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W` tf N iu�aca dui anc� io uoijnat dd v � .t V SNPI SIHI SA0oV SHOWS NI TIId OZ JAN INVOI'IddV u •paluei8 aq Ztuuad a aao;ag uotlleatldde stgl gltm pall;aq Zsnu1'sueld pule suetd fold •dg THAJ SNOLLIQNOO allfIJd13 alll IVHM QNV OIIV SNOLL -IQNOO 9NLLSIX3 alll JLVHM SNV'Id 9NIANWHOOM HHI(INV NOLLVOI'IddV 51141 NIO'H3 HNIWHH,LHQ NV0 dM JLVH,L H,L'H0A las OS Hg JSfINt MO'I3$'HOd QH'I'IV0 VIVA dH,L`(jgj dd00V H$AVW NOLLVOI'IddV SIM JVHI HHQHO NI MON � y 0 `� Crzt of 'WLz#tl�ii��tnti 1 - of QC; i�..C) �laseachusrtte - DEPARTMENT OF BUILDING INSPECTIONS INSPECTOR 212 Main Street ' Municipal Building Northampton, Mass. 01060 Square Footage Amount Basement @ .10 11"1--0 i / lst Floor @ .40 �'e} fy`j 2nd Floor @ .20 1/2 Floors, Attic, Garage .10 Deck, Porches .10 h TOTAL o¢���AMP�Q �S MAR 2 5 '1998 (r itt Of 'Wart4a pf an � � $lassncatssrtta cn DEPARTMENT OF BUILDFNG INSPECTIONS 212 Main Street ' Municipal Building ' Northampton, Mass. 01060 ' WORKER'S COMPENSATTON INSURANCE AFFIDAVIT (licenserJpermittce} with a principal place of business/residence at: 0027 (strc�t/city/state/np� do hereby certify, under the pains and penalties of perjury, that: I am an employer providing the following worker's compensation coverage for my employees worlang on this job: Gib iVg�}r n� W0-d2_00,7,q 7Y r, (Insurance Company) (Policy Number) (Expiration Date) ( } I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (Name of Contractor) (Iasi r c; Company/Poky Number) (Expiration Date) (Name of Contractor) (Insurance Company/Poticy Nw bes) (Expiration Dale) (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (stf-Ch wkli6ocal shoe ifnoo..xy to ioctudc information pertaining to all oodractors) ( ) I am a sole proprietor and have no one working for me. ( ) I am a home owner performing all the work myself. NOTE:plea=be aware that while hoamw=s who employ pca=to do maiukssance,corauuctioa or repair work on a dwelling of not-cK*than throe units is which the homwwncr reside+or oa tho grounds appurtenant Iharto are not generally oo=idacd to be employers under the vvocket's comp_s4on Act(G1,152,m l(5)�application by a homeowner for a Gomse or permit may-id—tho legal etaw of an employ=under tho Wodccle Compcmaison,Act r underz d that a copy of this rtatcmcal may be forwarded to(be Depwtmcot of Indmdrial Amid—&Offi—of lusrrranrn for the coverage verification and that failwc to secure ooverago under sxtion 25 A of MGL 152 can kad to the impmition of criminal Penalties LIOI &Zday of up to S1,500.00 and/or imprise�of up to one year and civil peaaltics in the form of a Stop Work order and a against me. For ctepr¢tme�hnl attic oily Permit Number iocnserlP tSce . �.ju ., .,,..� ��..,�..� ivt CRANBERRY POND I o � ci uo -- ----_ 77E COURSE 197. 14' --- � 0 i IJ S • L=16 . 16' Ls44.50' S L=279.53 0 11 4 00 � 4��4> _--- `39- 10 , 9 S?y 0 4 L,56.48' r' Conditions: Driveway Permit In lieu of plan approved by City Engineer I agree to the following added conditions: 1) I will contact the Department of Public Works and have an inspector check and approve the graded gravel base prior to paving to insure compliance with slope and location; 2) I further agree that if in the inspections any of the permit conditions are not met that I will at no expense to the City remove and replace the driveway as directed by the City Engineer. By: Petitioner NOTE: The Public Works Department recommends that you provide a plan showing the proposed driveway with grades and location in the future to avoid possible expense which you will incur by not getting approval of actual plans in advance. 4 t #03-97 C I T Y OF N O R T H A M P T O N, M A S S. February 12 1997 THE BOARD OF PUBLIC WORKS The undersigned respectfully petiition your honorable body for Permission to install driveway at Lot #3 - 66 Woodland Drive Fifteen (15) foot maximum width at the street line. Gutter drainage not to be disturbed. All drainage shall be directed off the driveway surface to adjacent land and not on the existing roadway. Driveway surface to be paved if the grade of the proposed driveway exceeds 37 or more. By: James F. BoyFStreet 193 Northamp _ Easthampton, MA 01027 Proposed Location ( 413) 586-8561 Inspected by: \ Gravel Base Grade Inspected by: Final Approval: THE BOARD OF PUBLIC WORKS Voted that petition be granted. $25.00 Fee Paid check # 17847 Samuel B. Brindis, P.E. , Director of Public (SUBJECT TO ATTACHED CONDITION 1 & 2) NORTHAMPTON WATER DEPARTMENT 237 PROSPECT STREET NORTHAMPTON, MA 01060 586-6950 Ext. 300 Subject: Municipal Water Availability Location: 66 Woodland Drive Lot # 3 Inquiry Made By: Boyle - Date of Inquiry: February 13 , 1997 Municipal Water Main in Front of Location: YES X NO Size/Material/Age of Water Main: 8" DI 1996 Approximate Street Pressure: 42 PSI Size of Service Connection: i" Copper Comments: The City of Northampton has not accepted responsibility for the maintenance of the water main and service connections as of this date of inquiry. A corresponding "water entrance fee" shall be paid prior to making any connection to the municipal water system. Arrangements of such installation shall be made with the Northampton Water Department with a minimum of 5 working days notification. All work shall conform to Northampton Water Department specifications. C arles Borowski Superintendent of Water Enclosure: Letter to Frank Sienkiewicz from Sam Brindis, dated June 14 , 1991. cc: Samuel B. Brindis, Director, DPW Peter McNulty, Jr. , Assistant Director, DPW George Andrikidis, Assistant City Engineer Frank Sienkiewicz, Building Inspector C: \LMB\Forms\Availabl.Wat WETLANL; • '- Marker . loc,afibins �3 A -41 A-40 i .RA_ 44 \ A-45y . ._ �A-46 00000000000000000c?go om00000000000n00000000000000 l��• r 284 4D' \ w L( T No ARC (, ?RCA= 2n, ED Sf Tg S E SIDS- �. A K s-.2 (_IMIT OF WOR /T(',, "\ 5 I uaN J \ \\ PAVED ul / /'lob �10,0 \ pp0 I 27 h rA "cr, 1� ?66 c� , s % �/ <-3 e _ XPAVED \ - CO u _ � I A-39 p,-41 Rp_42 A,-4 0 43 1 ►A"38 ----------------- -------- = 278 t - v, 4 �p-37 A- 3j ao op�QO°oo�� J A�.26 f A-36 / O z /oo� 284 $ \ lv gn : lgg8 _ b LCT Nor , aU /11W 0 -3� / u E 20 S 7�tF +/ ? ( �/ 20' \ Sr T E SLOE �+Ck /�4� =�"'" �o f 7E.icx PROPOiED 5ET8A K SETBACK Q, �3 A" HOUSE 66 1 Fste o i (TYP�C nN. Ft<2 0, j Y oti. CO JI ---- - 66• cF� iiiiiiiiiiiiiiiiiiiiiililillilljlllllllllllIIIIIIIIIIIIIIIIIIillillilillillillillillillillillillilliillillillillillillilI i� d 14r Inr 11 LF'r LXI'=TINC, SILT I FENCE TO REMAIN PIZ M A 14 A-15 ^ EXISTING ►- . . ,�. ---------------� A-18 [WORK LIMIT LINE u �f \ _ IAN oo ._ - --- ---__ ° 00000°` 20 LOT N0. 2 - ooc o1 PARCEL AREA= ROPOSED ��� 77,900 S.F. 21 � "USE # 34 ! Zu tit 28o i 9 8 / _ I S�T9q / 292 �! r0 JJf.Sa7��" , l• 1A1fN / //� ( 288 ' lu 2a4 _A-2_8 ,.. lu \ PAVED (i °O ~ I 14,1 4] OQ �� A-27 A-35 Si ? Z�. S�pEI A-34 p \ \ r I A-30 4ck A-33 A-31 \ g $BB�BB \ L07 NU. PARCEL AREA 69,700 c r _-_�0' WETLAN- 'ROCEDURES `��----- ----__-- - - _ _- - Q Q�'w Aq ► rN1 -1z, 2 Cj) Z v 10<1 10 \ 1 Z 10 W s to " r Q 1 1 O �. co M I q M III m - o a o j => Q♦ 1 Q lal J z SIOPF ;f 3:110 J 3 z 10 a r �cea } Q M w O W 1/ 10 d F o o � = Oz N I 1.06 0 w ? ,zz hh P Q N Q � u 1 r mW to �J� I I C o= p OWE a Lj u , CE I � z Q* / W I— 11 d D Ir 1 O O LL)U z W m ~ ,11 o Ip � a W o1 , o Q J s W 1 \ 1 11 1 !Ala ia V) 0 U-1 Oo �\ O �\ p 1 �y rnl cp ^ Q % 1 co 11 p C4 CO r\ v ! o O N p l N 1\ (Y ° OO` 1 I dN `1 Q '` 1 � I pll �•l . r; O 11 0 \ s p \ N t m C = per �m 11 w d 1m ' > 100 `l W I ii s — LaJN ) z •-- ja) o — d Issued By NorthamptgLi, n rvation Commission S i g n a tu r-es: U L cu This Order must be signed by a majority of the Conservation Commission. on this ' d^a�x of /�,�nv,elh&r' 1996, before me personally appeared (L . // 0 54*1 a roll n , to me known to be the person described in and who executed the foregoing instrument and acknowledged that he/she executed the same as his/her free act and deed. , No ary�Pub is My commission expires The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land upon which the proposed work is to be done, or any ten residents of the City or town in which such land is located, are hereby notified of their right to request the Department of Environmental Protection to issue a Superseding Order, providing the request is made by certified mail or hand delivery to the Department, with the appropriate filing fee and Fee Transmittal Form as provided in 310 CMR 10.03(7), within ten days from the date of issuance of this determination. