HomeMy WebLinkAbout2016 Jun 28 - Sign Off Transmittal Sheet, Certified Plot Plan - Deck_ t �.�_ �_ ,.,� _ � . �� _ � _,�._o,�s .�-�s.,�,�,.��� �--_,.. _ _
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'`��'�� o��Yq� TOWN OF YARMOUTH
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'�`''���``���� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: `�'� ���,.,t��,.,.
Proposed Improvement:��y�,,,"5�����:'^r � lZ,, � 1�,,, c��
Applicant: �`�.� ���,n� Tel. No.: S�� ���" �`� 1
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Address: �� �r_�,,p---�1�', �.-�.���„��,A�,,, Date Filed• t�"� �
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**If you would like e-mail notification of sign off,pdease provide e-mail address: �t..JW
Owner Name: ����a_.- ��b\�Z � ���
Owner Address: ��� �ti�.��^�.,rtC.L �V�_ � Owner Tel.No.: �j��( -�(���
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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 septic system location;
(2.) Floor plan labeling ALL rooms within building
- (all existing and proposed) -
Note:Floor plans not required for decks,sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
........................................................................................................................................................................................................:................................................................................. ............................................................................
REVIEWED BY: DATE: � � � 1�
PLEASE NOTE
COMMENTS/CONDITIONS:
Certified Piot Plan in Yarmouth, MA
Address : 105 Constance Ave . Pre ared For : Deborah Poole
Assessor's Map: 86 �t: �a Baxter Nye Engineering & Surveying
Commuoity Ponel Number 250015 0586 J, Effective Date July i6, 2014 Reglstefed PFofessionol
F.I.R.M. Map Tones: X (un-shaded) E�gineers and Land Surveyors
Plan Reference: Plan 8odc 220, Page 149 78 North Street, 3rd Floor
Hyannts, MA 02601
Oeed Reference: Book i904, Poge 148 phone-(508) 771-7502 Fax-{508)-771-7622
Owner. Deborah Poole $Cale : �U = 2�' Date : 06-21-2016
Zoning District: R-40
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