37-004 (6) •
1 0. Do any signs exist on the property? YES_________
IF YES, describe size, type and
Are there any proposed changes to or additions of signs intended for the property? YES_ , A
IF YES, describe size, type and location: __________________
11 ALL INFORMATION KUST BE COMPLETED, or PERMIT CAN BE DENIED DOE v,
LACK OF INFORMATION.
r b . i a c o l tca,-, L.
by tia Dui
Required
Existing Proposed By Zoning
Lot size
Frontage
Setbacks
-
- side L: R: L: R:
•
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
# of - Parking Spaces
# of Loading Docks
Fill:
< voiume -t& location)
13. Certification: I hereby certify that the information onLa±uc
is true and accurate to the best of my knowledge.
DATE: APPLICANT 's SIGNATURE -
NOTE: lianuranoe of ea zoninu permit doe..o not relieve nppJjo9ti E“.Arrien t
zoning requtremente nrid, r-41 rf-quirec per Iron, the idocmc-s.
Commloolon, Deportment of Publics Works and other opplionble permit uro;Ititich
FILE I
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File Nu. �V"(�3
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ZONING ?� APPLICATION (§10.2)
~^��'�m�� /-���`�'� APPLICATION
PLEASE TYPE OR PRINT ALL ZNFORKATZON
1. Name of Applicant:_ ( _ �` \ (� d (���-���____��!_'�-__--_-'_____________
Address: C� ~7/� L-\[)��/l{� — ( Te|ephona� �
� ' / 9 ' ` � -'--- ����~ ------ � ^�^~— -~=-==-�`^'---------
2. OvvnerofPoupe�y� - \ [L/\�� [ -
() r - 1.5 ___.______--_--_________________
Address: - 79 T 1'Nre Or. (`,_ . _______To|ephone�
3. Status of Applicant: Owner Contract Purchaser __
Other (explain): |i
4. Job Location: \/{}�'` �� \ �U[`'~l��L{�l/���r) 41034 (�
� ^^�^�~`-�^ ~ '� ' ' -^-^ �- -~-~~~-' -
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Parcel Id: Zoning Map Parcel# Distriot(s):_ _________________
(TOBEF|LLED|NBYTHEBU|LD|NGOEPARTMENT)
5. Existing Use ofSkucture �� k(7t)
S Description of Proposed UsoNVork/P/oject/]ccupahoo: (Use additional sheets if noces
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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 Dep-artrbent Files.
8. Has a Special PermitNariance/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/o/ Document # ____
A. Does the site contain a brook, body of water or weands? NOK DON'T KNOVY YES _______
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained date i»sund:______
(FORM CONTINUES ON OTHER SIDF
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File ;t MP- 2003 -0182
APPLICANT /CONTACT PERSON POWERS GARY JR
ADDRESS/PHONE 579 FLORENCE RD (413) 586 -5007 O f Q a U 4
PROPERT ' •
r 5 �
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid )6/
Typeof Construction: HOME OFF /OCC REG_ I AWNCARE BUSINESS
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 PRESENTED:
Approved 1•' Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER : §
Intermediate Project : Site Plan AND/OR Special Permit with Site Plan
Major Projecf Site Plan AND -OR Special Permit with Site Plan
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 Ilealth Well Water Potability Board of I Iealth
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 \1GL 40:A � u the t_)fliee
Planning & Development for more information.