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HomeMy WebLinkAboutBLD-19-001193 • �il2tixG gj3oAr .- ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 Massachusetts State Building Code,780 CMR Building Permit Application To Construct,Repair, Renovate Or Demolish a One-or Two-Family Dwelling This Section For Official Use Only Building PermitNumber: ' ,Date Applied: . • Building bfficial(Print Name) SignaEtue , Date • . ,SECTION 1:SITE INFORMATION. • 1.1 Pro erty ddress: 1.2 Assessorp&Parcel Nutpb}T �d, ��hiS`riu2- 127 O(/J / 1.1a Is this an accepted street?yes_ no . ' Map Number . Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,154) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ • Check if yes❑ . • SECTION 21 PROPERTY OWNERSHIP'. ' - 2.1 O erl of Record: KSEr1t1►4 'et+I He. F1ut— Dr9, y ou?g MO Name(Print) City,State,ZLn 9 aDa-0 sr-mac - ILZ0 P7 no wa No.and Street Telephone Email Address ' SECTION :.DESCRIPTION OF PROPOSED wOR1C2(c):ic$all that apply) New Construction❑ E'dsting Building❑ Owner-Occupied ❑ Repairs(s) ❑ 1 Alteration(s) ❑ Addition ❑ Demolition 0 Accessory Bldg. ❑ Number of Units_ Other ❑ Specify: . Brief Description of Proposed Worle':044)444.Ne. CNC1.64eil rf4.=J4 7 fiA)– 9 -- s� rt a Am �i /),—Ars, r1 JWSvLts ,u6 PO4 w` #_6. 47p, a c 44 tp')y-1 gig rJri YS__ . SECTION;4:ESTIYi IATED CONSTRUCTION EstimatedCosts: • (Labor and Materials) . - - ' OfneialVse Only',_ 1.Building $ f0S 8) :1.Building PetmitFee;$ 1 $c) ,Indicate hew a de>=u.n..e 2018 2.Electrical $ t ❑Standard CityIT wn Application Fee.`:'. :. • ..- •. .'1 ❑.TotaiProjebtCesti-,(Item6)xmultilier... ; DING DEPART 3.Plumbing $ 2: Other Fees: $ $ A. . ..•. ..a - —__-NS 4.MechanicalList (HVAC) $ 5.Mechanical (Fire All Fee $ Tot :.:.w.-$: • . .•. .t -. . Suppression) al s:$ 'CheckN6:.• Check Amotnit: Cash Amo I t Y 6.Total Project Cost: $ p p coo— p Paid in Full ' O Oirtstanding Balatce Due: b , 6 __- SECTION 5:.CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) ,,.i ivt�.0Lj j/ License . .�J pone Name o1l2SL Holder ///wwc FP4st i a S List CSL Type(see below) No.ea Street ' T i. Description 1611,S ,� Qa(�) ' Unrestricted(Buildings up to 35,000 cu.R) � 13. “.(1 M R Restricted I&2 Family Dwelling_ City o State,ZIP M Masonry RC Roofing Covering • _ WS Window and Siding • t SF Solid Fuel Homing Appliances 77y � s5q o al, m- rh I l I , I insulation Telephone Email address tri C_I I. D('p YJ�mo(tion 5.2 Registered Home Improvement Contractor(HIC) ale)(M� I yF1 �'`l��) HIC Registration Number Expired Date HIC Company Name or HIC Re 'strant N e 60 raitrflt9-tt( Ad /76777 /?1n err No.and rt Email address �>swIs mA X71/ ZS/ City/Town,State,ZIP Telephone SECTION 6:WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuanc f the building permit. Signed Affidavit Attached? Yes No...........❑ SECTION 7a:OWNER AU EHORIZATION TO BE COMPLETED W I EN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I as Owner of the subject property,hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application. 1\Print Owner's Name(Electronic Signature) Date • • SECTION 7b: OWNER'OR AU'1HORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. hl = Let'i3 ?/77A-Ca Print Owner's or Authorized Agent's Name(Electronic Signature) • Date . NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contactor (not retzsteredin the Home Improvement Contactor(HIC)Promzm),will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A.Other important information on the HIC Program can be found at www.mass.2ov/oca Information on the Constriction Supervisor License can be found at www.mass.aov/dos 2. When substantial work is planned,provide the information below Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" c �u-t Department of Industrial Accidents •. =t' 1= . 1 Congress Street, Suite 100 • • Boston, MA 02114-2017 --•=•-• • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bailders/Contractors/Eleeuicians/Plumbers. TO BE FILED WITH THE FERMI i i iNG AUTHORITY. Applicant Information Please Print Le¢ibly Name (Business/Organization/Individual): Address: • City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.01 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.0 1 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.01 am a homeowner doing all work myself.[No workers comp. i ce required]: 9. ❑Demolition 4.0 1 am a homeowner and will be hiring contractors to co duct all wo on myproperty. 1 ill 10 Building addition ensure that all contractors either have workers'come ation in . e or are sole 11.0 Electrical repairs or additions proprietors with no employees. 