HomeMy WebLinkAboutBLD-80-236 J(1 '!r► No. .. `.: c
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Application for a Permit to Build
y'� Fee must accompa 7t/his application
113 Yarmouth rl d 19&0
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TO THE BOARD OF SELECTMEN _
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner R 75062-t_ C. (YR g- Address 30&A m9 c-A,-t/-C . 65"(,
2. Name of Architect (if any) _.
3. Name of guilder Sits) CZL
4. Precinct No. Lot No. Nit- Plan: Name or No. y N /2,
5. Name of StreQe1 }M(78f.,'' (..}%/N Cr '
6. Purpose of Building D E C.- .,
7. Material Gl f 001 , �1
8. Estimated cost of building AS-00. ? - .._t'
(6 x'20 /
9. Dwelling 44 w/S � Sr t,L G0./ Sii�.0
ao
10. Cottage /../ o ; /6 it .
11. Heat (i d /213 1
12. Basement 4✓ p . j i
13. Garage ,d' a 13
COat
14. Store ,C/ l9 I
/C c C .
15. Shop ,t/
16. No. of stories
17. Is there to be a Store in the lower storey ND _ .
18. Size of Lot. No. of feet front .. Z,/� No. of feet rear ...€242 No: of feet deep
/4/._C 62
19. Size of building. No. of feet front No. of feet side No. of feet rear
20. Distance from nearest building:'Fiont \‘‘a 'QA.;'\lde, ft; side ft.; rear
21. Distance back from line or street from rear lot line line
Show by diagram the location of propsed building with relation to dis ,y .djo reverse side.
Name...:'/ir efraT
Address ) C ^r -M.rei.1�:.�1...t1..! C \ tJ.1 ;I
Street Name
so
r Left Side Depth of Lot
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m V' r
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w,Cn Q ;i w.
'7 1.• C
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Right Side Depth of Lot i-1
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4
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Street Name
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• BUILDING PERMIT REVIEW
� � / l `*- . BLDG PERMIT NO
APPLICANT_` t jt
LOCATION OF .PROPERTY •e/l4 +fee7LL.4,•✓= -Ocnth .' • DATE.FILED: "- ' '
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN"?NDIVIDUAL. - '. - i
▪ - MUST FOLLOW. IN ORDER TO OBTAIN• A PERMIT TO BUILD OR ALTER A .BUILDING.,"-THE BUILDING;- .`.
•DEPARTMENT -WILL"_:CHECK'ON :THE FOLLOWING: (A): CONSERVANCY 'DISTRICTS: (B)'::. HISTORICAL'Lt. : _'
DISTRICTS (C)1: FLOODS-
PLAIN 'ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE ;
APPLICANT THROUGH•THE FOLLOWING AGENCIES
i RESIDENTIAL BUILDING :'
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE
B) `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 FDR IOT. RELEASE , =
2 `COMMERCIAL BUILDING T = 1 '
�A) ENGINEERING DEPARTMENT FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOG PHY. SITE _
PLAN REVIEW `
�Ky 1 B) CONSERVATION COMMITTEE IF LOT BORDERS ANY TYPE OF WETLANDS . - _
C) PLANNING BOARD TO `SEE IF. LOT-COMPLIES WITH ZONING BY-LAWS.
0) 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 -, _ _
---:;
▪ I ENGINEERING DEPARTMENT: YES •DOES NOT APPLY - SIGNATURE ~' `=w . DAT '
▪ 2 • CONSERVAT3ON COMMITTEE:
.YES:—.DOES NOT APPLY - SIGNATURE i1��1_ DATE, Flt
3 PLANNING BOARD: YES ` DOES NOT APPLY • SIGNAT � DATE -`
It • BOARD OF HEALTH YES • DOES NOT APPLY CL•SIGNAf lv DATE, yiegi:
S. FIRE DEPARTMENT:. - YES DOES NOT APPLY_SIGNAT - DATE
COMMENTS
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