HomeMy WebLinkAboutBLD-80-214 OK k',Je
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l\ k / Application for a Permit to Build •
t okt. Fee must accompany this application � •
1\v Yarmouth ..:2"/—A 19 a'
TO THE BOARD OF SELECTMEN ,
The undersigned hereby applies for a permit to build, according to the following specifications:
1, Name of Owner Thy 49 eh /,41/0 •'%1r Address as ,pagy4jr Rd
2. Name of Architect (if any) - We./ yryrn/,V)1/1 1 i'iZ
3; Name of Builder ,..//41 For VA! SO /Oi'notti&
4; Precinct No. 0171 Lot No. 4.6 Plan: Name or No. Ass esu A4ii aG
5; Name of Street .Z 9_,q pp/y,�jy /jc(
6. Purpose of Building Parc 1
7. Material 14404:1 "jC)N/J)c. / / X 4n
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8. Estimated cost of building co coo (/4 �i //iH ) aed_ratAnd.
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9. Dwelling ,, � "'���+
10. Cottage
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11. Heat /1/01) f✓ /6
12. Basement /v4dt 'L I r
13. Garage /'
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14. Store 0c....--•
4 jOilo
15. Shop
16. No. of stories p/9 C.
17. Is there to be a Store in the lower storey
18. Size of Lot. No. of feet front 'Idorof feet rear No. of feet deep
/ i1.3'en No. of feet rear .,fib
19. Size of building.. No. of feet front�.:..f W No. of feet side .
20. Distance, from nearest building: Front ' ' " . ft.; side ft.; side ft.; rear
21. Distance tack 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.
Name8...ay.L4c..,..i.t...... F1.1. ../.fi'-L :aAddress. 4.. S .rG. 44.2mL AZ
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Rear of Lot
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Frontage of Lot 10• l w� y
Street Name B• /.. . CGU
PLOT PLAN
BUILDING PERP,IT REVIEW+ - _
BLDG PERMIT N0:
PPL I CANT /. TfJ �G/J �O `I
OCATION DF�PROPERTY RR n�� :• Aan c • DATE.FILED - -
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE 'PROCEDURESAN'INDIVIDUAL. •
UST FOLLOW IN ORDER TO OBTAIN- A PERMIT TO BUILD OR ALTER A .BUILDING. =THE BUILDING ...
EPARTHENT -WILL' CHECK•ON .THE FOLLOWING: (A) CONSERVANCY DISTRICTS: (B):-' HISTORICAL •
STRICTS (C)_ F.LOOD PLAINS-'ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE:=-;•••••:. ,:-
PLICANT TH$OUGH•THE FOL•LOWING•AGENCIES: :- a• _
• RESIDENTIAL BUILDING: ~ _ - - t
CHECK WITH THE HEALTH DEPARTMENY IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE •
DISPOSAL ` - - •
6) CHECK WITH, CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYPE- OF WETLANDS.
EXAMPLES:- STREAMS, PONDS,. RIVERS,:OCEAN, BAY, BOGS, MARSH,. ETC. r:' '. :,-�`
C) CHECK--WITH. PLANNING BOARD FOR:10T,RELEASEIT , _ _ � ` -_ _ •
• ' COMMERCIAL BUILDING _ =_
A) ; ENGINEERING DEPARTMENT—FOR-PARKING AND DRAINAGE REQUIREMENTS,. TOPOG2APHY SITE s
PLAN REVIEW: r ' - "1 _ - =-
•U) •: CONSERVATION COM{IITTEE—IF LOT BORDERS ANY TYPE OF WETLANDS, _ * ' :- - rxs
C) PLANNING BOARD=TQ SEE IFLOT COMPLIES WITH ZONING BY-LAWS. •
v) 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) „
_ DBY:/IED -Ce
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rE{NGINEERING DEPARTMENT = YES • DOES NOT APPLY IGNATURE:=_ ; 2%;,•1;;;',2,,;„:: DATE;,17-t& ' l ;r
rCONSERVAT3ON COMMITTEE ,YES'-_DOES NOT_ APPLY' SIGNATURE = ®M Z 't'= DATES '
sx+__ _ ,• '.-eir•...:: _-' .:' •- _ • - - •--r..< __ ,•._ 3•.77�.- r -
PLRNNtiffi •BOARD: ''••YES t. DOES NOT APPLY:. SIGNAT ' ' • :.' DATE -
I,8'bARD OF HEALTH YESc�6.DES NOT APPLY • SIGNA ••fi7e=r4 }DATEjA
FIRE-4EPARTneNT ., • YES DOES. NOT APPLY_SIGNA •E • • - DATE^=
ENTS:
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