HomeMy WebLinkAbout2010 Jun 07 - Sign Off Transmittal Sheet, Plans - Deck ���� �
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°��Y��o TOWN OF YARMOUTH
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o a� HEALTH DEPARTMENT
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�' PERMiT APPLICATION SIGN OFF TRANSMITTAL SH�ET
To be completed by Applicant:
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Building Site Location: /�p [.e w,•�S �m,� Map NoP�,ot No.:��2
Proposed Improvemem: /�G� G
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APPlicant:_� . � .��s �fY7.4i'a TeLNo.:6lJ S"a7,-6'6J��
Address: /pr5 1c..ui:a Oi�p/�„c.s�o.�� DaieFiled: �Tv+Jc z o'�v/O
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**Ifyou would like e-mail noh;ficatiort ofsrgn oJJ;please pravrde e-mail address: �
Owner Name: � • �o..,a. S G G'./r�.n.;> i
Owner Address:T�/�'' �„��f ��{Lc�y., �er�TeL 1�Io �.7 �Sa7-S�3 �
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R E S ID E N T I A L A N D/O R C 0 1 1 4 ME R C I A L B U I L D I N G " I
HEALTH DEPARTMENT: Detemtines Compliance to State and Town Regulations; i.e., Requiremems
For Septage Disposal and other Public Heakh Activities. I
i
Please sn¢mit four (4) copies of plans, to include: j
(1.) Site Plan showing ezisting baildings, water line location, j
and septic system lceation;
� (2.) F7oor plan labeling ALL moms within building
(all�xisting and proposed)—
Note:,Floo�pinns nottequired,�'or decks, sheds, tvntdows, roo.j'ingi �
(3.) If�cessary, Title S-°application signed by licensed installer
wi�i fee. , i
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REVIEWEDBY: DATE: ���IO
PLEASE NOTE
COMIv1ENTS/CONDTTIONS:
� PLOT PLAN
i PROPERTY ADDRESS: #100 LEWIS ROAD YARMOUTH MASSACHUSETTS
I �r.ai F: 1 IN.=20 FT. DATE: MAY 28. 2010
( :_: � 50.00' �/
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„t LOT 167: ^
i � 6,433ts.f.
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i LOT 169 .ba o ��'s ��o � ' �
" � � DECK -- �r
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; N � ��2 gTy 3 r LOT 165
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� 50.00' 1
� 10o LEWIS ROAD
I hereby certify that the building on this pla� is located on the ground as shown and is not
located within a special flood hazard area as detertnined from F.EM.A. flood insurance map.
Community Panei No. 250015 0005 D
Dated: JULY 2. 1992 ���,ZH OF,yq sq
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VTP ASSOCIATES. INC. o .wseaH �'y
Surveyws - qv� Engrs. � R� ��„
132 ADAMS STREET 2ND RO�t SUITE 3 � �� ^'
NEWf�l. �IA 02456 o No.3gp5t -�
REqS1RY OF DEEDS: id e " A P `'~
DEED REF: BOOK 3384 PAGE 029 CERT. Fp�j�, �6173 969-2330 �9'�SURV��Q
PLAN REF: Book 25 Page 49
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LOCATION MAP - SUBJECT PROPERTY
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