HomeMy WebLinkAboutBLD-80-199 Ar.)11 o ' F " Application for a Permit to Build
Fee must accompany this applica
Yarmouth art: -91-19...9.‘?.
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
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1. Name of Owner �°�xl122lhi �i�(ip7rbols4 Address
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2. Name of Architect (if any)
3. Name of Builder g2,2iJ3/ r-4-t.A--
4. Precinct No. 4- • Lot No. I? LI -h 8 Plan: Name or No. A.M. `)-t34
5. Name of Street 3 b doJu ;Ay,
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6. Purpose of Bu}lding 19 bpd _ ` _ D S G k /91 St
7. Material ��'' tt _ _ _t_ (jr�'4-
8. Estimated cost of building �u-o o .o a Se
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9. Dwelling ti
10. Cottage >, . r
11. Heat -
12. Basement 7,.-- .
13. Garage .- . _. .
14. Store 11..--
15. Shop zyr
16. No. of stories tKe___
17. Is there to be a Store in the lower storey '-`19,
18. Size of�Lot�..�l/No. of feet front Q ° . No. of feet rear ' - b No. of feet deep / �
19. Size of b ding No. of feet front .2a No. of feet side / 2- No. of feet rear •' "--
20. Distance from nearest building: Front • ft.; side C ft.; side t ft; rear '
21. Distance back from line or street MJF 1 , from-tearllot 4ine": side line
Show by diagram the location of propsed building with relation to distances from adjoining lots, o9 rgverse
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(...___;_____1_4A/L______\ 0
BUILDIUG PERMIT REVIEW-
.; . • : -*- . • : . "Z:i •••
APPLICANT : `lYW Z P/'S .S5 / &,V'S�-• `' BLDG PERMIT NO: _ •
IOCATI0 OF -PROPERTY: 3t , H4Ailvit. :- /,-'ke/YC• , -'._ . DATEiFILEOc " `• ' '
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE •PROCEDURES AN. '1NDIVIDUAL. - •: -,•••.
- _
MUST FOLLOW IN ORDER TO OBTAIN- A PERMIT TO BU_ ILD OR ALTER A .BUILDING. - THE BUILDING'•;;•' .'`.'
-DEPARTMENT *WILL' CHECK ON :THE:.FOLLOWING:- (A)' CONSERVANCY 'DISTRICTS: (B);•1. HISTORICAL••• =r-.-•
DISTRICTS (C), tFLOOD PLAINS-'ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE :":••- • -APPLICANT THROUGH-THE FOLLOWING AGENCIES
i. • RESIDENTIAL BUILDING: " ., - . - • • -
• . A) • CHECK WITH THE HEALTH DEPARTMENY IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE '
- DISPOSAL.' -
r
B) CHECK WITH CONSERVAION COMMITTEE IF THE LOT BORDERSON ANY TYPE OF WETLANDS:-.
T : 4_• .
EXAMPLES:. STREAMS, PONDS, RIVERS, OCEAN, "BAY, BOGS, MARSH,. ETC. • -
C) CHECK WITH PLANNING BOARD•FOR 10T RELEASE �, _
2. COMMERCIAL—BUILDING1, .,-...!---.,:r.-..:7, _ , ' -
A) „ ENGINEERING DEPARTMENT FOR PARKING AND DRAINAGE REQUIREMENTS, TOPO PHY SITE
••••-::/i.:-.4:::::: PLAN REVIEW:+ ': : .< 1-::C.:. •''.-
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-FORPROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS). - -
. . . ... . . . - . .. - • . . . _ '-
REVIEWED BY •,. c •r _ „ S
1 ENGINEERING DEPARTMENT YES'Yr DOES NOT APPLY SIGNATURELac 4,: ; DATE
.2.-- CONSERVAT3ON COMMITTEE . YES DOES NOT -APPLY' •:. SIGNATURE Mir."ir k -......-7--...••••:•-•-••••••••-•:44.•
-' `= DATE ft
3 PLANNING BOARD YES ”- DOES NOT APPLY SIGNATU' :"' 'y '-/DATE •--
4 BOARD OF -HEALTH: • YES_DOES NOT_APPLYO SIGNA ,t�„j1��/ ' / DATE
5. FIRE DEPARTMENT:. _ : • YES DOES. NOT APPLY_SIGNATf - DATE
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COMMENTS. • '••
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