Demo ZPA 2012-11-01File # MP-2013-0055
APPLICANT/CONTACT PERSON FITZGERALD HAROLD R
ADDRESS/PHONE 37 MARY JANE LANE (413) 586-2529 0
PROPERTY LOCATION 87 BRIDGE ST - SHAW'S
MAP 32A PARCEL 185 001 ZONE URC(100)/
THIS SECTION FOR OFFICIAL USE ONLY:
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid %__, —
Typeof Construction: ZPA - DEMO SHAW MOTEL & ALL PROPERTY ON SAME LOT (7 & 9 POMEROY
TEM
New Construction
Non Structural interior renovations
Addition to Existin
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 . VAdditional permits required (see below)
IN a "I Bills) 1 05
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:
J�QkA.01XV100 bELALf �i t5TDKA A U ' 0 M VS Si 6 /'a
Curb Cut from DPW
Septic Approval Board of Health
Permit from Conservation Commission
Permit from Elm Street Commission
Well Water Potability Board of Health
Signature of Building Official
Permit from CB Architecture Conunittee
Permit DPW Storm Water Management
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.
Water Availability Sewer Availability
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact the Office of
Planning & Development for more information.
o - 12012
Me No.
Please type or print all information and return this form to the Building
Inspector's Office with the $x5, filing (check or money order) payable to the
City ofNorthaWton
1. Name of Appl
2. Owner of Property:
3. Status of Applicant: Owner
4. Job Location: 7� 1
5. Existing Use of Structure/ Property:
0
Contract Purchaser
Telephone:
Lesseq Other
M
-- � 6. DescAption of Proposed Use/Work/Project/Occupation: (Use additional sheets if necessary):
=I
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 YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON7 KNOW YES
IF YES: enter Book Page and/or Document #
9.Does the site contain a brook, body of water or wetlands? NO I' DON7 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)
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N — 120
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Please type or print all information and return this form to the Building
Inspector's Office with the $15filingfee (check or money order) payable to the
1. Name of',
2,
3, Status of Applicant: Owner
E)dsting Use of Structure/ Property:
�
7. Attached Plans: Sketch Plan _________ Site Plan ________, Engineered/SurvsyedPtany
8. Has aSpecial Find ever been issued for/on the site?
NO YES IF YES, date issued:
IF YES: Was t permit recorded at the Registry ofDeeds?
NO DONTKNOYY YE3________
IF YES: enter Book Page and/or Document#
'
9.Does the site contain a brook, body of water orwetlands? NO 0DNT 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 nn Other Side)
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W:\Documents\FORMS\original\Building-Inspector\Zoning-Perrnit-Application-passive.doc 8/4/2004
QeschpdoomfPnopusedUse/YYork/pnoect/Occupation: (Use additional sheets ifnecessary):