31B_193G Helen Hills Chapel- historic district commission determinationAPPLICANT: rk
ADDRESS
PHONE:
RE: Land or Buildings at:
Historic District Commission Determination
USE THIS FORM ONLY AFTER A PUBLIC HEARING
-Ili PIA&A
1 it ::11. 1 1
47 .i..awima
Elm Street, Northampton, ASSESSORS' MAP #:10, PARCEL dq�
The Historic District Commission has determined that (the Commission will check one of three boxes):
If checked and signed, THE PROJECT IS APPROPRIATE under the ordinance and MGL C. 40C.
THIS SERVES AS A CERTIFICATE OF APPROPRIATENESS, with the condition that all work be
done in accordance with the description provided by the applicant in his/her application to the Historic
District Commission and the following conditions (if any).
If checked and signed, THERE IS A UNIQUE HARDSHIP under the ordinance and MGL. C. 40C.
THIS SERVES AS A CER'1li1CATE OF HARDSHIP, with the condition that all work be done in
accordance with the description provided by the applicant in his/her application to the Historic District
Commission and the following conditions (if any).
PROJECT IS NOT APPROPRIATE NOR A HARDSHIP under the ordinance and M.G.L. C. 40C.
THIS SERVES AS A DISAPPROVAL OF A CERTIFICATE OF HARDSHIP.
If, within 14 days, the applicant does not modify to their project as detailed below, THIS SHALL
ALSO SERVE AS DISAPPROVAL OF A CERTIFICATE OF APPROPRIATENESS.
If, within 14 days, the applicant addresses the reasons for denial and modifies their project as
detailed below, and files these modifications with the Commission, the Commission shall, within a
reasonable time period, issue a Certificate of Appropriateness. A Certificate of Appropriateness, with
appropriate dimensional, set -back and other requirements and conditions cannot be issued without these
modifications because the project, as described, does not meet the criteria. These requirements are only for
the purpose of preventing developments incongruous to the historic aspects or characteristics of the
surroundings and of the historic district.
(C:1
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The Commission should address how the project meets OR fails to meet to Appropriateness criteria:
1. The general design, arrangement, texture and material of the features involved and the appropriateness of
the size and shape of the building or 'structure in the relationship to land area upon which the building is
situated and to buildings and structures in the vicinity: including: maintain construction design, building
alignment, setback, height, and articulation that are consistent or compatible with traditional
patterns of surrounding buildings and avoid mirrored or highly reflective glass:
1_ i�a✓�
2. The relation of such features involved to similar features of buildings and structures in the surrounding
area, including: preserve, to the extend practical and consistent with encouraging consistent setbacks
and heights, high quality views of landmark buildings:
v v
0
3. The historic and architectural value and significance of the site, buildings or structure, including: avoid
exterior or facade changes to buildings that would damage historic features or are not otherwise
readily reversible except when such changes replicate historic features, restore previously damaged
historical features, or are otherwise compatible with the detail and character of the district:
to
If the Commission denies a Certificate of Appropriateness or if an applicant applies directly for Certificate of
Wardship, the Commission should address how the project meets or fails to meet all the hardship criteria:
1. Conditions especially affecting the building or structures involved but not affecting the historic district
generally:
2. Failure to approve the application will involve a substantial hardship, financial or otherwise:
3. Application may be approved without substantial detriment to the public welfare and without substantial
derogation from the intent and purposes of the Ordinance:
The Historic Commission vote was (kr aih L rs^-d"° -v, •s o c Di s tr ict ommisgion:
Cipag ict 1I1vrek
DATE:
RIATENE 'AND HARDSHIP, eln street
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form ai proved 3/3/97)
07 /06/01 FRI 13:57 FAX 413 587 1264
I
TRANSMISSION OK
TX,RX NO
CONNECTION TEL
CONNECTION ID
ST. TIME
USAGE T
PGS. SENT
RESULT
To Be Published: July (1 time)
Bill To: Office of Planning Development
11:
:1::1:: TX REPORT 1 1
0397
07/06 13:57
00'43
1
OK
PLA.NN.ING AND DEVELOPMENT CITY OF NORTHAMPTON
CittHalf 2I kain St►ret, t ICorthainprort, MA 0106u -3195 1 .3E3 1 587- 2.66 •Fax 58 7 -r264
wayneieirien, Director Chia il :pianning@a ci cg.n0 rtbam p Er) n.m a.HS in mrnet :WV ntnorcba m mart p
ELM STREET HISTORIC DISTRICT COMMISSION
PUBLIC HEARING NOTICE
95855293
The Historic District Commission will hold a public hearing on Wednesday, July 25 2001 at
4:30 p.m. in the Hearing Room, Room 18, 2n floor, City Hall, Northampton, Mass_ regarding
the application of Smith College for renovations at Helen Hills Hills Chapel at 123 Elm Street,
Assessor's Map 31B, Parcel 193.
