BLD-80-375 53- cf
\io I air 4:1/47"�� /A No. 3 7•� —
-_Application for."a Permit to Build
Fee must accompa this application
Yarmouth .. .7 1914
'7'717)
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner 4haegr Yrci%9P1 CcWS ni Address 3( -bp Yy
2. Name of Architect (if any) // a`
3. Name of Builder
4. Precinct No. 3 Lot No.. I Plan: Name or No. A.M. $3-CI
5. Name of Street 3/ 6 /"n/e vq
6. Purpose of Building
7. Material M C
8. Estimated cost of building Q,5717) 490
9. Dwelling
10. Cottage f1 pp fba 7z x.47'H b FF r/}' ,,e: 13a),0ci11.\
11. Heat fl X f Add r n a Ad
ge
12. Basement
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(----- 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 distances from adjoining lots, on reverse side.
Name G....//``_Gr.`4K...iJ/1 ^ // /� U // �o
Address Lo r�L..QZC`e fn2... P/ ' a
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Street Name ...._ ,
po w/y4 rft/1
p Len Side Depth of Lot
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Z
II ___ r
a '
'1 ' A
2.
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a r
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a• y
c;ti•
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Right Side Depth of Lot .
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Street Name
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-....„
BUILDING PERMIT REVIEW
WAR(
APPLICANT: ./it _ateT /7, (n.US/FL i -. BLDG PERMIT NO:n ..
LOCATION OF PROPERTY: a/ 6e .e Rd' DATE FILED: /rttec7 7 / /Fed"...4*. S .
yras (U/ ��
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 44ITH 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 CdINITTEE-IF LOT BORDERS ANY TYPD 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).
•
REV BY:
1
EI GIN G DEPARTMENT: YES V DOES NOT APPLY SIGNATURE t.,._ _ _*F a. ,
I DATE 7/7/go
SERVATION CCUAMITTEE: YES W /SIGNATURE V SIGNATURE t.:_ ._• €. I.� ____DATE-7/7ISo-- -
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE DATE
BO1125 OF HEALTH: YESIZfIES NOT APPLY SIGNATURE 6 DATE -2h/
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: 11,2) Mo CNA:4G$ oR ADDmoa 'To EX.iSTiPJ FotwackTio4 y�,
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