HomeMy WebLinkAboutBLD-80-380 1I •
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q/ tb Application for a Permit to Build No.
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Fee must company this application
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit ttt/o build, accord' g to the following specifications: //r�_ /
1. Name of Ownert/4"
Address�/fr / `�l
2. Name of Architect (if any) '
3. Name of Builder tec-LA eYerince-rt
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4. Precinct No. 4 Lot No.. a 1-7 Plan: Name or No. 1 ? a C a, .
5. Name of Street /f T / Qj' .i` .t L(-_-7-A)Q"C
6. Purpose of Building tJ
T. Material fee t,q C e L 41('C cr<
8. Estimated cost of buildintl Co,C9-P) WtNioco
9. Dwelling
10: Cottage
fro C4 cd es or Jvy
�I Nl S Ff iS 4- '.. it-t o
11. Heat
12. Basement
13. Garage
14. Store
15. Shop
16. No. of stories
17. Is there to b'e s.Store in t$e-lowei storeyy-----'--------- ,.-- --------e-.------._-.-_---.__.-- ---,--._
18. Size of Lot. No. bf 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 front nearest building: a Front‘.• ft:; side ft.; side ft.; rear
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21. Distance back from,line�r street.... ',pont rear lot line side line
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Show byl d'dgram"the location or•propsed,builaing with relation to distances f ad' fining lots n reverse side.
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Rear of Lot
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Frontage of Lot
Street Name
PLOT PLAN Liew'"' aZ-.4-0- f 41.4-ti-enGtt-tra
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BUILDING PERMIT REVIEW
11
APPL -CANT: /' i BLDG PERMIT NO:
LOCATION 4F PROPERTY:"! - 27_44:1R v �� � DATE FILED:
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN INDIVIDUUAL 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 REFERENCE TO SEPTIC SYSTEMS FOR SEWAGE DISPOSAL.
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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:
4) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE PLAN
REVIEW.
B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPD OF WETLANDS.
C) PLANNING BOARD- TO SEE IF LOT COMPLIES WITH ZONING BY-LAhS.
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC.
E) FIRE DEPARTMENT FOR PROPERTY PROTECTION, PEPSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
REVIEWED BY: /
MINEERING DEPARTMENT: YES /DOES NOT APPLY SIGNATURE alseADSALArk,, DATE 7/10/8o
(SERVATION COMMITTEE: YES DOES:NOT:APPLY/SIGNATURE 116+51!/&.4a DATE 7/(b/$p
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE �. DATE--
OF
ATE--OF HEALTH:- YESc-LOES NOT APPLY SIGNATURE P' 4:14A DATE*114a
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: ( 4,;)- Pdoc:1004405c:1004405OR • ADDrrj 3 7o FouMDAY►oI)
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