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17C-253 (13) 507412 p THE COMMONWEALTH OF MASSACHUSI~M N. : '. �; 7I0.ES+OE AWND:�04T GENERAL LAWS,CHAPTER I80,:Section 7 I bmby= fy IbRt, upon an-examination of the within written Artides of Amendment,and the Ming fee is the amount of S/S-' 0 U having bwa , said articles am decmad to have been filed with me this Aay of 1 F-�erave date WILLIAM FRANCIS GALVIN secretary of the Commonwealth PHOTOCOPY OF ARTICLES OF AMENDMENT TO BE SENT TO: Barry L. Mjjntzer, .Rsq. Deutsch. Williams Brooks DeRetsis Iioll.and & Drachman, •P.C., 99 Sixmmez Street Boston, .MA 02110-1235 Telephone: (61,7) 951-2300 T �S.abic•� 0L THE COMMONWEALT" OF MASSACHUSETTS RESTATED ARTICLE'S OF pR�GANI2ATIUIV (General Laws. Chapter 1813.Section 7) 1 hereby approve the within restated articles of organisation and. the filing tee in the amount o(3 6 having been paid, said article$are deemed to have been filed with Me this day 19CY3 Of u-h G MICHAEL JOSEPH CON.NOLLY secretary of Me CPmmOnWebtth State House;l oston,Mass. TO OF"FILLED IN BY CORPORATION . PROM COPY Or RESTATED ARTICLES OF ORGANt7AIION TO BE SFNT To- R. Scott Cooper, Esq. Deutsch Williams Brooks DeRensis Holland & Dra.chman, P.C. 99 Summer Street Boston, MA 02110-1235 in order to assist the Corporations Division process Your °7!stare.d Articles as quickly as possible , please address all doc�Iments to : Office of the Secretary of State ATT: in-put Section One Ashburton Place , Room 1717 Boston , MA 02108 Ogly amendments xhewrticiew organization of the corporation as-heretofore amended, except am if there eve no such arnen(Iments, State -None".) IN wITNESS VVHV-RF.OIF AND UNEWR THE PSNALTIFS OF PFAJURY. we have hereto signed our names this day of in the year 19 Clerk Su'san auger ` ' . ^ _ � l cONT.IL1ti iT...ON SHEET 4E (i) the payment has been approved or ratified (1) by 'a majority vote of the directors who are not at that time parties to the proceeding or (2) by a majority .vote of a committee of two or more directors who are not at that time parties to the proceeding and are selected for this purpose by the full board (in which selection directors who are parties may participate) ; or (ii) the action is taken in rel anoe upon the opinion of independent legal counsel. (who may be counsel to the corporation) appointed for the .purpose by vote of the directors in the manner .specified in clauses (1) or (2) of subparagraph (i) or., if that manner is not poss:tble., appointed by .a majority of the full board of directors then the directors have otherwise acted in accordance with the standard of conduct applied to directors under Chapter 180. of the Massachusetts General Laws, as amended; or (iv) a court having jurisdiction shall have approved the payment. The indemnification provided hereunder shall inure to the benefit of the heirs, executors and aaidinistrators of any Indemnified officer entitled to indbmni.fieation hereunder, fihe. right of indemnification under this paragraph shall be in addition to and not exclusive of all other rights to which any person may be entitled. Nothing contained in this paragraph shall affect any rights to 'indemnification to which corporation employees, agents, directors, officers and other persons may be entitled by contract or otherwise under law. No amendment or repeal of the provisions of this paragraph which adversely affects the. right of an Indemnified officer under this paragraph shall apply to that Indemnified Officer with respect to the acts or omissions of such Indemnified officer that occurred at any time prior to such amendment or repeal, unless such amendment or repeal was voted for by or was made with the written consent of such indemnified officer. rev.artorg • it J 1 Y CC�IITZ'NUA'1'IOR .SHEET 4':n (j) The corporation shall, to the extent legally permissible, indemnify each person who may serve or who has served at time as a director, executive director, president, vice president, treasurer, assistant treasurer, clerk, assistant clerk or other officer of the corporation, or any other employee or other agent of the .corporati,on, or any person who serves at the corporation"s request as director., officer, employee, or other agent of another organization, or who at the request of the corporation may serve or at any time has served as a, fiduciary or trustee of any ,employee benefit plan of the corporation (collectively, "Tndemn.ifJed officers'° or individually, "Indemnified officer") , against all expenses and liabilities, including, 'without limitation., counsel fees, judgments, fines, -.