HomeMy WebLinkAboutBLD-81-670 ► r1) 4 70
Application for aPermit to Build No.
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/� 'Fee must accomp y this application
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TO THE BOARD OF SELECTMEN .
The undersigned hereby applies for a permit to build, according to the following specifications: ,.
1. Name of Owner EP /A/ F. N- LR ROE S. SI•larttcp Address . / , L/Cff-rWouSe M—VD •
2. Name of Architect (if any) -
3. Name of Builder .SEL F-
4.
4. Precinct No. 3 Lot No. G Nan: Name or No. A.M . 67- 14
5. Name of Street/ L/6{tT#o USE Bc.VP• 4 jef
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6. Purpose of Building SI-07)/0
7. Material WOOD SKEW-/ oc/d •
8. Estimated cost of building $2.5o0. Oo .�u0l0 O r.l
9. Dwelling �n F''0 C
10. Cottage .�t�y}" /6/x o/ _
11. Heat FOR CES fi'or W*TE R / -'V
12. Basement
2 A o
13. Garage
14. Store 5
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15. Shop .
16. No. of stories 2-
17. Is there to be a Store in the lower storey MO
18. Size of Lot. No. of feet front No. of feet rear •No. of feet deep
19. Size of building. No. of feet front 70 No. of feet side ZSd- 2-0 No. of feet rear 70
20. Distance from nearest building: Front ft.; side ft.; side ft.; rear -
21. Distance back from line or street from rear lot line , side line
Show by diagram the location of propsed building with relation to dista s from adjoining lots, on reverse side.
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Address / *"yyam�-#1.4"--/ang,,. y:24' ! /kin
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Street Name
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O Left Side Depth of Lot
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Right Side Depth of Lot
Street Name
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APPLICANT: a-PGd/1,/ F 5h'EP,4-g.D BLDG . PERMIT NO.
LOCATION OF PROPERTY:/L/c//7310056 !RL✓73 So, yne,�loum ,y f DATE FILED: /o/6/8'/
,S A.M . 6'1- L6
THE/FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN
INDIVIDUAL MUST FOLLOW IN ORDER TO OBTAIN A PERMIT TO BUILD OR ALTER A
BUILDING. THE BUILDING DEPARTMENT WILL CHECK ON THE FOLLOWING: (A) CON-
SERVANCY DISTRICTS (B) HISTORICAL DISTRICTS ( C) FLOOD PLAINS ZONING, AND
WILL BE RESPONSIBLE FOR ASSISTING THE APPICAIJT THROUGH THE FOLLOWING
AGENCIES.
1. RES IDEIJTIAL BUILDING:
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS
FOR SEWAGE DISPOSAL.
B) CHECK WITH CONSERVATION COI.4dITTEE IF THE LOT BORDERS ON ANY TYPE
OF -WETLANDS. EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS,
MARSH, ETC.
2. COTCMERGIAI,.:BUILDING:
A) EIIGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS,
TOPOGRAPHY SITE PLAN REVIE.7.
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS.
C) PLANNING BOARD-TO SEE IF LOT COLTLIES WIT i ZONING BY-LAWS .
D) BOARD OF HEALTH-FOR SE','1AGE DISPOSAL REQQUIRESJTS, HEALTH RELATE
ACTIVITIES . EXALTLES: SAUNA BATHS, SWIMMING POOLS, RESTAURANTS,
HI'C.
E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY,
(SPRINKLERS, SMOKE DETECTORS) .
=IT BY:
;. . ✓�rTCz:IEERING DEPARTMENT: YES(DOES NOT APPLYSIGNA`I'UR /. .. L •;, ', to
DATE /6 fel
2. CONSERVATION COMMITTEE: YES DOES NOT APPLYfSIGNATUR: (L.t M, IATE4
3. PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE "/
4 . BOARD OF HEALTH: YES DOES NOT APPLYSIGNATUREA DATE /916/8/
5 . FIRE DEPARTL'ENT: YES DOES NOT APPLY SIGNATURE DATE
CO?MEN?S: \
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