17C-167 (11) R
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:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
This colmm to be filled in
by the Building Department
Required
Existing Proposed By Zoning
Lot size
so' I 7�(��x 51. 'Scc Plat) f-mw kD
Frontage
Setbacks 1 �O
- side L: A R: ,(/j L: X' R: t
- rear o�G
Building height 5 —
,� S�(7►ZY 1�u*i1a �3� 5
Bldg Square footage
SSE 0
%Open Space:
(Lot area minus bldg v
&paved parkingi
# of Parking spaces
# of Loading Docks
Fill:
{volume -& location)
V�J � lJnr-rx_xot)
13 . Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE: I 1/ 1[�� APPLICANT's SIGNATURE 1`
NOTE: l"umnoa of a zoning permit does not relieve an pplioant's bur en to 0o wit -4211
zoning requirements and obtain all required permits fr the Board Health, Con a ration
Commission. Department of Publio Works and other applionble permit granting authoritjos.
FILE #
File No.
ZONING PERMIT APPLICATION (§10 . 2)
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant: r npl2i v 4 `/ol7lC - Leozy
Address:. ,� High �TZF6-1 wo
ru ^ce Telephone: y)3 - qq- Y595"
2. Owner of Property: Nozmf3 JJ��
Address:—h S E , F'kcX�nCF Telephone: q)3 -5� - 3?0
3. Status of Applicant: Owner Contract Purchaser Lessee
_ Other(explain): Si bl k-
L
4. Job Location: f onrrracj '
Parcel Id: Zoning Map# Parcel# District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property \1t ('Pf7i' 2(-Q2 Icy
6. Description of Pro osed Use/Work/Project/Occupation: (Use additional sheets if nec ary):
i7 Lou i- T.Q
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 KNOW- Z 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-2000-0104
APPLICANT/CONTACT PERSON LEARY JANICE&MARTY
ADDRESS/PHONE 38 HIGH ST (413)584-4595 Q
PROPERTY LOCATION 42 HIGH ST
MAP 17C PARCEL 167 ZONE URB
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM F LED OUT
Fee P ' O6 0/0
uildin Permit Filled out
Fee Paid
jypeof Construction: CONSTRUCT SFH W/ATT GARAGE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Buildina Plans Included:
Owner/Statement or License
3 sets of Plans/Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
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
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.