BLD-80-083 �- �e 10 y (of x
�r'\ Q' /` 3
S�.: � Application for a Permit to Build No.
Fee must accompany this a kation t -
Yarmouth 1_Yr'-`0 a..., 19.2.0..
a-ai-
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner 31-I
1 f I eV� rn' as C`'`O` & Address 3't CRC" "x:\neaa-t)r
2. Name of At 1/4Aa,4-nn.O J'ern,
chitect (if any) ...
3. Name of Builder
4. Precinct No. 2, Lot No. fo I Plan: Name or No. / o 2. - 1)61
5. Name of Street fro whep-sl--- ri tjaa_cYna°131-
6.
)l_6. Purpose of Building 'BCI a a o m " Cos a- c -e-
7. Material tin;ng e 5 --
(I
8. Estimated cost of building 15'a o —
--- 1�
_ 9.9.-- Dwelling—
1 d .•
10. Cottage
11. Heat.- noose he e - O
Cl,
12. Basement +'c a /
13. Garage 4�,�
14. Store
15. Shop
16. No. of stories 1
17. Is there to be a Store In the lower storey,_.'tl p _ ,
3..
18. Size of Lot. No. of feet front t Q.cl..n c No. of feet rear 1- (). 9 t No. of feet deep ... \7 a.:o,a
19. Size of building. No. of feet front Fes" No. of feet side 11 ck No. of feet rear Va-
.S- Sl?J�a l 4..�.; side
20. Distance from nearest building: Front ft:; side.. k ...ft,; side ft.; rear
21. Distance back from line or street.A.-fkr' .5i...X, from rear lot line side line 33- IA
Show by diagram the location of propsed building with relation to distances f �m adjoining lots, on reverse side. o/)
Address 1,17 . ra"�"
a,2-9S/d G�
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• . .. i
'
, ' Rear of Lot 1.31:2• 0'00 7e-d- : r : , . ; .
•
•
,o, I
c„.....
C f q
1 O
c • 1 a
1
a
mt ,, ,,
v W s ' 2
4
Frontage of Lot ,,.11).Q..,0,1, %-f��
•
•
Street Name.R.ccowhQ4 Tt•.
1
•
PLOT PLAN
•
BUILDING PERMIT REVIEW
$ AP2L�.CANT: S\1:vl -111, e '� BLDG PERMIT NO:
LOCATION OF PROPERTY:
- 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 WILLCHECK. ON•.THEFOLLOWING:• (A) „CONSERVANCY DISTRICTS (B) ; HISTORICAL '
DISTRICTS (C) ,4 FLOOD PLAINS*ZONING, AND WILL- BERESPONSIBLE FOR ASSISTING THE •°
APPLICANT THROUGH THE FOLLOWING AGENCIES ;.
1.: RESIDENTIAL BUILDING:, ', _'
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE
DISPOSAL.
B) ,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 FOR LOT RELEASE , -`
2. COMMERCIAL'BUILDING i.
A) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE
PLAN REVIEW : >
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS. ,
PLANNING BOARD-TO• SEE IF LOT COMPLIES WITH ZO
• NING BY-LAWS.
• ) 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) • "
REVI ED BY: • ;Jr
1 . GINEERING DEPARTMENT SI
YES ✓ DOES NOT APPLY GNATUREy ' u$ -• DATE Z1 86.
+ ' 2. ONSERVATION COMMITTEE YES DOES NOT APPLY/SIGNATURE �__• e A • DATE221 $0
3. PLANNING BOARD: YES DOES NOT APPLY_SIGNA�T - DATE • -
4. BOARD OF HEALTH YES DOES NOT APPLY IiSIGN AMIT„, ze 'G DATt:y` ".
5. FIRE DEPARTMENT: YES DOES NOT APPLY SIGNA ••E • DATE
COMMENTS: ' Y