----.------ tc se_.tAxes .-p�na3 ties ,and settlement paymen'.ts, .re.as.bnably incurred by or imposed"upon such person'"ln conn� '.i –&rzy- -- -- --– threatened, pending or completed action, suit ar proceeding whether civil, criminal, administrative or investigative (a "proceeding") in which an Indemnified Officer may ..became involved by reason of serving or having served in such capacity (other than a proceeding voluntarily initiated by such person unless a majority of the full board or directors authorized the proceeding) ; provided that no indemnification shall be provided for any such Indewnif ied officer with respect to any matter as to which the Indemnified officer -shall ;have been finally adjudicated in any proceeding not to have acted in-�.good faith in the reasonable belief that such Indemnified btficex's. action was in the best interests of the corporation or, to the extent that such matter relates to service with respect to an employee benefit plain, in -the best .interests of the participants or beneficiaries of such employee benef it. plan:;, and further provided that any compromise or settlement payment :shall be -approved by the corporation in the aIMe manner as provided below for the authorization of indemni:f icatiOn. Such indemnification may, to the extent a.uthdri Zed by ''the board of directors of the corporation, include payment by the . corporation of expenses incurred in defending a civil or criminal action or proceeding in advance of the final disposition of such action or proceeding, upon receipt of an undertaking by the indennified Officer to repay such payment if not entitled to indemnification under this paragraph, which undertaking may be accepted without regard to the financial ability of such Indemnified officer to make repayment. �ndemx�.i.ficatxon_ox_pdy-ante shall be..— c izd by the coxporatian under thYs onclusively_�eemed author paragraph, and each director and officer of the corporation approving such payment shall be wholly protected, if: coNT11MATIO.N .8B-ENT 4C successor sections thereto, as a majority of the total number of the directors of. the corporation may by vote designate and in such proportions and in such manner as ma)y be determined in such vote.; provided, further, that the corporation's property may be applied to charitable, religious., literary or educational purposes in accordance with the doctrine of gy nres in all respects as a court having jurisdiction in the premises may direct. (h) Subject to the .provisions of paragraphs (d) and (e) of this Article A, no contract or other transaction of this corporation with any other person, corporation, association, or partnership shall be affected or invalidated by the fact that (i) is a .stockholder in o member of..ouch .other — corporation, association or .partnership of the officers or directors of this corporation is an officer, director or partner of such other corporation, association or partnership, or (iii) any officer or .director of this corporation, individually or jointly with others, is a party to or is interested in such contract or transaction. Any director of this corporation may be counted in .determining the existence of a quorum at Any meeting of the board of directors for the purpose of authorizing or ratifying any such contract or transaction, and may vote thereon, with .Like force and effect as if he were not so interested or wete not an officer., director or partner of such other •corporaton, -association or partnership. (i) No officer or director of the corporation shall be personally liable to the corporation ..for monetary .damages for or arising out of a breach of .f.iduciary duty as an officer or director notwithstanding any provision of law imposing such liability; provided, however, that the .foregoing shall not eliminate or limit the liability of an .officer or, director to the extent 'that such liability is imposed' by appl- cable law (i) for a breach of the .director's :duty