HomeMy WebLinkAboutBLD-19-003153 Elliott, Ken
From: Cipro, Linda
Sent: Wednesday, November 28,2018 4:23 PM
To: Hall, Lee; Elliott, Ken; Inkley, Brad; Renaud, Philip; Murphy, Bruce; Huck, Kevin;Sawyer,
Jon;Simonian, Philip; Smith, Scott
Subject: final for occupancy 23 U Whites Path
Good Afternoon,
The Building Department is scheduled to conduct a final for occupancy inspection at 23 U Whites Path—Flower shop—
on Tuesday 12/4/18 and would like for you to attend.The contact person is Kristina D'Orlando and she can be reached
at 774-251-0066. Please notify me regarding your inspection results.
Thank you,
Linda
iy/Lfiib
1
Hall, Lee
From: Cipro, Linda
Sent: • Wednesday, November 28, 2018 4:23 PM
To: Hall, Lee; Elliott, Ken; Inkley, Brad; Renaud, Philip; Murphy, Bruce; Huck, Kevin; Sawyer,
Jon; Simonian, Philip;Smith, Scott
Subject: final for occupancy 23 U Whites Path
Good Afternoon,
The Building Department is scheduled to conduct a final for occupancy inspection at 23 U Whites Path-Flowersho —
ortTuesday 12/4/18and tvould like for you to attend.The contact person is Kristina D'Orl'ando and"she can be reached
at 774.251-0066 Please notify me regarding your inspection results.
Thank you,
Linda
x /- / 96
O
fr q7, 5
/0. (611,r
1
0i-Yet 4TOWN OF YARMOUTH Building Department CERTIFICATE OF
2 (508) 398-2231 ext.1261 OCCUPANCY
N }� ec
PERMIT NO BLD-19-003153
i..n.c«c Ss
wq,`�-• KRISTINAD'ORLANDO
ADDRESS:23 U WHITES PATH, SOUTH YARMOUTH, MA 02664 ZONING DISTRICT Bldg.Type: Commercial
SUBDIVISION MAP BLOCK LOT 097.21C28BUILDING IS TO
IBE
REMARKS Use&Occupancy- Retail Flower shop/design studio- .• upancy .ubje- . - r
final inspections.
DATE: /25/F CERTBUILDING O F CIAL: ON `=
OSCAR TAYLORS LLC
BUILDING DEPT BY
23B2 WHITES PATH
SOUTH YARMOUTH, MA PHONE
i1S PERMIT CONVEYS NO RIGHT TO OCCUPOY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR
?RMANENTLY.ENCROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE
JRISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF
JBLIC WORKS.
CERTIFICATE OF OCCUPANCY
BUILDING INSPECTIONS APPROVALS
FIRE: // OTHER
DATE: /9Q s/I r DATE:
INSPECTOR: 1'..P-P-t-rt--• ?Act INSPECTOR:
ELECTRICAL y/ /, BOARD OF HEALTH
DATE: I 1 r e DATE: dig
INSPECTOR: __ 1 INSPECTOR:
PLUMBING/GAS FINAL BUILDING
DATE: /A/51/1 DATE: /.7- j/
INSPECTOR: INSPECTOR: '` h�
COMMUNITY DEVELOPMENT: DATE NAME
•Cipro, Linda
From: Murphy, Bruce
Sent Wednesday, November 28, 2018 5:02 PM
To: Cipro, Linda
Subject: RE:final for occupancy 23 U Whites Path-OK
The flower shop is fine with the Health Dept.
Bruce
From:Cipro, Linda
Sent:Wednesday, November 28, 2018 4:23 PM
To:Hall, Lee<lhall@yarmouth.ma.us>; Elliott, Ken<KElliott@yarmouth.ma.us>; Inkley, Brad
<binkley@yarmouth.ma.us>; Renaud, Philip<PRenaud@yarmouth.ma.us>; Murphy, Bruce
<BMurphy@yarmouth.ma.us>; Huck, Kevin<KHuck@yarmouth.ma.us>;Sawyer,Jon<jsawyer@yarmouth.ma.us>;
Simonian, Philip<PSimonian@yarmouth.ma.us>;Smith,Scott<ssmith@yarmouth.ma.us>
Subject:final for occupancy 23 U Whites Path
Good Afternoon,
The Building Department is scheduled to conduct a final for occupancy inspection at 23 U Whites Path—Flower shop—
on Tuesday 12/4/18 and would like for you to attend.The contact person is Kristina D'Orlando and she can be reached
at 774-251-0066. Please notify me regarding your inspection results.
Thank you,
Linda
1
I'
of•YgR BUILDING PERMIT APPLICATION
s
A."