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and the applicant. Detach on dotted line and submit to the Northampton Conservation Commission prior to commencement of work. PLEASE NOTE--THIS IS NOT REQUIRED IF THE COMMISSION HAS ALREADY RECORDED THE ORDER, AS IS THEIR USUAL PRACTICE, UNLESS LAND IS REGISTERED IN LAND COURT. - - •• - . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . .. .. . . . . .. . . . . . . . . . . . To Northampton Conservation commission: Please be advised that the Order of Conditions for the project at . File Number 246- has been recorded at the Registry of Hampshire County and has been noted in the chain of title of the affected property in accordance with General Condition 8 on , 19 If recorded land, the Enstrument number which identifies this transaction is If registered land, the document number which identifies this transaction is Signature Applicant page 5-6 (memorex\wp\conscom\order.cc) 25. If checked: [X ] YES An "As Built" plan shall be included with the project engineer's certification, detailing the post-development conditions of the site: 26. Any change or deviation from the Notice of Intent, plans and/or order of Conditions approved by the Commission, prior to or during construction, shall require the applicant to file a request for an amendment with the Conservation commission. It shall include a written inquiry as to whether or not the change is substantial enough to require the filing of a new Notice of Intent. After making a positive determination, the Commission shall conduct a public hearing for the purpose of amending the Order or to issue a new Order, if a new Notice of Intent is required. 27. Prior to the start of any site work, excavation or construction, a preconstruction conference shall be held on the site, between the contractor conducting the work, the site/project engineer, the applicant, and a member or agent of the Conservation commission, in order to ensure that the requirements of this Order are understood by all parties. 28. Once the limit-of-work line has been established, the applicant shall notify the Conservation Commission that the line is in place, prior to the commencement of any site work. 29. Permanent markers shall be installed along the Limit of Work Line as shown on the attached plans. The As-Built plan showing the location of the markers shall be submitted to the Conservation Commission prior to requesting a Certificate of Compliance. 30. Erosion control devices shall remain in place until all disturbed surfaces have been stabilized with a vegetative cover or until the Commission has authorized their removal. 31. Erosion control devices shall be inspected regularly. Any entrapped silt shall be removed to an area outside the buffer zone and wetland resource areas, and hay bales or other devices shall be replaced as necessary. 32. During all phases of construction, all disturbed or exposed areas shall be brought to finish grade and either: a) loamed and seeded for permanent stabilization, in accordance with U.S. Soil Conservation Service procedures; or b) stabilized in another way approved by the Conservation Commission. Areas that cannot be permanently stabilized within 30 days of disturbance shall be stabilized by temporary measures acceptable to the Conservation Commission. page 5-5 (memorex\wp\conscom\order.cc) 17. Areas of construction shall remain in a stable condition at the close of each construction day. Erosion controls shall be inspected at this time, and maintained or reinforced to meet specifications in the plans and this order; 18. All construction areas shall be restored to original condition or better upon completion of the project, including replanting of vegetation; 19. The Commission and its agents shall have the right to enter and inspect the property at any time for compliance with the conditions of this Order, the Act, and Wetlands Protection Regulations: 310 CMR 10.00 and Chapter 24 of the City's Ordinances: "The Wetlands Protection Ordinance". They shall have the right to request and receive any data or documentation that is deemed necessary for evaluation of compliance. 