of loyalty to the corporation`, (ii) for .acts or omissions not in good faith% or which involve intentional misconduct or 'a knowing-violation of law, or for any transaction from which the officer or director derived an improper personal benefit. The foregoing provision shall not eliminate or limit the liability of an officer or director for any actor omission occurring prior to the date upon which the foregoing provision became effective. To the extent permitted -by law, no amendment or deletion of the foregoing provisions of this paragraph (i,) which restricts or limits the limitation on or. .be' eifft-Ctive. with- respect- .to .actions and...om &s-irons .af .. any officer or director occurring prior to the date said amendment or deletion became effective. C0NTTNUATJ0JN $'HEET 4B rk, ,and -501(c) (3) of the Code, or under any successor sections 'thereto. All powers of this corporation shall be exercised only in such manner as will assure the operation of this corporation exclusively for said educational, charitable, religious or literary purposes, as so defined, it being the intention that this corporation shall be exempt from :federal income tax and that contributions to it shall be deductible pursuant to said sections of said .Code, .and. all purposes and powers herein .shall be interpreted and exercised consistently with this intention. (f) In the event that the corporation is a private foundation as that term is defined in Section 509 of the Cade., then notwithstanding any other provisions of the articles of organization -or the by.^laws Of the corporation, the following The corporation shall distribute the income for .each taxable year at such time and in such manner as not to become subject to the- tax on undistributed income imposed by Section 4942 of the Code. The corporation shall not engage in any act of self-dealing as defined in .Section 4941(d) of the Code; nor retain any excess business holdings as defined in Sect,ibn 4943(c) of the code;. nor make any investments in such manner as to incur tax liability under Section 4944 of the Code; nor make any taxable expenditures as defined i-n section 4945(d) of the Code. (g) Except as may be otherwise required or permitted by law, the vorporatian '�aay at any time authorize a petition for its dissolution to be ;filed with the Supreme Judicial Court of the Commonwealth of Massachusetts pursuant to section 11A of , Chapter 180 of the MasIsachusetts General :Laws by the affirmative vote of a majority of the directors of the corporation then in off.XCe; provided, however, that in the event of any liquidation, dissolution, termination, or winding up of the corporation (whether voluntary, involuntary or by 'operation of law) , 'the property or assets of the corporation remaining after providing for the payment of its debts and obligations shall be conveyed, transferred, distributed, and set over outright to one or more educational, cbaritable, religious or literary institutions or ..organ' — —- similar to those of the corporation, contributions to wh.i.ch nonprofit institutions or organizations are deductible under Section 170 (c) of 'the Code and which qualify yo such sections as exempt f income tax under section 501 (c) (3) of may, from time to time, be amended or added to or under any CONTxNUATIDN SHEET 4A Other lawful provisions, if any, for the conduct and regulation of the business and affairs of the corporation, for its voluntary dissolution, or for limiting, defining, or regulating the power of the corporation, or of its directors or officers, are as follows: (a) In addition to the powers granted to the corporation by Massachusetts General Laws chapter 180, as amended., the corporation shall have and may exercise in 'furtherance of its corporate purposes each of the powers specified in Section 9A of Massachusetts General Laws Chapter 156B, as amended. (b) The directors may make, amend or repeal the By-laws in whole or in part LLin`the-manner set forth ,in„the By-_laws._ (c) The corporation may be a partner in any enterprise which it would have the power to' conduct by itself, may be a stockholder in any corporation to the -extent permissible under Section 301(c) (3) of the Internal Revenue Code of 7.98.6 as the same may be amended from time to time, and