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23A-106 (2) lPI_ .j e s �2a 7 41 STOCKADE FENCE 4 W, / t^fAle b `L o d LANDSCAPE AREA d 0 o' C! cL iii Y U !` I I �' 0 aL (NI . I\j �` it O m kl IPF I a I a) 4. NEIGHBORING. 20 - IPF N •S COCRETF_' WALK 1 ° ' . ° - — 1 –J s 10'. RIGHT OF WAY 300K 6003; PAGE 24 ,� rn N 7 , • ftz, LJ to / _ � L' 6 1 W I ` .=r THE PREMISESSHOWN ARE of \ _ SUBJECT TO AND /OR • TQGETF ER WITH THE f ~ BENEFITS OF ANY AND ALL i I UP AGREEMENTS, CONDITIONS, i I C OVEN A NTS, EA IPF r 30.00 RESERVATIONS,' � !PF RESTRICTIONS, RIGHTS', AND AKINGS OF RECORD. I 'I � T CO 1 SOUT MAIN S T E 11'1' - - -- I _ I I , I HE MORTGAGE 1/IASTEf AND THE C .A.T.I.C. 1 1 knowledge, information anc belief, from information supplied to me, I hereby report tha the premises have been led and that this inspection [plat shoWs the improvement or improvements as loc ted on'the premises deslcribed, !+ irn.--- „.r,m „N+ r,r imrArr-,,mmon10 arcs nntiraiv snnithin Int IinAC that thRrR ar'A nn P r 1 c I r n R r. h n - 1,(Aat4 44 tin the orernises i 1 ' i 1 i 1 1 11 I' 1 1 i / ' ----XII ---' 1 I (----", V 1 - - q a 6-' \i/76,/ i (_S y,&,/,t /r • . s7 ._ - V - - - S5: l �; � � '.. * tia /a A.S - „_ . - ' ,..., '.. .q.-- ' ... 0 GP - V do, ., . , � ti� � 4� .�� t".: o ♦ o,�o C. ♦ c,♦ 5 ♦ ♦♦ semi � •••/>. ,i i' / il /AN s \ ‘‘ p 9 � s ♦ O / ,,, rt -- / \ . ._ , \ City of Northampton y`` Massachusetts A-* l DEPARTMENT OF BUILDING INSPECTIONS • . , sk �!' �,a r -,�w 212 Main Street • Municipal Building 4xe - Northampton, MA 01060 s INSPECTOR Louis Hasbrouck Chuck Miller Building Commissioner Assistant Commissioner HOME OWNER EXEMPTION ACKNOWLEDGEMENT The State of Massachusetts allows the homeowner the right under 780CMR 108.3.4 to act as his /her construction supervisor. The state defines "Homeowner" as, " Person(s) who owns a parcel on which he /she resides or intends to be, a one or two family dwelling, attached or detached structures accessory to such use and /or farm structures. A person who constructs more than one home in a two- year period shall not be considered a home owner." The building department for the City of Northampton wants any person(s) who seek to use the home owner exemption, to act as their own construction supervisor, to be aware that by doing so you become responsible for compliance with state building codes and regulations. The inspection process requires that the building department be called to inspect work at various stages, which include foundation /footinqs (before backfill), sonotube holes (before pour), a rough building inspection (before work is concealed), insulation inspection (if required) and a final building inspection. The building department requires these inspections before the work is concealed, failure to secure these inspections can result in failure to obtain a certificate of occupancy until the work can be inspected. If the homeowner hires other trades to perform work (electrical, plumbing & gas) the homeowner will be responsible to make sure that the trades hired secure their proper permits in conjunction to the building permit issued, and that they get their required inspections. Failure of the individual trades to secure the permits and inspections as required can DELAY the project until such time as the proper permits and inspections are made I, . U. A OA. �� - r ,, _/.. s .;, nderstand the above. (Home owner /resident's signature requesting exemption) I will call to schedule all required building inspections necessary for the building permit issued to me. Date 5 Address of work location / J i ' 2 -"if , C • The Commonwealth of Massachusetts Department of Industrial Accidents a —At= t= t let= Office of Investigations i. 600 Washington Street ,, *, Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ Contractors /Electricians/Plumbers Applicant Information Please Print Legibly Name ( Business /Organization/Individual): -SCOS4 N CON AI KY +hl /Ci1 t SL GONAIk,Y Address: )lj ] S J^44m/ S - FL.orz Emcs 01,4-= 0 / 0 1 a3 , _ yv Lit City /State /Zip: Phone #: Li /.1 5 -a/- -/ 'p> 7 Are you an employer? Check the appropriate box: Type of project (required): 1. ❑ I am a employer with 4. n I am a general contractor and I 6. ci>ew construction employees (full and/or part- time).* have hired the sub - contractors 2. El I am a sole proprietor or partner- listed on the attached sheet. 7. Memodeling These sub - contractors have ship and have no employees 8. Demolition working for me in any capacity. employees and have workers' 9. ❑ uildin addition [No workers' comp. insurance comp. insurance. quired.] 5. n We are a corporation and its 10.B1ectrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 repairs insurance required.] t c. 152, § 1(4), and we have no employees. [No workers' 13.0 Other .c 6yj) comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub - contractors and state whether or not those entities have employees. If the sub - contractors have employees, they must provide their workers' comp. policy number. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City /State /Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and p:i' ,'ties r �- / erju t at he information provided above is true and correct. V ., � � Signature:� C Date: 5 j Phone #: 1 , Official use only. Do not write-in- this- area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: r ' SECTION 8 - CONSTRUCTION SERVICES; 8.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : License Number Address Expiration Date Signature Telephone 9 `egisteFed. ' orn mprovemen , ,Contra' or.'` .., . , ._ i?:Y3R . i Not Applicable ❑ Company Name Registration Number Address Expiration Date Telephone SECTION 10- WORKERS' COMPENSATION INSURANCE AFFIDAVIT (M G L c 152, § 2 5C(6)) - Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ❑ No ❑ 11 I ome Owne xe The current exemption for "homeowners" was extended to include Owner- occupied Dwellings of one (1) or two(2) families and to allow such homeowner to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner: Person (s) who own a parcel of land on which he /she resides or intends to reside; on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/ or farm structures. A person who constructs more than one home in a two -year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he /she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152 (Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death) of the Massachusetts General Laws Annotated, you may be liable for person(s) you hire to perform work for you under this permit. The undersigned "homeowner" certifies and assumes responsibility for compliance with a State Building Code, City of Northampton Ordinances, State and Local Zoning Laws and Stat Mass husetts ral Laws Annotated. Homeowner Signature r ./ L 'G SECTION 5= DESCRIPTION OF PROPOSED WORK (check all applicable) , New House n Addition 0 Replacement_W' dows Alteration(s) E Roofing n �✓ Or Doors L I Accessory Bldg. I .. Demolition New Signs [0] Decks [0 Siding [O] Other [ID] Brief De cr' • ' • , of Proposed Work: •�;` • h 8N 1 51- 1 - 1N0 0 PL :4; , r 1,0 / cm—pi p-M]) r nY /iqm ( ri) Alteration of existing bedroom Yes V No Adding new bedroom Yes ✓ No Attached Narrative Renovating unfinished basement ✓ Yes No Plans Attached Roll - Sheet &a 1f ev :house and,.orA adcl t on }to ex�sti -ng : ; Ode' omp ;ete heafo to�nrirrq: a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each ' g. Energy Conservation Compliance. Masscheck Energy Compliance form attached? h. Type of construction i. Is construction within 100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No . I. Septic Tank City Sewer Private well City water Supply SECTION 7a OWNER AUTHORIZATION TO BE. COMPLETED WHEN OWNERS AGENT OR CONTRACTOR. APPLIES FOR BUILDI'NGPERMIT I, 5VS/1 -A( (O/ynt,h,/ .'>' m / (/j,4DL_ ( i/4Ati Y , as Owner of the subject property hereby authorize £ O% AI - to act on my behalf, in all matters relative t. aut • "zed by t•' • ilding permit application. Signature of Owner Da e I, ,-1- q j'vM S t j ,f,V j_ C/9/t'H 7Z/ , as Owner /Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury . CC of .. ' ' / = :1/} r C8MnFlaY Print Name 1 _. A• A C am' . 'L LL�Z' Signature of Owner /Agent ` Date J Section 4. ZONING All Information Must Be Completed. Permit Can Be Denied Due To Incomplete Information b • Existing Proposed Required by o 1 ' This clumn to • • in by • Building Department 1 1 °s Lot Size A t AC" Frontage 3 0 ' Setbacks Front is-3 i a Side ∎-.0 jC L:' I R: 1 L: ' R:' E Rear J SS+ 3 I Building Height ;cj i I 1 ' Bldg. Square Footage 1 I-1 % 1 10 Open Space Footage % _ , (Lot area minus bldg & paved 8 i 1 1 parking) i i I # of Parking Spaces q ` -- Fill: ___,_ _ _ _.___ _ _____ ___ _ ` _ ___._______ __,.______ il (volume & Location) A. Has a Special Permit /Variance /Findin ever been issued for /on the site? NO 0 DONT KNOW O YES 0 IF YES, date issued::` IF YES: Was the permit recorded at the Registry of Deeds? NO 0 DONT KNOW 0 YES 0 IF YES: enter Book Page= ! and /or Document # j B. Does the site contain a brook, body of water or wetlands? NO 0 DONT KNOW (3 YES 0 IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained 0 , Date Issued: C. Do any signs exist on the property? YES 0 NO O IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ? YES 0 NO e 1 IF YES, describe size, type and location: E. Will the construction activity disturb (clearing, grading, excavation, or filling) over 1 acre or is it part of a common plan that will disturb over 1 acre? YES 0 NO 0 IF YES, then a Northampton Storm Water Management Permit from the DPW is required. „ 9 Departmeat se only R EC A_. ✓ED i of INlorthampton Status afPerrr Bu (ding Department ve r® u wa; i lilt 8 . 12 Main Street Sever ep tcAtral salt w Room 100 Wet- a ' aiIa ® it' d ort ampton, MA 01060 fir® ® - anent . OFBURDINC.,, • 3 -5:7 -1240 Fax 413 - 587 -1272 F40. NORTHAMPTON, MA ai Ott e Sped APPLICATION TO CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING SECTION 1 - SITE INFORMATION q r 9 ”` f ^K e g al This sectlolt to be m d by w coplete offl �:, ce ' 'w1 "T 1.1 Property Address: l I J D014 hit IV ' ak u tl x � dr a' a.�'.' .�` 'w.r 5'f£�., # n...�h ?4 5 gagitat. air*I p-1--©v , CK Zone k Overlay Dis'trici � � t ,- Elm St `Drstncf:: n CBS istrlct „. SECTION 2- PROPERTY OWNERSHIP /AUTHORIZED AGENT I; 2.1 Owner of Record: W 1C Y I e... ./ 1 1 s - 441-IN S Pj-vyii'r, ca /f 4 0/0p Name (Print) Current Mailing Address: o �y p j .O' t` i 7 r e l 7 / ` Litt ` 230 l `2� � Telephone Signature 2.2 Authorized Agent: Name (Print) Current Mailing Address: Signature Telephone SECTION 3 -ESTIMATED CONSTRUCTION COSTS Item Estimated Cost (Dollars) to be Official Use Only completed by permit applicant 1. Building COO - (a)' Permit Fee 2. Electrical n L1r) (b) Estimated Total Cost of d r Construction from (6) 3. Plumbing 6 C oci Building Permit Fee f 4. Mechanical (HVAC) f () S , 5. Fire Protection r 6. Total= (1 +2 +3 +4 +5) it o 5 d Check Number - This Section For Official Use Only Date Building Permit Number: Issued: Signature: Building Commissioner /inspector of Buildings Date File # BP- 2012 -0972 APPLICANT /CONTACT PERSON CONNERY MICHAEL & SUSAN ADDRESS/PHONE 141 SOUTH MAIN ST FLORENCE (413) 529 -1877 () PROPERTY LOCATION 141 SOUTH MAIN ST MAP 23A PARCEL 106 001 ZONE URB(100)/ THIS SECTION FOR OFFICIAL USE ONLY: PERMIT APPLICATION CHECKLIST ENCLOSED REQUIRED DATE ZONING FORM FILLED OUT Fee Paid Building Permit Filled out ; A . n Fee Paid Typeof Construction: RENOVATE 1ST & 2ND FLR BATHS, KITCHEN & FOYER & D New Construction Non Structural interior renovations Addition to Existing Accessory Structure 1 Building Plans Included: .� Owner/ Statement or License 3 sets of Plans / Plot Plan THE F OWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON INF ATION 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 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 Street Commission Permit DPW Storm Water Management •• c itio elay e - 4141 V f 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 Office of Planning & Development for more information. 141 SOUTH MAIN ST BP-2012-0972 GIS #: COMMONWEALTH OF MASSACHUSETTS Map:Block: 23A - 106 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: renovation BUILDING PERMIT Permit # BP- 2012 -0972 Project # JS- 2012- 001689 Est. Cost: $40500.00 Fee: $243.