20. This Order of Conditions shall apply to any successor in interest or successor in control; 21. The contractor is as responsible as the applicant and property owner for any violations of the Orders of Condition and penalties under the law, while all activities regulated by this Order are being performed. A copy of this Order and associated plans shall remain on site during all construction and/or building activities. The project manager and all equipment operators shall be familiar with the approved plans, and shall be informed of their location on the site. This location shall be accessible to all contractors whenever work is occuring on site. A copy of the plans and Order must always be on-site and in all excavating machinery when work is being performed; 22. All required permits must be obtained from the Planning Board, Zoning Board, Department of Public Works, and Building Inspector prior to the start of projects involving fill within any wetland resource area; 23. The owner of the property described in this Order, must advise any potential buyer of the property that any construction or alteration to said property, including brush cutting or clearance, may require action by the Northampton Conservation Commission. Any instrument conveying any or all of the owners' interest in said property or any portion thereof, shall contain similar language as follows: "This property may be subject to the Northampton Wetlands Protection Ordinance, Wetlands Protection Act, an Order of Conditions, and/or a Determination of Applicability from the Northampton Conservation Commission"; 24. Upon completion of the project, the Applicant shall submit a certification that all work has been done in conformance with the provisions of the Order of Conditions and request a Certificate of Compliance. If checked: [ ] YES Certification shall be by a Professional Engineer or by a Wetlands Consultant who shall have been approved by the Commission: page 5-4 (memorex\wp\conscom\order.cc) e f 9. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the works, "Massachusetts Department of Environmental Protection, File Number 246-396 ". 10. Where the Department of Environmental Protection is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 11. Upon completion of the work described herein, the applicant shall forthwith request in writing that a Certificate of Compliance be issued stating that the work has been satisfactorily completed. 12. The work shall conform to the following plans and special conditions: PLANS TITLE DATED SIGNED & STAMPED $Y: Woodland Drive - Lots 1 2 3 09130/96 Lawrence R. Smith & 4, Proposed Home Site Deve1- 10/24/96 (revised) opment, Sandalwood Estates, prepared by Killam Associates New England. All Plans on File with Northampton Conservation Commission Special Conditions: 13. The applicant shall notify the Commission, in writing, as to the date that the work will be commencing on the project. Said notification must be received by the Commission no sooner than (10) days and no later than five (5) days prior to the commencement of the approved activity; 14. No area within the 100 year floodplain, any wetland, or area within 100 feet of a wetland or 40 feet of a 100 year floodplain, as defined in 310 CMR 10, and City of Northampton Ordinances - Chapter 24, shall be permissible disposal sites, unless such areas are specifically approved by the Commission; 15. Excavated material and topsoil stockpiles shall be located and stabilized so as to minimize washing into wetland areas or waterways; 16. Adequate measures shall be 'taken to prevent erosion ailu siltation of all dir;furbed areas, and shall be implemented prior to