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HomeMy WebLinkAbout104 Chapel Road b D TO THE B ING I�1T P R Of the APPLICATION FOR TO" OF SOUTH WHMSAM CO[i111i, PLAN EXAMINATION AND BUILDING PERMIT IMPORTANT — Applicant to complete all items in sections: 1, 11, 111, IV, IX. O ZONING I• AT (LOCATION) 0 DISTRICT LOCATION (NO.) (sT ET) OF BETWEEN AND BUILDING (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK SIZE N II. TYPE AND COST OF BUILDING — All applicants complete Parts A — D �v A. TYPE OF IMPROVEMENT D. PROPOSED USE — For"Wrecking" most recent use M 1 ❑ New building Residential Nonresidential 2❑ Additi n(if residential, enter number 12❑ One family 18❑ Amusement, recreational of new housing units added, i/any, 13 T family — Ent n Part D, 13) ❑ wo or more 19 Church, other religi us am Enter ❑ 3 number of units— — — — —►_._ 20❑ Industrial KAItperation14❑ Transient hotel, motel, 21 ❑ Parking garage 4ea (See 2 above)ir, replacement or dormitory — Enter number 5 ❑ Wrecking (1/multifamily residential, of units ——————— — -i 22❑ Service station, repair garage enter number of units in building in 15❑ Garage 23 ❑ Hospital, institutional Part D, 13) 16 ❑ Carport I` 24❑ Office, bank, professional 6 ❑ Moving (relocation) OCF WWII 25 Public utility 7 ❑ Foundati n only 17❑ Other — Speci/y ❑ Y � �� Cr�n ,� � 26❑ School, library, other educati nal B. OWNERSHIP 27❑ Stores, mercantile 8 ❑ Privat (individual, corporation, '' v /' 28 ❑ Tanks, towers n nprofit institution, etc.) lNn�l�C4� • 29❑ Other — Specify 9 ❑ Public (Federal, State, or I cal gov rnment) C. COST (Omit cents) Nonresidential — Describe in detail proposed use of buildings, .g., f d processing plant, machine shop, laundry building at hospital, elementary 10. Cost of improvement............... 0 Q G school, secondary school, college, parochial school, parking garag for, department store, rental office building, office building at industrial plant. To be installed but not included If use of existing building is being changed, enter proposed use. in the above cost o. Electrical...................... b. Plumbing ...................... c.H ating, air conditioning......... d. Other(elevator, etc.)............ 11. TOTAL COST OF IMPROVEMENT $r0 oDQ III. SELECTED CHARACTERISTICS OF BUILDING — For new buildings and additions, complete Parts E — L; for wrecking, complete only Part J, for all others skip t IV. E. PRINCIPAL TYPE OF FRAME G. TYPE OF SEWAGE DISPOSAL J. DIMENSIONS 30❑Masonry(wall bearing) 40❑ Public or private company 48• Number of stories............... 31 ❑ W ad from 41 ❑ Private (septic tank, etc.) 49• Total square feet of floor area, all floors, based on exterior 32❑ Structural steel dimensions .................... 33❑ Reinf reed concrete H. TYPE OF WATER SUPPLY 34❑ Oth r — Specify 42❑ Public or private company 50. Total land area, sq. ft. ........... 43❑ Private(well, cistern) K. NUMBER OF OFF-STREET PARKING SPACES F. PRINCIPAL TYPE OF HEATING FUEL I. TYPE OF MECHANICAL 51. Enclosed ....................... 35❑ Gas Will there be central air 52. Outdoors........................ 367011 conditioning? L. RESIDENTIAL BUILDINGS ONLY 37❑ Electricity 44❑ Y s 45❑ N 53. Number f bedr ms.............. 38❑ Coal 39❑ Other— Specify Will there be an elevator? 54. Number f Full.......... 46❑ Yes 47❑ N bathrooms Parti a(........ IV. IDENTIFICATION — To b compl t d by all applicants Nam Mai ling addr ss — Number, street, c:tv, and State ZIP code Tel. No. eo,4, Owner or Lessee (. 2. Contractor 3. Architect or Engineer The owner of this building and the undersigned agree to conform to all applicable laws of this jurisdiction. Signature of app ',ca t Address Application dot w / DO NOT WRITE BELOW THIS LINE V. PLAN REVIEW RECORD — For office use Plans Review Required Check Plan Review Date Plans B Date Plans By Notes Fee Started y Approved BUILDING $ PLUMBING $ MECHANICAL $ ELECTRICAL $ OTHER $ VI. ADDITIONAL PERMITS REQUIRED OR OTHER JURISDICTION APPROVALS Permit or Approval I Check Date Number B Permit or Approval I Check Date Number By pp Obtained y pp Obtained BOILER PLUMBING CURB OR SIDEWALK CUT ROOFING ELEVATOR SEWER ELECTRICAL SIGN OR BILLBOARD FURNACE STREET GRADES GR: N'G, USE OF PUBLIC AREAS OIL BURNER WRECKING OTHER OTHER VII. VALIDATION Building _ P rmit number Bui Iding Permit issued 19 Building Permit Fe $ zz prove y: TI L 4 TOWN OF SOUTH WINDSOR BUILDING PERNIIT Date Aug. 9 1 198 5 Fee Paid $. . .6 0.0 0 Est. Value $10.1.0 0 0 Permit N° 14595 on the side of Chapel Road Saw Street No. 104 Owner John T,awtnn Applicant J n h n Lawton CERTIFICATE OF OCCUPANCY ISSUED: I Date No. Fee Paid $ CLASSIFICATION Alterations i BUILDING PERMTr NY 14595 OFFICE OF THE BUILDING INSPECTOR of the Town of South Windsor, Conn. _ 9 South Windsor, Conn. Auu 1985 I i � rtt t faPtt- , That John Lawton I is hereby granted permission to A l ts•ra t i nn s can Awe l 1 i n g I at estimated value of $1. on the side of - 10 4 Chapel Road Sava on land owned by John Lawton Said Work to be as described in Application No. 14895 and to conform to specifications and plans filed with said Application, and Building By. Laws of THE TOWN OF SOUTH WINDSOR. Issued Aug- 9 1985 Building Inspector. Streets and sidewalks, obstructed by excavations or building materials, must be guarded by barriers during the day and by both barriers and colored lights by night. SECTION 1343, GENERAL STATUTES OF CONNECTICUT: "When any person shall place or keep building materials, or any obstacle in any highway (or any sidewalk) either with or without a license therefor from the city or borough in which such highway may be situated, he shall pay said city, town or borough all costs and damages which it shall sustain, or be compelled to reason therefor." VO o L QA�'E Fff3, ..2 9, e d 6,�SV.o ✓vA>''.�'f2 iYo,yiE Fo��i✓/� h'.E.�.eE.�T .�.�. 1'�ic.f'ic 14 �J r9R E-,9 L �F/�p /. S/O E Y.,N,�.o ,���'E�/.Iio is�s �.✓ lii o.c.�Ti���.� r<f T gi � i TE/7 �/ ,�'o �''o�Vi.✓G RE-�,�,C,�+�AarV.t � Q �v 'ov v -9 '� ,,��old /✓" , } w�c c y PERMIT # Application For 3123 2 � DEPARTMENT DECISION 334 ,geatmg Permit cd 3 APPLICATION IS HEREBY: DEPARTMENT OF LICENSES AND INSPECTIONS N {' APPROVED DISAPPROVED TOWN OF SOUTH WINDSOR I~ 0 cd 5 00 � �'~DAT A�— CHIEF INSPECTOR APPLICATIONS MUST BE PRINTED OR TYPED. BEGIN WITH NUMBER ONE BELOW O C 1. LOCATION OF JOB o carp o cd $4 NO. STREET 4-2O cd v LOT NO. FLOOR APT. NO. .