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Homeowner as Contractor Lot Size(sq. ft.): 5052.96 Owner: CONNERY MICHAEL & SUSAN Zoning: URB(100)/ Applicant: CONNERY MICHAEL & SUSAN AT: 141 SOUTH MAIN ST Applicant Address: Phone: Insurance: 141 SOUTH MAIN ST (413) 529 -1877 0 FLORENCEMA01062 ISSUED ON:5/17/2012 0:00:00 TO PERFORM THE FOLLOWING WORK: RENOVATE 1ST & 2ND FLR BATHS, KITCHEN & FOYER POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House # Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace /Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 5/17/2012 0:00:00 $243.00 212 Main Street, Phone (413) 587 -1240, Fax: (413) 587 -1272 Louis Hasbrouck — Building Commissioner I i 1 z (. „,,A r....1 i ° g 0 > t�N Q) a s jz� / `� A , . c'• 1 GARAGE 1 / l C;(c' ...5 \ e l i r , i , r = r HOUSE u o a 15'_0„ , 1 , , 1 , 1 r I I I I , , , , I , i , 53 M 17� ; ' 1 1 , Tom McCann,, , Drafting n , r Mike Connerly r J , 413- 7314480 f lot flan 5 ,,e;,� , 1 10. Do any signs exist 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 V IF YES, describe size, type and location: 11. Will the construction activity disturb (clearing, grading, excavation, or filling) oven'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 . k) 3 II `D BY K=»GOINTTNG Lot Size Frontage 5 Setbacks Front 15 Side L: R: L: It: L R: t . Rear t Building Height Building Square Footage k % Open Space: (lot area �u minus building & paved parking # of Parking Spaces # of Loading Docks :. Fill: (volume & location) 13. Certification: I hereby certify that the information contained herein is true and accurate to the best of my knowledge. Date: Applicant's Signature NOTE: Issuance of a zoning permit does not relieve an applicant's burden 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. 8/4/2004 W:\Documents \FORMS \original\Building - Inspector\ Zoning - Permit - Application - passive.doc File No. OP ,� q 3fi wo. 4 k 3x , tt ��° r : u�s c � ° x �.' Sq'7Y �xa ' ` x< r ..: 11r ® x , ,r . :. p i p, g C q 3 �, x � � ,» , a+ P i, 4 , ` , + , � .f' � ";s 9 . ,,I =' V 4x ) 4eliz,? . 4\ w 1 u.- V= ii . k . m.:. , 1 , ', ,. .M5-4"'3x 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 ofNorthampton ( ci 1. Name of Applicant: S M-r/ CC M V!Y -' /1 0i !> i - W/ CoNA/6 23e)-- Address: i 1 1 i SIVA f _Cr; c Tel ephone: 2. - Owner of Property: .f a Address: S /144 Telephone: i 3. Status of Applicant: Owner V ' Contract Purchaser Lessee Other (explain) 4. Job Location: , ....\ '' ‘'1 11/ 1 V s 2 z =. *." max. ,.c �" f , n -.au 4 ' - 3r �s q ,7t-M.+y° v,. , nt - a xe. ' a ,;;t0 , � ` , ,e ;�+ ; ;, 1e� t' w ,�+'""r`'ti; `1F 4 �r " `, c k°'' `, i-.,r" t ` 4 z� ,.y'y' , ...e,;,,,, �A . a e t' e e t, i n '" ` ` � i evpl i g n w + c _ b� v . " .°u` s �'- ^".f`°xu L, � " ,rfi "t : ,,,*, 3 -, * =xi - V y : V ie Q '+ k. r� 4 e A k � ; t �" -� , ., n-i f.ee 4 - e »tr t,aBusi j R-55VI : f a $ k : �, rt E pI a N 8y H EPA tTMEN $f ` A �� h x tRG. � R.cca . ni �.1. � .r.'nm S W i& �, .a .. ... .. 4w.N. .i f.., � - H '�y,.- F?Nky l . . 5. Existing Use of Structure /Property: �ce(! f.. 6. escripti f po Use /Work/Prct/O cu ation: (Use a ditional sheets if necessary): / Pro d v 13- of oje IMa > � W& M' / /s - AD t2n4 /28eivi 11q v kiqt- B 81 3-4 r w� , dL1 &-4_ Hig,_ )j' PYw} c i ,— ffar qA( 6 -- eve-7,e. _ - c"1 h / 44S g;-- 4" " 7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans 8. Has a Special Permit /Variance /Finding ever been issued for /on the site? NO DONT KNOW j 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 /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) W:\ Documents\ FORMS \original \Building- Inspector\Zoning- Permit- Application- passive.doc 8/4/2004 File # MP- 2012 -0127 APPLICANT /CONTACT PERSON CONNERY MICHAEL & SUSAN ADDRESS/PHONE 141 SOUTH MAIN ST (413) 529 -1877 () PROPERTY LOCATION 141 SOUTH MAIN ST MAP 23A PARCEL 106 001 ZONE URB(100)/ 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: ZPA - ADDITION 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 titional permits required (see below) PT PT ANNTN(`_ UC A DTA DTI DAiTT'T DPi (ITTTDu" TTNTIL'D • S un ....i.. t S5 F 2t W a i a y .aa a a vai V1� . 3 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: § 3S0 '_ 9 a 3 • Finding Special Permit Variance* Ott C ! !vR. r (keg' 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 Peanut from CB Architecture Committee Permit from Elm Street Commission Permit DPW Storm Water Management 5 1 74 / 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.