32C-179 (43) 10. Do any signs ebst 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?YES NO
IF YES,describe size,type and location: E VA, N 1�o moo "`'-" 6�t i
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
,p Tbi.a —7— to be fi ll d is
16-t G 1�`+�tS°� ��✓r r' by the 2ai3d=q Department
t Required I
Existing Proposed By Zoning
Lot size
Frontage
Setbacks -frnnt
- side L: R: L• R:
- rear
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paired parkingi
# of -Parking spaces
#' of Loading Docks
Fill:
volt me--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowl cage.
--
DA'L'E: APPLICANT'S SIGNATURE !e
NOTE: Issuanoe'of a zoning permit does not relieve nn applioanr= burden to oomaM With etl
ae3nir_g req■_irema:ts and c.b.ain ail required permits from the Board of Health, Conserv'stion
Commission. Department of Publio Works and other appliomble permit nrnnting authoritles.
FILE it
r
File No. r� A
ZONING PERMIT APPLICATION (§I0 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: 4001t-- J -e Ll rj
Address: S&4✓1 C 4( � � Telephone:
2. Owner of Property:
I-A ,, FL l f i.�s A--J
Address: Po GrIA 1'44(-A-90AJ 17"0 Tfelephone:
3. Status of Applicant: Owner Contract Purchaser Lessee
Other(explain):
4. Job Location: -J-77- ^
YPLI PL-"SA-ft-J-1—
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property V 4-G A-'"'r L_v T-
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
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 Permit/Variance/Finding ever been issued for/on the site?
NO DON'T KNCV%' i ' 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 Obtained ,date issued:
(FORM CONTINUES ON OTHER SIDE)
File#MP-2007-0022
APPLICANT/CONTACT PERSON Oliver Iselin
ADDRESS/PHONE 36 Service Center (413)584-1224
P} OC, 332 PLEASANT ST,
� � + -
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONWai _ORM LLED OUT
Fee
Build ing Permit Filled out
Fee Paid
Tpeof Construction: ZPA-SLEEP DISORDER DIAGNOSIS&TREATMENT CENTER
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
INFO ATION PRESENTED:
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: §
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 mmission
2cx�
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 MGL 40A. Contact the Office of
Planning&Development for more information.