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Application No.
j4,� � � pp for a Per it to Build 1Q�
"t` / fee must accompany is application wA
Yarmouth MAetU//ma�c 19$0
TO THE BOARD OF SELECTMEN ,
The undersigned hereby applies for a permit t`ob/uild, according to the following specifications:
1. Name of Owner Mits. DAdWA� Y`)/Jt Up* ` t Address 79 ELLA5 CIeet MA oz6�S
,t y�Ae itO t ti Fbe-r,
2. Name of Architect (if any) A[\R SsoupirES /
3. Name of Builder ')1EVE {}t red
4. Precinct No.
2.. Lot No. Plan:.Name or No.
IIP>- i.e
5. Name of Streetr)f.cta 5 C(tCL 7.! ` ) r:
p 5, See r';
6. Purpose of Building SUJJ Ro n M Av p e 1.... H , -t '
7. Material rf-rtt4 Jr
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8. Estimated cost of buiidin4 LJ"
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9. Dwelling . . _... • /•• j.•
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10. Cottage 1 , 1` 1,.. . ,` {a ,
11. Heat • twee_ . 6P 5C t' D 4, , s
12. Basement NO 17.1'
13. Garage �. .... ` :., ._..
14. Store
• 15. Shop
16. No. of stories ,
17. Is there to be a Store in the lower storey
12D
18. Size of Lot. No, of feet front 100 c.1 .No! of feet rear 10Q1 0V No. of feet deep .f
CEX. ROUSE t-AVD,Kltt o.p ti)p" lib �Q
19. Size of building. No. of feet front �...1..!,�.. No. of feet side .7 No. of feet rear .. . .r
hh� 1f l F I f
20. Distance from nearest building: Front ft.;
'!ft.; side jQ.Qft.; side ft.; rear
.tions£f Ar ict0 . tf 1 f COM" 8�
21. Distance back from line or street from rear lot line .....l..C , side line V? C
ZOO/PG 1
Show by diagram the location of propsed building with relation to distances from djoiningdjoilottss,on reverse side.
Name .a//� YG..iilff/f {��/,+r�J�.—
Address20 1..44/4/...1 .... f i 4 7 kl rL2:f`-•�
_ Street Nam`
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Application to 1_ r$
,01 OPEC pP f 4�� '
. ,
Old Kings Highway Regional Historic District Committee
e �+ • r • in the Town of Yarmouth for a
CERTIFICATE OF APPROPRIATENESS
Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEG�ES THAT APPLY:
1. Exterior Building Construction: 0 New Building Addition ❑ Alteration
Indicate type of building: 0 House 0 Garage ❑ Commercial 0 Other
2. Exterior Painting: 0 •
3. Signs or Billboards: ❑ New sign 0 Existing sign 0 Repainting existing sign
4. Structure: ❑.Fence 0 Wall ❑ Flagpole ❑ Other
(Please read other side for explanation and requirements).
TYPE OR PRINT LEGIBLY DAT
ADDRESS OF PROPOSED WORK C�I1R�CLE/YA�AASSESS P N0. li
OWNER ' "� " A^R,� WIM5t-0 YY • ASSESSORS LOT NO.
HOME ADDRESS T' TEL. NO.
•
FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
street or way. (Attach additional sheet if necessary). •
Mee, fr-MA L trt� ELS
s,1 ' c1ecL6) 'PACS Rona" F
f ►srt-, 3t) ECUs
CIecLE (% 2t�+ tdt ceiaLevc)):. Mrct. LxEgsrr %es*/ 92 Mhirls
V JVE Exterwev ( o 'erti7eW I Mk.N >`-Y :WWA ER Sox 95 •
:K-0O FI ►� • •i; 015 conv5 ' b t . , .q . 'a , Piro a, -- 15
AGENT OR CONTRACTOR ,4 KKo AI�),�pj�rV�C'A-t-cs TEL. NO. _ CI�C�
"/
ADDRESS 0 Mp iN ) M:M
5rt OO-r { foer `
DETAI LED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done(see No. B,other side), including
materials to be used, if specifications do not accompany plans. In the case of signs,give locations of existing signs and proposed
locations of new signs: (Attach additional sheet,if necessary).
•
_ 4&„
Signed
Owner-Contractor-Agent
Space below line for Committee use.
Received by H.D.C.
Date / The Certificate is hereby g, f-CD Date &/ . 6 /12)
Time �� \-6 �� - PI?
1 �/'.`
/ 2$714 1
Approved IMPORTANT: If Certificate is approved, approval is subject to the 2d day appeal period
provided in the Act. ��a
Disapproved Please return to: Yarmouth Historic District Committee (/
P.O. Box 124,Yarmouth Port,Mass.02675
•
ADDITIONAL INFORMATION FOR MAKING AND FILING AN APPLICATION
FOR A CERTIFICATE OF APPROPRIATENESS,"
•
The four categories for which a Certificate of Appropriateness is required are: (application for demolition or removal is a
separate form).
1. EXTERIOR BUILDING CONSTRUCTION (new or existing buildings): An application is required for any exterior of a
building to be erected or altered including windows, doors, siding, roof, light etc., that will be visible from any public street,
way or public place. The following scale drawings are required in duplicate with application: plot plan (if addition — show
existing buildings in outline), floor plan and elevations. Also required are snap shots of existing buildings, where additions or
alterations are to be made. No plot plan is required for addition or alteration which does not touch the ground.
2. EXTERIOR PAINTING: An application is required for any portion of a building, structure or sign to be painted that is
visible from a public street, way or public place. Color samples must be attached to these applications. An application is not
required when repainting existing colors, changing to white,or using colors approved by the Town Historic District Committee.
3. SIGNS OR BILLBOARDS: An application is required for any sign or billboard to be erected within the District, with the
following exceptions:
a. Existing signs or billboards on November 27, 1974 shall have until November 27, 1977 to secure an approved Certificate
of Appropriateness.
b. Temporary signs for use in connection with any official celebration or parade or any charitable drive as long as they are
removed within three days of the event Certain other temporary signs that the Committee feels does not detract from
the Act may be allowed with the prior permission of the Committee.
c. Real Estate signs of not more than 3 square feet in area advertising the sale or rental of the premises on which they are
' • erected or displayed.
d. A single sign of not more than 1 square foot in area showing the name, occupation or address of the occupant of the
premises on which they are erected or displayed in a residential zone.
4. STRUCTURE: An application is required to build or alter any structure within the District which is defined by the Act as a
combination of materials other than a building, sign or billboard, but including stone walls,flagpoles,hedges, gates, fences, etc.
• GENERAL REQUIREMENTS
•
5. Work on projects requiring approval shall not be started until the Certificate of Appropriateness has been filed with the Town
Clerk by the Committee. Approval is subject to the 20 day appeal period provided in the Act.
•'•1
6. No changes shall be made from the original approved specifications without advance approval of the Commission on an
amended application filed with the Committee.
7. A separate application'must be filed with each project requiring a Certificate of Appropriateness.
8. Under heading of "Detailed Description of Proposed Work" give detailed data on such architectural features as: foundation,
chimney, siding, roofing, roof pitch, sash and doors, window and door frames, trim, gutters—leaders, roofing and paint color.
9. Unless application is complete and legible and all material required is supplied,application will not be accepted or acted upon.
s.,
Copies of the Act establishing the Regional Historic District may be obtained at the Town Hall.. ,
,
4
••" .
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•
,•-, BUILDING PERMIT REVIEW
APpLICANT: `•..s-0,R ."*A.'"‘"1/41 ".""-****.". hM :!*1 *t i". ` .�p
- ?" , } BLDG PERMIT NO:
LOCATION OF PROPERTY: 11 r:I!_1r: Cir`ct: rt DATE FILED: It/r/WO
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 i -
DISTRICTS (C) FLOOD PLAINS ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE r -
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: _
A) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY, SITE ` -
PLAN 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). -
REVIEWED BY
1 . '4NGINEERING DEPARTMENT: YES 1. DOES NOT APPLY SIGNATURE , < f, 4:: DAT
2. (CONSERVATION COMMITTEE: YES DOES NOT APPLY ✓SIGNATUR'4119We' DAT i�po
•
3. PLANNING BOARD: • YES_DOES NOT APPLY_SIGNATUU .
� 'DATE .
• 4.�OARD OF HEALTH YESC- DOES NOT APPLY_SIGN'UIil !. ---- DATE0t2
5. FIRE DEPARTMENT: YES DOES NOT APPLY SIGNA ••E . DATE . -
COMMENTS: . r
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