� O LV 0 2. OWNER TO 0 w 0 0 3. ADDRESS- /I—ly cHfy)>l�-L y So w I vas 0 4.PHONE y cd C! s. APPLICANT T w Q on o 0 a. ADDRESS 6 6 ���� .1 La's ['cd `d T t( 6 re T I O 7.PHONE!i2 � I S. LICENSE N0. a s. EXPIRATION DATE OF LICENSE 0 vv 10. ESTIMATED COST S� o r" 11. IS THIS A CONTRACT COST? I YES ❑ NO bp � 12. FEE ENCLOSED S 3.00 a� 0 ai 13. TYPE OF BUILDING: PKRESIDENTIAL ❑ COMMERCIAL O 14. ce 14. TYPE OF JOB: ❑ INDUSTRIAL RIGINAL ALTER �i ❑ INSTALLATION (� ADDITI+ONON REPAIR `7 APPLICATION R HEATIN,'gq PERMIT (Continued fr m Reverse Side) 11 LOCATION OF JOB JO q tee NO. STREET FLOOR APT.NO. 12. TYPE OF INSTALLATION: ❑ OIL BURNER �I HEATING SYSTEM ❑ VENTILATION ❑ SPRINKLER ❑ GAS BURNER ❑ STACK ❑ INCINERATOR ❑ MISCELLANEOUS IDENTIFY SIZE LOCATION SIZE SIZE y 13. OF TANK ,) 7 OF TANK OF FILL OF VENT 14. B.T.U. EQUIP. AT REGISTER FURNACE,MA Na 0. AT BONNET FIRING RATE BOILER OR FURNACE MAKE AND N B'f. SQ. FT. NE B.T.U. OR SQ. FT. GROSS FIRING RATE O FLOORS TO BE HEATED NEW OR OLD BUILDING el INRLLLATED - YES OR NO A4 O TYPE OF WALL jnke�� -INSUoLATION ROOF OR CEILING INSULATION AVG. SYSTEM WATER TEMP. B.T.U./SQ. FT./HR. EMISSION INDOOR-OUTDOOR TEMPERATURE DIFFERENCE go 'FAHRENHEIT MAKE OF RADIATION: BASEBOARD�COPPER CONVECTORS, OR C.I. RADIATION. OUTPUT PER SECTION OR LINEAL OF RADIATION. SQ. FT. OR B.T.U. LUl- DESCRIPTION OF WORK 6AW gl cle 15. TO BE DONE: LRK � 7oicc- K u�} D 0 0 o -V/'\ L=s 7 c c 14 ®-T tt-.1-7- u�r 15. HEAT LOSS SCHEDULE. (TO BE INCLUDED FOR ALL JOBS). ROOM SIZE WINDOWSIcV AREA - SQUARE FEET B.T.U. B.T.U. 9 o DISTRIBUTION INSTALLED AND DOORS VOLUME TOTAL TOTAL y NO. LL ROOM << GLASS NET WALL CEILING FLOOR C�1. AT 70•F CORRECTED <j LL REGISTER L W N AND W v TEMP. TO H TYPE AND SIZE RAD. OR LEADER SIZE < f� ' • �U i�r `I� DIFF. 0 •F O m N SQ. FT. FREE AREA y 3 a OOo / 'D 1� lCo � 3Goo� 7cgo 0 Sao l7X !'/z- J 3w3 2'20 0 C Y�av S 30 V 1 J '+0 3 a 0 0 o o G:5 tic? 7 413 d x 711 2� 3w ro O S�00 &2v z G o 4000 ga, 20 lZ ^� O I d Ct &YOG 7310 I 76 3W 313 00. 4E41p V,/406 1AYoe /70 TOTALS A. HEAT LOSS FROM BUILDING 00 B.T.U./HR. B. DOMESTIC HOT WATER DEMAND U --- - B.T.U./HR. C. PIPING, OTHER THAN NORMAL B.T.U./HR. ALLOWANCE FOR HEAT VALVE OF FUEL (A B C) FACTOR Q 17. ELECTRICAL WORK BY: NAME ADDRESS SUBCONTRACTORS AND 18. THEIR TRADES ALL WORK COVERED BY THIS APPLICATION HAS BEEN AUTHORIZED BY THE (OWNER) OR (AGENT) OF THIS PROPERTY AND WILL BE DONE IN STRICT ACCORDANCE WITH THE BUILDING CODE. APPLICATION TO BE COMPLETELY FILLED IN. DATE SIGNATURE OF APPLICANT Electric# 104 CHAPEL RO PPLICATION FOR BUILDING PERMIT Plumbing# C4 ZA2- 4,D HVAC # 23393 Date: Sprinkler# NO' FINAL PRO V Estimated Cost $ O(.07 " Building I 1 13t9L T7 COMPLETE RED BOXED AREAS Permit Fee $ Engineerin TYPE OR PRINT ONLY Occupancy Fee $ Affidavit SIGN ON REVERSE SIDE Appr.for CO. Lift 6 'aYI N ? Total Fee $ �- TO BUILDING DEPARTMENT, TOWN OF SOUTH WINDSOR,CT (Additional Cost) $ Th undersigned hereby applies to do work according to the following specifications: Job Location Ab y_ (` "eA Lot No. Side of Street 1ii-1, 1-,Zone Applicant-G t I C"A. b•.G►wiv,... Tel.# Address ip i4 12 kwo e.( fZ1. S Uj%1'-d5o r Zip o&o71—Lic. # Own r eA-9 JaCt� Address__ Sc.n, c" Architect N I K Address Sq. Ft.New Area: 1st FI. LA 90 2nd Fl. 3rd FI. Total New Area #Rooms #Lavatories 0 #Bathrooms 0 #Garages a Purpose of this permit: v 02_0 , X t-D S-6 K: �� a `AA 5�-►• ma's r .. -� T t cv City Water C WellJZ Septic System �C Sewer J Use Group - Construction Type r / Basement Garage Approved Revised 6/95 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked, and agree that this budding is to be located the proper distance from all street lines,side yard lines and required distances from all other zones and is located in a zone in which this building and its use is allowed. Signed I hereby apply for a Certificate of Occupancy for the work described in this applicat n for the permit Signed -- DO NOT WRITE BE OW THIS LINE -- INSPECTION COMMENTS PERMIT DEPARTMENT DECISION APPLICATION FOR ELECTRICAL PERMIT Application is hereby : TOWN OF SOUTH WINDSOR BUILDING INSPECTION DEPT. APPROVED DISAPPROVED 1540 SULLIVAN AVENUE 644-2511 Ext . 