HomeMy WebLinkAboutBLD-80-171 •
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l91D N° 1..
/ � .7E Application for a Permit to Build
Fee must accompany this application G
Yarmouth 7 /7 19.r)
9-7—ced
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner W/{Y A/C (c/A.G fl45 Address ot 7 lv/L d 4165 S 2' t.E°rftC
2. Name of Architect (if any) a -
3. Name of Builder floJag1
4. Precinct No. q2. Lot No. KC-tc Plan: Name or No. A.M. 8$-Kis
5. Name of Str6% W lip Ron TittAce.
6. Purpose of Building G.j_d oc'
7. Material t..,o o P
f '
8.
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8. Estimated cost of building ,,,=O ° e Pt.i4 c c 6i-
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19. Dwelling �'/?r{ .o G t21I o
10. Cottage
11. Heat
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 l No. of feet side a1¢/ No. of feet rear A.:CC
20. Distance from nearest building: Front :.../.. ..:.G ft.; side ft.; side ft.; rear
21. Distance back from line or street 5'4 from rear lot line /,4 side line t?
Show by diagram the location of propsed building with relation to distancesncfrom adjoining lots, on reverse side.
Name 4 (✓1,- cy� f�. . . ..0
Address 1 ..t.... ,C./..G se.e.c
Street Name '
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r ; ¶t eft-Side Depth of Lot
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Right Side Depth of Lot
Street Name
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• BUILDII.G PERY•IT REVIEW+
APPLICANT: - ja,��. ,• • • BLDG PERMIT NO:
LOCATION OF -PROPERTY: 9 /.!l%G .• • t[qc�B;e9C/6 DATE FILED
THE FOLLOWING CHECK OFF SHEET IS DESIGNED TO CLARIFY THE •PROCEDURES AN'1NDIVIDUAL
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 -
1. • RESIDENTIAL BUILDING r �= • ,•
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 BOAR D'FOR LOT R•ELEASE , --- _ _
2 COMMERCIAL BUILD•ING _ - i `
A):, ENGINEERING DEPARTMENT FOR PARKING AND DRAINAGE REQUIREMENTS, TOPO s PHY SITE
PLAN REVIEW '`-- 6:-, a3 •- ‘• :!;;;41-14:. , -
16) . CONSERVATION�COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS. -*
•
PLANNING BOARD-TO 'SEE IFLOT. COMPLIES WITH ZONING BY-LAWS. • •
.
of 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) ;, -
• t _ • r _
BY ' .
RE• VIEWED • i - • .., • �� s ::
1 ENGINEERING DEPARTMENT: = YES ✓ DOES NOT APPLY - SIGNATURE a =f '% DATE
2.- CONSERVATION COMMITTEE: . ,YES_'_DOES NOT APPLY-V SIGNATURE 1 ,_n. T ' --` z'-' DATE•, ..`
3. +' PLANNING BOARD • •• YES " DOES NOT APPLY_SIGN•TURE:• "" -DATE'?
4. • BOARD OF HEALTH: YES . DOES NOT APPLY• SI• GNA . • . e' �. 4 DATE04
5.- FIRE DEPARTMENT: - • YES_DOES NOT APPLY_SIGNA RE • • • DATE
COMMENTS:
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