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iitC. • Application for aPermit to Build No.
' 'Fee must accompany this applicatio
Yarmouth v (.1012.77 'ti 19 8O
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner G A a hies g, AwgACs' • Address 3t-duH.a.l- AVG
2. Name of Architect (If any) c/ • -
3. Name of Builder 0 vN' N e I^
4. Precinct No. 4 Lot No. V a 37 Plan: Name or No. #77q f 3,4e of .3 3
5'. Name of Street 3 / 8u'/" & 71'. e 33-v 87 •
6: Purpose of Building S 1 u Yu J e
7. Material VJcord 1-3''4 141 4- /1 Dot ol A t S *gi96C
VS. Estimated cost of building tir/ S ��/?(
9. Dwelling
ba C$ h U1 apr'y
10. Cottage 1 a4
11. Heat !t
12. Basement
13. Garage y4S ... q / J ,J 'on f0
14. Store
15. Shop
16. No. of stories d n 'e
' 17. Is there to be a Store in the lower storey n 0
18. Size of Lot. No. of feet front g S ' 3 S', No. of feet rear 7 S. CU No. of feet deep /S 0
119. Size of building. No. of feet front No. of feet side No. of feet rear
•r; 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 f m adjoining lots, o reverse side.
Name �j n �.
Address 3 ! v 1
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4.
.:Rear of Lot. 9 5. CO .
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58 I ..-
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• Frontage of Lot / Si 4'3 5 __...
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Street Name eQ VG
PLOT PLAN
i N
/ /LJf BUILDING// PERMIT REVIEW
APPLICANT: C /i
h ad-es E• JAeS BLDG PERMIT NO:
LOCATION'OF PROPERTY.: 3 y /3,.,t/i0- //v a 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: r,
kar •
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 FOOLS, RESTAURANTS, ETC.
E) FIRE DEPARTMENT FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
IEWED BY: / J
. . ��•. .NLN T TtYYES V DOES NOT APPLY SIGNATURE 1!_ e DATE 6/24/BO
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YESES NOT APPLY SIGNATURE 3• DATE�y_ is f�.
FIRE rnrrAa YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: Q oy ., Ct