30B-112 i.10 Net b
File # MP- 2011 -0038
i j Q f, M.A i 1o
APPLICANT /CONTACT PERSON DAVID McCUTCHEON
ADDRESS/PHONE 263 SYLVESTOR RD (413) 529 -9973
PROPE; ° �J0
� � r i t 100
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
Z FORM ONING ILLED OUT
Building Permit Filled out Fjs yCp
Fee Paid
Typeof Construction: ZPA - USE
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 PRES TED: 3 f l/w 4
Approved ` Additional permits required (see below) l w d V 5
PLANNING BOARD PERMIT REQUIRED UNDER : § 3 So TA BL 0 C Li S6
Intermediate Project : Site Plan AND /OR pecial Permit with Site '
Major Project: Site Plan AND /OR p- = - wii 1 e • an
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
/ /ts
Signature of Building 0 ficial 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.