36-073 (11) r
10. Do any signs e)dst 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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colsmm to bs filY.ed in
by tha Banding Department
Required o
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
&Paved parkingi
# of Parking spaces
#- of Loading Docks
Fill:
{vo1-ume--& location)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DME: Z— APPLICANT's SIGNATURE/&F-"�? �"{µ�
NOTE: Issumnoe of a zoning permit does not relieve an applioanYs burden to oom Wlt
zoning requirements and obtain all required Pn halt
q Permits from the Board of Health, Conservation
Commisslon, Department of Publio Works and other applioabla permit granting authorities.
FILE #
File No.
ZONING PERMIT APPLICATION (§10 . 2
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: X'<'- 0, 0�d- 5
Address: $1 LD4A �fk a- �sl2hw An Telephone: 4 ZA 7
2. Owner of Property: ►��--
�u1��ll
�Q4f C_ S
Address: Telephone:
3. Status of Applicant: _Owner Contract Purchaser Lessee
Other(explla�in)::/�
4. Job Location: g11 b1tiGM,o" °� � D[o(.Z— �yvY
Parcel Id: Zoning Ma p# 1;16 Parcel# 6.7 3 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property
6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
rG 1i o GW it d✓C
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/Vadance/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_z", DON'T KNOIA` 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)
Filed— - File No.
`� ��� OF ROME OFFICE/OCCUPATION (§10 . 2 & 11. 11)
With the ��Building Inspector
N) X�Ai v
Address : 0j1,&, Telephone: 3 �YNf
2 . fJa PTi1Aerty �1��(etn �lt�101a6Z
Address: AN Telephone: J,4n,y
3 . Status of Applicant:JOwner __Contract Purchaser Lessee
Other (explain:
4 . Parcel Identification: Map -7- 96 Parcel
Zoning District(s) (include overlays) _
Street Address
S . Narrative Description f 'PProposed Home Office: (Use additional sheets
if necessary) b rfr�Ge-- V dJG:1�01n %.- -1 I" U C� C201!)
13 apd3�olSb 1 ikA P� —
,� --
6 . Is this a legal residential building? �� u►�� YES 2 0
7 . Will there be an employee/owner who doesn't live in the home YES t
8 . Will you ever see clients or customers at your site? YES
How often
For what purposes
9 . Will there be any signs for the home Office? YES 0
10 . Will there be any goods sold from the premises or any sale of
goods stored on premises , either retail or wholesale, or any
display of goods on premises? YES
11. Will there be any outdoor storage of materials? YES i(D
12 . Will your use be totally within a building and not cause any
outward manifestation (including traffic generation, parking
congestion, noise, air pollution, and materials storage) ? ES N0
If NO explain:
13 . Attach Plans (if applicable) �(C60, de , bw'tl� je,.O �+
14 . Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non-criminal fines and
criminal and civil actions .
Date: ��-2��� Applicant's Signature.,&,,
THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF THIS YEAR AND MUST THEN BE RENEWED
Denied as presented---Reason:
Signature of Building Inspector Date
NOTE: Issuance of a permit doss not relieve an applicant's burden to comply with all zoning requirements and obtain all roquirod pormlts
from the Board of Heatth,Conservation Commisslon, Department of Public Works and other applicable permit granting authorities.
File#MP-2003-0030
APPLICANT/CONTACT PERSON ETCHELLS MAUREEN C&MARC
ADDRESS/PHONE 411 WESTHAMPTON RD (413)586-4217 Q
PROPERTY LOC
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out
Fee Paid
Typeof Construction: COMPUTER WORK AT HOME -ENGINEER
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 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 p
Received&Recorded at Registry of Deed ��j IVY
Other Permits Required:
Curb Cut from DPW Water Availabil A � .p-,,4,&
Septic Approval Board of Health We
Permit from Conservation Commission
Permit from Elm Street Commission
Signature of Building Official
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.