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it is issued.
ALSO be>,y;., '�,hat ;.�:,.f -- t�!"`#s_.naPr ,i^i
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r�an�x€a ❑ Additiien Kt:p :'3'.-s #3 F�lieaattca(S) sa+evftng D
Demn#rT_. ❑ New Si gn$ D1?CtkS ( i�uu.y�uj LtutiST�Q! r
a a}' � 1
�z e- Yes _!(,.� No Adding new hedroom
RennuAina us s;n;shea basement Yes v No
:y: I
,.,c 0i tuna.§,,•One Family Two Family other
b - iitNurnber of rooms in each family unit Number of ctstr,.,nm5rt
i rropozae€i Square footage of new construction. DfSZtensions �
1,
f�y� livieuivd of,heating? Fireplar_-e9 nr;"decd * :_ Number of ea-h
I e ! ,� _ti a .t /�. ..... ..,es loan attached?
En+zrov Conse��3:_.: ___ _ --- Mas,�,,.a
1 ';Type of consUruction o,
s` •,, ., „art
w". n fl, wstlands? Yes No. ?5 r :r,:=7,,,,W Min _- No Yes
` 9ment or cellar floor belo fin IShSd glade
Y'
•.,:' tl h,"!rJ n;�nwfnir.f to thn Rteilrlinq and 7nnina rew jatrons'> —_-. Yes No.
F, Septic Tank City Sewe: Private well City+ester Supply �
i I _ '° - -.
V� ,4 V.'9�.E.��F�R e'evge TO #— F9i�
as Owner of the sut)t ,
r.r
fthorize 1
���_ p=e7�`��..`-::,-.I>°ar�� _+_:`.--''-_#....k ##?nn7e. -s.-ff:ia nl•tldnr f�r,:+t`:�L3U :rE tlJ
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6•t E^2ltn+S a '�!ftlF§t!]r_1J 1.L*.C.?vl m6+l4as u
{`».belief.
l`54lad 1under the pains and penalties of per,'iry, � !}
€,t Name 1
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P ON61' g �IS T arm i''1-11-111 Au"L m 1�e Tr.+fVAH A wiT Off+ N
:�.a.: .-„i E '-d'.- � � ..� 7G��Qif' ]r1L'1(lYil1 �Ht\ Dri ��jiEF�
Existing Proposed Required by Zoning
Lot min t0000 ;PIT 14, 000
Frontage 100 t Y`. 100
` , Ssiva wi A.WAL
Side L:22-5 R:_� L: R: 47
,..; Rear `` r
LtN y'`
Building Height 0
131ag.Squam Footage q 10 t of i 13 /a ,
-!age
rT i (Lot snS Minut bid&R paved
i n5fa4
a.
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k of Parkin Spaces
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Fill: ur= i
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A. Has a Special Permit/Variance/Finding ever been issued forlon the site?
NO DONT KNOW YES
IF YES,date issued. s'
IF YES: Was the permit recorded at the Registry of Deeds? i
NO DONT KNOW 1� YES
IF YES: enter Book Page and/or Document#
B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW
YES
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Needs to be obtained Obtained Date Issued:
C. Do any signs exist on the property? YES NO
ti 7
IF YE5,describe size, type and location: 1 s;
D. Are here any proposed changes to or additions of signs intended for the property?YES
No
IF YES, describe size, type and location:
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J)iy 2 2004
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....__._ 7, a -e- a k✓�.r .a'v A p
212 Main Stieet
h" t.. tttlflllrr E}epHEiTT1E3hT� rc sor y ��V
yyr II s'
RESC)(11 100 I �ia A -.n.. w�L�url4l s _,.max♦ �� ?� �1��,
Narthwipton,MA 01060 , 'r Er
phone 413 87-1240 Fax 413-587-1272
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' .ai,. ...1�iit't�O..n-rata"W.�.....°•_': fi frx#�+r�w� ..-.: ,.,. � ,� �I'
r` ''• APPLICATION TO CONSTRUCT,ALTER,REPAIR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELL-Naas
SETE INFORMATION �
T —— Tt:is$ect lie + . ,s w ffice afi � W
Mao
Unit!
a` tut UnR $«e^ OR) ;
X 1:153 RIK C De tJt'
�!,a i,Ert C-' zone Avertay("strict`
x
h
Elm St olawrt Ce DisYdts
pRdpgRTY OWNERSHIPIAUTHORIZED a!` N'E
' Current Melling Aadte:
a��j.( i
t ritiil tFl — } 2f tP �
E ., Telephone 1 '
Y _
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41.nATaA AQ_EAt'
W`M
#+�►ife(Prtrt) Current Mailing Address
h
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I Sign re Telephone
�Ef 7iC1tiE 3:ESTIMATED CONSTRUCTION COSTS
1SR Estimated Cost(Dollars)to be Official Use Only + A
corno)eted±LpLrrnit a P i nt
# ,9trtding (a)Building Permit Fee
-'DO. C'0
"Electrical (b)Estimated Total Cost of ;h
570.0o Consvuction from s
r3 i Plumbing Guitdi��'P€nnit Fee
K 0;
#C' Mechanical(HVAC) I
A Fine Protection 11'
Total¢(1 +2 13+4+5) Check fiumb¢r
This Section For Official Use Only
,1•.: .
4' ' Date
Building Permit Number: issued:
gnature:
Building Commissioner/inspector of Buildings Date
t -
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