BE RENEWED
Denied as px es?ntPd--- p�asor.:
Signature of Building Inspector Date
NOTE: i==,anc of it pornft dons noc ro(tove an sppttc -rt'a burden to comph'l wti a!I zoning rG-�uIremantz and obf :in a[[ roqulrod porn
from L4e Eo rd o{ HoaiL4, Cocisorra Son CornmLz ion., Department of Flubffc .Wok,_ and ocher apptfcanb4a pornit granting at::5or.:Ios_
File No.
ZONING PERMIT APPLICATION ( §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant
Address: Ih�fl`� l/tpiir , A x PE 4� Telephone: L .! L 3 I f �� �1 I /
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):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
S. Existing Use of Structure/Property r1C�nn o
S. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
L
u t c L4 am
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 PermftNadance/Finding ever been issued for /on the site?
NO DON'T KNO:N 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 C:oncervat on C- ommis;,io;,?
Needs to be obtained Obtained , date issued:
(FORM CONTINUES ON OTHER SIDE)
10. Do any signs east 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? YESO
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
Mi x w2— fj 7 7 ;=
by the Banding Departmea t
Required t
E JYIStIA le Proposed oposed By ZZ o1 - 1iI tt j". t
Lot size
Frontage
Setbacks frnnt
- side L: R: L: R:
- rear
Building height
Bldg Square footage
%Open Space:
Lot area minus bldg
&paved Park-L
# of� parking spaces
f of Loading Docks
Fill:
{ vol -ume - -& location)
13. Certification I hereby ce?-ti fy tt t�,
L Vr V1L Vtr lli Gtr, la L.l �ta3
is true and accurate to the best of my knowledge. f�
DATE: 1? . I(t `� APPLICANT's SIGNA.TJ
NOTE: cos a zoning permit does not relieve an applioan:s rden to o w lt4 .imll
zoning requirements and obtain all required permits from the Board of Health, Conservation
Commission. Department of iPubiio Works and other applicable permit granting authoritles.
FILE #