230 ate 0ng Inbpector Application must be printed or typed 1 . LOCATION OF JOB /© y C& FEE SCHEDULE No . Street $ 0 - $19000 - $10.00 Floor Apt . No. Over $1,000 - $10.00 2 . OWNER /2 //✓ �J per $1 ,000 or - r�� fraction thereof 3. ADDRESS /Q !L C&69� 4. APPLICANT 5 . ADDRESS J�-,7d --0 cl 6. ESTIMATED COST $ �d 7 . IS THIS A CONTRACT COST s N 8. FEE ENCLOSED $ a33 9. TYPE OF BUILDING: RESIDENTIAL COMMERCIAL 10. TYPE OF JOB : Origin 1 Installation alteration<ditio Repair Rn 3A 11i88 APPLICATION FOR ELECTRICAL PERMIT (Continued from Reverse Side) 11 . LOCATION OF JOB /O 141 C1-W ,�C NO STREET APT. NO , 12 . TYPE OF INSTALLATION /- �I 13 . SIZE OF MAIN FEEDER _ 14 . NO . OF LIGHT LOOPS 15 . NO. OF HEAT LOOPS 16 . NO . OF POWER LOOPS 17 . NO. OF LIGHT OUTLETS Z 18 . NO . OF HEAT CIRCUITS 19 . NO. OF POWER OUTLETS 20 . NO. OF CONVENIENCE OUTLETS _ 21. NO. OF HEAT CIRCUITS 22 . NO. OF POWER CIRCUITS 23 . NO. OF LIGHT CIRCUITS 24. SIZE OF HEAT CIRCUITS 25 . NO. OF MOTORS 26 . NO . OF PANELS 27 . TOTAL WATTAGE 28 . NO . OF POWER FEEDERS 29 . NO. OF SWITCHES_ 30 . A/C LOAD 31. SIZE OF POWER FEEDERS 32 . NO . OF FIXTURES 33 . TOTAL HORSEPOWER 34 . NAME OF SUBCONTRACTORS AND THEIR TRADES 35 . REMARKS AND FURTHER DETAILS : A03 ;71(F LICENSE NO. SIGNATURE OF APPLICANT DATE PHONE NUMBER: �y7 �-���f� BActric# APPLICATION FOR BUILDING PERMIT Plumbing# 104 Cha_Ae 1 Road HVAC # Date: -T�Z�f Sprinkler# �• 2 3 6 5 4 FINAL APPROVALS Estimated Cost $ >�',j0 Building y yt 4/sb COMPLETE RED BOXED AREAS Permit Fee $ ILO Engineering TYPE OR PRINT ONLY Occupancy Fee $ Affidavit SIGN ON REVERSE SIDE Appr.for CO. Total Fee $ zj TO BUILDING DEPARTMENT, TOWN OF SOUTH WNDSOR,CT (Additional Cost) $ Th and rsigned hereby applies to do work according to the following specifications: Job Location 0 Lot No. Side of Street Zone Applicant 4, f Tel. #�m-53ab Address , Zip 6607CI Lic. # Own r 'G Z,w7& Address rt So. wi•t cJj a r- Architect Address Sq. Ft.New Area: Ist FI. 2nd Fl. 3rd FI. Total New Area #Rooms Z # Lavatories #Bathrooms #Garages Purpose of this permit: Aw`+-i �c.� yyy%, &✓060 City Water ` Well Septic System ❑ Sewer El Use Group PAJ114 Construction Type rV 4 Area / Basement Garage Approved by Date 2.6 G Rwamd 6/95 I hereby agree to conform to all the requirements of the Laws of the State of Connecticut and the Ordinances of the Town of South Windsor and to notify the Building Inspector of any alteration in the plans or specifications of the Building for which this permit is asked,and agree that this building is to be located the proper 4tance from all street lines,side yard lines and required distances from all other zones and is located in a zone 1 which this b ing and its use is allowed. Signed � ��+ 1 hereby apply for a Certificate of Occupancy for the work described in this application for the permit Signed -- DO NOT WRITE BELOW THIS LINE -- INSPECTION COMMENTS p, > Tertific #e Pursuant to Permit No. 9 a This Certifies that the Wood/Coal Stove installation for which the above named Permit was granted has been duly inspected and is hereby approved. Owner Brian Lawton Street Septeagber 2 4 , /� it g Inspector Property Of � C t 3RIAN P. & JAN T. I,Ak'"'Ql�,t 104 Chapel_ Rd , i So. Windsor Scal 1 "-40' i I hereby certify to First Federal Savings and Loan Assoc. of East Hartford and/or Conn. Housing Finance Authority and Conn. Attorneys Title Insurance Co. that an examination of the above 1 property revealed the followings 1 . Foundation located as shown 2. Premises does not conform to present Zoning requirements i A . Lot size- Variance granted Kay 5, 1985 B. Min, lot set back - 50' C Min. side yard - 20' �`, ' ...