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Application for a Permit to Build No.
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Fee must accompany this application , )
Yarmouth 19(' -
\30_2
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner dens' CD // fit viset` Address a e p t/vC yc sr
S• graK PIOJT$
2. Name of Architect (if any) 6', /3n35c
3. Name of Builder S-' /Y!n2Zvl2
4. Precinct No. 3 Lot No. 7 Plan: Name or No. 61 p . (r' 7
6. . Name of Street 0.2 9 (v.-Rd Cit. sr. S• q/q
6. Purpose of Building /in nee 6 K/red/rtl •t- gip Coo(-,, -- 7 ff
7. Material kJ0cl
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8. Estimated cost of building /J^ 000 52 2./ a
9. Dwelling . . �����7�t �/ •
10. Cottage
11. Heat DIG 2.4��
) //'C f 3
12. Basement c t 4cvc- s'p nc£
13. Garage
14. Store
15. Shop.
• 16. No. of stories /
17. Is there to be a Store in the lower stony /1/'o
18. Size of Lot. No. of feet front 2120 No. of feet rear /0 d No; of feet deep /0 a
19. Size of building. No. of feet front • No. of feet side No. of feet rear
20. Distance from nearest building: Front /,54 ft.; side 7s' ft.; side .(la ft.; rear /oo
21. Distance back from line or street .3P1 from rear lot line in / , side line 3 F' J
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
Address 2s D.t*si;.
Street Name -- •
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r _ Left Side Depth of Lot /D O
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- Right Side Depth of Lot ....f bQ
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Street Name ... 7 V 4�£�J -c..- AD -
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• BUILDING PERMIT REVIEW
_ 1•
! APPLICANT: & IFF BASS £-1 r BLDG PERMIT N0:
LOCATION OF PROPERTY: a:B or-I 4v2 St DATE FILED: ' •
So. offCY"to4 T 1-F - . ..
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN INDIVIDUAL
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"_1
DISTRICTS (C) 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.
BY 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, TOPOGRAPHY SITE " -
PLAN REVIEW. ;
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 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
%/11. ENGINEERING DEPARTMENT: YES DOES NOT APPLY SIGNATURE s / DAT
V✓2. CONSERVATION COMMITTEE: YES ' .DOES NOT APPLY�SIGNATURE � ' _ ; •- ` - DATE z
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE
- ✓ 4. BOARD OF HEALTH: - YES ES NOT APPLY - SIGNATURE6x4 1)(A4 �i�I�DATE*,4C-)
S. FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE / " DATE -
•
COMMENTS: -
tas-.0L .-
' -yrs P`� ,