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No. 3 yINA" Application for. a Permit to ild
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/ Fee must accompany this applicat //
r, ‘.l..lT� 19 Pc
Yarmouth
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications: / / "
1. Name of Owner j�°S�/L' m • bet ais n Address 3 y/iy�dl/aaelre A'V/
2. Name of Architect (if any) A/one • . ! , wP/� /l1`2
3. Name of Builder Se 'F' /
4. Precinct No. 3 Lot No. // /a ,C Plan: Name or No. At. `7
5. Name of Street 39 Met/714 taxer Rd , A.M. 21-1416F
61. Purpose of Building T O/ SAr C/
7: Material Q./00 d
8. Estimated cost of building , co / r
¢ �Q / n g
9. Dwelling �o
10. Cottage LJ e 6 D OM,f r y S'Hc'0
gee' 15
11. Heat ��
12. Basement
13. Garage
14. Store
15. Shop
16. No. of stories 0A(,°
17. Is there to be a Store in the lower storey
18. Size of Lot. No. of feet front ‘ 0 No. of feet rear6 0 No of feet deep /y:!
6
19. Size of building. No. of feet front 3 No. of feet side G No. of feet rear ....0
20. Distance from nearest building: Front 4/0 ft.; side 42 • ft.; side Araft.; rear—Le'a1. Distance back from line or street 42.r , from rear lot line /-5-- , side line f e/i
s
Show by diagram the location of propsed building with relation to distances fro adjoining lots, on reverse side.
Name o m
d _
Address -37.... 7/19►U4�.., Alia
I
•
Street Name ` "'
o Left Side Depth of Lot •
-4
rOD OP MOGM
z
a
.. In • 0
m 0
0 0
m ^
0
•
1 . .
Right Side Depth of Lot
•
Street Name
�• BUILDING PERMIT REVIEW
APPLICANT: .e°S//e %i ' vciuSo/7 BLDG PERMIT NO:
LOCATION OF PROPERTY: 3 9 ,974 t 'a rX,*p /Poi. DATE FILED:
&sr ver
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.
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 TYPE OF WETLANDS.
EXAMPLES: STREAMS, PONDS, RIVERS, OCEAN, BAY, BOGS, MARSH, ETC.
C) CHECK WITH PLANNING BOARD FOR LOT RELEASE.
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:
ENGINEERING DEPARTMENT: YES/DOES NOT APPLY SIGNATURE altdOZ. )uAri , DATE 6/6`64)
CONSERVATION COMMITTEE:LAES_DOFS:NOT.APPLY/SIGNATURE L k C.,rn.ceo, DATE 6`6/So
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE {�,/ DATE /
BOARD OF HEALTH:✓ YES vWOES NOT APPLY SIGNATURE. / DATE C/(/f0
FIRE DEPARTMENT: YES DOES NOT APPLYSIGNATURE DATE
COMMENTS:
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