HomeMy WebLinkAbout2013 Dec 31 - Sign Off Transmittal Sheet, Plans - Stairs from 1st to 2nd Floor r�.�,- �_ _.�. �...�,_ �,r. _ _- -�-�-.�-,�---P .�--� -n.,.-,����. .� _ ��._ _ _
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�o��A�,� TOi�VN OF YARMOUTH
- w-:�° HEALTH DEPARTMENT
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�' `��,�ME•` ' pEkMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: �1,� /'��I.-f1'�--c-}'��t`� �?'`� ff ` /'�"� �p J/�
Proposed Improvement: �/yt�4 � � /7-��.7'�C� �.�'�`"'f'�-� �.N / r;
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Applicant:_�i� a. /�f`o t'Zd,dZ�.� /�o it/J yl �N�i Tel.No.: .��' 7�"-��'���f
Address: �(! t� •,C i�-( G��'� L��'�'`�� �'"1� ��`� Date Filed: lZ / /,?
**Ifyou would like e-mail notification ofsign off,please provide e-mail address:
Owner Name: �/ll�f�/ /,,,�o r ��-t�G✓'� c-
�- � c� /y�.��t� � .,!'.' yr,�.�,,,,, �f� ��- 2!'�=�Gx 1T
Owner Address: Owner Tel.No.:
RFSIDENTIAL AND/OR COMMERCIAL BUILDING
HEALTH DEPARTMENT: ?3etermines Compliance to State and Town Regulations; i.e.,Requirements
For Septage Disposal and other Public Health Activities.
Please submit three (3) copies of�lans,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) —
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:��//��
PLEASE NOTE
COMMENTS/CONDITIONS:
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DEC 312013
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