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- t - - ----Application for a P mit-to-Build No.
•Fee must • pany this application
Yarmouth .... 1986
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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/A-7-s 2,7 ti S Pa.:1,..) Address 9 ea, -Da 72 e RS
•
2. Name of Architect (if any) sxme
3. Name of Builder „Wte
4. Precinct No. 3 Lot No. Vo Plan: Name or No.. A.M.. 69 -132(.4
5. Name of Street v/ 9 . Cap*
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6. Purpose of Building EA/0/0-Ct •PA eSitt e
7. Material
8. Estimated cost of buildinr5-00-cie)
9. Dwelling A/0
10. Cottage NO
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11. Heat Aio
12. Basement A Jo
13. Garage Ain
14. Store NO
15. Shop ,kid •
16. No. of stories /
17. Is there to be a Store in the lower storey AL.1
18. Size of Lot. No. of feet front; -NO:allot-rear- Nor-of feet
19. Size Size of building. No. of feet front / -77 No. of feet side y 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.
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VAddress 9 0, 20)
Street Name
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O Left side Depth of Lot - -
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Right Side Depth of Lot
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Street Name C'.1
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BUILDING PERMIT REVIEW
WAS•it 11 di i
APPLICANT: V kro'77C11• :7;1 91o',*/,J BLDG PERMIT NO:
LO CATION OF PROPERTY:/ 9 Cri`,*L 3ld,Jje/ GPS DATE FILED: �, / 1r/7 6
THE FOLLOWING CHECK-OFF SHEET IS DESIGNED TO CLARIFY THE PROCEDURES AN INDIVILILAL MUST
FOLLOW TN 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 COI:IMITTEE-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).
�RREVIEWED
-DIGEERING DEPARTMENT: YES ✓ DOES NOT APPLYSIGNATURE IR,Itu�es.)l Jhh.w.t,,,,, DATE 7)/41 So
NSERVATION Ca-IMITTEE: YF5_DOES=NOT APPLY✓SIGNATURE S. 1)4e,A GIS, DATE 7/1_6 90
/ : - YES TOES NOT APPLY_SIGNATURE DATE
BOARD OF HEALTH: Yr.S4----WES NOT APPLY NRE I
_=SIG _ATU � r- __ .DATE-2 OP- -
FIT: .. YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: l 1
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