� .%: 3• No Zoning Violations �,�� �,wE TH�� ;„ Certified substantially correct o J(An H. Keithline, Jr. ''4L 10. Sol OOs . 7 p ` 01 IA � 0 A . QX ,'G to M _ _ -_r�.•.�. • .r wr.. ...w•w. ...... �..�. .... _ ....w..r w..�..... .....•.,rr•r..rr«w�.rr«.«r�.+•�+r wr r+��i ii i! •r,�. CERTIFICATION OF ZONING COMPLIANCE Proposed building(s), use(s) and/or structure(s) -s shown on this plan appear(s) to be In :onformance with current South Windsor ,;gulations. Variances and special exception-Z may apply, )ate 7 /,z 9C ._ g f cement Officer yxa� # ?3a 94 o� 10 THE BUILDING DEPT. TOW,,' 1-his certifi^d that this plan and spoc(fic t,.--s-re,ru, copies of the proposed building or aiteratiuns to bF orected at 'C 6 C/ Street t•)P'tiler w;t`i amen ruts stated in !pplicition an, ilc d ,`.Ili pl in ,and I grve to c.,mpl,i with :II zoning, :ildine rd st,te laws and such orders as sh,Jl tit d "y the iluii,,mg DUp,irtrncnt during pendency is ipplication and final iss ante of a building wrmit. lies plain 19 approved ubiect to the condition that )rd,,rs and ordinance regulating building shall be plied with. Conditionally Approved These filed with Building Inspector lark eatk i,__.__ No. -W330 Cl aveland Legal Blank Service,Inc. WARRANTEE DEED(Survivorship) 114SS East Hartford,Connecticut 06108 To all People to whom th s Pr s nts shall come, Greet-Inge 1 KNOW YE, THAT We, E JOHN J. LAWTON, JR. and SHIRLEY M. LAWTON, a of the Town of South Windsor, County of Hartford and State of Connecticut for the consideration of One ($1.00) Dollar and other valuable considerations, ;w received to our full satisfaction of BRIAN P. LAWTON and JAN C. LAWTON, of 93 Dover Road, in the Town of South Windsor, County of Hartford and State of Connecticut ,a do give, grant, bargain, sell and confirm unto the said BRIAN P. LAWTON and JAN C. LAWTON and the survivor of them, and the heirs and assigns of the survivor of them forever a certain piece or parcel of land, together with the buildings and improvements thereon and appurtenances thereto, located and situated on the northerly side of Chapel Road, in the Town of South Windsor, County of Hartford and State of Connecticut, and being more particularly bounded and described as follows, to wit: NORTHERLY: by land now or formerly of John J. Lawton, Jr. and Shirley M. Lawton, One Hundred (100) feet; EASTERLY: by land now or formerly of John J. Lawton, Jr. and Shirley M. Lawton, Two Hundred Fifty (250) feet; SOUTHERLY: by Chapel Road, One Hundred (100) feet; WESTERLY: by land now or formerly of Maude N. Carroll, Two Hundred Fifty (250) feet. Said premises are a"portion of land described in a Quit-Claim Deed from John J. Lawton to John J. Lawton, Jr. and Shirley M. Lawton recorded in Volume 107 at Page 12 o_ the South Windsor Land Records. •� Conveyance Tax received g 6' Conveyance Tax received q• s...vVr.