HomeMy WebLinkAboutBLD-80-179 4 ) — (-()I to 01 ,
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Q° ' Application for a Per itBui1d
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Fee must accompany thi pplication
Yarmouth . ' pnn ' / 19 6°-2;1
TO THE BOARD OF SELECTMEN
The undersigned hereby�yapplies for a permit to build, according to the following specifications:
1. Name of Owner net Q r/lieh C/I Q+Yy) `J r r 114 Address Shy/i Th
2. Name of Architect (if any) L -/ p
3. Name of Builder W///a r eP 1 , fi Q d T e rl b r 7
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4. Precinct No. 3 Lot No. n U) / G V Plan: Name or No. Xi5. Name of Street a S ni i th P,cf.. SY A.M. 52-W 16
6. Purpose of Building / Car ' (yQYq
7. Material Wel Jcif
8. Estimated cost of building oZ J 0'f'1•
9. Dwelling t,
10. Cottage
11. Heat
12. Basement •
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13. Garage re S
14. Store v
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 0 No. of feet rear l
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 distances
fromfrjoining 11/p,����, omreverse/ ide.
Name lir Alfa /,(c...X�</l t 4. .-�GVLL
Address....J ° 4 4,�1./' 1r iF.f:-.er;en (/Ac /
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Street Name
r - Len Side Depth of Lot 7S O e
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Right Side Depth of Lot 7S ¢ a
Street Name ZO 5 C P0149
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BUILDIUG Pt?✓IT REL'iEN
- , - -
APPLICANTT: -11,b,e1//ff '•@hy ,i i4e.,C/4.) • BLDG PERMIT NO
LOCATION OF PROPERTY .� '\5>// 0 IZR \Sy � %g„ DATE.FILED-?
THE FOLLOWING CHECKOFF SHEET IS DESIGNED TO CLARIFY THE 'PROCEDURES AN•INDIVIOUAL. - ;,• -,F
MUST FOLLOW. IN ORDER TO OBTAIN. A PERMIT TO BUILD OR ALTER A .BUILDING. ' THE BUILDING Ye
DEPARTMENT WILL CHECK ON :THE: FOLLOWING:- (A): CONSERVANCY DISTRICTS: (B):-'t HISTORICAL ••:-c
DISTRICTS (C) = FLOOD PLAINS_'.ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE .;
APPLICANT THROUGH•THE FOLLOWING AGENCIES _ _
T. ! RESIDENTIAL BUILDING:
A- ) CHECK WITH THE HEALTH DEPARTMEI€r IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE
DISPOSAL ` -
B) rCHEC-K WITH CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYPE OF WETLANDS
• EXAMPLES:. STREAMS, PONDS, .-RIVERS, • OCEAN; BAY, BOGS, MARSH,. ETC: •- - c •
•
• C) _CHECK WITH PLANNING BOARD FDR 10T RELEASE , •
2 COMMERCIAL BUILDING [ : , a
- l . + a_v ms s+ +h s..t .�, • ' 1, 3'
A) ; ENGv.INEERING DEPARTMENT FOR PARKING AND DRAINAGE REQUIREMENTS;_ TOPO( PHY SITE
•PLAN REVIEW. r r}
B) CONSERVATION COMMITTEE IF LOTBORDERSANY TYPE OF WETLANDS •
C) PLANNING BOARD-TO 'SEEIF 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 . : _ ,`, c<_
T NGINEERING DEPARTMENT YES ✓ DOES NOT APPLY •SIGNATURE t,,,�L-`', -- -t DATE gic
•2 CONSERVATION COMMITTEE YES_"_DOES NOT APPLY' SIGNATURE -� i ,.r;' DATE ti
» . • •
3 LANNING BOARD YES DOES NOT APPLY • SIGNAT ® yDATE
I • `BOARD OF HEALTH YES DOES NOT APPLY vSIGNA + l 'n '�J!g�/'� j �ATEA
5. FIRE DEPARTMENT: _ • • YES DOES. NOT APPLY SIGNAT r • - DATE• _
COMMENTS: _ ._
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