HomeMy WebLinkAboutBLD-80-219 3 . '
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Application for a Permit to Build Ne.
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Fee must ac pang this application
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TO THE BOARD OF SELECTMEN
The undersigned hereby appliesli/ for a permit to build, according to the following specifications: �/
1. Name of Owner ,4,/& ' Ski,/ Address /7 54h '1
tv 4. ' %9H.Yo`•.7/11
2. Name of Architect (if any) •
3. Name of Builder &A/Ain 4• //': E ee'f •
4. Precinct No. S Lot No. /.s" lPlan:`Name or No. 44— 93 K IS
5. Name of Street /7 range.. .4. So; Y.9ni•roi`f� =' f•
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6. Purpose of Building ,(1�� A, M -- IiciZ " _._.
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7. Material Way/ FjPowf4 I : I i..\ ,,: + % m.
8. Estimated cost of building / ,rcv I{ � r ! f)PACD D,r/(wa 64'
9. -Dwelling i� . i'�x n
10. -Cottage . \ ! .., 1-
., moi.
11. Heat ' '
12. Basement Cr4A✓/ w/ o•�i rT C5,0 ` sy
13. _Garage / 1 , i
14. -Store- Y f $
15. --Shep'
16. No. of stories / ..
17. Is there to be a Store In the lower storey , NO
18. Size of Lot. No. of feet front No. of feet rear Nth of feet deep •
37' .29•
19. Size of building. No. of feet front ty�` �` No,of feet side +{'? No. of feet rear 702 .
20. Distance from nearest building: Front 4'f!IWJ`r'74t.; side!ILx!9 f4((fft,; side4tXr.J*K7<ft.; rear 20 '
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.
Name / 7gui. $H441 /
Address (7 .f4 74". Iv S. j 4P#w.w//
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Street Name C" r 4.4;...: -.
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Right Side Depth of Lot
Street Name r/4 in.
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BUILDING PERMIT REVIEW •-
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APPLICANT'?-• -4 ail:- r"MI'- a ` - - BLDG PERMIT NO `
LOCATION OF 'PROPERTY. % .TA)ziJia :eiti:• =-S: .yMnros7 - _ DATE-FILED. -
' THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES ArINDIVIDUAL. - '
MUST FOLLOW. IN ORDER T_ O .OBTAIN. A PERMIT TO BUILD OR ALTER A .BUILDING. - THE BUILDING -;='.
.--•DEPARTMENT_•WILLy. CHECK_ ONTHE. FOLLOWING: (A) CONSERVANCY DISTRICTS' (B):-'t. HISTORICAL
DISTRICTS -IC)? PLAINSr'ZONING,• AND WILL BE_RESPONSIBLE FOR ASSISTING TEE-.- --- -
• APPLICANT THROUGH.THE FOLLOWING AGENCIES _ 3.4'- -
i RESIDENTIAL BUILDING. t ". _.
A) CHECKWITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE ' , , •
;; DISPOSAL :F -
,B) :: CHECK WITH CONSERVATION COMMITTEE IF THE LOT .BORDERSONANY TYPE OFWETLANDS.
EXAMPLES • •STREAMS, PONDS, RIVERS, •OCEAN, BAY, BOGS, MARSH,. ET4
C) CHECK WITH PLANNING BOARD_ FDR 10T RELEASE .. r- -;_, ;
2 COMMERCIAL BUILDING K - -•
;:.A1.,-ENGINEERING DEPARTMENT-FOR. AND DRAINAGE REQUIREMENTS,• TOPCGPPHY SITE
> F `'�. PLAN REVIEW', •` _
r
.: rr 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 HEALTF,-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLESSAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC. - - ' . • .
'E) - FIRE DEPARTMENT FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS). -
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REVID BY . . 1 i.7.7'; .. n � :�:=::
I NEERING DEPARTMENT YES DOES DATE• i
2 CONSERVATION COMMITTEE YES '_DOES NOT APPLY SIGNATURE f ir' Tlt:' "i7 z DATE4J3a)ky
4 'B'OARDIOF HEALTH YES J DOES NOT APPLY tt IGNATURE,.. ' a- DATE r�
•
5. FIRE DEPARTMENT: `;, _ - • YES DOES NOT APPLY '_SIGNATURE - - - DATE - -
COMMENTS
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