HomeMy WebLinkAbout2018 Feb 13 - Sign Off Transmittal, Floor Plans - Basement Remodel o� Yqk TOWN OF YARMOUTH
HEALTH DEPARTMENT
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t`./. PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: /in.t i Ave
Proposed Improvement: ' 0 /,fin 4 i._ dim
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Applicant: de)c g/5,01712--t- (C 4` f AS ,1i c ( Al.L• Tel No.: 7r/ 7SI 76/-3
Address: /1 5-IA7P Q Alt, i/it -1 0/ fJ 1 Date Filed: Wc-
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**If you would like e-mail notification of sign off,please provide e-mail address: , J Dom;4V 6 0.57,),,--t ha k. •
Owner Name: C,4i,si,h ok /✓( ry ��/ t1
Owner Address: , 9 74' A&r- /0✓c. J - �� ,M Owner Tel. Ni).: C/7 STo 7s z
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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: DATE: o.1i ,/(c
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PLEASE NOTE
COMMENTS/CONDITIONS:
CCe
Name C1A r►s—ht.4.. r-1c
Custom Remodel of New England Address S a,,,,I,.h. Lj a/ r.1.t.''h
ii Sixth Road Woburn,Ma.oi8o1 781-937-9000 HIC license 180705
Contract Sketch Homeowner X C A,r(A11 ! 4.-t om Date Contractor 5 i�
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