PBSP
SPECIAL PERMIT FILING CHECKLIST
Applications will not be
stamped in at the Town Clerk's office for the Planning Board, until the
Planning Department determines that the following items are included with the
application:
1. Application
must be filled out completely and correctly.
(Map and Parcel must be included and can be found in the Assessors
Office) Attachment 1
2. Special Permit
filing fee. Checks payable to the Town
of
3. Plan drawn in
accordance with the requirements listed in the Town of
4. Abutters List
Request form must be completed (Assessor
will be notified when application is stamped in by the Town Clerk) Attachment 3
5. A complete submittal
checklist must be submitted along with copies of plans:
Attachment 2
IMPROPER OR INCOMPLETE FILINGS
WILL RESULT IN A DELAY IN DECISION, TOWN CLERK WILL SIGN AND STAMP AFTER
PLANNING DEPARTMENT SIGNS OFF.
____________________________
Planning
Department
____________________________
Town
Clerk
Attachment
1
TOWN OF
APPLICATION FOR PLANNING
BOARD SPECIAL PERMIT
A REGISTERED PLAN MUST BE FILED WITH THIS APPLICATION FORM
Date _______________
Applicant: _________________________________________________________________________________
Full name Address phone number
Applicant’s E-mail Address:___________________________
Owner: ___________________________________________________________________________________
Full name Address phone number
Lessee: ___________________________________________________________________________________
Full name Address phone number
Tax Map # _________
1. Location of Premises: _________________________________________________________________
2. Zoning District: ______________________________________________________________________
3. Parcel Size: ________________________________
4. (Cluster applications only): Applicable Land Area: ___________Open Space Percentage: ___________
5. (Cluster applications only): Number of Affordable Units: ____________ % of Affordable Units: _______
6. Number of existing buildings on parcel: ___________________________________________________
7. State proposed use of premises: __________________________________________________________
____________________________________________________________________________________
8. Zoning by-law provision under which application is made: ____________________________________
____________________________________________________________________________________
9. Other Permits Required and Status of Applications: __________________________________________
____________________________________________________________________________________
10. Special Permit Plan Waivers Requested: ___________________________________________________
____________________________________________________________________________________
__________________ ________________ Received:
Signature
of Applicant Signature
of Owner
_________________Town Clerk
Attachment
2
Before any Special Permit application can be filed at
the town clerk's office, the following departments must receive the specified
information and sign below that the information has been received. Departments have 14 days within which they
may comment on the proposed plan.
Board
of Health
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Fire
Department
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Department
of Public Works
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Building
Department
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Conservation
Commission
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Police
Department
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
Assessor's
Department
(1
Sets of Plans) Received By:
_________________________Date: _______________
(1
copy of special permit application)
Planning
Department
(1
Sets of Plans) Received By:
_________________________Date:
_______________
(1
copy of special permit application)
DATE REQUESTED: In
Person ____
By
Phone ____
PROPERTY ADDRESS:
APPLICANT:
PURPOSE
(BOARD):
Board of Assessors
DATE: ______________, 2001
To Whom It May
Concern:
The attached list of
abutters, as submitted, as to the property of:
Located at:
Shown as Map ,
on the most recent
Assessors Tax Rolls (January 1, 2001) is correct to my knowledge and belief.
Assessor’s Clerk
ABUTTERS LIST AND
LABELS RECEIVED:
BY: ___________________________ ON: _________________
_______________________ ON: _______________
_______________________ ON: _______________
mydocs\\Assessor\c\ABUTTERSLISTREQUEST.doc