HomeMy WebLinkAbout2016 May 11 - Sign Off Transmittal Sheet, Plan - Remodel/Addition,-__ � ... _ �.�,�. a
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.o�--Y�� TOWN OF YARMOUTH '
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�� � ��°- ° HEALTH DEPARTMENT
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� ��� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET '
To be completed by Applicant: � ��I
Building Site Location: /f� /� �G�� --r� ✓� !/"a.a•��
Proposed Improvement: ��.� M�d'� �� -t xr,�� ���,rc .�,_� .���� � .j' 9�u,�.-�„-
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Applicant: C�,�c,..= l,��,�—�.t�,.� Tel.No.: .�a G- ?J7- y?6 7 �
Address: I° �. r��,� f.� � a � ,�/��-t �^'►2 Date Filed: -�� /i /6
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**Ifyou would like e-mail notification ofsign off,please provide e-maid address: ��++ �w`(� ctiyr�<_� �''. �� r�' �
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OwnerName: C`r,u,+ � �`'�� ��—'
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Owner Address: /��- ��y f �� � f/ �^'t Owner Tel.No.:���� �?7� l 7�� !
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RESIDENTIAL AND/OR COMMERCIAL BUILDING '
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HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements ;
, For Septa.ge Disposal and other Public Health Activities. ;
Please submit three (3) copies of plans, to include: �
(1.) Site Plan showing existing buildings, water line location, - �
and septic system location; �
(2.) Floor plan labeling ALL rooms within building �
(all existing and proposed) — l
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Note:Floor plans not required for decks,sheds, windows, roofing; ;
(3.) If necessary, Title 5 application signed by licensed installer �
with fee.
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REVIEWED BY: DATE: S� << �G►
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PLEASE NOTE � � � �
COMMENTS/CONDITIONS: /�
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LOCUS MAP
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GENERAL NO TES :
I. THIS PLAN IS FOR PERMITTING PURPOSES ONLY.
2. VERTICAL DATUM IS ASSUMED FOR BENCH MARKS
SET. SEE S1 TE PLAN.
3. BEFORE CONSTRUCTION CALL "DIG -SAFE'.
I -888 -DIG -SAFE AND THE LOCAL WATER DEPT.
FOR LOCATION OF UNDERGROUND UTILITIES.
4. NO DETERMINATION HAS BEEN MADE AS TO
COMPLIANCE WITH DEED RESTRICTIONS OR ZONING
REGULATIONS. IT SHALL REMAIN THE CLIENTS
RESPONSIBILITY TO OBTAIN ALL PERMITS. SPECIAL
PERMITS. VARIANCES ETC. FOR THIS PROJECT.
5. IT SHALL REMAIN THE CLIENT'S RESPONSIBILITY
TO HAVE THE PROPOSED BUILDING FOUNDATION
DESIGNED TO ACCOUNT FOR THE EXISTING GRADE
AND SOIL COND 1 T I ONS AT THE LOCATION OF THE
PROPOSED BUILDING.
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HEALTH BERT,
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WMEMR
0 /0 20 40
S l TE PLAN OF LAND
153 NORTH MAIN STREET. MAP 80. PARCEL 13
SOUTH YARMOUTH. MA.
PREPARED FOR:
N ORM TO ALL CRAIG WHIT TEN
TOWN BY LA S RE ULAfilONa
SCALE: I"- 20' APRIL 30, 20/6
YARMOUT,WWATtER DEPT ATS STEPHEN A. HAAS
ENGINEERING, INC
P.Q. Box 16
South Fannia MA 02660
362—S132
JOB NO: 15-072