HomeMy WebLinkAbout2015 Oct 08 - Sign Off Transmittal Sheets, Floor Plans - Demo & New Construction of 3 BR Home ���,�.,�.�_ ��.. _
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� �,o�'���� TOWN OF YARIY�UTH
w o�w -� w���y HEALTH DEPA�TMENT
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� 4'�•�NE`•` ' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
' To be completed by Applicant:
Building Site Location: J� /'�6 Y'G cr, n R.1� . (A)c �, t1 V�_�(�-. b� ���
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Proposed Improvement: � �
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Applicant: G� J!LITTC�r� Tel.No.: JrU���Z� 3�C�
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Address: rp � � ��l�t A/Z. � 4✓r� ,�• c'�ZG7�j DateFiled:
**Ifyou would dike e-mail notification ofsign off,please provide e-mail address:
_"Owner Name: t�� �,,
b?�c S
Owner Address:�1 ��/tij,� ��, ��'� t✓� �l�'� Owner Tel.No.:
....................................................................................................................................................................................:...........................................................................:.................................................................................................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
H�ALTH DEPARTMENT: Determines Compliance to State and Town Regula�ions; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of plans, to include:
(l.) Site Plan showing existing buildings, water line location,
� and septic system location;
(2.) Floor plan labeling ALL rooms within building
(all ezisting and proposed) —
Note:Floor plans nof required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
. with fee.
..............................:............................................................................................................................................................................. ..........................� ......................................................................................................
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REVIEWED BY: C/� DAT�: /I '" � %�
PLEASE NOTE
COMMENTS/CONDITIONS: ,
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�o���?�,, TOWN OF YARMOUTH
� -� "�`c, HEALTH DEPARTMENT '
�_'`'��„�`�� � PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET !
�
To be completed by Applicant:�
Building Site Location:_ 1 j �0✓�(�,�,h �,� . w t �/,�,�_�. C�Z 67�
Proposed Improvement: �.����`,-��, ��,n
Applicant:���u-�/� Tel. No.: �ca��{�13�,Z
�
Address: � (� � � 4 Z(7� Date Filed: �1' Z�t-�S"
�T �—
**If y,ou would like e-mail notification of sign o,f�;please provide e-mail address:
,� .,.
'Owner Name:�a�'j�.�r� ��.�r�I�t t'� -e--
,
Owner Address: �(� ��T ,,�.�. ,� , Owner Tel.No.:
........:........................................�.�...�...:�r..�.............�...............:..�.z:.�..��`:.....................:.......................
.......................................................................................................................
RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Require�nents
For Septage Disposal and other Public Health Activities. �
f •
Please submit three (3) co ' ' of plans, to include:
(1.) Site Plan showin zisting buildings, water line location,
and septic syste location;
(2.) Floor plan label g ALL rooms within building �'"�
(all existing an proposed)—
Note:Floor plans t r�' �l for decks,sheds, windows, roofing; �°`
(3.) If neces�ary, Ti e�5 application si sd by licensed installer
with fe�. � =-�,.....�,�,..
.. ............................................................................................................................ ...............:....................................................................................................................................................................:.............................
;
REVIEWED BY: DATE: /��% �`
�.
P�,EASE NOTE �� �
COMMENTS/CONDITION :
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