�l' • •vs'"v L.J Town Clerk of South Windsor Town Clerk of South Windsor tOW N sE� ne s 1540 SULLIVAN AVENUE SOUTH WINDSOR, CONN. 06074 SOR•co AREA CODE 860/644-2511 July 23, 1996 CERTIFIED #Z262392685 Brian & Jan Lawton 104 Chapel Road South Windsor, CT 06074 RE: Appl. #2321-96 - Brian & Jan Lawton Dear Mr. & Mrs . Lawton: At the July 11, 1996 meeting of the South Windsor Zoning Board of Appeals, the Board approved your request for a 30 ' variance to Section 10.2 to allow for existing structure and addition 20 ' from front property line, A-40 Zone. The Board concluded the hardship on the property to be that the property pre-dates existing zoning regulations . Any new building, or alterations/additions to existing buildings require a building permit prior to start of construction. This action is effective upon your filing the enclosed form in the Town Clerk's office at your own expense. Very truly yours, e\ % )d �r. Jo ph J. Car o, Chairman Zoning Board of Appeals JJC:dr Attmt. cc: Building Department VOI. 007 PAGE 00'1 004305;9 r I, Joseph J. Carino, Chairman of the South Windsor Zoning Board of Appeals hereby certify that on July 110 1996, the Zoning Board of Appeals granted to: Brian i Jan Lawton, a 30' variance to Section 10.2 to allow for existing structure and addition 20' from front property line, A-40 Zone. on premises located: 104 Chapel Road and more particularly bounded and described as follows: piece or parcel of land, together with the buildings and improvements thereon and appurtenances thereto, located and situated on the northerly side of chapel Bond, in the town of South Windsor. County of Hartford and State of Connecticuts and bai.-.Q zest particularly bounded and described as follows, to wit: NORTHERLY: by land now or formerly of John J. Lawton. Jr. and Shirley M. Lawton, .Oas Hundred (100) feet; e EASTERLY: by land now or formerly of John J: Lawton. Jr. and Shirley M. Lawton, Two Hundred Fifty (250) feat; SOUTHERLY: by chapel Road. One Hundred (100) feet; WESTERLY: by land now or formerly of Maude N. Carroll, Two Hundred Fifty (250) feat. Said premises are a portion of land described in a Quit-Clain Deed from John J. Lawton to John J. Lawton. Jr. and Shirley M. Lawton recorded in Volume 107 at Page 12 of the South Windsor Land Records. OWNER OF RECORD: Brian P. i Jan C. Lawton Dated at South Windsor, Connecticut this 23rd day of July 1996. , u-Lcn_a r- Joseph J. Car' o, Chairman PUBLIC ACT 175-317 Received for Record this day of (Ir4t, 199(0 at oprn VOLUME (10 f PAGE TOWN CLERK 1.,L._:.�Q -),Rclluaal ;:1t TGAI CLERK HOME OCCUPATION FORM Minor ZEO Approval Date A� 00/193M7 ASSESSOR'S USE ONLY: Major PZC Approval Date Home Occupation Type Expiration Date Code NameLVr �+ I Address of proposed occupation: Telephone 2222"�5,i c D Zone �d Description of Occupation: !,;7 if n ia46 efYP7 si s A PROPOSED SIGN Please use the boxes or an attached sheet to provide the following: 1. Attach copy of plot plan if applicable. 2. Use box A (or attach sketch)to draw proposed signage . 3. Use box B (or attach sketch) to draw the floor plan of the home occupation area. Y)O 4. Architectural elevations for any proposed additions or modifications must be provided. B. FLOOR PLAN (Basement 1st Floor 2nd Floor) Floor area of dwelling 20 Floor area of home occu anonf % of floor area I have read the regulations regarding home occupations and intend to comply with said regulations. I understand I must notify the Planning Depar ent ' writing upon termination of this occupation at this address. � Signature of Applicant Date 0,�G�-7` Signature of Owner Date White = Assessor Yellow = Applicant Pink = Street File