HomeMy WebLinkAboutBLD-81-795 •w Det( 6e.bi. 7 / LC
. Application for a Permit to Build No.
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TO THE BOARD OF SELECTMEN _
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The undersigned hereby applies for a permit/rtop build, according to the following specifications:
1. Name of Owner P3 of W,L�j//4/i Address /9,41/e4,41/6-1
2. Name of Architect (if any)
3. Name of Builder
i4vmod9" 6.01147
4. Precinct No. 4. Lot No. 84. Plan: Name or No. A.M. 44 _ma E$4.
5. Name o[ Street 11 A5colt/ ,dE
6. Purpose of Building Sim/ ,Op v!
7. Material &flew/ Son 2,aOr. o,uLy /,..X s&'
8. Estimated cost of building ,GSD 00
01/:.3 D
9. Dwelling / a
10. Cottage y i i3 5 _
11. Heat /Vele
12. Basement /YO/fier
13. Garage
14. Store
15. Shop -
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16. No. of stories /
17. Is there to be a Store In the lower storey ,o ^
18. Size of Lot. No. of feet front .....£3 0 No, of feet rear ST G No. of feet deep 2/c.?
19. Size of building. No. of feet front 5 5-- No. of feet side "1.'2 No. of feet rear
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 distances from adjoi d�ing ts, n rev side.
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Address...l.3.. ��9!.X< i .A`/
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. Rear of Lot -
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Frontage of Lot ,
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....................... .1‘...73 J-t ! 11(., Jilt: . .......street Name ' ,://led res,/,.,. .„.,,, ,...,...... moll try.li L.) .0;1 .:vni,:ii,d la sste &I.
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PLOT PLAN '
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Al5PLICANT: 4'lf` waS4V51P BLDG . PERMIT NO.
LOCATION OF PROPERTY: /9 ////e64, /-fid!% DAmE FILED: ,ll1 l£l/
f� M. 44-684- /
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 .'.ILL CHECK ON THE FOLLOWING: (A) CON-
SERVANCY DISTRICTS (B) HISTORICAL DISTRICTS ( C) FLOOD PLAINS ZONING, ANn
WILL BE RESPONSIBLE FOR ASSISTING THE APPICATIT THROUGH THE FOLLOWING
AGENCIES.
1 . RESIDENTIAL BUILDING:
A) CHECK WITH THE HEALTH DEPART:'ENT IN REFERENCE TO SEPTIC SYSTEMS
FOR SEWAGE DISPOSAL.
B) CHECK WITH CONSERVATION CO"rTITTEE IF THE LOT BORDERS ON ANY TYPE
OF -WETLANDS. EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS,
MARSH, ETC.
2. COT, TERGIAI,./BUILDING:
A) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQTIIREM.ENTS,
TOPOGRAPHY SITE PLAN REVIEW.
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS.
C) PLANNING BOARD-TO SEE IF LOT CO'TLIES ', ITR ZONING BY-LAWS .
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATE
ACTIVITIES. EXAMPLES: SAUNA BATHS, S::"I MING POOLS, RESTAUR.AN?S,
ETC.
E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, -
(SPRINKLERS, SMOKE DETECTORS) .
R IEWED BY:
ENGIITEERING DEPARTMENT: YES ✓DOES NOT APPLY SIGNAT'JRi , k .1�._ ATE/1z (
2. CONSERVATION COMMITTEE: YES DOES NOT APPLY /AGNATUF' J .1 _ '!ATEnhgi
3. PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE ! f
pn
BOARD OF HEALTH: YES DOES NOT APPLYSIGNATUR y��pUyaDATEn4
5 . FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMLIENTS: