BLD-80-326 (540 Old Townhouse Road) 2 — C,-
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No. ac
\b,
\aOb/>1PPlication
for a Permit to Build
Tee must accompan application
\ +" Yarmouth ...C,�/ 19P
/lo
TO THE BOARD OF SELECTMEN
The undersigned hereby/maapplies for a permit to build, according to the following specifications:/ 7—
L Name of Owner / t 40 / 2 °'s V Address h ? `J t N i res ,'° -/ 4
FannrE4 Amyx, 066Iti..
2. Name of Architect (if any)
3. Name of Builder /C.4- .LJ c2 vt V -
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4. Precinct No. Lot No. ,�/ y+ Plan: Name or No. - -
5. Name of Street O / 0 r0 W N t ///0 fry"L /2d
fi Purpose of Building 6,P`7 t-es
7: Material When, ,cwf#r L G: riot I a (L
8. Estimated cost of building, 0-e-0 Vffie 7.17 ° � �
ort:
9. Dwelling
10. Cottage i /
11. Heat `.�f05 /4-0, 7- 4 //Z
12. Basement
13. Garage
14. Store
15. Shop
16. No. of stories
17. Is there to be a Store In the lower storey Ai.d
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 No. of feet rear
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 distapces.fCCJJronnnad�iniing lots, n reverse side.
Address.. f .f/ /11 7:2- 6 74
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t Right Side Depth of Lot
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BUILDING PERMIT REVIEW
M•• y� ter-
APPLICANT: /C/�Dt jr) / /2 Vit BLDG PERMIT NO:
LOCATION OF PROPERTY: , C4'S-- O /c✓ Te vie Hv sir-c no', DATE FILED:
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.
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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 FOOLS, RESTAURANTS, ETC.
E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
ZMEWED BYBY: �`-�� �—
, INEERING DEPARTMENT: YESt/DOES NOT APPLY SIGNATURE a'_ /` ,D., DATE 6��O/PG
SoNSERVATION COMMITTEE: YES_DOES_NOT:APPLY t/ SIGNATURE�� //erCs,. DATEG//o/Pn
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE
4ARD OF HEALTH: YES ES NOT APPLY SIGNATURE �J DATE' JI3/0
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE / DATE
COMMENTS:
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