HomeMy WebLinkAbout2017 Aug 24 - Sign off Transmittal, Demolition Sign Off Sheet.,..�:r �. _ _.._-_-� _
,aY-�Ya� TOWN OF YARMOUTH
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�, ��•-;� HEALTH DEPARTMENT
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��«''� `'��� PERMIT APPLICt�TION SIGN OFF TRANSMITTAL SHEET
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To be completed by Applicant:
Building Site Location:��� Z, �j��}Q„ '?� �,.},�.�T{�..� m t�� 1'1('�0. C�Z,��
Proposed Improvement:��'�j������.��� �1����Q�
APplicant��15��.- f�l.�� �.0 - �f1C• Tel. No.: � 'y�-U�d
Address:��... �3 ���"'�`� ���� �j..�(���.�,�, C�ZC�H�jj Date Filed: � y f �
**Ifyou would like e-mail notifacation ofsign ofJ;please provide e-mail address: G..�`�C�„!'[ C}�.�� }Y- COM
Owner Name: , � y���(,Y'��-��t�l._�Q..Y�f'1�—��Q �Y�...'C1'Q"'(�..fY`�
Owner Address:��� ��1 �'��..`���C}�-1(� �(`(�Owner Tel. No.:
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RESIDENTIAL AND/OR COMMERCIAL BUILDING
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)—
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: � 4` � ��
PLEASE NOTE
COMMENTS/COND IONS:
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�o��Y9R,� TOWN OF YARMOUTH
a _ , � _y BUILDING DEPARTMENT
" MATTA�.�Cp. .-�J ' 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261
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BUILDING DEPARTMENT
TOTAL DEMOLITION SIGN-OFF FORM
State Building Code(780 CMR) Chapter 33, Section 3303.6-Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all
utilities having service connections within the structure, such as water, electric, gas sewer and
other connections. A permit to demolish or remove a building or structure shall not be issued
until a release is obtained from the utilities, stating that their respective service connections and
appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged
in a safe manner."
i "All debris shall be disposed of in accordance with 780CMR 111.5."
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Water Dept.: Date:
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Board of Health: Date: ��.�ir(i-]`�
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Fire Dept.: Date:
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Historic Commission: Date: � `
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Conservation: Date: � ��
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Comcast: Date: N��
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