HomeMy WebLinkAboutBLD-80-134 cktt\S° it Application for a Pe it to Build No.
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Fee must accomp. y this application
Yarmouth r" ^l'•Z, •19
TO THE BOARD OF SELECTMEN
The undersigned hereby
/ applies for a permit
to build, according to the following specifications:
1. Name of Owner l/ a l C r �" ` �D Address /.2 J/,1 " P�frala—
2. Name of Architect (if any)
3. Name of Builder l/(/U J e227 fr/ v ea v
4. Precinct No. / Lot No. Plan: Name or No.
5. Name of Street n��v1 n1 `wQr ✓
6. Purpose of Building 614 f'�_ I` C-
7. Material
459/4
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8. Estimated cost of building Z /4 1;4 0,r,o, Sn rf cr
9. Dwelling 6cl'GH U t 42 d ere
io. cottage bt `
ala tr f aJJAfQ
11. Heat g t r'S;•)�'
12. Basement
13. Garage ,
14. Store
15. Shop
16. No. of stories
17. Is there to be a Store in the lower storey
18. Size of Lot. No. of feet front • No. of feet rear No. of feet deep
19. Size of building. No. of feet front No. of feet side 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
•• ances from add nniiing lots, on reverse side.
• Name. f./��Ll� .. Sf�f/.f«.�/`tic'LCi {�'
Addressf..rel.i ./. ....4 .N..:�.Ll. �9P l
Street Name
v
o Left Side Depth of Lot
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z
Cee
z
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.- s .• m
m 2
0
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0
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r "
/r 1
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Right Side Depth of Lot
•
Street Name
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BUILDING PERMIT REVIEI: .
APPLICtpiT: he• /IXplv . d r •- • • BLDG PERMIT NO: -
LOCATION OF 'PROPERTY p/�irrrivxl S fiti�,� ' • DATE FILED /��j` •
- 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:;;-`-ti- =
-DEPARTMENT 'WILL� CHECK ON .THE: FOLLOWING:• (A); CONSERVANCY DISTRICTS (B)-:•;. HISTORICAL _
DISTRICTS (C)T FLOOD PLAINS-'ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE, -
• APPLICANT THROUGH-THE FOLLOWING AGENCIES _ -
Y J.
--
1. • RESIDENTIAL BUILDING: ` r - • • • • `
A) CHECK WITH THE HEALTH DEPARTMENY_ IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE.
' , ' - DISPOSAL -
B) +CHECK WITHCONSERVATION (COMMITTEE IF THE LOT BORDERS ON ANY TYPE OF WETLANDS -
•- i•, EXAMPLES:• STREAMS, PONDS, _RIVERS, -OCEAN, -BAY, BOGS, MARSH,. ETC: •.--_-;,-:••-•` -.. • .-
• C) CHECK WITH-PLANNING BOARD 'FDR LOT RELEASE ' t
• 2. -COMMERCIAL-BUILDING ,r, . , - 'z_ • ` , r r
• ,_A) • ENGINEERING DEPARTMENTFOR PARKING AND DRAINAGE REQUIREMENTS, TOPOG PHY SITE
r r`', PLAN REVIEW: r : 4 - .t• - r` -
B) CONSERVATION COMMITTEE IF LOT BORDERS ANY TYPE OF WETLANDS - _
SEEC) PLANNING BOARD TO 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 t•
DETECTORS) :- - -
REVIEWED BY •_• y . ,: • F• . __ .D>._- t � --
1 ENGINEERING DEPARTMENT YES` DOES NOT APPLY_ GNATURE7 rrs - � DATE
2 CONSERVATION COMMITTEE:_ ..YES DOES NOT APPLY" SIGNATUR ,,, DATQ-
3 PLANNING BOARD YES " DOES NOT APPLY SIGNATUray; : DATE--• ••
L. BOARD OF HEALTH YES DOES NOT APPLYisi/SIGNATU' .ii./� �✓ i;�elr DATES-e/
5. FIRE DEPARTMENT: - YES DOES. NOT APPLY_SIGNAT ` • - DATE -
S 1!/, J - is -Op c•cuov o .ONG ' t- pt.
Z.Slefe--eb; "Forme dS6" ' .std" jr---EIV-r �}.i i. _.
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