HomeMy WebLinkAboutBLD-80-039 6;:j. 1/4
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cI Application for a Per it to Build
Fee must accompany this plication
Yarmouth / 43 194,41..
/-� 3 — ore)
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner V, LL/Ft 77; A. SEGEIt m4.n Address 19 %//wp iT£2. ne3 So •wa4"n -
2. Name of Architect (if any) n+mr+4..
3. Name of Builder 2 Fa2q'n of i
4. Precinct No. 3R
Lot No. IS Plan: Name or No. sheer el
5. Name of Street//// OO Jwp,Tf2 LA
6. Purpose of Building FLO tlekai (400w
7. Material (.<WOodd, gLas`a-SCn.EC1
est. l�
8. Estimated cost of building /01 OO
9. Dwelling 'Yn j Ii ou se
10. Cottage ""t1,0
11. Heat CS /o Q
12. Basement M 0
13. Garage m 0
14. Store MA
15. Shop in
16. No. of stories 0.)1 fi
17. Is there to be a Store in the lower storey MO
18. Size of Lot. No. of feet front .420 / No. of feet rear ...../.10 No. of feet deep ../.../
19. Size of building. No. of feet front LP-) No. of feet side /a / No. of feet rear ....L v4
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 adjoining lots, on reverse side.
"4.011 7:3oR) b. Name..is-24- "^d 'd.• P.7'mctm7
Address.../c1 Ja,„al) gang. . S4
Skeet Name Jii_ja trc e-- it7-16.--,
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r „ , /
0 Left Side Depth of Lot (A/ •
--I
i- I •011 MO an
X. Da
‘ = t
...
ii,.... .
Cn "I C6in
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a a
Z i C
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1 ic ( . -77 _-7-.... ---- .z. •
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tp
511 re - at
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.... .-- 7e
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Right Side Depth of Lot .../.// I
•
, .-, .., /n.,...
Street Name F.J.V.-F) i "I” .r7 "Ce
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BUILDING ?:-.RM: r REQ'. -
•
ArPLICP:NT: a•----- -- --- • BLDG PERMIT NO:
LOCATION OF •PROPLRTY:1y_:J - do.,sa 0y• c'sc__�__ : , '•- DATE. FILED: • _________
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED 70• 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)' CONSERVANCY DISTRICTS (B):-'HISTORICAL'.
DISTRICTS (C) . FLOOD PLAINS- ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE _ • -
APPLICANT THROUGH THE FOLLOWING AGENCIES,
I . RESIDENTIAL BUILDING: •• ' ••• -
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE. TO SEPTIC SYSTEMS FOR SEWAGE ' •
DISPOSAL. :,
• -6) CHECK WITH CONSERVATION COMMITTEE IF THE LOT .BORDERS ON ANY TYPE OF WETLANDS.
• EXAMPLES: STREAMS, PONDS, RIVERS, - OCEAN, BAY, BOGS, MARSH,. ETC- _
C) CHECK WITH PLANNING BOARD FDR LOT 'RELEASE:-_;c-_ .- -- _ -_ _ _ -
2_ COMMERCIAL BUILDING
A) ENGINEERING DEPARTMENT -FOR. PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE
PIAN REVIEW_ _ \ - _
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS; - -
. C) PLANNING BOARD-TO• SEE IF LOT COMPLIES WITH ZONING BY-LAWS.
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES. •
EXAMPLES: - SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC. . -
-E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE '
DETECTORS)_ _.
,- ENGINEERING DEPARTMENT YES /DOESNOT APPLY_SIGNATURE' 4-Y- n DATE 'Jtr.
CONSERVATION COMMITTEE: . YES .DOES NOT.APPLY VIGNATURE /J :, ` Jgiti : DATEOi/fl
: —�
_ ' PLANNING-BDARC `""YES - F,s--N-D -A-R-P-6Y-X54.6NAT1IR -7-'1::- -- 1; - ./
- BOARD OF HE.4LTH: YES_DOES NOT APPLY_SIGNATURE . DATE
- FIRE DEPARTMENT: • YES_DOES NOT APPLY SIGNATURE . • DATE
OY.MENTS: . .
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