BLD-80-435 Oar
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No.
\ ,b Application for a ;Pe it to Build
,` Fee must accompany his application
Yarmouth 1- 19 '
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, accordi g to the following specifications: y
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1. Name of Owner ijvivss s a Et iz-AhF7//' Ai, ) fir Address d0 /f kV/NS /4W G RAST m JA*R,,,,o writ
2. Name of Architect (if any) .
3. Name of Builder 6 5 L
A.M. 34=SI
4. Precinct No. 4 Lot No.. r1 Plan: Name or No. '3 r
ens
5. Name of Street 1 whyry/.0 vi/ c tA1 /7cA- b ,
6. Purpose of Building L,i CLOS in(C CAP Po R 7
7. Material y✓o o D r
EA/C L o-1 a Cern a
lat 8. Estimated cost of building /p-r-o MS' OK tQ
9. Dwelling A ,4„..,..r
..
10. Cottage Cl.:-- Pc a. ' �� ".."`""i-Ant, C.it H d✓'t d (' W R.d.
11. Heat j4,
12. Basement J(
40, \
13. Garage I ' /
14. Store •
15. Shop 0,/ 'g�
16. No. of stories
17. Is there to be a Store in the lower storey
18. Size of Lot. N0JS?bt trot?' 1/4•014 Z'a 1 fjj No.tf to tt rear No. of feet deep
19. Size of building. No. of feet front /CC- No. of feet side .....1.Z No. of feet rear ..1 2
20. Distance from nearest building: Front ft.; side ft.; side ft. ear
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. `''..
Name �,p,
Address etc P'1 i n^� d ,&• 1V ti'^"-sat/
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I i. Rear of Lot
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91
Frontage of Lot
Street Name 4-0.1 t)4 ilS4. C.t-f 1 Crof
PLOT PLAN
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._+ J" r BUILDING PERMIT REVIEW ►,• 1 : -,
APPLICANTsO 41I 0BLDG PERMIT NO:
LOCATION PROPERTY: o i • . , i. .v„_ DATE FILED: 7/?/fl
THE FOLLOWING CHECK-OFF SHEET IS SIGNED 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.
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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.
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COMMERCIAL BUILDING:
A) ENGINEERING DEPARTMENT-FOR PARKING AND DRAINAGE REQUIREMENTS, TOPOGRAPHY SITE PLAN
REVIEW. %
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B) CONSERVATION COMMITTEE-IF LOT BORDERS ANY TYPE OF WETLANDS.
C) PLANNING BOARD- TO SEE IF LOT COMPLWITH ZONING BY-LAWS.
D) BOARD OF HEALTH-FOR SEWAGE DISPOSAL REQUIREMENTS, HEALTH RELATED ACTIVITIES.
EXAMPLES: SAUNA BATHS, SWIMMING PO , RESTAURANTS, 'ETC. ` -
E) FIRE DEPARTMENT FOR PROPERTY PROTECTION, PERSONAL SAFETY ,(SPRINKLERS, SMOKE
DETECTORS). . --- .
I
REVIEWED BY: t1'
ENGINEERING DEPARTMENT: YES V/DOES NOT APPLY S� (2is
ATURE JS€. �(lMti]r DATE 7/23/So
CONSERVATION CCMRMITTEE: YES ✓DOESI.NOT;APPLY SIGNATURE ( t''�),,, DATE 0)
PLANNING BOARD: rYES DOES NOT APPLY SIGNATURE" DATE
PM \---,,$)a) .w"a:'+.'.A, 1•n.^,
BOARD OF HEALTH: YES DOES NOT APPLY SIGNATURE P' 97/t11417
DATE 7 ',-
FIRE DEPARTMENT: YES DOES NOT APPLY SIGNATURE DATE
COMMENTS: 'to vow,
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