BLD-80-351 a:5)
V `t No. I
Application for a Permit to Build
Fee must accompany this application _
Yarmouth az se 19p
G--27crO
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permitbuuild, according to the following specifications: !- /�
1: Name of Owner�/2'6R•¢ °' ti /f(. r'--t*'� i'"4.3 Address 2.L W/L9IL0r-o 4 rh)6 led
2. Name of Architect (if any)
3. Name of Builder —
4. Precinct No. i0� � Lot No. q Plan: Name or No. / ' kL
5: Name of Street"/•
'mb0 J 6:724y A 3i/ If
6: Purpose of Building 5112P CCe7- Q/� // a d n/L i
7: Material i}�JO� I/` o"���a 1/ Gr t*� A
8. Estimated cost of building `y J d
9. _ Dwelling t/O
10. Cottage ca
11. Heat p f
12. Basement ,d d
13. Garage 0Q' .
14. Store ,dd ,
15. Shop ed
16. No. of stories I
17. Is there to be a Store In the lower storey 410
Cs
18. Size of Lot. No. of feet front No: of feet rear if- C No. of feet deep it 0
19. Size of building. No. of feet front '� I-' No. of feet side 9z - No.-of feerrear'"-`- --
i
20. Distance from nearest building: Front Z I ft.; side ft.; side f/t.; rear
21. Distance back from line or street /OA , from rear lot line /� , side line !y
Show by diagram the location of propsed building with relation to di noes from
.... adjoining los onrevversreverse
de.
Nam fie- #4-" , ers
AddressL -6.. /Oni ' iv �vc_ri
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' Rear of Lot l S •
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Frontage of Lot ?S. ?
Street Name.YYl Lint? CI-AY ' O,
PLOT PLAN
•
PPL I CANT: / "•'.• .. BLOC PERMIT •NO:•
OCATION OF 'PROPERTY: -.,' �ce: eizej-iii izzi • • ."4,2,' DATE.FILED: • •'
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THE FOLLOWING CHECK-OFF SHEET IS-DESIGNED TO CLARIFY THE PROCEDURES AN- :.•- s�r,_ _
ST FOLLOW IN- ORDER TO OBTAIN• A PERMIT TO BUILD OR ALTER A•-BUILDING. THE BUILDING::=:='.;
PARTMENT'WILL`CHECK•ONTHEFOLLOWING: (A)f • CONSERVANCY DISTRICTS- ( ):=1. HISTORICAL::
STRICTS . (C) _ FS-.
LOOD PLAINZONING,• AND WILL BE RESPONSIBLE FOR•ASSISTING THE::::'_
PLICANT THROUGH•THE FOLLOWING•AGENCIES:. -,._ :::•'; .•'= -°-' ?".-::::::).**:::;;:t. ' • =
RESIDENTIAL BUILDING: _ ' _ r - _ ''
A) • CHECK WITH THE HEALTH DEPARTMENT I-N REFERENCE TO SEPTIC SYSTEMS FOR/SEWAGE • ,
B) •CHECK WITH CONSERVATION COMMITTEE IF THE' LOT BORDERS ON ANY TYPE. OF�WETLANDS.; : -. :
•- . EXAMPLES:. STREAMS, PONDS, :RIVERS,:OCEAN, BAY, _BOGS, MARSH,. ETC: ;'; - •" '-
C)
C) CHECK.WITH PLANNING BOARD'FOR•LOTRELEASE: -== `" _ ''-c•_ -� - - r _`
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;:"."2.3-:::.i..:•.2.11-7--773:-:::::
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COMMERCIAL-BUILDING: _% - *- i': -'' ' _
- J +els •'•i�-• ; r•.r ^ +i:'' -•-. • • .•'• � ♦ ..r. ;•1-
r•A).•.• ENGINEERING DEPARTMENT-FOR-PARKING AND DRAINAGE REQUIREMENTS, TOPO( PHY SITEI_ C=: >
.4 '- PLAN REVIEW:`.__ _7r Vr;-';:' `t y- _> -. - :-:x - _ a,...•• } r
_ _ .i_�a : .. _ _tet_ _.'.._ - :
–_r'I•• � •1 :., •.. : .l _--7'•n ti..-S'•..._. _ \ -I.J Ni -v.. • r ..'•::,-'_. .` •-�r��_:
B).;. CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS.:'-*•".-'-:' --
C) PLANNING BOARD-TO 'SEE IF LOT COMPLIES WITH ZONING BY-LAWS. . •-
0) BOARD OF. HLTH-
EAFOR SEWAGE DISPOSALIREQUIREMENTS, HEALTH RELATED ACTIVITIES. .
EXAMPLES: • SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC. : •• _ . - - -
-E) FIRE DEPARTMENT-FOR' PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS). -- :�.- _ • -
_ - ____ - •v �_�r_�.r..ter:::. +es
-C- _-` -.4,.±..i......-:::_z._;:-.1..a_ _ .:i.•�'�� -:'ewe_.:: n -.
I ED BY: -•-'?� -;.r';�_.0- _ - _ - - 3-�:: - -:. ==r,-.,, Y.sr=s•c:'.
_- i$-7i 1 __ "Cr. � .-•- "•4`it
GINEERING DEPARTMENT:'` YES DOES NOT APPLY IGNATURE. c �9._= z DAT 1r
. .. Y -• '.S � 't„ - s>. - -r...: _.•tea• {
NSERVATION COMMITTEE: .YES:..DOES NOT APPLY'% SIGNATURE ,? `,,r.- :DATE,— 0-.
•:. t : - - • .. ?:. := til3 : DATE = •- :;'e
PLANNING BOARD: = "•YES DOES. NOT APPLY_SIGNATURE•''`: r.
,y x i
HOARD OF HEALTH: . YES�/uOES NOT APPLY SIGNATURE-. :`DATE; ,.2 :
FIRE DEPARTMENT:. • .• . - - • YES_DOES• NOT APPLY_SIGNATURE • ' . Et
• - DAT . -.
ENTS:
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