any construction. Sedimentation and erosion control devices shall be placed according to standards set in U.S.D.A. Soil Conservation Service, "Guidelines for Soil and Water Conservation in Urbanized Areas of Massachusetts". Placement of sedimentation and erosion control shall be directed at the site by the project engineer in order to accomplish maximum control of erosion to ensure that no eroded materials will enter wetland resource areas. Hay bales must be staked. Silt fencing must be installed in a dug trench with sufficient porosity to allow detained water to pass through while trapping suspended sediments; page 5-3 (memorex\wp\conscom\order.cc) Therefore, the Northampton Conservation Commission hereby finds that the following conditions are necessary, in accordance with the Performance Standards set forth in the regulations, to protect those interests checked above. The Conservation commission orders that all work shall be performed in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the following conditions modify or differ from the plans, specifications or other proposals submitted with the Notice of Intent, the conditions shall control. General Conditions 3 . Failure to comply with all conditions stated herein, and with all related statutes and other regulatory measures, shall be deemed cause to revoke or modify this Order. 2. The Order does not grant any property rights or any exclusive privileges; it does not authorize any injury to private property or invasion of private rights. 3. This Order does not relieve the permittee or any other person of the necessity of complying with all other applicable federal, state or local statutes, ordinances, by-laws or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this .Order unless either of the following apply: (a) the work is a maintenance dredging project as provided for in the Act; or (b) the time for completion has been extended to a specified date more than three years, but less than five years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse, rubbish or debris, including but not limited to lumber, bricks, plaster, wire, lath, paper, cardboard, pipe, tires, ashes, refrigerators, motor vehicles or parts of any of the foregoing. The applicant is prohibited from using demolition materials, asphalt, large chunks of concrete, ticeo stilmp= and general refuse; ? No work wall be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, until all proceedings, before the Department have been completed. 8. No work shall be undertaken until the Final order has been recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done. In the case of registered land, the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. The recording information shall be proposed work is to be done. The recording information shall be submitted to the Commission on the form at the end of this Order prior to commencement of the work. The Commission usually will record the Order in the Registry of Deeds. It is the applicant's responsibility to insure the Order is properly recorded. page 5-2 (memorex\wp\conscom\order.cc) 310CMR 10.99 DEP File No. ;4,6-396 :BAR 2 5 ►998 (To be provided by DEP) Form 5 City/Town Northampton Applicant James & Patricia Boyle Commonwealth Hap # 35 Parcel #19 of Massachusetts 42 19 Order of Conditions Massachusetts Wetlands Protection Act G.L. c. 131, 540 and the Northampton Wetlands Protection Ordinance From Northampton Conservation Commission Issuing Authority To: James F... & Patricia A Boyle James F & Patricia A. Boyle Name of property owner Name of Applicant 4 Tiffany Lane, Northampton, MA 01060 4 Tiffany Lane Northampton, MA Address Address 'Phis Order is issued and delivered as follows: [ ] by hand delivery to applicant or representative on (date) [X] by certified mail, return receipt requested on December 17, 1996. This project is located in Northampton at134, 158, 166 & 174 Woodland Drive. The property is recorded at the Registry of Hampshire County Book 4822 Page 216 Certificate (if registered) N/A The Notice of Intent for this rro4ecL was riled on J,Lgbcr ?. 