BLD-80-359 66
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No.
• gni A lication for a Permit to Build
Fee mud accompany this application j)
Yarmouth 44.,7
•, !o-3043
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner PIS nACitf . .64t/1dSOA) Address 34 e0c41etWE PA77-/•
2. Name of Architect (if any) fPAu[ .t3uCvnJT "
3. Name of Builder `I / I/ ,/
4. Precinct No. Lot No. Qb Plan: Name or No. 6 /�•f(�/j/ J
5. Name of Street*okth4RAIC MTN •
6. Purpose of Building >-ct< {� /
7: Material <VOOA ".Cahne� it 1" `�` �a/x �Y /
8. Estimated cost of building `tticO.CV
i
9. Dwelling /�
10. Cottage 'T e `
11. Heat GAS / 48 r .•
12. Basement YES U`S
4.
13. Garage Yes -1
14. Store AGO
15. Shop K0
16. No. of stories of
17. Is there to be a Store in the lower storey Alp
18. Size of Lot. No. of feet front 7P No. of feet rear !Q ' No. of feet deep
19. Size of building. No. of feet front / No. of feet side J`e• No. of feet rear i
20. Distance from nearest building: Front ft.; side 4..0 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 from adjoining lots, on reverse side.
Name Ici.NY... .:.b!f!ASQ.sa
Address a%..f"Pcat..62 L....607/
Street Nameb4(, g.C..MJI.T.1f -
oLeft Side Depth of Lot
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W
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o m �Z 1$ 1
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w I'a WO liar
Right Side Depth of Lot
Street Name
e
1
BUILDING PERMIT REVIEW
APPLIOANT: MC. Att );bavillco
BLDG PERMIT NO:
IOCAT,ION OF PROPERTY: CDtRtLKN F Part o V4ennun4 DATE FILED:
{
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN INDIVIDUAL MUST
FOLLOW IN ORDER TO OBTAIN A PEP IIT 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 COhMITTEE-IF LOT BORDERS ANY TMPD OF WETLANDS.
C) PLANNING BOARD- TO SEE IF LOT COMPLIES WITH ZONING BY-LADS.
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 SSIGNATURE ; , 'Aief DATE I,/Z7/&n
CONSERVATION COMMITTEE: -_?YES_DOES:NOT_APPLY ✓SIGNATURE 41P ,_ - /94, l., DATE
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE
BOARD OF HEALTH: xhSC— ES NOT APPLY SIGNATURE V,- DATE C/a?4).0
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: