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I Nap, Application_for a Permit to‘Build No.
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Fee must accompany this appli tion X1
Yarmouth ' 7— /0 19..0
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TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner(Itc.(4,, Z 1 (jun. ot F{`1 Address 3 a 0 p-..,Q„ fitr4_., 5 i yavv*oaC Lt
2. Name of Architect (if any) 7
3. Name of Builder ^Sc e ok Y•/} �,e_
4. Precinct No. 3 Lot No. t/ ' 'Plan: Name or No4/ '. 7()— L 94
5. Name of Street .3. 4 �', ,
6. Purpose of Building 'Cv1o �
� 5Ct.
7. Material Wood ���
S. Estimated cost of building IVO 0.cv 0 /=—
9. Dwelling
10. Cottage '. / 5
11. Heat q3A
12. Basement I ' _..
13. Garage 4I
14. Store
15. Shop
16. No. of stories
17. Is there to be a Store In the lower storey r,
18. Size of Lot. No.'of feet front/ -,1x00 No. of feet rear I O U No. of feet deep q:! '
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--19. Size of building. No. of feet front t'{ No. of feet side .4 '1 No. of feet rear ..../.`.
20. Distance from nearest building: Front ft.; side ft.; side ft.; rear....................
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21. Distance back from line or street fid , from rear lot line 12 6 side line
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
NameVP
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‘ Address C' t,a 4, tI , S'# 4H M IS
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' Street Name
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- p Left Side Depth of Lot 4S
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Right Side Depth of Lot . 9+s
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Street Name
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BUILDING PERMIT REVIEW
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APPLIO
CANT:-- BLDG PERMIT NO:
LOCA±ION OF PROPERTY: 3a, tort o Ng_ -5•y 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 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 COMMITTEE-IF LOT BORDERS ANY TYPE? OF WETLANDS.
C) PLANNING BOARD- TO SFP 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 NED BY:
FINS, G DEPARTMENT: YES DOES NOT APPLY SIGNATURE ) IuIA'Q� F JQ'1a,,,,�;,,, DATE 7/10/So
CO ERVATION COMMITTEE: YES_DOES:NOT:APPLY ✓ SIGNATURE (44, :.)', ate DATE TROlao
PLANNING-BOARD: YES_DOES NOT APPLY SIGNATURE / DATE
BOAT I) OF HEALTH: YES CES NOT APPLY SIGNATURE �` /___ DATE '0%
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: