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HomeMy WebLinkAbout2013 Nov 06 - Sign Off Transmittal Sheet, Floor Plans ��� ��� � _ .. e ,��.���. _ .. � -:.�. �,_� , , ,. . . `�. �-� --- �� 8 � �G� -�1 So � of.Yq:� TOWN OF YARMOUTH � } � ��:� �� a ���� HEALTH DEPARTMENT _},� Y M'���M�`'` � pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be compdeted by Applicant: Building Site Location: '7 n mQ S�QC�i US�US �l�'��R.�/1�p(,t'� , �Q- doZ�►�3 i r'�in"vG.�-i/ � � Pro osed Improvement: 1 trOlt�t �� ' �eJ�P�C. r�- � G � be .,,,,,, • e � ; ,, { � � ��k' � � P � I � ? W; ���' ' Applicant: � - `� '�'�� Tel.No.: .sV g� �.S�c�'K lr a-S� I � � , � k � i� Address: 1�4� f� 7-�"���� ate;Filed:���'�� ' F � �: a �1 !✓ , � **Ifyou would dike e-mail notification ofsign off,please " ovide e-mail address:�t � ` �,,, . Owner Name: �''� t Owner Address: g . �l Own •..��g'' -���5''��'�S � . er Tel.No.. � ; .........................::....................................................................................................................................................................................................................................................................................................................................:.. RESIDENTIAL AND/OR COMMERCIAL BUII.DING 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 pians, to include: (1.) �ite Plan showing existing buildings, water line location, and septic,system locatioa;w (2.) Floor pl�ap.labeling A��o�oms within building (all existing and propose�)� �� 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: �� �' I „3 PLEASE NOTE COMMENTS/COND TIONS: N��� �� �e c�vc� � h r'U`w� y— � 1�S� c��U cM,�.. FLOORPLAN SKETCH ; Borrower: Brian Dongelewic FIIQ NO.: 73471St5119974 � Property Address:40 Massachuseris Ave Case No..135t362129 � City:West Yarmouth State:MA Zip:02673-5819 te+�der:uoahea vVno(esare � I �S ,,��� ,�� e� � �� � �,s �-�,"��;�-`���.r' �"`� 3�,,�'0 .z v,� �,�-� �,o� �,� o� tr1''"''v��" � '� I � D0°`sz• ar ar �aa,e� � aa�, esw � �� � ,� e ifrfittlg�e�B�v�K � �' 32' 32' 32' � � � i��C�1�Q�7GD h�V 0 6 2013 HEALTH DEPT. � � �M��.� I �: I � n�► c�cu►��s stn�nRv Lnrs�� e�a�ct�ov+� � ` coas o�oA ' +�es�e etec�aa� � � I GI.A1 � Pirsi Y2aor ...$96.0 � Birst Floor �. �. .Seoond.Floor��� 768_0 166t,0 � �_p : ��� �`2.0 � 128.0 B.4tlT Sase�ent 768_O T6$.O �.O z 32.0 32$.8 I P/Y 8orc� � � �192_fl � ��192_D: �.� � i6_0 z 90_0� � � 6{g_p . � .Saoond Floor � �. � � � � � .. . .32.0 r� 26.Q��� .TSB_fl � ! � � � .. . . � � . . . . .. . .. . , . . � � : . . . � . . � . . . . . . . � � � I � � . . . � .. . . . . . . � . ! 1 � � .�. . � � . .. � � . � Net LIYABLE Ai68 {tOl�dEd) 9564 4 fk�i1S (tWYlded) 3664 i I — - -- _J