HomeMy WebLinkAboutBLD-80-058 ! P _ ' OR / D§' j
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e Application for a-Permi o Build No.
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'Fee must accompany this -pplicatton
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
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1. Name of Owner d t/R-LE- a,dd s ,,., PKWY
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2. Name of Architect (if any) '
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3. Name of Builder
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4. Precinct No. 3 Lot No. ✓ 00 Plan: Name or No. /2,9f q ni/f
5. Name of Street Cl_ 0,, Q/V C/L 0,412.,0 way
6. Purpose of Building :b
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7. Material
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201-
8. Estimated cost t,ir
9. Dwelling _ o /lai•Tieel
10. Cottage 5's
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11. Heat.., e o Heir WATt t 61'/ oltc� /
12. Basement
13. Garage 1
14. Store
16. No. of stories / -
17. Is there to be a Store in the lower storey Ali
18. Size of Lot. No. of feet front ./.39. No. of feet rear prrx? No. of feet deep .1.EP
19. Size of building. No. of feet front /a No. of feet side /7/ No. of feet rear
20. Distance from nearest building: Front ft.; side ft.; side ft.; rear
21. Distance back from line or street S g , from rear lot line r1...S , side line I' �. •
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side. . ; ;
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Address gc., 8fr'' ' o/t/e 2 0iC G./i12 'r t
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Rear of Lot
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Frontage of Lot :....L.3 7
, Street Name 9,oss "f' y` rte.?, ,
• PLOT PLAN
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BUILDING ?G :IT 'DC:=
,( BLDG PERMIT N0:
AF?LIGAtiT:_ p/in) • T 4U2t.-- /E _' - --
LOCATION OF 'PROPER TY: 023. SS ____ `- DATE. FILED: '
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)' CONSERVANCY DISTRICTS (B)':` HISTORICAL-- --
DISTRICTS (C) . FLOOD' PLAINS ZONING, 'AND WILL BE RESPONSIBLE FOR ASSISTING THE ,'. : -
APPLICANT THROUGH THE FOLLOWING AGENCIES, -
F . RESIDENTIAL QUILDING:
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERRENCE. TO SEPTIC SYSTEMS FOR SEWAGE - •
RDISPOSAL r
•B) i CHECK WITH CONSERVATION -COMMITTEE IF THE LOT .BORDERS ON ANY TYPE OF WETLANDS.
. EXAMPLES: STREAMS, PONDS, RIVRS, ' OCEAN, 'BAY, BOGS, MARSH,. ETC-
C) CHECK WITH PLANNING BOARD 'TOR LOT .RELEASE.:;c'-_ .. . - . . ' °--
2. COMMERCIAL-BUILDING '_--- - .: _'_ : .:.: :- :t-71.-.
. ,
A) I.ENGINEERING DEPARTMENT FOR--PARKING AND DRAINAGE •REQUIREMENTS, TOPOGRAPHY SITE _
PLAN REVIEW.' \
B) CONSERVATION COMIMITTEE-IF LOT BORDERS ANY TYPE DF WETLANDS, . - . • _ .
. C) PLANNING BOARD-TO SEE IF LOT COMPLIES WITH ZONING BY-LAWS.
0) BOARD OF HEALTF'.-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) . • -
1.
. - ---T•-_-.2:-i-___ - - - - :
ENGINEERING DEPARTMENT YES7 DOES NOTAPPLYSIGNATURE -= - DATE -
'ONSERVAT1ON COMMITTEE: • YES -- .DOES NOT.APPLY__ -
SIGNATURE d ' DATE D.
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PI ANNING ROARD- - YFC 11(1FCNnT nPPI Y • [Tr'.�fTJIP •- /_yr -- nnTG- . :
BOARD OF HEALTH: YES LDOES NOT APPLY SIGNATUJ3 � /xi -
p ‹ * DAT,E,2„ -
FIRE DEPARTMENT: • YES____DOES NOT APPLY_ SIGNAT
. .� • DATE
OMMENTS: :.
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