01 001
SMITH COLLEGE
July 11, 2001
Peg Keller
Planning and Development
City of Northampton
Northampton, MA 01060
RE: Helen Hills Hills Chapel Renovations
Dear Peg,
Thank -you for scheduling the public hearing for the Helen Hills Hills Chapel Elevator addition
project. Since there was not a quorum available for the Historic Commission meeting that was
scheduled for June 28, 2001, we were not able to meet with the commission prior to the public
hearing. In the interests of time, Smith College hereby waives the right to present our plans at a
regular commission meeting. We will present our plans to the commission at the public hearing
scheduled for July 25, 2001.
Please feel free to contact me if you have any comments or questions.
Sincerely,
Barbara W. Spalding, Project Manager
Smith College, Physical Plant
Tel.: 585 -2257
Fax.: 585 -2398
Email: bspaldin @smith.edu
Cc: Peter Lapointe, Kuhn Riddle Architects
Robert McCullough, Manager of Capital Projects, Smith College
file
Physical Plant Department
JUL 1 8 2001 li-J
DEPT Of PLANNING
NORTHAMPTON, MA 01060
1 22 2001
!'i OF PI A N G A For Historic District Certificate
APPLICANT. a G.S 11-' T a I -ra C, A... 1 c. PAWS' S' i+ CAL. l'AL
ADDRESS I- 1Au'ST .ST.: A.1n2THel -w,P BOA), ,4i4 of Q4 3
PHONE: ,4P ?I- A,v-r ,6 A426r4 -2A S P/4 t--i !BOG 5 ,S 2-25 7
OWNER
ADDRESS•
S W) VT C._P) I F.
IZl� .vEST ST.
RE: Land or Buildings at: 123 Elm Street, Northampton, ASSESSORS' MAP #:31 PARCEL 19 3
Pursuant to Chapter 40C of the General Laws of Massachusetts, application is hereby made for issuance of a
Certificate for work within a Local Historic District for:
new building alteration demolition or. removal Q addition/expansion
re- siding re- roofing repair /replacement porch/deck
sign(s) other (specify•
Description of proposed work:
1 fJ O (LD ER.. lb IM1 A K C TI-(- E• C- t-f4t-P
£v»iTN- u.S F P2.0 Po sE s Tr) 4.A) .4 DoL 7b A) OA) Th#IL.
Xi 2. E o 114E WEST' SinF eg 2'H- C -FAPEL 1
6 o N r J r 3 S To f' E L-E..vA 7j 2 'i tt FF E Ai E ut.) Co A .)S7'2r ic,l i� J
A- P-- A LD IJ E S 6, A) L.L. x 1 T/
1 U ff 1 TF (ilie� �I�YJKl(Z D o rj i172-1 etet 0 f
I hereby certify that the information on this application and any plans submitted herewith are correct and constitute
a complete description of the work proposed. I grant the Historic District Commission members and agents the
right to enter my property to inspect the proposed work. If I am not the property owner, I certify that I have
received the owner's permission to apply for this certification and am authorized to act of the owner's behalf for this
application:
Si nature of Applicant/Owner
The Historic District Commission 'has::determined that:(the' ommission ::will:check:'one;of'two. boxes below)
El If.checked.and signed, THE:PR:OJECT IS::EXEMP:T >UND 126:- 5: Subsectio n(s).
:.see: list of:exem'tions :SERVES A:S :THE<:CER 1F. C:A:TE: OF:NON: AP4P:LICABJLITY >with
the.condition:>that> all :work be:::done::in accordance<with the description :;pr ovided 'by?the<applicant<in
this:application and::the:followin •:conditions.: itan
CI PROJECT IS'NOT:>EXEIVIP:T JNDER §26 5i< >A CERTJ.EICA:•T:E?'.O7: NON:i,A PPIiIOABII ITY IS.
DENIED .'<The'::Coiiunission:will hold;a public hearing toaconsider Certificate:°: of .iAppropriateness:.or::
Hardship: on: :Specifically:
Historic Commission or Authorized Subcommittee/Agent:
r
DATE:
Date ///c/
June 22, 2001
Denny Nolan
Elm Street Historic District Commission
City Hall
Northampton, MA 01060
RE: Helen Hills Hills Chapel Renovations
Dear Denny,
Please find enclosed 1 Application for Historic District Certificate, with 3 architectural drawings
sheets for the project known as Helen Hills Hills Chapel Renovation. One sheet is from the
original building construction documents showing the existing building elevations. The other 2
sheets are elevations of the proposed change to the north end of the west side of the Chapel.
It is my understanding that there is a commission meeting scheduled for June 28, at 4:30 pm. I
would like to add the discussion of this project to the agenda for this meeting. I also talked to
Peg Kellor at the planning department, and she said that this application would generate
notification for a public hearing, which I believe will be required. Could you let me know when
that will be?
Please let me know if any other information is needed for this application and hearing.
Sincerely,
Cl
SMITH COLLEGE
S■6 4Z
Barbara W. Spalding, Project Manager
Smith College, Physical Plant
Tel. 585 -2257
Fax. 585 -2398
Email: bspaldin @smith.edu
Cc: Peter Lapointe, Kuhn Riddle Architects
Robert McCullough, Manager of Capital Projects, Smith College
file
Physical Plant Department
Smith College
Northampton, Massachusetts 01063
T (413) 585 -2400 F (413) 585 -2444
ti
111
8
z
a
'1
Jun 28 01 01:36p
11
n70T BUILDING INSPECTI
!A 010
JUN 2 6 2001
1. Name of Applicant:
Needs to be obtained
Pi./ e No OPO ��(D
ON'NG PERMIT APPLICATION §10.2)
PLEASE TYPE OR PRINT ALL INFORMATION
g=g&
c /D rPrf-1'StC..A-L_ i pt roT 12_co Lo CST Welephone: 5 $S' 2257 &hrzB.404 Spau>,�vc�
2. Owner of Property: .SA-✓h r
Address: Telephone:
3. Status of Applicant: X. Owner Contract Purchaser Lessee
Other (explain):
4. Job Location: Z. e
Parcel Id: Zoning Map# .31 Parcel# 11 3 District(s): /al/ Aa
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure/Property 1z-Eu ak S /_A
Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary):
>i O io K Tt-f
C Fo A 3- sTo P F
NO DON'T KNOW YES
IF YES: enter Book Page and /or Document
IF YES, has a permit been or need to be obtained from the Conservation Commission?
Obtained date issued;
(FORM CONTINUES ON OTHER SIDE)
7, Attached Plans: f 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 PermitNariance/Finding ever been issued for /on the site?
NO DON'T KNOW YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
p. 2
9. Does the site contain a brook, body of water or wetlands? NO V DON'T KNOW YES
Jun 28 01 01:36p
10. Do any signs exist on the property? YES V NO
IF YES, describe size, type and location: g 4t.bin) DEvUTc Fic—Tr 0
Et Ery (+1 LA-.S •f -(t_ t_S G,6 P GL
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 ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
is true and accurate to the best of my knowledge.
DATE:
p.3
This cola= to bs f112ed it
by the Building Dopar taco t
contained herein
APPLICANT 's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applioenes burden to comply witty .a
zoning requirements and obtain all required permits from the Board of Health. Consei- veiti•
Commission, Department of Public Works and other applicable permit granting a uthorities
FILE
Existing
Proposed
Required
By Zoning
Lot size
r
ill, DOD Si(-f
Sek_w,
Frontage
4
Say.
Setbacks frnnt
S0
3 2
side
L: sz' R: S
L: 50 R: 5 Co
rear
cO.c")E '-0 .U�i4
SA-
Building height
Bldg Square footage
3, 000
15 5 z- Lf
%Open Space:
•(Lot area minus bldg
&paved parking)
-I- 607 t
it 5 9 o/v
of 'Parking spaces
N G
of Loading Docks
i
0
Fill:
2( volume location)
N R
NA
13. Certification: I
hereby' r,01-1-4F,
+4,.4
Jun 28 01 01:36p
10. Do any signs exist on the property? YES V NO
IF YES, describe size, type and location: g 4t.bin) DEvUTc Fic—Tr 0
Et Ery (+1 LA-.S •f -(t_ t_S G,6 P GL
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 ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
is true and accurate to the best of my knowledge.
DATE:
p.3
This cola= to bs f112ed it
by the Building Dopar taco t
contained herein
APPLICANT 's SIGNATURE
NOTE: Issuanoe of a zoning permit does not relieve an applioenes burden to comply witty .a
zoning requirements and obtain all required permits from the Board of Health. Consei- veiti•
Commission, Department of Public Works and other applicable permit granting a uthorities
FILE
Jun 28 01 01:35p
File MP- 2001 -0164
APPLICANT /CONTACT PERSON Smith College 41)..