5.❑1 am a general contractor and I have hired the sub-con.• on listed on th•attached s et 12. Plumbing repairs or additions These sub-contractors have employees and have worke-'comp.insurance. 13.0 Roof repairs 6.❑We are a corporation and its officers have exercised thei right of exemption p L c. 14.❑Other 152,§1(4),and we have no employees.[Na workers'co •p.insurance required.] *Any applicant that checks box#1 must also fill out the section b ow showing their •rken' •-•'emotion.. '- information t Homeowners who submit this affidavit indicating they are doing. work and then ' outside contractors must submit a new adavit indicating such. :Contractors that check this box must=ached an additional sheet sh'wing then.•e of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide. eir wo• en'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 • and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License.# • Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City-/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6: Other Contact Person: Phone#: ' TOWN OF YARMOUTH A c BUILDING DEPARTMENT F �%j j 1146 Route 28,South Yarmouth,MA 02664 ' S;•-........-",•„.- 508-398-2231. ext. 1261 Fax 508-398-0836 • • BUILDING DEPARTMENT , DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 1115, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at , • t.. 1'.= air : , PUP;r0 0 Work Address Is to be disposed of at the following location: yn�+c.i H C70_444 9�t19.( Said disposal site shall be a licensed solid waste facility as defined by M.G.L. is . .ter 111, Section 150A. 1' ill .1?-47//," S gnature of Application Date Permit No. The Commonwealth of Massachusetts Department of Industrial Accidents j — 1 Congress Street,Suite 100 . Boston,MA 02114-2017 www mass. ov/dia * g Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Alexey Lebedev/Dream Home Improvement LLC Address:60 Franklin ave City/State/Zip: Hyannis, MA, 02601 Phone#:774-208-3589 Are you an employer?Check the appropriate box: Type of project(required): LEI I am a employer with employees(full and/or part-time).• 7. ❑New construction 21E11 am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required] 3.0 1 am a homeowner doing all work myself.[No workers'comp.insurance required]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ]0 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.0Plumbing repairs or additions 50 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.:Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil .enalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this state en may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the .ains and p nal les of• -rjury that the information provided above is true and correct. Signature: �` Date: S/2 x//9 . Phone#:774-208-3589 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CS-108208 • ALEXEY LEBEDEV µ' 60 FRANKLIN AVENUE Hyannis MA 02601 11/27/2018 . /1//' (6'///////'////'/v///; /I/ . 76/%J///�((i(4O Office of Consumer Affairs and Business Regulation One Ashburton Place - Suite 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Type: LLC DREAM HOME IMPROVEMENT LLC. Re piration: 076777 Exxpiration: 60 FRANKLIN AVE. s/za;2otg HYANNIS, MA 02601 Update Address and return card. • Office of Consumer Affairs&Business Regulation NOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:LLC before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Regulation 176777 09,24.2019 10 Park Plaza•Suite 617O_, DREAM HOME IMPROVEMENT LW. Boston,MA 02116 j ALEXEYLEBEDEV 60 FRANKLIN AVE. HYANNIS,MA 02601 Lc" Undersecretary Not valid without signature ACCORD® CERTIFICATE OF LIABILITY INSURANCE DATE A MM/DO 8 Y) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva NAME: Eastern Insurance Group PHONE (508)997-6061 FAX (508)990-2731 PAID No,Exit' (NC,No): 439 State Rd. E-MAIL a aiva southeastemins.com ADDRESS: p P.G.Box 79398 INSURER(S)AFFORDING COVERAGE NAIL North Dartmouth MA 02747 INSURER A: Arbella Mutual Ins Co 17000 INSURED INSURER B: ASIC Dream Home Improvements LLC INSURER C: 60 Franklin Ave INSURER D: INSURER E: Hyannis MA 02601 INSURER F: _ COVERAGES CERTIFICATE NUMBER: 2018-19 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDIYYYI) (MMIDDNYTfl LIMITS X COMMERCIAL GENERALUABIUTYEACH OCCURRENCE I$ 1,000,000 IDAMAGE TU HENTED 10 00 CLAIMS-MADE OCCUR PREMISES(Ea occurrence) S _ MED EXP(Any one person) § 5,000 A 952005317803 03/08/2018 03/08/2019PERSONAL 3ADV INJURY § 1,000,000 GENLAGGREGATE LIMIT APPLIES PER' GENERAL AGGREGATE § 2,000,000 X POLICY ❑ilra fl LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER' § AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT § _ (Ea student ANY AUTO BODILY INJURY(Per serson) § OWNED SCHEDULED BODILY INJURY(per accident) 5 AUTOS ONLY — AUTOS HIRED NON-OWNED PROPERTY DAMAGE _ AUTOS ONLY AUTOS ONLY (Per accident) _ § UMBRELLA UAB OCCUR EACH OCCURRENCE EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ S WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LJABILITY YIN STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ NIA VVCC50050156792018A 03/08/2018 03/08/2019 EL EACH ACCIDENT § 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 1,000,000 II yes,desmbe under 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Display Purposes Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ®1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD • 1Ctc ccovcti i1 ;-(e u.'r)44 etc r t941"44 we ace OK i4.- -fl, trc' •fie: ' eQkd. 4.4.1 60 60 Franklin Ave, Hyannis, MA, 02601 Home Email: Improvement LLC. 508-332-8119 John Collinson Project Manager 774-208-3589 Alexey Lebedev Owner/Contractor HIC #: 17xxxx CS #: CS-10xxxx Contract DATE: June, 28, 2018 PHONE: 617-830-7966 NAME: Ksenya Khinchuk ity f iL'Crtc'_ 1 f 617-73f 7kK? EMAIL: LL // d�f� /'" -el2-S�3-75'7 MAIL ADDRESS: ',�o d7!'Q'7/D7Otl/ 4. 4 nr'� � /i "9 JOB ADDRESS: 25 Brewster Rd, West Yarmouth, MA, 02673 Dream Home Improvement hereby proposes to perform the following services in a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Convert porch into bedroom Remove and dispose flooring, subfloor, wall coverings and drywall on ceiling. - Remove sliding door and frame wall 16 O.C. with plywood on exterior and white cedar shingles. - Feed new duct work from basement for heating or as an alternative install new electric baseboard heat with separate thermostat by licensed electrician. - Insulate floor with IG@, walls with R15 and ceiling with R43. All labor,materials,disposal and permit fees are Included in a price.All additional extra work will be charged 70$/h plus materials • - Install %" T&G sub floor with laminate floor covering - Install '/:" drywall on walls and ceiling with 3 coats of tape and mud. - Install PFJ base board and trim around windows. - Prime and paint walls, ceiling and trim. - Clean the job site after completion. - Project Total: 8520.00 Payments: uream dome Iniprcvamcnt LAX acctpL Un cc pop Iicflll; nrst payment of 33% contract price has to be received due at contract signing as a deposit, second payment of 33% due when project is started,final payment of 34% is due when project is complete plus any possible extra has to be received or mailed within a week after project completion. Dream Home Improvement LLC will complete the project within 40 days after the contract is signed and received with a first payment. Please make a check payable to "Alexey Lebedev" Initials: /7: (i Compliance with Laws:Contractor agrees that it is properly licensed and insured under Massachusetts General Laws Chapter 142A and that It will perform the services contracted for herein in compliance with applicable building codes, laws, statutes and ordinances. Parties' Understanding of This Agreement: by signing this agreement,the undersigned Parties acknowledge they have had the opportunity to ask any questions concerning its terms; have read,understand and agree that its terms are fair and reasonable;and agree to be bound by the terms in their entirety. This agreement is effective as of the date it is executed by all the undersigned. C ���A 719Jzsiy All labor,materials,disposal and permit fees are Included In a price.All additional extra work will be charged 70$/h plus materials ,n pr'r 1 t f 60 Franklin Ave, Hyannis, MA,02601 Home NI Email: Improvement LLC. 508-332-8119 John Collinson Project Manager 774-208-3589 Alexey Lebedev Owner/Contractor HIC #: 17xxxx CS #: CS-10xxxx • Contract DATE:June, 28, 2018 PHONE: 617-830-7966 NAME: Ksenya Khinchuk 4u/ PteitC t3 ( 7-731 77(4 EMAIL: "r, ell- .. ca- 7.)'7& MAIL ADDRESS: 110 strathmore Rd, PH#1, Brighton, MA, 02135 JOB ADDRESS: 25 Brewster Rd, West Yarmouth, MA, 02673 Dream Home Improvement hereby proposes to perform the following services in ___a neat, professional like manner in accordance with the manufacturer's specifications and local building code. Replace siding on left gable wall and fence on rear of the house - Remove and dispose old siding on left gable wall. All labor,materials,disposal and permit fees are Included in a price.All additional extra work will be charged 70$/h plus materials Supply and install — CertainTeed