HomeMy WebLinkAbout1978 - Bldg. Permit App.; Plot Plan Showing Addition; OKH Cert. of Appropriateness No.
Application for a Permit to Build
Fee must accompany this application
Yarmouth 19
TO THE BOARD OF SELECTMEN
The undersigned hereby applies for a permit to build, according to the following specifications:
1. Name of Owner 1(11- .';1;14 5. t'lrt.PAT12i k Address 11`1 Wt$T si":1t1rrnCUTN 8040
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2. Name of Architect (if any)
3. Name of Builder 'n r,c/ F 7 7 j)4? 7I(k
4. Precinct No. + Lot No. 1,0T 41- Plan: Name or No. Pi ii-; Boo k I I 17AGG 47t3
5. Name of Stree41 RA% ` ►11 mcg t+i h R as
6. Purpose of Building i-f4;VI;t`` R .11 ow-cPty! e +et'
7. Material L.it
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8. Estimated cost of building
9. `Dwelling '}r':
10. Cottage AR;
11. Heat 'IL
12. Basement #0,0 s ,v t✓
13. Garage
. 14. Store A,Cw �
15. Shop
16. No. of stories + /61-:61
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17. Is there tobe a Store in the lower storey A..",0
18. Size of Lot. No. of feet front I. .(r) No. of feet rear /PO No. of feet deep
19. Size of building. No. of feet front Mt, 3+ No. of feet side `" No. of feet rear of' 34
20. Distance from nearest building: Front '$O ft.; side 74 ft.; side 0 ft,; rear 3°0
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21. Distance back from line or street 4'1° , from rear lot line 5 , side line. ..I' 12. •
Show by diagram the location of propsed building with relation to distances from adjoining lots, on reverse side.
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Address P(? ule S j Lail!o?. '.4:'. 120 ...
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Rear of Lot
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Frontage of Lot
Street Name
PLOT PLAN
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4Application to '
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Cts` ° ,h'� Old-King's Highway Regional Historic District Committee
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CERTIFICATE OF APPROPRIATENESS
Application is hereby made, in triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs
accompanying this application for:
CHECK CATEGORIES THAT APPLY: %.
1. Exterior Building Construction: ED New Building ►4 Addition P Alteration r Y
Indicate type of building: ' House 0 Garage 0 Commercial 0 Other
2. Exterior Painting: 0 : "
3. Signs or Billboards: New sign 0 Existing sign ❑ Repainting existing sign '+
4. Structure: 0 Fence 0 Wall 0 Flagpole ❑ Other ;
(Please read other side for explanation and requirements). 't
'PIC. (y, tql$ ,4 ,.
TYPE OR PRINT LEGIBLY DATE
ADDRESS OF PROPOSED WORK 117
WeS i -1A cowl Es). ASSESSORS MAP NO. t02-
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li OWNER gAPrRA S(k*`tfoe-D Fr>izPAi'VtIC.K. ASSESSORS LOT NO. H 4 '
HOME ADDRESS ill WEST IRIZMOON, RD . 9ARrto•s1?I Fo2T TEL. NO. 3.6 — 6°'"r'''.''' l'''''':1 '
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, FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public
str a So.r way.pr,(Attach ad itioni I tTsheL )f 1+2ne4ceeG ry).EC2zCaortoot{ t..,MtE Po&U�t0A,E
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1-A42-0-1 A. FttzPA4"Rtuc TEL No. SC'-2- - (2014 C)AGENT OR CONTRACTOR ,
r ADDRESS 11/ WEST yA2MoJt}t 20 Ni bQU1 Pari
DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No.8,other side), including
:,; materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed
locations of new signs. (Attach additional sheet, if necessary).
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Signed �'
,( Owner- ontractor•Ageni
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Space below line for Committee use.
:t Received by H.D.C.
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Date f a'f/,` 7 r The Certificate is hereby Dte.s
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Approved [ IMPORTANT: If Certificate is approved, approval is subject to the 20 day appeal period
provided in-the Act.
Disapproved 0 Please return to: Yarmouth Historic District Committee
P.O. Box 124,Yarmouth Port, Mass.'02675