APPLICATION TO CONSTRUCT, REPAIR,RENOVATE, CHANGE THE USE,OCCUPANCY OF,
OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO MILYDWELLING1Town ofVtrmoutii Building Department R 1= Ci 1146 Route 28 • Yarmouth, MA 02664-1.192
Tel: 505.398-2231 ext. 1261 Fax 508-39 0 €OV 16 2 18 1
Office Uge Only Planning Board Information Assessors Department Infa1fnn
BUILDING DEPARTMENT
Pe it ko. g CV 3/i Plan Type m BY a
Endorsement Date..
Permit Fee $ 60
Recording Date New
Deposit Recd. $ �jr 0 Date_ Plan No. 1.4 Property Dimensions:
Net Due $ Q -' Other Lot Area(st) Frontage(h) Lot Coverage
This Section for Office Use Only .
Building Permit Number. Date Issued:
Signature: i.14- /7-7 7-/e5 Certificate of Occupancy
uildl g Orficial Date- is Is nal required
Section 1 - Site Information
1.1 Property Address: 1.2 Zoning Information:
,� � �
23 }0� WIniACI3 .12:01h e
tinLICIS POWIL• Mk n7 C$-f Zoning District Proposed Use
1.3 Building Setbacks(ft) '
Front Yard Side Yards Rear Yard
Required Provided Required Provided Required Provided i
1.4 Water Supply(M.O.L c.4e.S 54) 1.5 Flood Zone Int:email= Comments
Public Private Zone: BFE: •
Section 2- Property Ownership/Authorized Agent .
2.1 Owner of Record:
X 6 E MittnNU1c)c—S', 6�RQZ1R`Ilg2's(LlS d332 WN1T�S CM-wn' M1` ctsc-4
\ Name(p' Mailing Address: m(} 37.106t1
--56%--3a4—b,-la-1
Signature Telephone Telephone 7
2.2 Authori 1634 Email Address:
jUli e•spnarths}erQT.lacto,Cayv\
KriS+.00 -S+.00I1'G1asercir-rjen it5\10rmou -
Name(print) j.�/'7�J, /�- ��/r•���/\ Mailing Address: 4 ofizg
` 1 / -1 . WI ' Cro J
Si nature elephone Fax ail Address: i
. Section 3 -Construction Services niUe.CapC.Cod,(ec tv O.i I.COM
3.1 Licensed Construction Supervisor Not Applicable ❑
License Number
Address
- - - Expiration Date
Signature Telephone Email Address:
.
.t
,
3.2 Registered Home Improvement Contractor.
Company Hams Not Applicable ❑
Registration Number
Address
• Expiration Date
Signature Telephone
Section 4-Workers'Compensation Insurance Affidavit(M.G.L c. 152 S 250(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 issuance of the building permit.
Signed Affidavit Attached Yes No
Section 5- Professional Design and Construction Services-for Buildings and Structures Subject
to Construction Control Pursuant to 780 CMR 116(containing more than 35,000 c.f.of enclosed space)
Section 5.1 Registered Architect
Not Applicable CI
Name(Registrant): Registration Number
Address
Expiration Date
Signature Telephone
Section 5.2 Registered Professional Engineer(s)
Name Area of Responsibaity
Address Registration Number
Signature Telephone Expiration Date
Name , Area of Responsibility
Address Registration Number
' Signature Telephone Expiration Date
Name • Are. • Responsbl
u
Address 4 •... , ' . .+a
Signature Telephone Expiration Date
Hams Area of Responsibility
Address Registration Number
Signature Telephone Expiration Date
Section 5.3 General Contractor
, Not Applicable ❑
Company Hams
Person Responsible for Construction
Address
Signature Telephone
A -
• Section 6- Description of Proposed Work(check all applicable)
' New Construction ❑ (tor multiple family only) No.of Bedrooms (for multiple family only) No.of Bathrooms
Existing Bldg. ❑ Repair(s) ❑ Alterations ❑ Addition ❑
Accessory Bldg. ❑ Type Demolition Other Specify:
Brief Description of Prop a d Wor .
A 10\& 9C %(\olp Onci desc n
Stud In
Section 7- Use Group and Construction Type
Building Use Group(Check as applicapable) Construction Type
• A ASSEMBLY ❑ A-1 ❑ A-2 ❑ A-3 ❑ lA ❑
A4 ❑ A-5 ❑ 18 ❑
B BUSINESS ❑ 2A ❑
E EDUCATIONAL 0 28 ❑
F FACTORY ❑ F-1 ❑ . F-2 ❑ 2C ❑
H HIGH HAZARD ❑ 3A ❑
I INSTITUTIONAL 0 1-r ❑ 42 ❑ I.3 ❑ 33 ❑
M MERCHANTILE ❑ 4 0
R RESIDENTIAL 0 R-1 ❑ R-2 ❑ R-3 ❑ SA ❑
S STORAGE ❑ S-1 ❑ S-2 ❑ SB ❑
U UTILITY ❑ SPECIFY: •
M MIXED USE ❑
SPECIFY:
S SPECIAL USE 0 SPECIFY:
Complete thissection if existing building undergoingrenovations:additions and/or change In use.
Existing Use Group: Proposed Use Group:
Existing Hazard Index 780 CMR 34 Proposed Hazard Index 780 CMR 34
Section 8 Building Height and Area I •
Building Area Existing(if applicable) Proposed
Number of floors or stories;: .....
include basement levels
Floor Area per Floor(sf)
Total Area All Moors (sf)
Total Height(ft)
Section 9 -STRUCTURAL PEER REVIEW (780CMR 110 11)
Independent Structural Engineering Structural Peer Review Required Yes No
SECTION 10a OWNER AUTHORIZATION-TO BE COMPLETED WHEN
OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
GEae- E OCU 61W(NthQFC occc R 1'AP OJts /t-VCs Owner of the subject property,
herebyauthorize-4KR1S11NVQ 1 '0214N/00 to act on
my behalf, in all matters rely ive to work authorized by this building permit application.
tt`13\18'
Signature •1 Ow - - /- — Date
o .a A cm ten
tik
r.
SECTION
<10(b OWNER/AUTHORIZED AGENT DECLARATION
I, - b( d )`O( ` )A by , asOwner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and acurate, to
the best of my knowledge and belief.
Signed under the paiinss and penalties/rof perjury. •itarasise*/4011P°
(ISfi(b`-7- J((Cncl e•COQ- = Qt1,161R{JaCES(UU.1K
Print Name
<<I131ig
Signature of Own,. 1077!"^" Date
•
Section 11 - E-TIMATED CONSTRUCTION COSTS
Item sEstimated Cost(Dollars)to be
completed by permit applicant
1.Building
2.Electrical
3.Plumbing/Gas
4.Mechanical(HVAC)
5.Fire Protection
6.Totala(1+2+3+4+5)
7.Total Square FL Irvn.w magas a.mrove)
Check Below
0 Conservation-Commission Filing
(if applicable)
❑ Old Kings Highway&Historical
Commission approval
(if applicable) •
•% t The Commonwealth of Massachusetts
--- Department of Industrial Accidents
= �''•_`t
• . Office of Investigations
_e— li600 Washington Street •
�
= `r Boston,MA 02111
iwww.mass gov/din
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information /t /► , ,._�I Please Print Legibly
Name (Business/Organization/Individual): l( kka 1�J'UI 1`�LJI� C C• • ` ' : '
t/Address: Z3 Untk WIAZAti1 S Cl„ _,._ (j �p
City/State/Zip: Phone# f,14' '`u� - (�j CA 7!�`
Are you an employer?Check the appropriate box:
1.0 I am a employer with 4. 0 I am a general contractor and I Type of project(required):
employees(fall and/or part-time).* have hired the sub-contractors . 6 El construction
2.KI am a sole proprietor or partner_ listed on the attached sheet. 7. 0 Remodeling
ship and have no employees These sub-contractors have g. 0 Demolition
working for me in any capacity, employees and have workers'
[No workers' comp. insurancecomp,insurance.t 9• ❑Building addition
required:] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions
3.0 I am a homeowner doing all work officers have exercised their . 11.0 Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs
3a.❑ insurance required.]t C. I52, §1(4),and we have no
I am a homeowner acting as a employees.[No workers' 13.0 Other —
general contractor(refer to#4)
comp.insurance required_].
'Any applicant that checks box#1 est also fill out the section below showing their worked tompeasatio4oucy information.
•
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors crmst submit a new affidavit indicating such.
:Contractors that check this box must attached as pMritional sheet showing the name of the sub-contactors end state whether or not those entities have
employees. If the sub-contract®have employees,they must provide their woken'comp.policy number. -
I am an employer that is providing workers'compensation insurancefor my employees Below is the policy and job site
information
Insurance Company Name:
Policy#or Self-its.Lie.#: . 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cerci under the pains and penalties of perjury that the information provided above is true and correct
•/
/ Sitmature:
VVV 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): •
1.Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and Instructions . `�=`
Mzaelmsetts General Laws chapter 152 requires.all employers to provide workers'compensation fat thea employees. •coated office, '
Pursuant to this statute,an employes is defined as"...every person in the service of another under any
express oc implied,oral or written."
