BLD-80-373 GD7 - d30 6IC 313
At ' ? No.
Y Application for a Permit to Build
Fee must accompany this ication� 1 -771
. ..._ Yarmouth7-7.... / O Srv....1920
� 7
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for
a permit to build, according to the following specifications: �/
1. Name of Owner MI. `� '/�� n c#4efOS Address .ZOfMPLETa/✓ fiL W /.
2. Name of Architect (if any) "
3. Name of Builder DwwER
g� Z�6 thesegi gYfde
4. Precinct No. I• Lot No. Plan: Name or No. 6 7
5 Name of St el vawaetam PLS 17 •
6! Purpose of Building T Segg , 'N Dice-
7. Material WOOD get 6c..0
8. Estimated cost of building 6 OO A� f 3 pt 13 6x I SI,
9. Dwelling toe7
10. Cottage _ - ._- _ ... . . tt`� 64-crit-r
11. Heat \F P
12. Basement ge gr
13. Garage
14. Store •
15. Shop
16. No. of stories
17. Is there to be a Store in the lower storey ,.
18. Size of Lot. No, of feet front 94. 's No. of feet rear 7l' "C— No: of feet deep
/2.73
19: Size of building; "No.-of feet front' -L O No: of feet side � ""No.-of feet rear--"L 0—
I i. Q
20. Distance from nearest building: Front Ar cd ft.; side..:.'? ft.; side ''� ft.; .rear...ry.1 V
21. Distance back from line or street..... `3 /, from rear lot line , , side line....../.0p ,
Show by diagram the location of propsed building with relation to distances/isffr�om�fadjoini gg{�111 , oon_reverse
siside.
Name`rwG%�iZ2�rr/y.�yLaiQfr�"`� ��/r
Address...g.f7 ' l . . ... (! ) 4 .
A
I .
Street Name
S\
O Lett Side Depth o Lot /00 � it ,--•�,
-i s; �,
r--
a
, ,____
a, .
z COi
PP e„8.13"7 �lii:
0
^ �
kxli
3
iTi
i,
GHRA6E i
CO n if
Sr .,. It. 1.. •
.�
.M.
Right Side Depth of Lot /'C j '- j t ;'
t.: ; `"{
G it "L0
ty
Wil
l
Street Name .... rte.
` .,
Sirs 1
BUILDING PERMIT REVIEW
APPLitANT: C. et 64.4K2-f BLDG PERMIT NO:
LOCATION OF PROPERTY: '2n' 7-1,1411.n. tff,/ fl DATE FILED:
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PPJOCEDURES 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 REFERE$CE 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 COPIALITTEE-IF LOT BORDERSrANY-TYPEE, 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 NIA tile/Acta, DATE 6/Z4/8e
CONSERVATION CCM-ALITTEE: YESDOES:NOT:APPLY/SIGNATURE I Luj) �7p DATE CIZb/A4
PLANNING BOARD: YESDOES NOT APPLY SIGNATURE /( DATE
BOARD OF HEALTH: YES_vDOES NOT APPLYSIGNATUREsgz` — —DATE 41.9
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: