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Application for a Perto Build. =:
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cni� 10\, Tee must accompany this a lication
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Yarmouth 19 O v
TQ THE BOARD OF SELECTMEN
The undersigned hereby applies for/a permitpe� to build, according to the following specifications:
1. Name of Owner (s(/a.�Y/V p, gUg//` e Address 67 with
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2. Name of Architect (if any)
3: Name of Builder " " / _ / C. a.. . (' /� _� `�� Ai�
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4: Precinct No. 2. Lot No. 7 Plan: Name or No. /4/Z/./D;z 117
5! Name of Street G q Lc,X'"`' fi-c-et `'� ���� ��cc."�/ 1 147 i
8� Purpose of Building j' t� v... a/MA C W�A.1 -�/YC�
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7. Material
8. Estimated cost of building — Q
9. Dwelling I O
10. Cottage
11. Heat r'C '
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12. Basement -TLd .
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13. Garage --wt - 4.
1,4. Store rue
15. Shop '720 ' -
16. No. of stories I
17. Is there to be a Store in the lower storey _ .
18. Size of Lot. No. of feet front • " ~ ' No. of feet rear No. of feet deep
19. Size of building. ' No. of feet front / No. of feet side I? No. of feet rear I 0
20. Distance from nearest building: Front • ft.; side ft.; aide 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 e.
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Rear of Lot ....0.erlik
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Frontage of Lot .
Street Name.(.(.1 .../. 0...... 4
PLOT PLAN
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p :r BUILDING PERMIT REVIEW
APPLICANT4 9-I ,JBLDG PERMIT.NO:
LOCATION OF PROP , • - _ ��I, / _, DATE ILEO:
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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,DISTRICTS (C) FLOOD
PLAINS ZONING, AND WILL BE RESPONSIBLE FOR ASSISTING:THE APPLICANT THROUGH THE FOLLOWING
AGENCIES. S,
RESIDENTIAL BUILDING: •
A) CHECK WITH THE HEALTH DEPARTMENT IN REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE DISPOSAL.
B) CHECK WITH CONSERVATION COMMITTEE IF THE LOT BORDERS ON ANY TYTY IOF WETLANDS.
EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS, MARSH, ETC. ,
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C) CHECK WITH PLANNING BOARD FOR LOT RELEASE. T.1
COMMERCIAL BUILDING:
A) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS f TOPOGRAPHY SITE PLAN
REVIEW.
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS.
C) PLANNING BOARD- TO SEE IF DOT COMPLIES WITH ZONING BY-LAWS.
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETCa, 4
E) FIRE DEPARTMENT FOR PROPERTY PROTECTION, PERSONAL SAFETY,,;(SPRINKLERS, SMOKE
DETECTORS).
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REVIEWED BY: .:
IIGGINEERING DEPARTMENT: YES�DOES NOT APPLY SIGNATURE I.. 'ir F 4. , DATE 4/7/90
CONSERVATION COMMITTEE: YES_DOES,NOT:APPLY✓ SIGNATURE I..; _z • _ �. _ _ DATE GjZ/eO
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE •°c" `+. DATE
HOARD OF HEALTH: YESES NOT APPLY SIGNATURE r' e-Y1( r / DATE_' '
FIRE DEPARTMENT: YES DOES NOT APPLYSIGNATURE '4'rth ` DATE
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COMMENTS: „*
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REF '` r7 E -4C r -- ' -/A-- ', ,- '":71 . -"'°‘1•-)
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I ; HE REFIY C C_ P 'i trr rti .A -: T +Ir F1UIL UING / 4EG LAND .SURVE R
SHOWN ON TH 13 .^ LA 'J 13 LOG ", TS O ON '.
THE GROUND AS SHO1•/ `; I4c rc_ nP4 , `» '
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i MON!.RAN,1R, w
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JHAN, JR . R A SSOCIATES 9�oy t+�oQ
REGISTERED LAND SURVEYORS a ENGINEERS �? Su � •
651 MAIN STREET . DEFINISPORT, MASS. 024339
Application to •
IPS 413°3>e
ar "' ;�,,� Old King's Highway Regional Historic District Committee
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I in`the Town of Yarmouth for a
CERTIFICATION OF EXEMPTION
Application is hereby made, in triplicate,for the issuance of a certificate of exemption untie-Section 6 and 7 of Chapter 470,
Acts and Resolvesot Messachusetts, 1973, as amended for proposed work as described below and on plans,drawings,or photo-
graphs accompanying this application.`. c
TYPE OR PRINT LEGIBLY / L,' DATE
ADDRESS OF PROPOSED WORK f' Y /I/77/rE (RC `/f O4) ASSESSOR 1AP NO.
OWNER 12L.1-4), `a/;di/ • Ft)if) T!-
,,// � �� ASSESSORS LOT NO. •
HOME ADDRESS /I /AT c — a'C k 71 o&p TEL NO. 342---937 2--
AGENT OR CONTRACTOR Lr< a— Y.7a..—J--4--
0/9 J6� ,/ _
ADDRESS /6 7 j ,V#rc TEL.NO. Loi?� }3 C — TSS re"•This application is forexemption of proposed exteyo_44.„-L-4
truction on the ground that:
kr •(1) It will not be visible from any way or public place.
❑ (2) It is within a category declared entitled to exemption by Old King's Highway Regional Historic District Commission.
(Check applicable box)
PROPOSED WORK: Describe and furnish plan of proposed work,showing location on lot, and, if an addition is involved,show-
ing location of existing buildi g.
,a�:e. f a, c ,� t Intl C�¢ c t:b/
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i 1 SIGNED L1 /1? /17/
_ Space below line for Committee use. d OI - Owner-Contractor-AgentW
Received by H.D.C. The Certificate is hereby 4' � —SI K t de
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Date 13• ir5 L / -4, V( �
Time 'I/ of �Y�y,e_
By Date
Approved C7 The categories of work entitled to exemption are listed on
Disapproved 0 the back of this form.