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WcHPlicafion or a-Permitto Build
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!The`.undersigned hereby applies for a permit to build, according to the following specifications:
Ir. 1. `.Name of Owner R( N (-1-y <�cffoot-_ Address /O c4ZTE,e a,,,,„ • y/loc
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) 2. 'Name of Architect (if any)
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3. Nae of Builder Cept 1 sOG . l xJG
�' 4. .Precinct No. 3 Lot No.. ZZ."423 Plan: Name or No.A.M. 53 - M 2Z.-2.3
0 5. Name of Stre ( oN0 �(o/I
6 8.: Purpoe. of Building i v(*TE cMop`— (HDD I Dace, R cm du
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1 1 Materia ` r +a :•.:.
WooD FKAFit� - .
8.' swi tated cost of building ltS 2,000
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14/ 9^ Dwelling ,.: t' i
V 10. Dotage- i4 '
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1611 1* Hat)' f E(,sy/sod,
12. itasement
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13. Garage I !I�1J j�1 . •
X14. Storms 1: :(
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/�15. Sho� r
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nom'rtri8. No. of storie4 ,DNe:
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17. Is the`to be a Sto the.lower storey - -" "
18. Size'of.LoN. Noo of feetfronq __-No.of feet rear No. of feet deep
NC //•l19.' Sizerorbttilding. , No.-of feet front. i.2� No. of feet side $ No. of feet rear- 4D
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20.f4 Distance from heareit building:. Front` ft.; side ft.; side - 'ft.; rear
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-21. Dista4 itrhct back fromior'street a from rear lot line , side line •
Show by diagram the location of propsed building with relation to distances f m adjoining lots, on neversid. , `
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BUILDING PERMIT REVIEW
APPLICANT:`'N�� „1 / BLDG PERMIT N0:
LOCATION OF PR o � ks. • — DATE FILED: 7- SHL/--¢3n
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
RESIDEt7TIAL BUILDING:'
A) CHECK 4::ITH THE HEALTH DEPARTMENT IN REFEREDICE 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.
0) CHECK WITH PLANNING BOARD FOR LOT RELEASE. '
COMMERCIAL BUILDING: J
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 SEE IF LOT COMPLIES WITH ZONING BY-LADS.
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING POOLS, RESTAURANTS, ETC.
Ej• FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE .
LeriCTORS).
REV . s BY:
EN a MN' ' G DEPARTMENT: YES DOES NOT APPLY ✓ SIGNATURE E _ r 4, DATE 7/14/£30
CON' ATION Ca4MITTEE: YFS_DOES:NOT APPLY SIGNATURE n/�1, L
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13 DATE 714484
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE -- ---DATE
BOARDVF HEALTH L _,_ -YES_-DOES NOT APPLY SIGNATURE !D- DATE 9/0?_,
FIRE DEPARTMENT: YES DOES NOT APPLY_SIGNATURE DATE
COMMENTS:
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4144-4•` new:do o r4.
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