ADDRESS/PHONE 126 WEST ST (413) 585 -2424
PROPERTY LOCATION 123 ELM ST
MAP 31B PARCEL 193 ZONE URC HD
ZONING FORM
ee •ai•
Building Permit Filled out
Fee Paid
Denied as presented:
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
iLLENJ
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION:
Approved as presented/based on information presented.
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans Plot Plan
ENCLOSED REQUIRED DATE
Tvpeof Construction: ADD TO N. END OF WEST SIDE OF THE CHAPEL FOR A 3 -STOP ELEVATOR
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 Permit from CB Architecture Committee
/1 Os+1 IY1 }'J c ,,sSl
e;/:‘? 4 .4olio v
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.
p.1
f��� S1vtITI -i C ®LLEGS
June 22, 2001
Denny Nolan
Elm Street Historic District Commission
City Hall
Northampton, MA 01060
RE: Helen Hills Hills Chapel Renovations
Dear Denny,
Physical Plant Department
Smith College
Northampton, Massachusetts 01063
T (413) 585 -2400 F (413) 585 -2444
Please find enclosed 1 Application for Historic District Certificate, with 3 architectural drawings
sheets for the project known as Helen Hills Hills Chapel Renovation. One sheet is from the
original building construction documents showing the existing building elevations. The other 2
sheets are elevations of the proposed change to the north end of the west side of the Chapel.
It is my understanding that there is a commission meeting scheduled for June 28, at 4:30 pm. I
would like to add the discussion of this project to the agenda for this meeting. I also talked to
Peg Kellor at the planning department, and she said that this application would generate
notification for a public hearing, which I believe will be required. Could you let me know when
that will be?
Please let me know if any other information is needed for this application and hearing.
Sincerely,
0-4-4-c-JAr e<J
Barbara W. Spalding, Project Manager
Smith College, Physical Plant
Tel. 585 -2257
Fax. 585 -2398
Email: bspaldin @smith.edu
Cc: Peter Lapointe, Kuhn Riddle Architects
Robert McCullough, Manager of Capital Projects, Smith College
file
Scanned
Digitized
Checked
OWNER
ADDRESS
JUN 22 2001
For Historic District Certificate
APPLICANT: .(169 1f Vii! i) l� r�;'r °7's PI -A-N T
ADDRESS: L- T Z n. 1 orD
PHONE: APP 4.2gi1 -2A SP/4-L-b to 58,5 Z2 7
P1 or PIA
SVInlrl-1 C.J7)1 a .I~ p
I2-6 1�1EST s t
RE: Land or Buildings at: 12-3 Elm Street, Northampton, ASSESSORS' MAP #:31 PARCEL 19 3
Pursuant to Chapter 40C of the General Laws of Massachusetts, application is hereby made for issuance of a
Certificate for work within a Local Historic District for:
new building alteration demolition or removal pi addition/expansion
re- siding re- roofing repair /replacement porch/deck
sign(s) other (specify)
Description of proposed work:
1 N cal) l`2 "r'o vin G ThE Gt+,4PEL P
S v» t '71 L-L F Pee) Pc s s Tn B L U L- A--A) DC 110 i J o yU T
Note AND o P Ti-F WE s T S r no l4 C- 4- A-PEL. To
A 3 S To P L-1=vA Ta 2. 1 tfE. AV E Gt.) CD Ais ,Lc-Ti Dn.)
14 A- e. ✓2 4 A-n). +DE S 1 6, N L 1 L L. /1. A4 Tuh{ F_x 15 71A.)
Lo tf-1 T'F 0-1.-9 1- PAcrett .,l3 \Ae o o r r '2 i et-1 r A-$P g-.4 i t S I JG L ADo
I hereby certify that the information on this application and any plans submitted herewith are correct and constitute
a complete description of the work proposed. I grant the Historic District Commission members and agents the
right to enter my property to inspect the proposed work. If I am not the property owner, I certify that I have
received the owner's permission to apply for this certification and am authorized to act of the owner's behalf for this
application: 1
Si nature of A. •licant/Owner -�J a-5a o Date ea 1 9 C
The Historic District .Commission .has::determined that:(the ommission: atwill:ch'eckon'e:•oftwo.boxes below):..
If. checked:and signed, TB E 2RO.: ECT'IS >EXEMPT> UNDER §26: -5 Subsection(s).
(see:hst >of:exemptians):' <THISSERVES �::S:TNF:CER CA'IE:OF:NON B]LITY:vscith;
the•condition<that:ali: work >be::done: in:.accordance witl the<leserip'tion:provaidedibiyth'e:applicantan
this:a lication•: :and:the:followin .:conditions.: if,an
Cl PROJECT :IS: NOT: >EXEMPMUNDER §2645 :ii GERTLN?tCAdp:C ON= AEPIiICABIBEEMIS..