" association,corporation of other legal entity,or any two a more
o f eecpf�ar is defined a to indiverpartnership,i iR of a deceased employes,a to
of the foregoing engaged in a joist enterprise,and including the legal representatives
receiver at trustee of as individual,partaagiP+association or other legal entity,employing empkryees. However the
own=of a dwelling home having not tore than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs persona to do ar'inten'^''",constvctioo or repair work on such dwelling bane
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGI.chapter 152,§25C(6)also states that"every state or loaf licensing egeacy shall withhold the issuance or
renewal of a license or permit to operate a business or to construct baildfap In the eoosmocwnith for ay
acceptableevidence of a Ingmar with the linens=avenge req "
:ppiksat who here not product
• Additionally,MGL chapter 152,§25C(7)states"Neither the c=monwealth res[any of its political subdivisions shall '
public work until acceptable evidence of campliaoe ' stanc
enter into any contract for the pafmsmsoe of
requirements of this chapter have been presented to the contracting aut1 ty"
•
Applicants
Please fill out the workers'compcnsat+oa affidavit completely,by checking the boxes that apply to your siltation sad,if
necessary,supply sorb-conractm(s)name(s),address(es)sad phone number(s)along with their certificate(s)of
iaaaarrce. Limited inability Companies(LLC)at Limited Liability ity Partnerships(LLP)with no employes other than the
members ar partum are not required to carry workers'compensation insurance. If an LLC at LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to S Department of Industrial
• • Accidents far confirmation of insurance coverage. Alae be surf to sip and date the affidavit. The affidavit should
be retroed to the city or town that the application for the palish at license is being requested,not the Departsiel of
Industrial Accident,. Should you haw any questions rep/ding the law or if you are required to obelus a workers'
compensation policy,plisse call the Department at the IMinba listed below. Self-insured companies should enter their
self-iissorance license member on the appeopriate lion
City or Tows Offietsfe •
Please be nate that the affidavit is complete and printed legibly. The Department has provided i space at the bon=
of the affidavit for you to fill out in the event the Office of Iaves6ga ions has to contact you regarding the applicant.
Please be sure to fill in the permit/license numb=which will be used as a reference member. In addition,an applicant
•
that moat submit multiple p=nitliicense applications in any given year,need only submit ore affidavit indicating current
policy int tmatioa(if necessary)and under lob Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that ha been officially stamped oar marked by the city or town may be provided to the
applicant s proof that a valid affidavit is on Ms for future pernuta at licenses. A new affidavit sant be filled out each
yea.Where a bora owner of citizen is obtaining a license or permit not related to any business or commercial ventre
(Le.a dog license or permit to burn leans etc.)said person is NOT required to complete this affidavit
The Office of Investigation would like to tank you in advance fa your cooperation and should you have any goestions.
please do not hesitate to give us a call
Me Department's address,telephone and fax anther:
The Commonwealth of Massachusetts
Department of Industrial Accidents
°Mee of Investigations
• 600 Washington Street
Boston,MA 02111
Tel. 11 617-7274900 ext 406 or 1-877-MASSAF.E. . .
Fax fi 617-727-7749 •
Revised 11-22-06 • www mass gov/dia
� _.,�_� 'Y9 y TOWN OF YARMOUTH
r• e O BUILDING DEPARTMENT
c -`�%i '' a 1146 Route 28,South Yarmouth,MA 02664
• •?f;o �. i 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 111.5,
I hereby certify that the debris resulting from the proposed work/demolition to be
conducted at
Work Address
Is to be disposed of at the following location:
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Chapter 111, Section 150A.
Signature of Application Date
Permit No.
MGL AND FIRE
TOWN OF YARMOUTH
REVIEWED FOR CODE COMPLIANCE.
54 ERRORS OR OMMISSIONS DO NOT RELIEVE
THE APPLICANT FROM THE RESPONSIBILITY
\ outOF"AS 4UII/j;QaMPLIANCE.
DATE: ) - `1I I
0—AP i. 1\°Q-C- ` C—
INSPECTOR
YARMOUTH FIRE PREVENTION
New Business Transmittal
Project Name: Botanique of Cape Cod Address: 23 Whites Path Unit U
Contact Name: Kristina D'Orlando Phone: 774-251-0066
IY N NA Subject Regulation
ES 0
X Building Numbers MGL Chapter 148;sec 59
X Fire Lanes 527 CMR 1;22.3
X Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28
X Maintence of any equipment,system relating to 527CMR1 1.1.4
Fire Protection.
