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Town of Yarmouth Building Department
1146 Route 28, South Yarmouth, MA 02664 tel. 508-398-2231 ext.1261
Use and Occupancy Permit Application
In accordance with the provisions of the Massachusetts State Building Code, section 105.1
Application for a certif icate of use and occupancy permit
Name of Business fO 04 1N 001-v(P(-4
Property Address I If f , (,4 Unit#� '�12
Type of Business d( --\N cL 0
*Square Footage to be occupied *attach floor plan Fee: $60
The applicant is required to obtain approval sign-offs from the following departments�as --- -::IVE _;_
checked off below: — `'
X Health Department— 508-398-2231 ext. 1241 on 30 2019
X Fire Department— Fire Prevention, 96 Old Main Street, 508-398-2212 i 3 ' ���" 4-)A``T"'''
Other
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Building owners Signature Applicant Signature
Please note: this permit is for use and occupancy only. Any work requiring a building permit
will require a licensed contractor to submit an additional application with all the required
information based on the scope of the project.
**Office use only**
Zoning District a / Proposed Use 76 Change of Use: Yes No
Allowed Use: Yes `7No APD Waiver: Yes No N/A
0,,,, ,, ,o'°.:‘ZZ",_— //-5-77
Building Officials Signature Date
ot:Y'k TOWN OF YARMOUTH
7.° HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:/ \
Building Site Location: LP 1 0- ' (0_k �/ a K`'� f7opL '
Proposed Improvement: o4- Qvt 4ic a
Applicant:\ � `G �' �����` '�� Tel. No.:'Y�' l --
- 0g/
Address:��� �V�,t,�.c�.-�,�;•�.� ��n�`��wtl�- Date Filed: L. (7411.
**If you would like e-mail notification of sign off please provide e-mail address:
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,
RECEIVED and septic system location;
SEP 13 2019 (2.) Floor plan labeling ALL rooms within building
(all existing and proposed) —
HEALTH DEPT. 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: < I7/I
PLEASE NOTE
COMMENTS/CONDITIONS:
MGL AND FIRE
TOWN OF YARMOUTH
REVIEWED FOR CODE COMPLIANCE.
rRRORS OR OMMISSIONS DO NOT RELIEVE
THE APPLICANT FROM 1-HE RESPONSIBIL IY
� + F "Ai BUILT' COMPLir.NCE.
DATE:. L__ - ?
YARMOUTH FIRE PREVENTION
New Business Transmittal
Project Name: Yoga of Yarmouth Port Address: 161 Rt. 6A
Contact Name: Deb Mareb Phone: 508-681-5308
Y N NA Subject Regulation
ES O
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 1; 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: 10-24-2019
Copy for Applicant Copy to Building Department Copy to Fire Prevention
Entered in Firehouse I—I Final Inspection