Loading...
HomeMy WebLinkAbout2017 Sep 15 - Sign Off Transmittal, Plans�-�-•-�•�----, _-_.. ,____ ,.,�-. _....� .-....�.�..�.-,--.-� __ _ .� _ �_._�_�_-� �...r . m,.� ____ _ _ 4 �-�,,.F� . _ . . . ' .- .... . . ...i. � .� .� . . . . � . . . . �� ' .� ��.. � . � o� Ya� � $ TOWN OF YARMOUTH 3 • .,,,.,�,,� �; � �t�- � HEALTH DEPARTMENT a r-� ..� -�i"� ��~'', ``�''� pERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET � . "^`ti�N�.� . .. . To be completed by Applicant: Building Site Location: ' � �- Prop�sed I p ove ent: �" _��. � r �"��-� � � � �. , � . �- .`�`"' ' ���- �-�- `�- �~� �.�. - Applicant: � �•( �- �?,� �l�'zt� '���.,� Tel. No.: - � � F-�` � 1�j ,�-���_,�d�a�S C i ���Il� ()r�-'(.��D ! ? � � Address: � � S�� tL ��L1,�1 Date Filed: **Ifyou woudd like e-mail notafication ofsign off,pdease provide e-mail address: Owner Name: fi' � 6 � -.�� / Owner Address: � ' � �` y � �� Owner Tel. No.: �JC1 � ti� , I�', � �� �( 5 , 1�( � :...........................................................................................................................................................................................................................:..:............................:..................................................................................................... RESIDENTIAL AND/OR COMMERCIAL BUILDING 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 plans,to include: (l.) 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. ...................................................................................................................................................................................................................................................................................:.................................................................................... REVIEWED BY: DATE: /� / . PLEASE NOTE COMMENTS/CONDITIONS: P� l ov�L �cc � • {�4-�� J J cp /C�. -- -e G (-��-�h � �I I 6 , S.E'- ' -e''"'�t� � _ / _ va c�.� • �e.� �V � — u-�. �✓C /`uav..'� �� ��i - d�}�C�1 CJ� ��Q� 'rS.... �,l �-r�GC�/ !� l.yq �• / i L ja- V-1 ize-0, 0 Jj Q Q 'D f • Ul- 4C DATE: CZ LU _ .�UUN REVISED LTD% L "ER, -j ui Professional Building Designer P.O. Box 532 D�RqflN� �UMSEFJ So. Yarmouth, MA 02664 394-5296 Y. -=—�— , J / r -- M h a t 4 3 UJI czar _ DATE.LU Ui fN% 15 uuNAL .Iv i�.1 ;, REVISED Professional Building Desigil.or P.O: Box 532 f +°�QRAWING NUMQER.',, _ o Yarmouth, MA 02564 t � S . Yarmo • (508) 394-5296 1 ; - Ll s f J / r -- M h a t 4 3 UJI czar _ DATE.LU Ui fN% 15 uuNAL .Iv i�.1 ;, REVISED Professional Building Desigil.or P.O: Box 532 f +°�QRAWING NUMQER.',, _ o Yarmouth, MA 02564 t � S . Yarmo • (508) 394-5296 1