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• Application for a Permit to Buil No.
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Fee must accompany this application
Yarmouth 19
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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 Mti (,Cmb et,to Di Tilde ,* Address 1/J Sr/ver/e. %&. LLJ./ ftCCc�/c.
2. Name of Architect (if any)
3. Name of Builder Mr FrLL`IC Ade. Jr.
4. Precinct No. 4 Lot No. 4. Plan: Name or No. km, I S- ICI-4
5. Name of Street/CS) 'Vt* tel Let.
6. Purpose of Building &.VI!CVAS f C'r. b/ /ftiCLe—; J.11eatJtc(& ,j 7104-(..g-yt„ l/'Xa/
7. Material 7 X •7 U
8. Estimated cost of building $s` � "e O 000
9. Dwelling OLn9NCe (6>t
10. Cottage —a./ 7
11. Heat 2.1
( bat_�sq€I T.d Riawt•
12. Basement stt
/ )0
7-Y
13. b
Store
14. Store �p11
� D
15. Shop
16. No. of stories
17. Is there to be a Store in the lower storey
18. Size of Lot. No. •of feet front O O '� Z
/f / No. of feet rear 30 f t No. of feet deep 130 -
19. Size of building. No. of feet front g�� f# No. of feet side "IS [
s PI No. of feet rear To 7 t
20. Distance from nearest building: Front r 1 11 ft.; side 7 6 ft.; side /Q0 ft.; rear 7 1[�
21. Distance back from line or street 50..^fL , from rear lot line 116 *L side line 'hit
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
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Address 9.0 ScIV etteitXAt.
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.� Street Name ...LMit if A Oci
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p Left Side Depth Of Lot _ - -
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Y. Right Side Depth of Lot .
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Street Name
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;, BUILDING PERMIT REVIEW
AP?LI CANT: V n i bL r f? 1)1. 7L // ii BLDG PERMIT NO:
LOCATION OF PROPERTY: LIQ oIVerfa.a.i. 4141r. 'U. a,4'M1Vfit 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 CalMITTEE-IF LOT BORDERS ANY TMPD OF WETLANDS.
C) PLANNING BOARD- TO SEE IF LOT COMPLTRS 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).
.117., VIEWED BY:
1
LN INEERING DEPARTMENT: YES V DOES NOT APPLY SIGNATURE I-__'y _ 1, _ `. DATE 712t/EW
lCONSERVATION CCX4MITTEE: YES DOES_NOT:APPLY SIGNATURE Ma,. . \ DATE-11214GO
. : YES DOES NOT APPLY SIGNATURE DATE
YARD OF HEALTH: YES e/f]OES NOT APPLY_SIGNATURFL DATEr7/.2?,SD
PrIEEEXEMERT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: / � Q 0 '
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