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Application for a P emit to Build
Fee must accompany is application ie
Yarmouth
-5e-241 19 a)
S/C —PL
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 &7c..4/ySnJ-lq etOrd + w
.(Address // ' IC \Dr+VE.
ooq-h IJAr mo uI,MA
2. Name of Architect (If any)
" 3. Name of Builder 4cZ.*-n c .
4. Precinct No. .3 Lot No. /14 /0 Plan: Name or No. /4/1 iv f4()
5. Name of Street II SCCEr)lC -D1-+t%
6. Purpose of Building Fc, 1InQ A rabEr 64-1111-°°111 4- m&kinc1 broom Inrci6r
7. Material
C1/4) . a--+c.Qac,cr�t. �o4Gts X 10/359'
8. Estimated cost of building � 00°- ,'
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9. Dwelling �j l // //'
10. Cottage See AH�'c�.e II�id fick Neu/ A4fda 8742,
11. Heat
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12. Basement 0.(3°
13. Garage eh'
14. Store 715,..0
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 ..14;IA feet rear No. of feet deep
19. Size of building. No. of feet front Mr No. of feet side .ld i 3 No. of feet rear
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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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rO Left Side Depth of Lot t 3 D�
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Right Side Depth of Lot IZ$,
Street Name
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BUILDING PERMIT REVIEW
APPLICANT- ;?Lf.- - q-Ldi,rnA in �L , C� • BLDG PERMIT NO
LOCATION OF PROPERTY: j/ L H/ J�JLt� ca'- y C'; rU. DATE.FILED -
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN "ZNDIVIDUAL•
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):•tHISTORICAL -
--: DISTRICTS . (C) i' FLOOD PLAINS'ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING THE
APPLICANT THROUGH•THE FOLLOWING AGENCIES
1. RESIDENTIAL BUILDING: ; -- - ' -
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC' SYSTEMS FOR SEWAGE
DISPOSAL a
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 FOR LOT RELEASE -,'
2 ''COMMERCIAL BUILDING
A) ENGINEERING DEPARTMENT FOR PARKING AND DRAINAGE REQUIREMENTS, TOPZmPHY SITE
# PLAN REVIEW: _
CONS ERCAT ION COMMITTEE—IF LOT BORDERS ANY TYPE OF WETLANDS ,. • --
C)•.- PLANNING BOARD—TO SEE IF LOT COMPLIES WITH ZONING BY—LAWS.
D) HOARD 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 '
REVIEWED BY:BY
1. ENGINEERING DEPARTMENAYES DOES NOT APPLY_SIGNATURE•.�„�,isl- 4,?• J
-.
T: ✓ DATE:. Tj
2 CONSERVATION COMMITTEE: YES DOES NOT -APPLY'/SIGNATURE ( „_: , £ - DATE," co Ere;
3 PLANNING BOARD YES • DOESNOT APPLY • SIGNATrrE- '- - DATE
4 BOARD OF HEALTH YES ' DOES NOT APPLY t/SIGNAIU//
5. FIRE DEPARTMENT: YES DOES NOT APPLY SIGNA tiRE DATE
COMMENTS :�
tie"O-K "14-6.1 -
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