1996. Jr J The public hearing was closed on October 21, 1996. Findings: The Northampton Conservation Commission has reviewed the above-referenced Notice of Intent and plans and has held a public hearing on the project. Based on the information available to the Conservation Commission at this time, the Commission has determined that the area on which the proposed work is to be done is significant to the following interests in accordance with the Presumptions of Significance set forth in the regulations for each Area Subject to Protection Under the Act (check as appropriate) : [ ] Public water supply [X] Flood Control [ ] Land containing shellfish [ ] Private water supply [X] Storm damage prevention [ ] Fisheries [ ] Ground water supply [X] Prevention of pollution [ ] Protection of Wildlife Habitat Total Filing Fee Submitted $840.00 State Share $390.00 (1/2 fee in excess of $25) City Share 45 50.00 Total Refund Due $ City Portion $ State Portion $ (1/2 total) (1/2 total) page 5-1 (memorex\wp\conscom\order.cc) a♦ f4; 1fYK A �`I .., ..x:,aw�w•»+'14a)+'+r'.' Yr:.*o-A iA.. uti.-,. ..�< Au�'�};Arv17FA•i coi G' �a sf UP PLA �• o co S 10. Do any signs exist on the property? YES NO IF YES, describe size,type and location: 4 / V 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 MAST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. This COILU= to be filled in by the Building Department Required Existing Proposed By Zoning Lot size , �0 Z/ Frontage '2-4 1 Y ` J > t. r Z_o Setbacks - o - side L: / '-C' R: L: R: - rear --- Building height Bldg Square footage L k. °I°Open Space: (Lot area minus bldg &Paved parking f # of -Parking spaces ht of Loading Docks Fill: -(volume-& location) 13 . Certification: I hereby certify that the information contained herein G is true and accurate to the best of my knowledge. /In DATE: - 1- APPLICANT'S SIGNATURE NOTE: lunuanoe o a zoning permit does not relieve an p cant's burdem zoning requirements and obtain all re uired Pty witty all q Permits f the Board of H Conservt�tion �Commisslon. Department of Publio Worku and other applicable permit gr authorities. FILE # MAR 2 51998 File No. 9, ' . 3� ) ZONING PERMIT APPLICATION (§10 . 2) PLEASE TYPE OR PRINT ALL INFORMATION 1. Name of Applicant: 13 Address: ��/�1`.�%` Y ` � Ss Telephone:(5T E' !F f 2. Owner of Property:,:v�i✓-,�'h�5 —' Address: Telephone: 3. Status of Applicant: �/°Owne Contract Purchaser Lessee Other(explain): 4. Job Location: Parcel Id: Zoning Map# Parcel# 12,941 District(s):R (TO BE FILLED IN BY THE BUILDING DEPARTMENT) 5. Existing Use of Structure/Property Z �' 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): -511 e 53 / 7. Attached Plans: —�7�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. S. Has a Special Permit/Variance/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 c/ IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained ,date issued; Z C — =`�- (FORM CONTINUES ON OTHER SIDE) A FILE # 3 2 13 9 a, . MAR 2 5 ,g98 APPLICANT/CQNTACT PERSON: ae ADDRESS/PHONE: PROPERTY LOCATION: - MAP PARCEL: ZONE THIS SECTION FOR-OFFICIAL USE ONLY: PERAUT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE Ft-t- Pnid lRiiilding Permit Filled nnt 13 4% ✓`" Type of Constniction- Sptp, of Plans Ld�— lnn �a 0 8� a THE OLLOWING ACTION S BEEN TAKEN 0 THIS AP ICATION- 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 Regigtxy 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-Bd of Health Well Water Potability-Bd Health Per it:fro7m:,Conservation C in fission Signature uilding Inspecto Date NOTE:Issuanoa of es zoning permit does not relieve an applioant's burden to oomply with all _ zoning requirements and obtain ail required permits from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorttles. o ono o b n a w Ro ° y ON C ° J w OD Ct b o b d rt Cn �y � C n UC t� r t� Lr is C aq V CD '�-' Z 0 < z CD LO j �± �y g 0 � 8 � � M . p; CrQ z w � C/1 � t/1 � 5 � w w' Off. pt• p p O cr p W 0:)a �j O � � � Q• I � W N ;"' ado ° o � o v� d-Q � y o � � R• O G R. 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