X *Hazardous Materials Storage 527 CMR 1;60.1
X Emergency Plan Required 527CMR1 10.9.1
X Commercial cooking,Hood systems 527CMR1 50.2.1.1
X Commercial Cooking Hood Systems Cleaning 527CMR1 50.5.4
X *Commercial Cooking Extinguishment System 527CMR1 50.4.3
X *Candles,open flames,and portable cooking 527CMR1 17.3.2,20.1.1.1
X Blocking electrical panel 527CMR1 10.19.5.1
X Blocking exits 527CMR1 14.4.1
Extension cords shall not be used as a 527CMR1 11.1.7.6, 11.1.7.1
X substitute to permanent wiring
X Limit storage heights to 24 inches below 527CMR1
ceiling without sprinklers 18 inches with
X Maintain Aisle width of 36 Inch's(3 Feet) 780CMR 1101.1
X Storage inside/outside Buildings 527 CMR I; 10.19.4,4.4.3.1.1,19.1.2,34.1.1
X The right to inspect MGL Chapter 148 Sec.4
X *Upholstery 527 CMR 1;20.6.2.5
X *Trash Containers 527 CMR 1; 19.1.1, 1.12
X Any Hazard to the Public Chapter 148;sec 28
X *Curtains,Draperies,Blinds 527 CMR 1; 12.6.2
Description of planned project/other requirements:
The YFD support the application, subject to applicable submissions,permits
and inspections.
A Permit from YFD is required any time a fire protection system is shut down.
* YFD permit required-depending on occupancy and submittal
Plan Reviewed By: Captain Kevin Huck Date: 11-14-2018
Copy for Applicant 0 Copy to Building Department II Copy to Fire Prevention
Entered in Firehouse C Final Inspection
tR At, YARMOUTH FIRE DEPARTMENT
��1► _ 96 OLD MAIN STREET
�ia �v SOUTH YARMOUTH,MA 02664
PH.:508-398-2212 /FAX:508-760-4861
1,
Dirt- FIRE AND SAFETY INSPECTION REPORT
ADDRESS OF INSPECTION: Z3 la-I J%C S 1P 47-14 v til I I U
YARMOUTH PORT 171 SOUTH YARMOUTH ❑ WEST YARMOUTH
NAME: 3oT/ I !i ( QVc-.7 /� RISTIr/4 b ' oRLA,4T
Eg OWNER ❑ MANAGER TENANT OTHER(explain):
DATE: 11-/4-n TIME: 2.3t PHONE: 7. 257 . 0066
NAME: PHONE:
OWNERS MAILING ADDRESS:
An inspection of the above captioned property was conducted by the undersigned during which the following
fire or safety deficiencies(D)or violations(v)were observed and noted for correction:
STIR? KIK LcR READS NEE73 Et)sc-oTi-(off PL4r's /,Z MI6.
You are hereby ordered to abate or correct the deficiencies or violations within / 3 days.Failure to do
so may result in civil and/or criminal complaints being filed.
Signed: /C. G(� Title: c.
/ 44 /Ai,J /-(uC�
Copy Received By:
Original-Owner/Tenant YellowCopy-Fire Department FBP 99-1
`'t4, TOWN OF YARMOUTH
gt, tigi HEALTH DEPARTMENT
le.o,_� ,.3 `Iiy
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: ` 1 \_
Building Site Location: U n t V w'1\ SI , '1 O i V A a S
Proposed Improvement: CSC and OCC upancl
ettia;liov rs 3-\-.op ovrd or-}- Stud zo c weir i ? &cc pc 4
Applicant: VCl i fQ b O&Ckr1C , Tel. No.: 11 1 131 OCCG
Address: fl Chase C-order, Ln to(Mcg /Mlc C2 lSate FiilleJd: ?-/0-18
if
•• youwouldlikee-mail notification of sign off please provide e-mail address: igU€CCtpeCa. c1'M0.iI.Ccu4
Owner Name:
Owner Address: Owner Tel.No.:
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: EP.--- DATE: 9 —1°— /C9
PLEASE NOTE
COMMENTS/CONDITIONS:
(socr_..w)
Cx17 ,1‘,7
Cf het- +kreaer
TOWN C
REVIEWED FOR RUILDINL;AkU .
ANC:. ERRORS CR OGC.11S1CL
W3(tLS ho�y� A.FPIVCJ N7 PROM THE RESPONm.;:�iiY .
DA i; //a77P9 Ca
OFFI�'L
; C,
I -
DINEOWED
SEP 10 2018
%t n ., I _ U ares HEALTH DEPT.
EX IT {Fro` or)
2S (onik v) WW-'S 'Pc*\ 5`�atMa