DENIED he>C6Mlnissioh 4'ill::hold;a public:hearing to<consider: a<Certificate:;of A:ppropriateness:.or::
Hardship: on: :Specifically:
Historic Commission or Authorized Subcommittee/Agent:
DATE:
FORM B BUILDING
DO NOT WRITE IN THIS SPACE
USGS Quadrant
MHC Photo. no.
location
eets and
h.
COMMISSION
use� Boston
1. Town Northampton
Address Elm Street, Smith campus
Name Helen Hills Hills Chapel
(over)
In Area no.
Form no.
31s ict3
Present use college chapel
Present owner Smith. College
3. Description:
Date 1
Source Smith College Archives
Style Neo- Colonial
Architect William and Geoffrey Platt
of .New York c/
Exterior wall fabric --g
Outbuildings (describe) none
Other features pedimented, columned
facade; steeple
`1 Altered no Date
Moved no Date
5. Lot size:
Less than one acre Over one acre
Approximate frontage
Approximate distance of building from street
6. Recorded by Ann. Gilkerson/ Robin Stroi
Organization Northampton Historical
Commissiuu
Date March 23, 1977
Scanned
Digitized
Checked
^Jun 28 01 01:36p
JUN 2 6 2001
n-o- rF BUILDING INSPECT
:A010
File Aro. —/gyp
ON LNG PERMIT APPLICATION §10.2)
PLEASE TYPE OR PR NT ALL INFORMATION
1. Name of Applicant: c F i•- son cc; ,1<
Address: `/D HA cJL,S 3T t 2_6> Lo CS"f s1Telephone: 5 8S- 2257 (6A.iz i S,
2. Owner of Property: SA---, E
Address: Telephone:
3. Status of Applicant: D, Owner Contract Purchaser Lessee
Other (explain):
4. Job Location:
Parcel Id: Zoning Map# 3'I Parcel t 3 District(s):
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
Existing Use of Structure/Property 1Z-eu _.t- AP L_.
6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary):
A D►Ti or) Tr, t `1 Iry N o K F Tt-t r
C P AL..
Fo P- A 3 s Top
Scanned
Digitized
Checked
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)
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 PermitNariance/Finding ever been issued for /on the site?
NO DON'T KNOW 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
p. 2
9. Does the site contain a brook, body of water or wetlands? NO V DON'T KNOW YES
'.Jun co ul ui:abp
10. Do any signs exist on the property?
IF YES, describe size, type and location: gu_ii.bito bBL. -F( c_sz;- r
1.-E-N (+7 t,LS N-r LL.s GE4 i�P GL''
Are there any proposed changes to or additions of signs intended for the property? YES
IF YES, describe size, type and location:
11. ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO
LACK OF INFORMATION.
go 200F 1.-ixic
3 S' s TEPPL
Lot size
Frontage
Setbacks
side
rear
Building height
Bldg Square footage
Existing
OoD
o
L: SO R: s 6
%Open Space:
(Lot area minus bldg
&paved parking)
of 'Parking Spaces
of Loading Docks
Fill:
vo1-u.me location
YES V NO
APPLICANT'S SIGNATURE
Proposed
This cols= to b. filled y
by the Building I?cpnrtmt t
Required
By Zoning
P.3
13. Certification: I hereby certify that the information contained herein
is true and accurate to the best of my knowledge.
DATE:
NOTE: issuanoe of a'=oning permit does not relieve an epplioant's burden to comply with a
zoning requirements and obtain ail required permits from the Board of Health, Consrvnt;•
Commission. Department of Public Work and other applicable permit granting authorities
FILE
,Jun 28 01 01:35p
File MP- 2001 -0164
APPLICANT /CONTACT PERSON Smith College
ADDRESS/PHONE 126 WEST ST (413) 585 -2424
PROPERTY LOCATION 123 ELM ST
MAP 31B PARCEL 193 ZONE URC HD
ZONING FORM
ee •air
Building Permit Filled out
Fee Paid
Tvpeof Construction: ADD TO N. END OF WEST SIDE OF THE CHAPEL FOR A 3 -STOP ELEVATOR
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:
Approved as presented/based on information presented.
fr Denied as presented:
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
RLEY/M
ENCLOSED REQUIRED DATE
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 Permit from CB Architecture Committee
m r7 CD'--stssior✓
Signature of Building Official Date
,i8Xce)/
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.
p. 1