HomeMy WebLinkAboutBLD-80-378 4,71:11\:1)\/
tto Application for a Permit to Build No.
Fee must accompan his application
Yarmouth 7 r 191 `
2- &- go
TO THE BOARD OF SELECTMEN
The undersigned hereby applies fo/r'�a permit to build, accordingJcoto the following specifications:/ 0 ��l
1. Name of Owner C�,c,Uf u t�4�/v.•yp h,,. '- QLt_r Address 7 U C�6 e % 0--x'+10-w-t
2. Name of Architect (if any) !/// (/'
3. Name of Builder --77e-0----1
4. Precinct No. 3 Lot No. 12 Plan: Name or No.A. M. 52.—WIZ
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5. Name of Street 773-1-rt--T-4--'4- `
6. Purpose of Building
7. Material JO;
8. Estimated cost of building _ .ota
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9. Dwelling t)
10. Cottage U
11. Heat
12. Basement U �/
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( Noof feet rear .:::..:.: ."-No:of feet deep
19.--Size of buildings No. of feet front 4 No. of feet side lY No. of feet rear S
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 a 'oining lots, on reverse� side.
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Name :u �k1!A.Gc...11�:flLl-'A�`'�
Address-.. .Z GG :.8.#D .s..1.-4)-7./CIX:17-1.gr.fh .
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Street Name
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p Left Side Depth of Lot
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Right Side Depth of Lot
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Street Name
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S BUILDING PERMIT REVIEW
APPLICANT: /Ge' —C u�r c, ��t,6 BLDG PERMIT NO:
IOCATJON OF PROPERTY: 71✓ C _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:
A) CHECK WITH THE HEALTH DEPARTMENT IN REFEREDICE TO SEPTIC SYSTEMS FOR SEWAGE DISPOSAL.
B) CHECK WITH CONSERVATION C0?'2ITTEE 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 COO*fITTEE-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 POOLS, RESTAURANTS, ETC.
E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
REV a': BY:
ENG �/ • G DEPARTMENT: YES ✓ DOES NOT APPLY SIGNATURE RIAD D E,�a,:,tia, DATE 718/So
CON RVATION CaIMITTEE: YES DOES:NOT;APPLYIGNATURE {, e. ,ba,�;,Q, DATE 7b
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PLANN G BOARD: YES DOES NOT APPLY SIGNATURE DATE
BO OF HEALTH: YES�DOES NOT APPLY SIGNATURE �� DATE���% O
IRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: