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HomeMy WebLinkAbout2003 Jul 01 - Sign Off Transmittal - Addition� I � II • ..�,�• - _- --- •--..._._.__ ' , •�,• • � , �f,_ , � ' ' ; %•�o�-�,� TOWN OF YARMOUTH � � o , y BUILDING DEPARTMENT � Fc��.s'rz ; � BUII.DING PERMTT APPLICATION DEPARTMENTAL SIGN OFF TRANSMTITAL SHEET � i Buiiding Site Location: � �_� ,n i b • a � ,71 T') ��Map No:��Lot No:_'l N . i'_'r- � PIOpOSCd TII1PI'OVC[IICIIt: /-I�/I,1_(11+Z1 J .�7 `�I ��J*fr7�.s rl7i+ .: � . � ��1C8i1L: �A�.Ls�H PJ �_J'ai1r�' il:�'� � �lTI(t'i�/ �'i,Z.��C/1,711/�,r ,r�./l.Li � � Address: �i�I ���, �n?� •�f. S �G,. Te1No.:SA_Yv'�'I-9��I�Date Filed: ( �0 ,�--The Building Departmecrt'il be responsible for assisting the applicam by dispatching your plans and or application to the following apPlicable departments. , . � ' RESIDErIT[AL AND/OR COMMERCIAL BIIILDiNG WATER DEPARTMENT: Determiees Compliance of Water Availability end�existing locati�. i ENGINEERING DEPARTMENT: Detern�ines Compliance for Parking a�Dzainage. , f CONSERVATTON COMNIISSION: Detaanines Compliance to WetJands Acts;ie.,If Lot(s)Border any Type of - Wetlands,Streams,Ponds,Rivas,Oceans>Bogs,Bays,Marshlaad,Etc HEALTH DEPARTMENT: Deteimines Compliance to State and Town Regilati�s;ie.,Requirements For Septage Disposat end oth�Public Health Activities. FIItE DEPARTI�I�IFNT: Detemunes Compliance to State and Town Rcquiranentc for Personal f � ��Y.�P�Y Protection;i.e.,Smoke Detedazs,Sprinkler Systems,Etc. .....--•----------------------------------------------------------------------------------------------•---------......------........-----•----------- REVIEWED BY: , t. .WATER DEPARTMENT: DATE: N/A: 2. ENGINEERING DEPARTMENT: DATE: N/A ' i 3. CONSERVATION: DATE: N/q: � _ 4. HEAI.THDEPARTMErNf: �L DA1E: ��0� N/A , INDUST7�AL.1Nt�/OR COMMERCIAI,PER1►�►n'S ! S_ YVIltWG II+(SPECTOR DATE: N/A: 6. PLUMBINGINSPECTOR DAl'E: N/A: - �. FlRE DEPARTMENf: DA7'E: N/A: PLEASS NOTE ' COMMEN'['S: ' /v' a{ 1 S �{L �c. . 14c ' � � s S i RECEIPT OF COPY: SIGNATURE OF APPLICANT: DATE: ��-��- ��nr-w,��c - Ya�o.rcorr-H��c r�conr-�s� - caa�soa-��n�r�co.�.amn , ., ' . � i � r,o�.n�,:u��►n�cexa � uertn: csis9�ir . • 174MlD:9f91 O�AaID:60f AOOO/1IIW/ emsr: � a.e i �.l � r.�ro.u:oa�wnaoi�r. I cons s r. sxe r I �.w ca ed o� .�.�e.rea. �,�7� Elr�f Ct CA Daer/Rk� . . . odel 1 deatl�l� iattAC � US � . � e ] rrn`e / nme T�� � wip Surfa/ �� �Y 1 . .. � —8LS20W-_ i taiQWJI� rylSldiq � �C�WMI fI Iy / 4 tCova 7 Y/F�CI�Caep� .. . i �:.CONDWAfOB/LEHOAtED.1TA . taiat W�ll= ntl11S6a1 �� ettw ' �1 ..... IetarFkm= 4rdwad 'tIa um � ��� BM InfinyFud u ���ti R ta �.., CT� 1 ~�e�� unbvdle�eb �,�,. ` �P 8 ri i fhioan 9.arw.. � � , oWPmm� BueRue IW.W . 1B � . (�� 0.47t17 .� ' Am Sp7e 1e��n 0 �. �•,�p�p� f�.7� 2B �'a��` "� �483 y�� MR - - � 0 -'1 � FI/XED USE � .:.. ��Inc � �Y . - -^' —- � � � , L CaM.Code �i S�:`z t t�i i.,,, � i � IQi LYGLEFMt 1�0 IC�% . ' � � T B1��.� �.,� .__. .._, - . . � _ � O&Ol/7BU1LDlNGd�YARD/lEMS(LJ/XFAU!l�WCEXTRAF R6S(B � '� �} - ( Cafe « U! Unlb Yr. M d .Yolur . . . �,,�� };:' � �.�. Fna uiceucc�ar a :,uo,w�rr: i �w x� .�„ � cos o+bsr.. e � om im � tw � sum ucn Fw�n�c � ta e.ao v�r • teo .oo� , . � .s' - �.•�+�'.'_._.._ ;;qr�.k_ ..r � �:�; _ �` . . . _. f�,pf _ YSE ION � � ' � . � � on GH rea a Arre (/n��C � .YalYe ',S - '�s`— e�s �.e►w� �.ns �.�� �.�ns x� rro.in � sce �.�. • aw �zi »� u.cs x � �� For eRkonn.vw4rra tw u tf 111, FUS pperSmry Flu1�Yid 7 7M 7M 9r.76 90.sOt �:� . . 1 IIBIi me�t.U��da6ed 9 1�lSi 310 lL�l 1l,f0� .. .. y� , L ��- - ��g��� ! r•- ,�„ „ � � ��C@�� . . *�h! �'y �, �.,, � e (� W��nd� ' � � t i � � i i V � ' .of��"A?� OWE &TWO FAMILY ONLY- BUILDlNG PERMIT �,` �`- `` f��O APPLfCATION TO CONSTRUCT,REPAiR,RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING ' , ' ' � p���a Tu�vn of liu•mourh 13uildin�llei�artme:u� , � Y � �• '�' 1 J 1(i Itoute`?H • l:arrn�iulh.Mr102664-4492 I, ♦,,,,,,,`�:S'� � �'' �'� Tet: (5QK) 3'J�`t-_�`231 x261 Fax: (5(lR)398-?3G� FAX: ; �! � Office Use Only Ptanning Buard Intortnation Assessors DeparRrt�ni Informabort 7{, i Y Y PermitNo.��p�te � � EanType _ rzMaa � latr. Map. x:ttir s fndocsementaate��� bd ` �� d Permd Fee �S�-2. , : Y ; o�ar %w . ,� y Reco�ding Date �q pro�7egy D�mens�ans I Deposii Rec d $,�-S i�.Da#e r:" , � � � ,. ` � - � :, fan Ne : /g ; ;t . t Net Due t-�yg�z.,= � ': IIther =� A/LotArea(s� _� Front�age(ttX _�lotCoverage-. - � ` � �:` . This Sectiori(brAffice.Use�nl `a � Buildin Permif Numlier ,-< Date=.lssuetf.;:~ ., ...:__ ....:,. , , �. Si naturey �L =" � b�j�Fgx ` ����ficate of Occupansy _ , 9 � � � ., /� -x, ' . .BultlingOft(cral,... r- .. ate- . �is .,. . isnot �"+�' re�wted_ -,:. '' Section 1-Site lnformation" Use Group:R-4 Type:5 F3 • - � ��.� vrope.cy aaa■�s�: �^/� , 12 Zoning Infartnation:• • � 14.t���� C� f- � �—�C� t�40�T�o-�r ..�= Zoning District Proposed Use 1.3 Butlding Setbacks(R) Front Yard Side Yards - Rear Yard i Required Provided Required Provided Required Provided r 3 0 � � � � �,� �. �o, t_ 1.4 Water Supply(�II.G.L G 40.S 54) �1.5 FtoodZon�Tnformat�oru-�. - �' C"omments,,+ ,� �;� � Public Private Zone•. Y Y ,� - - -.�_.. BFE.,- >' Section 2-Propettybwriership/AutFlonzedAgent 21 Owner�R�cord: ��� � �tU K�M ,� S Y Name(print) Q� . Address r / � � � J 7�`(� i Sign2ture '� ' le e � 2.2 Authorized A nt: �N I GtJA�Y�v2 . J�easm �U�" D o� �aS� � Name(print �ngAddress - D-0 �sfn'!oK Si ature Telephone Seciion 3-Construciion:Services': 3.1 Licens d Construction u isor. ` �i � � � e � � : - � � D �r cense Num r !OJ ,�/ - Atldre.s � ��. a s C Expiration Date Signatur Telephone Q��/_�03 v t� 3.2 Registered Home tmp"roqement Contrector.- . Company P+�ame �ryfp C G en'►e Q �.✓ Not Appiicable Q 0 0� .�'1 L, „ ..� ` � � License Number Ad ress , . _ /t/ . 3p`/2�y� l97 ExpiraSion Date Signatu Tetephone 9-15•99 1 012 • nvro J • � ;Seciioti��4tz'y�oik'°�is"�Cotii�` risaiti'oz�fnsu"rana�kfiidauit'tT�1��s���'��Gj;. � ' + , Workers Compensation insurance aflidavit must be completed and submitted with this application. Failure ' . to provide this affidavit wiil resutt in the denial of the issuance of the bullding permit Signed Affidavit Attached Yes� � No.......... � � ; - �Section�b�:De�n"�"C1"�'or:o�:F?`'rbpai�d'171(otic�c}iec"f�'a1C"`p6caf7t��� • ' � New Construction ❑ No.of Bedrooms IVa of Bathrooms Ebsting Bidg. ❑ Aepair(s) ❑ Alterations ❑ Additlon � Accessory Bidg. ❑ Type Demolition Other Spec'rfy: Brief Description of Proposed Work: � � �a -1''3n Z sTsr . cvoo ; .� � 'LooC' t' r o kr c�ct.cJ 'Z.r �Loo o b.��h ' �/-t ! p� �'�+'Tt�'so �� 2ooM !�!/�g- e � �3 be �roo rn . j -s��o►��=�ma���-�; �o•: � • ; � Item Estimated Cost(Doliars)to be Check Below" _compleied by permR applicant � 1.Buildm ��O ❑ Conservation-Commission Filing ' 2.Electricel ' Cd appticable) 3.Plumbing/Gas 4.Mechanical(HVAC) ❑ Old K»gs Hi�hway&H'�storica! • i i5.Fire Protedion � Commissian approval I 6.Tota1=(1+2+3+4+5) C��P���e) � 7.Total Square Ft lnew�&add�io�a) • � ,�S�dO�t`7,„3�.,,C��an�i1��;�A�i�thonzaSaN'"Tut�'�.Cotiip�t�,tl"tIIR%7C �--� Q��.^ . i ,"�,wnec s��`'er��Q�ContractorAppiies��o�8i9dtling P,�[ut'it��f � - • � �� ,as owner of the subject property ! . � . . . . � _ hereby authorize to act on � my behalf,in all matters relaiive to work authorized by this buildingpermit application. '� I � Sfgnauae of O�mer _ . , Date •- ' $�C2�plt�4�<;,�11V}]�Gf�t�10fIZ�����eIi�8G�3Cd[i0�; . �� -e ,as OwnedAuthorized Agent . • ' - � ; hereby declare that the statemer�ts and information on the toregoing aPpiica6on are true and accurate, � � to the best of rny knowledge and belief. - : ' � � ' � G . . I Signed under the pains and penafties of pery'ury. � ' • � � �. �lE N e. �.Q.vs o � Print name ' � . ' , • ' . , � . � -30�03 � Signatu f OwnedAg.. . . � Date ' � - f , f .,.T.r�. ,. .� . J • � Se�iion;4p''y1/b`�xs'��.o�ti��nsatiorr ins.urdnc�A#�idavir�IG(�:�t:�c'9��T"s���;; t ' * , Workers Compensation Insurance affidavit must be completed and subm)tted with this application. Failure ' _ to provide this affidavit wi(I resull in the denial of the issuance of the buiiding peRnit. Signed Affidavit Attached Yes.�- � No.......... � �ection�5 D��n�'�i[it�;o'f�pi�a Woric;�cfiecT�'aIL•a P�'�abie�±; • +New CanstrucUon ❑ No.oi Bedrooms No.of Bathrooms Existing Bldg. ❑ Repalr(s) ❑ Nterations ❑ .Additlon � Accessory Bldg. 0 Type Demolition Other Specify: Briei Description of Proposed Work: � iZ 'r�� 2 Sl��' . l•0190 � � �L�� r � o .�, �k ,� �� �Goo c 6.� � d-L � ��✓Tz�'to 1Q� 2ooin Gl/i¢- e " ' �3 be �ou �n ...._ . .. � � � . Ms���������a:��������-��-5�; . ' Item Estimated Cost(Dollars)to be Check Belaw ,eompleted by permtt applicant ' 1.Bulding �o O ❑ Conservation-Commission Fliing � 2.Electricaf - (�f applicable) 3.Piumbing/Gas 4.Mechanical(HVAC) • 0 Old Kngs Hi�hway&Histor�al • 5.Fre Protectioo • Commission approvai 6.Tota1=(9+2+3+4+5) (if applicable) 7.Totai Square Ft p�ew harses 3 add�uar�s) • ,S�d�a.{�'7�-�f3aivne�';Autt�or�rdY�t�n "T�o,�be..Coriip.�.l�k�ti`VYti�ft,' �-- � ,_ �wrters��iCnr:Ctrnttactor>AppFies���i�'"B�`udtlingP,er�iiit�F�' —�`�3 �r{ . . �, ,as owner of the subject property hereby authorize to act on - my behalf,in ali matters relative to work author¢ed by this building�permit application. Signanae of O�mer . • ' , Date •� �ecti`orr"7fk„O�hr�tetl�K"�thonzie.�Ageii�DectaGatiofi � . �, � ,as OwnedAuthorized Agent hereby deGare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. - � ' � � � ' � � Signed under the pains and penalties of pery'ury. � � • • � '. �/F �J� �.Q.�JB o Print name . • . , • . . . , . • . � -30�-03 - Sigrtatu f OwnerJAgs . , Date ' -