Synthetic Roof Runner On entire wall. RoofRunnerTM lightweight synthetic polymer-based underlayment outperforms felt and outclasses other synthetics. Designed for use on roof decks and walls as a water- resistant layer beneath asphalt, cedar and vinyl shingles,this scrim-reinforced underlayment includes a special top surface treatment that provides excellent slip resistance, even when wet. Large roll size-4 feet wide x 250 feet long-speeds application. Supply and install —Vinyl Siding. On left gable of the house. Vinyl siding is plastic exterior siding for a house, used for decoration and weatherproofing, imitating wood clapboard. It is an engineered product, manufactured primarily from polyvinyl chloride (PVC) resin. Approximately 80 percent of its weight is PVC resin,with the remaining 20 percent being ingredients that impart color,opacity, gloss, impact resistance,flexibility, and durability. � Price - $1575 Initials: A : /1 Siding color: nu ' C-12u fly W i 1 tiu' ex Supply and install — Cedar #2 6' tall privacy fence. Damaged by storm missing fence 48.'With 5x5 Pressure treated posts going at least 30" into the ground which will withstand cape cod weather and cedar#2 pine will prove It's durability over the years. Price - $1300 Initials: c Project total: 2875.00 Payments: Dream Home Improvement LLC accept three payments:first payment of 33% contract price has to be received due at contract signing as a deposit, second payment of 33% All labor,materials,disposal and permit fees are Included in a price.All additional extra work will be charged 70$/h plus materials due when project Is started, final payment of 34% is due when project is complete plus any possible extra has to be received or mailed within a week after project completion. Dream Home Improvement LLC will complete the project within 40 days after the contract is signed and received with a first payment. Please make a check payable to "Alexey Lebedev" Initials: ,t_ l6 Compliance with Laws: Contractor agrees that it is properly licensed and insured under Massachusetts General Laws Chapter 142A and that it will perform the services contracted for herein in compliance with applicable building codes, laws, statutes and ordinances. Parties' Understanding of This Agreement: by signing this agreement,the undersigned Parties acknowledge they have had the opportunity to ask any questions concerning its terms; have read,understand and agree that its terms are fair and reasonable; and agree to be bound by the terms in their entirety. This agreement is effective as of the date it is executed by all the undersigned. rie 772,9/206'All labor,materials,disposal and permit fees are included In a price.All additional extra work will be charged 70$/h plus materials 04_Yqk TOWN OF YARMOUTH �rp HEALTH DEPARTMENTac 0 ,- \tt ^ " PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: a-1.' Q1=•• fig (Z R(� /1116 7 I &c06t,%--- Proposed Improvement: ea p.JV,=.(>i SUM Pst t t 1 7 w Z? HT-0.7- Oto clet. , Applicant: -mf eel-PUL'OA/ Tel. No.:d2 - a Address: // hti1 /�,t7 5'1 Ciltr . tow Date Filed: $4.>1l8 "//you would like e-mail notification of sign off please provide e-mail address: Owner Name: kc,'.SL f_(f/ r.1 c/.4fl`' Owner Address: c2f-- ,RAewereza Owner Tel. No.:6/7 $3a74610 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: (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. REVIEWED BY: jr6t7DATE: an-7M PLEASE NOTE COMMENTS/CONDITIONS: 5o t Hi v rAA * 3 8-e cLVo c L s. pc`tle. O«cd f u4 Icy S TL S. gY G 6-9 jv©T -to Rt u e tro,. C �Tr, -Pt b 1 o t.!n d SccL Re neat C- &.4>,e S TOWN OF YARMOUTH REVIEWED FOR BUILDING AND ZONING CODE COMPLI- ANCE. ERRORS OR OMMISSIONS DO NOT RELIEVE THE APPLICANT FROM THE RESPONSIBILITY OF'AS BUILT' • DA g 3o-„ ,i/��/ FILE COPY BUILDINQbF FICIAL F CIAL Metric Graph Paper �b ! I i�Ct j t-t'l► Vie. �, ; ,Ksc +ltq iGt#-vim I n�I n ' ” ,II li I' I. 'I - "II '.I' -rip I 1 1 1. 1 I'i ll •'. :Ii „ ':I�ilt i. I'll ' II ' ' I!.' .L iil� I '�I -,I! .. 'y _, ,:j _. i _:a: .�_- , I:I. _ !�: ��1 X11 II. i,1: :}:. }II-. ..._l, .,1; 1: : .1.. F.:. ' •.i I i $1 it - I Lr!— 1/ k 1 ,I 'µ I :.I .1 ;i i i { -.. ) . ! i � . I II 1 '. I,,I I''I I I • 'I . . i II .• 1 I 11 ..I -fit I E E€VE, ! - ar I �, . .. - - - II � , I � i' I Ii � T, i 'MILL_ j 1..f .I 1 :i 1 I 'I ' ' . i 11b I' 1 I p' t, 2. 7014 t --- I I 1 1 �.I lY, 1 ' I ' � I NEALT DEPT -• I '1 /HI/ ! J I `' f !"1,!!!'-it — .; I I I 1 7 I . I I . ` 1 of I 1. ! .;I ' I it •SII V j I III _ 11 I I '�'/ 1 I y ' I . . i'; . .. 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