HomeMy WebLinkAboutBLD-80-202 qD /7- 1 fi f C41A' a`
1J. N \\\. � .. No. 1. ! "�
�j/` Application for a Permit to Build
Fee must accompany this application
Yarmouth /-g0 19.fJ
1i0 THE BOARD OF SELECTMEN •
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner Address •
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2. Name of Architect (if any) •
3. Name of Builder �i-,
4: Precinct No. 4 • Lot No.Yi' ii Plan: Name or No...0 SCC t/7' Wit
6. Name of Street , ` U ` -e j_ 4Ll y'
6. Purpose of Building
7. Material , f" '� ,{ (J Q
002 iIOL t0 t 1 n ` `y/
8. Estimated.mst of building'S' 3/c0 D-
9. Dwelling
10. Cottage.:::t •
11. Heat -Ai
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 I 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 distances from adjoining lots, on reverse side.
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Street Name "
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O Left Side Depth of Lot
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Right Side Depth of Lot
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• • BBUILDING PER✓,IT REVIEW: - •
APPLIGANT: - --17 -;- \` / BLDG PERMIT NO:
•
LOCATION OF -PROPERTY • DATE.FILED •
THE FOLLOWING CHECK-OFF SHEET ISDESIGNSTO CLARIFY THE PROCEDURES AN •TNDINIOUAL. - ' •-,t_
MUST FOLLOW. IN ORDER TO OBTAIN. A PERMIT TO BUILD OR ALTER A .BUILDING. " THE BUILDING .;.•.[1.1.2..i....
: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 r- -
1 . RESIDENTIAL BUILDING: • - ' •• • -
A) • CHECK WITH THE HEALTH DEPARTMENT- IN REFERENCE TO SEPTIC SYSTEMS FOR .SEWAGE
- • DISPOSAL.•'-: ". -. •• = _.. • • • • • :. '_
5) 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 r •ws :-_,-- "
2 COMMERCIAL-BUILDING17,!.;..•:i:;,--.-.',:-2./.......::,;,... ..:
_A) • ENGINEERING DEPARTMENTFOR•PARKING AND DRAINAGE REQUIREMENTS, TOPCG? PHY SITE
`' PLAN REVIEW` ,a
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS -
C) PLANNING B• OARD TO -SEE IF LOT COMPLIES WITH ZONING BY-LAWS.
D) BOARD-OF H• EALTH-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). '.. - _ •
REV EWER BY:.'__ • >, ! • i•- r ":t-
1 GINEERING DEPARTMENT.'' YES• `/DOES NOT AP PLY_SIGNATUREIv - ;-:: DATE', . e'�'•
2, . CONSERVATION COMMITTEE: YES DOES NOT -APPLY"-' SIGNATUR i • = DATE 4'aZ'
3.- p1ANNiNr: RfARO• • YES ' DOES NOT APPLY SICNATLJ 7 - DATE
4: BOARD OF HEALTH: YES •
DOES NOT APPLY,/SIGNAT ! 1�2 DATEy/4—d
$.\ FIRE DEPARTMENT: YES DOES. NOT APPLY_SIGNAT•• - DATE •
COMMENTS: . ..
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