23C-066 (4) File#MP-2000-0007
APPLICANT/CONTACT PERSON John ZieminsIC ,. g
ADDRESS/PHONE 16 Dwight St (413)24'7-9014
JUN 2 7 ate
PROPERTY LOCATION 93 BLISS ST
MAP 23C PARCEL 066 ZONE URA
ur 3W1D'l1G 1"1ST
THIS SECTIONFd1 :4 ' CAL iJSE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONINCT OR I D OUT _
Fee Paid T 4570
Building Permit Filled out
Fee Paid
Typeof Construction: CONSTRUCT SINGLE FAMILY HOUSE W/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
THEfOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
1/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
jP/ 1, 7 ,2 - �r
Signature of Buildi 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.
t�f 1 f? U If~
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r t File No.��t/�
bFPTOF$UILD!fw,,v, Uh
tioRTkA,n.;;.Ter, ��H�1,;50 Z NING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: ,.../29/7/7,i 77`
Address:/tii 0G,.//G<le-T /`9/4- Telephone: c)":7"7 O, (.72_6 6 3 2O cp 4
2. Owner of Property: , fc64,4 -
Address: ?3 C i SS S/- f'✓"R.'-T7fi i0,Telephone:
3. Status of Applicant: Owner K Contract Purchaser Lessee
Other(explain):
4. Job Location: LP r- 03 66.4,55 Si'-
Parcel Id: Zoning Map# a3 Parcel# District(s): �,/f4 //el-CO°
(TO BE FILLED IN BY THE BUILDING DEPARTMENT
5. Existing Use of Structure/Property /-'4--c-/'7>-,/7 tea.
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
--7D /3 u--/ '-v /2t3( e>v cE- v GA77_,4a
7. Attached Plans: Sketch Plan �,<, Site Plan k 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?
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 D4 Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
10. Do any signs exist on the property? YES NO vt
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 column to be filled in
by the Building Department
Required ` I
Existing Proposed By Zoning
Lot size go o 3Y" SO F- See) e V s Q > � Pb�
Frontage /2 f i2 s-" `
Setbacks - frnnt 'vy 30
- side L: ° R: c) L: 1-‘ R: 3O 9J
- rear 0 go
Building height -.= L6 ' 3
Bldg Square footage -.2.. 3 5-2)
%Open Space:
(Lot area minus bldg P° "4 7 (J
' &paged parking) / ° O
# of 'Parking Spaces
#' fof Loading Docks
Fill:
(volume--& location) d O
13 . Certification: I hereby certify that the information contained herein
G is true and accurate to the best of my knowledge.
DATE: .7 ill r APPLICANT's SIGNATURE , ..NOTE: Issas noes of a zoning permit does not relieve an ep lioent's • den to oomply witty aiil
zoning requirements and obtain all required permits f m the Boa of Health, Conservation
Commission, Department of Publio Works and other app able permit granting authorities.
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