HomeMy WebLinkAboutBLD-80-173 G) n
P, o Application for a Permitto Build Nn.
\a • Fee must accompany this ap iication
_ Yarmouth W /a 19.s'e0
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit� to build, �a according to the following specifications:`` �/
1. _Name of Owner"MRt t'ivic .S. �js0 E JPko-' Address v Eh%4y 4' Pi' higivmlir (itea,
2. Name of Architect (if any)
6�NSD . Pa<CWTi9 • G -we, cry' I34 . MYatOlor( MO .
3. Name of Builder
4.' Precinct No. 5 Lot No. 4"51 Plan: Name or No. /9-- 4 C/
5. Name of Street di EAeokXt l/ ilej, GV,
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6. Purpose of Building —__—.-f
7. Material r:RAI/1Q
8. Estimated cost of building, 4 n0•0 %IL6
9. Dwelling ; 7/23 ,/A' i
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10. Cottage
11. Heat a'I": 1 ?
12. Basement/jJd '
13. Garage AM
14. Store A/d :
15. Shop n, )
16. No. of stories ( '
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17. Is there to be a Store in the lower storey /4/e'
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 d n s from adj ping lots, on reverse side.
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Street Name
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r g1oLeR'Side Depth of Lot... f.
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Right Side Depth of Lot
y Street Name ../ RGr//CA /1// IRQll„ p
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. ' • • . "-C.' • BUICOING PE20.1T REVIEW, ' ' •11:- • '
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APPLICANT: im virt5S: air-ZgA. " 1 •• • BLDG PERMIT NO: - •
• •-• " •
LOCATION OF PROPERTY: f- &Odic Oa- 44g DATE.FILED; ' • . •*".•
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-• • THE'FOLLOWING eHECKL-OF . SHEET IS DESIGNED TO CLARIFY THE 'PROCEDURES AN iNDIVIDUAL. 7•
MUST FOLLOW IN ORDER TO •OBTAIN A PERMIT TO BUILD OR ALTER A .BUILDING. --CTFtE BUILDING
.
•DEPARTMENT WILL• CHECK•ON :THE FOLLOWING( (A): CONSERVANCY DISTRICTS. (B) .; HISTORICAL
DISTRICTS • (C) ? Floor) PLAINs- 70NING,IANb WILL BE RESPONSIBLE FOR ASSISTING THE'::•-•••-•=-...1.'
••'• APPLICANT THROUGHTHEFOLLOWING AGENCIES: ; • .7-ft
1. RESIDENTIAL BUILDING: *.. • '; • ' *- • '4 1" • -
A) • CHECK WITH THE HEALTH DEPARTMEttf IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE •:
7 • DISPOSAL. - ' • •• " • 't
B) CHECK WITH CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYPE OF WETLANDS. ••
_ .
•• * EXAMPLES:, STREAMS, PONDS, RIVERS, (OCEAN, DAY, BOGS, MARSH,. ETC:
-• - • -• •
. C)...„.CHECK• W-.. .TH P1•L-•:•A•NtiNn"I.::N• G poa••••n••:1i-Ff-OR 10T•!. LEAS-ETt2 ,
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• COMMERCIALBUILDING:- • n -
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A) • fiMiNeERING DEPARTMENT-tORPARKING .%
AND DRAINAGE REQUIREMENTS,. TOPOGRAPHY,
puu,i5fREv Ew 1;z7 V--T:4"•••••••-.40 :-.77.:•7,j;"••••.; .'•;t•••••71• i•• ••••••" ::•
:B : CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS, •••• -•
• _
. . . . . . . • •
C) PLANNING BOARD-TO SEE IF LOT COMPLIIES WITH -120NING BY-LAWS. . • . •
• - • - •
" _ _ . •
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAt REQUIREIIENTS, HEALTH RELATED ACTIVITIES.
• EXAMPLES: ' SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC. • . •
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- - • I ' ' •
• -E) • FIRE-DEPARTMENT-F-0R PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE -
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REVI Eb ;••:. •••••:
• 1. INGINEERING DEPARTMEhT:.1.: 30ES NOT APPLY iIENATURE.
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2.• CONSERVATION COMMITTEE: .YES• -DOES NOT ARP Y SIGNATURE • .;
3.-'19"rkitiit4.6-1304RD: = :" • 7 DOES NOT APPLY ' SIGNA .- = DATE • • r;
4diii0ARD OF-HEALTH: , DOES NOT AFPLY e/fI GN• ' DATE.SA
5. FIRE4E-P-AR-TMeNT:. ; YES DOES NOT APPLY SIGNA ••E . • - DATE
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