25C-070 (2) 1
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MAR 1 9 Z13
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
IF YES,describe size,type and location:
11 . ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE -Ili
LACK OF INFORMATION.
This cola= to be
by the Building Drpartsant
Required i
Existing Proposed By Zoning
Lot size ^---
7
Frontage
Setbacks
- side L: ! ?t; R: 3t)4 L:
- rear — - _..---
r rj
I
Building height
Bldg Square footage
%Open Space:
(Lot area minus bldg
&paved parking)
Jr
# of Parking spaces ----
# of Loading Docks
Fill:
{vol-ume -& location) rl I jay
13 . Certification: I hereby certify that the information contained her,: i
is true and accurate to the best of my knowle*e. \
DATE: ( � APPLICANT's SIGNATURE
1
NOTE: Issua oe of a zoning permit does not relieve an applioant's burden to oomply with all
zoning requtremente and obtain all required permits from the 00ard of Health, Cong rv�t,«r
Commisslon, Department of Publio Works and other applioable permit granting authorities.
FILE #
`1
File No. /-
ZONING PERMIT APPLICATION ( 10 . 2)
- PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 3 �' �� �- 1�� � � � ` Telephone: H' T3" Sgt -)3 K
2. Owner of Property:
Address: Telephone: S ��
3. Status of Applicant: J/ Owner ____Contract Purchaser Lessee
Other(explain):
4. Job Location: Sc�mac_ (-,I ( 3y
Parcel Id: Zoning Map# a5r Parcel# JW O District(s): 'z/-16----4
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)'
S. Existing Use of Structure/Property_ Q WY\[,\�r OU:!±
6. Description of Proposed Use/Work/Project/Occupation: (Us additional sheets if necessary)-
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 i/ 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 V/ 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-2003-0132
APPLICANT/CONTACT PERSON BIVONA GARY
ADDRESS/PHONE 36 DAY AVE (413) 586-2938 Q
PROPERTY ..a
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
NIN ORM FILLED OUT l o h9 '
ee aid
Building Permit Filled out
Fee Paid
Typeof Construction: ZPA-CONVERT 2 FAMILY TO 3 FAMILY
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 P�STED-., ,
Approved
PLANNING BOARD PERMIT REQUIRED UNDER : §
Intermediate Project: Site Plan AND/OR Special Permit with Site Plan LC
Major Project: Site Plan AND/OR Special Permit with Site Plan
> '111VIIT REQUIRED UNDER: §
Finding Special Permit -� � `� ;�✓.} S �� t,�:
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
Signature of Building Offl6al 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.