HomeMy WebLinkAbout2016 Jun 23 - Sign Off Transmittal Sheet, Sketches - Shed Roof _ - �N�r
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o� Y'��,� TOWN OF YARMOUTH
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� �r - `-';c � HEALTH DEPARTMENT^� �
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���''' `��1� PERMI'�"APPLICATION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant: 4c'-�--� � t�`�'�'J �'e� ,
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Building Site Location: � � ��,(�Gc..�/� ���-F' 4 �,;���/Y1C3�-1�� � ;
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' Proposed Improvement: , 4 S G. .�. a �
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A licant: .� � .-��_.�-.�
Address: ���i 1�-+��'r�'�e- �v� • � ��..1ClYluS � fMA C�.U.D( Date Filed: � � I
**Ifyou would/ike e-maid notification ofsign off,please provide e-mail address: ����/")�( (?��p(���-,- �_�
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Owner Name: .�(� �' �Tt��U �17C�P
Owner Address: s���_ L� Q`�. � S U{Y2.rVl.L��- Owner TeL No.�'v� -(o��i - 7�aa
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; 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 �eptic system location;
(2.) Floor plan labeling ALL rooms within building �
t (a�l exisf ng and proposed) — �-
Note:Floor plans not required for decks,sheds, windows, roofing;
�.� If necessary, Title 5 application signed by licensed installer
with fee.
: ........... ............................................................................................................:........................................:.................................................... .......................................:.................
� REVIEWED BY: DATE: � O�c3 iC�
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PLEASE NOTE �
- COMMENTS/CONDITIONS: 1
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UNE or TWQ FAMILY —BUILDING PERNIIT
APPLICATIOIV REGtTLATORYA.PPROYALS NOTICE
Address of Proposeci Work:_ � l�l�ar� �� ��.�Ar�YI�L�I
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Scope of Proposed Work: I a �( �, S'C v'�'�e�, /�o c�-��
Date: � ��j`\lp
Baseci on the scope of work described abave,the applicant is required to abtain apgroval �
sign-offs from the fallowing departments as checked-off below: �� ��������
uHealth Dept.—5ti8-39&2Z31 ezt. 1241 ��a3J1� l��-� M�ST'S ���
/ t�c-�w S��<<
Coriservartion Comm.--508-39&2231 ezt 1288 "�S tiv� �9' �
✓ A'ater Dtpt.-- 99 Bgck Islaad Rd.phoae no.Si�&771-7921
Old Sings Hwy.8ist Comne.--508-39&2231 ert. 1Z92
Eng►inneering Dq�t.--508-39&2231 ezt. 1250
Fire Dept.—K.�vin Huck/James Armstrong,96 Old Niain S�SY
Note: Please call Fire Department for an appointmenk 508-398-2212
Other �
Appropriate plans andfor application shall be provided to each of the departments
checked-aff above. Each of the.se regulatory atrthurities has their own requirements
outside the jurisdiction af the Building Department Ail sepplicable approvala sha11 be
obtained priar to aubmit�ng s�baildiag permit application to the Bw'Iding Dept
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Thank you for cooperatian. i
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AppL :s S D�
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Rev. Dec.Zd15 �
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JUN 2 3- 2016
HEALTH DEPT.