may serve as a member of any corporation formed pursuant to Massachusetts General Laws, Chapter 180, as amended, and exempt from federal income tax under Section 501(c) (3) , of the Internal Revenue Code of 2986 as the same may be amended from time to time. (d) No part of the assets of :the corporation and no part of Any net earnings :of the corporation shall be divided among or inure to the benefit of any officer or director of the corporation or any private individual or be appropriated fo7r any purposes other than the purposes of the corporation as herein set forth except that the corporation shall be authorized and empowered to pay .reasonabl�e cbmpensation. for services actually rendered and to make payments and distributions in furtherance of its purposes as set forth in Article 2. No substantial part of the activities of the corporation shall be the carrying on -of propaganda-, or otherwisle attempting to influence legislation, and the corporation shall not participate in, or intervene in (including the publishing or distributing of statements) , any political campaign on behalf of any candidate for public office. It is intended that the corporation shall be entitled to qualify for exemption from federal income tax under Section 501(c) (3) of the Internal Revenue Code of 1986 as the same may be amended from time to time (the "Code") and shall not be a private foundation under Section 509.(a) of the Code. (..e.).. g Notwithstandin an thin else erein.p rovided -the .... . y g . . . h corporation is organized and shall be operated exclusively for educational, charitable, rel.igious .or literary purposes, as said terms have been and shall be defined pursuant to Sectioni> 170'(c) M ` \ f COIf'I'xNVATx0�7 6HE£7' 2A To do all and everything necessary, suitable and proper for the accomplishment of the purposes or attainment of any of the objects heretofore set out or mentioned, either alone or in association with other individuals, corporations, or partnerships, including but not limited to the county, state, federal and municipal bodies and authorities; To take and hold, by bequest, devise, gift., purchase, or lease either absolutely or in trust for such objects and purposes or any of them, any property, real, personal, or mixed, without limitation as to amount or value, except such limitations, if any, as may be imposed by law; To -sel-1, -convey, mortgage„ and dispose of any property, -- _ ;..... real, personar or mixeraZSd�ty-ir►vest° a3►d�:e3rlves� e-�a� nC].�Sa].....:.._......------ thereof and to deal with and expend the income therefrom for any of the before mentioned purposes, without limitation, except such ].imitations, if any, 'as may be contained. in the instrument under which such property is received; To receive any property, real, personal, or mixed, in trust, under the terms of any will., deed of trust, or other trust instrument for the foregoi:ng purposes or any of them., and in administering the same to carry out the directions and exercise the powers contained in the trust instrument under which the property was received, including the expenditure of the principal, as well as the income, for one or more of such purposes if authorized or directed in the trust instrument under which it is received; To receive., take title to, hold, and use the proceeds and income of stocks, bonds, obligations,, or other securities of any corporation or corporations, domestio or foreign, but only for the foregoing purposes, or some of them; To act as management agent for other charitable human services providers; To lend sums to other Charitable human services providers and to receive .security for such .loans; To borrow sums and grant mortgages and security htcrests; Ana in goneraw to do and perform such things and acts and transact such business .in connection with the foregoing -objectives not inconsistent -Chapter ...�.g.�. General Laws, and Section 501 (c) (3) of the Internal Revenue Code of 1.986, as amended (or any successor provision or provisions for either) . ' 3. •It the corporation has rfWreI then:one class of memberc, the designation of such classes. the manner of election or appointment, the duration of membership and the qualification and rights, including voting rights, of the members of each class,are as follows:- fnot applicable 04. Other lawful provisions. W,any, for the conduct and regulation of the business and affairs of the corporation, for its voluntary dissolution, or for limiting, defining. or regulating.the powers of the corporation. or of its directors or members,or of any class of members.are as follows_-- See additional provisions set forth on Continuation sheets 4A, 4B, 4C, Q & 4E. If there are no provisions State "None". 1 KaaM ca+eo,.z-3 asaa�tia�-oeoteis h� (,l.0UU=rtrWt1d14 Of AS}7iZLC' �7I'9JB � • FED ERA >=NTIFiCATI4N OFFICE OF THE SECRETARY OF STATE ONE A5HBU'RTON PLACE.8OSTON.MA 02108 NO 04420604.1 Mirluiei Joseph Connolly,Secretary RESTATED ARTICLES OF ORGANIZATION F General Laws, chapter Iso,Section 7 �J J � This certificate must be'submitted-to the Secretary of the Commonwealth within sixty days after the dale of the vote of members or stoakholdom adopting 4he restated articles of organization.The fee for filing this certificate is ;30.Make check payable to the Commonwealth of Massachusetts. " we, Daniel B. Kunhardt, Jr. President,4Vi-a Prer.Weai, and Susan Shauger ,Clerk(A �'•o�a of ..-----.._:_..._.__._ -- tai-ilea 1-t•h--As�vt.,.i�t-i�n--I rac._...-------.__............. INamt.ol corwalronl located at...... 13 Prospect Street, Greenfield, Massachusetts ` do hereby certify chat the following restatement of the articles of organization of the corporation was duly adopted at Uv a meeting held on -�`-�rr ! t 9 �1 tw vote of..... ...... members...............eF+arAae . being at least two thirds of its members legally qualified to vote in meetings of the corporation(or,in the case of.e corporation having capital stock, by the holders of at least two thirds of the capital.stock having the right to i ot thereon): 1. The name by which the corporation shell be known is;- The Franklin County Mental Health Association, Inc.. 2. The purposes for which the corporation is formed dre as follows:- To deliver 'human services to citizens of the Commonwealth through a comprehensive program. of residential care, outpatient care, educational rservices, and other treatment .programs including clinical programs for the mentally ill , emotionally disturbed, mentally retarded, developmentally disabled, substance abusers and other populations who would benefit from the delivery of the corporation's services. The purpose of the corporation's services are educational . See additional provisions set forth on Continuation Sheet 2A attached hereto. 1-"--. NOTE:U provisions for which the space provided under Articles 2,3 and 4 is not sufficient•additions should be sot out on continuation sheets to be numbered 2A,29,etc. Indicate under each Article where the provision is set, out. Continuation sheets shall be on VA" x 11"paper and must have a left-band margin 1 inch wide for binding. Only one side should be used. hl , Witlliatoa Francis Galvin r sccmtary of.the Commonwealth ' ONE ASHBURTON PLACE, BOSTON, MA 02108-1512 AR-M XS'-OF'AMENDMENT (Under G.L.Ch. 110..Swtion 7) l FEDERAL Er MFICAIION l /in NO. 042 .06041 Approved We, Daniel B. Kunhardl:, Jr. Presidentl't and Will i.am Murphy ClerklAsssaf The Franklin Coun�ental Health Association, Inc ^� Located at 13 Project Stxeet, Greenfield, Massachusetts (M"-wfi=cMA i =ofior w-dan)brNtwbrr.sow aly or Towir,S&&- ,up>b do hereby certify that these Articles of Amendment affecting Articles numbered: 1 0&vb=Xh ate w*d=JA4.s+ Wor 4 bcggamrnded;bftwby) of the Articles of Organization were duly adopted at a meeting held on July 11, 19 95 , by vote of-(/d)*•IP7 rn=bcrs/ beirsgat]cast two-atudsafitsL*=bers entitkd to vote tbcreon (or,in the mwofa corporation having.capital stock,by the holders of at]east twa-dtin*o0tr capital stacyl:entilcd to vote:thercon): VOTED: That the name of the Corporation be changed to "Clinical & Support Options, Inc." . P C M RA aaoe-.�rovidcd-on this form ia-insu.lricient;Additions%hall be set forth on separate x'I I",sbctwof pa06r leaving a left hand margin of at least one inch. Addition to more than one amendmeut may be continued on a single sheet so long as each amendment requiting eacb web addition is clearly indicated. c ¢ '4y i i ... ��� .,.t+� '� � � � + '�� r ,.. ,�F J u.� rte, t �� - td .� [� e • ..s :.ry �� �+ �,�.: t zt ' CXN 8r.Support Opu CP H,nhanci.iig 1,im. Stren}xhening Communities. • 1111 Federd skeet Greenk4d,MA 01301 4'13-773.1314 J Nix:413-774.1197 ST FAX TRANSMISSION REPORT TO: ,._..... d c c I DATE: Sr,, FAx #d Pages(inck,ding Cover): �.3.__... _._.._.. CONFIRM RECEIPT YES NO (Please Circle Choice) FROM: �4+ V-e, RE: _ CCMAMENTS: "11,e infcmnatirnt etmta.;,xxl in the:(:icsimilc Izansaa�sian is ir>teridcd for the use of dte indivixhtmd tc�whe»n it is addz�wcd and may cotttidtwcl ittfamiaticnt.which is privilcgod mid am hcimbal.ifytmi mu nm the intended mcipien�or the employee,or went mponsible for delivering the nae,�.vo�to tkte inlaxied ra:ipit�tt,ycni ate lxxrlry notificxt that;niy disse��inaticnt,distrtbutirnt,c>r on}ryntg o1'dtit C�)mtnunicalion�4t►idly pMmbited.I'f yva have mcivett this comtiwrt a tion in mar,please notify us nmmediately by telephnne and velum rxirinal facamtle widxnit, m wring any copies to U.a at die above Abe w via the Uninxt Sm.tew Ptxtui Service. 71temk j^4. s As fia swa T� r i�. d MIN S�, ° ?m yes 14 1 i k � i y; ,w r � i i FLORENCE REST HOME }iaot.l ��oGrt P�o,ri — Ctrs#" �`' rj�co�nd �Ioc�S T 1' '� r�_cx�l1'y — �yrr�fa�{n�y G?Citi �11`tPa�f�52�1Ct;1AccfS5 Uct,secvl 1 c0%- S �xtch�sh��'t 1JfiCe F\C�bY1�r f ICE- - �{ M 3tCt?Yi 'L g�n„�P.riYA tjGh.�`1y Gc1'Vt �tfrrrt.rn �C7L hl't �'.ULYti t h Vn ��tiitiilh"C � Fo P_ a t? — a l'!1 l tkO 01Yib G�Yt'1 i T'00 hY1 jto.',I i FLOOD PLAN S FRM.., 8 5) JJ 21 21 8 23 23 2C3 S 8 2 S FR/A/B 13 0953) 35 35 42 4 X' 42 61F< S 12 D 42 i PLOT PLAN \ 25; I 90 dii 25'� a� 3a[3 257 56.T e6.c a'a 22;n n s 4,2513 255 67 Parcel 227 l35.� 25# 3Ea.i �51hHN AY 6D623 ��� 226 95 S. SS a 43.44 1Mal 255 i 775 n 4135 S,l.i 1t6.4] 7131 Representation and descriptions of the property contained in this exclusive right to sell listing agreement are those of the owner and are not to be relied upon by any prospective buyer as being represented or verified by the realtor. Prospective buyers are advised to verify the accuracy of this information and the realtor and owner invite inspection by any competent specialist prior to making an offer on this property. Buyer's agents will be compensated only if they are present on the first occasion their buyer client inspects the sub- ject property. <r n. z., r , i _ _ r - lot ��__— ter:, -...w, rw s., NNrw from F MINNOW MINNOW sow= .. MINNa� ors MI t The property will be used as the location of the Emergency Service Program (ESP) for Hampshire County. The Emergency Services Program provides crisis behavioral health services 24 hours per day, seven days per week, 365 days per year (24/7/365) to individuals who are experiencing a behavioral health or psychiatric crisis. Qualified and trained professionals staff the following ESP services 24 hours a day 365 days a year: • Evaluation/assessment of psychiatric or behavioral health crises • short-term counseling • treatment and discharge planning • medication evaluation • Community Stabilization - brief stays in a staff supervised home-like setting. If an individual requires longer treatment; they are transfer to a different organization that provides the required services. The ESP mission is, whenever possible, to provide services in natural settings such as homes, schools, residential programs, courts, and police stations. Clients presenting with medical problems or a need for supervision are evaluated in secure environments and the ESP works closely with hospital emergency departments in this regard. Individuals and families will usually be screened by phone and referred to the most appropriate setting. Some individuals or families can be served best at the ESP site where there is a comfortable waiting room and clinical staff immediately available to perform assessments, counseling, and referral. Every crisis evaluation involves a treatment and discharge plan which, foremost, addresses safety of self and others as well as insures that individuals have a place to go to. The ESP must work very closely with the fabric of community healthcare and public service agencies throughout the county to provide effective services. Another ESP service, Crisis Stabilization, is achieved in two ways - by working intensively with individuals and families over a short period of time, or, alternatively, some clients can stay in Community Stabilization which is a staff- supervised 6 bed apartment at the ESP base location. In Community Stabilization clients are continually evaluated, helped with their medications and assisted in returning to their home setting. Stays are 3-5 days, but no client is discharged without a plan and a place to stay. Community Stabilization is a voluntary service. In summary, the ESP is part of the safety-net of community services dedicated to working with first responders, hospitals and healthcare providers, and agencies that work with the mental illness, substance abuse and homelessness. The ESP provides expertise and support to these community services while also assisting many individuals in avoiding the need for these services. Aside from clinical and psychiatric skill, the ESP provides the experience and knowledge to bring together agencies, resources and the individual strengths that will help individuals in emotional distress stabilize and function productively in their home community. y ' i 10. Do any signs exist on the property? YES NO IF YES, describe size, type and location: Arse there any proposed changes to or additions of signs intended f r the property? YES NO_ _ IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan of development that will disturb over 1,acre? °YES NO _� IF YES, then a Northampton Storm Water Management Permit from the DPW is required. 12. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION This column reserved for use by the Building Department EXISTING PROPOSED REQUIRED BY ZONING Lot Size yq l9 Frontage Setbacks Front Side L: R: L: R: L• R: Rear Building Height Building Square Footage %Open Space: (lot area minus building 8 paved parkin #of Parking Spaces #of Loading Docks �• V Fill: (volume 8t location) 13. Certification: I hereby certify that the information copfa—in'N herein is trua and rate to the best of wledge my kno{ . �Date: _ u 0 Applicant's Signature �—o NOTE:Issuance of a zoning permit does not relie an applicant's bur n to comply with all zoning requirements and obtain all required permits from the Board of Health,Conservation Commission, Historic and Architectural Boards,Department of Public Works and other applicable permit granting authorities. W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 4. APR 2 1 2009 r File No. �. _ ... tNLNG '' ' 1 ' JCATI+ o ! Please type or print all information and return this form to the Building Inspector's Office with the $15 filing fee (check or money order)payable to the City of Northampton 1. Name of Applicant: C) r 10 L2 C4 , TZ&C, C Cr � elephone:Address: 07 2. Owner of Property: M 0,:1 �,e rock I k Address: -7 5 Wj e� --> k- L"`t57 Telephone: 3. Status of Applicant: Owner Contract Purchaser Lessee Other (explain) 4. Job Location: Act 44.-fX %U(, 7�- T -6re Aeg. of 6+ Parcel Id' '" Zoning Map# Parcel# District(s} In U6 f eet Dftt Ja In entry(' usiness D>ISt , t (T©B .F�LLb;IN:BY TM"E$tILD1IIG pEPARTMENI), 5. Existing Use of Structure/Property: C u rrt.%+17 a.. G10%A.cQ 12es wi� 6. Description of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary): 7. Attached Plans: Sketch Plan Site Plan Engineered/Surveyed Plans ov.?ttt V0 8. Has a Special Permit/Variance/Finding ever been issued for/on the site? $at ��Jj'� P��M"� L �` &4A.�. NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book __ Page and/nr Dncument# 9.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: (Form Continues On Other Side) W:\Documents\FORMS\original\Building-Inspector\Zoning-Permit-Application-passive.doc 8/4/2004 File#MP-2009-0087 APPLICANT/CONTACT PERSON clinical&Support Options Inc ADDRESS/PHONE 111 Federal Street (413)773-1314 "Ri P 7, T L'253 €o THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM ILLED OUT o&(7M- .r Building Permit Filled out Fee Paid Typeof Construction: Emergency behavorial crisis service program to individuals experiencing behavorial or phychitric crisis 24/7/365 days a year New Construction Non Structural interior renovations Addition to Existing AccessoEy 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 INFOPdATION PRESENTED: pproved 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 S ssion Permit DPW Storm Water Manag ent 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.