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• Application for a Permit to Build
No. �
Fee must accompany this plication
Yarmouth .137:"---y ! 4- 19..15 i
TO THE BOARD OF SELECTMEN "" — a— — — ------- -.-—._.
The undersigned hereby applies for a permit to build, according to the following specifications:
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1. Name of Owner C/w f e. da`brCc AlE'y0 Address 'GJ 4 zf 'Ir O4.
2. Name of Architect (if any)
3. Name of Builder /(2 � •
4. Precinct N . 2, - Lot No. 1.21 - Plan: Name or No. Wit
5. Name of Street 70 ( 7ka„„,i;/ a 64 y zAL,
6. Purpose of Building —'-
7. Material ,deed-c:L�7C=�J CLU
8. Estimated cost of building / (YO
9. Dwelling 3
lo. cottage ,i/ 72-
11. Heat
12. Basement
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.bf feet front; No. of feet rear // No. of feet deep
19. Size of building. No. of feet front 3/ No. of feet side .......4/ No. of feet rear .....3'
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 diagramthe location of propsed building with relation to dista ces from adjoining lots, on reverse side.
Name... ./t `2 4
Address 70 /
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Street Name
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p - Lett Side Depth'of Lot..d10 Or / 2
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Right Side Depth of Lot ._/.Z / 3 s` r
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• Street Name ..Q 0 TW 4 P eC CAI I
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BUILDING PERMIT REVIEW
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APAICANT: 4N-•c Ii / e A_,,e , BLDG PERMIT NO:
IACATION OF PROPERTY: 7/'/ `12/4 c,{ ,Qtr (// 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 APPLICANTTHROUGHTHE 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 SEE IF LOT COMPLIES WITH ZONING BY-LAWS.
I)) BOARD OF- HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING FOOLS, RESTAURANTS, ETC.
E) FIRE DEPARTMENT-FOR PROPERTY PROTECTION, PERSONAL SAFETY, (SPRINKLERS, SMOKE
DETECTORS).
REV al BY:
ENG AK DEPARTMENT: YES ✓ DOES NOT APPLY SIGNATURE L.,_• _ j. • DATE 7/141 tiSo
CON i `9 ATION CaiMITTEE: YES_DOES:NOT"APPLY /SIGNATURE l .,_ .:� I. DATE 111 tei 8o
PLANNING BOARD: YES DOES NOT APPLY SIGNATURE A DATE
BOARD TH YES /f70ES NOT APPLY_SIGNATURE ' /fAsk ., DATE -2//941-0 ,
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: 14 2 N oy
ADDIT:oW 7o EXISTuaG Fouh:DATIo eJ