HomeMy WebLinkAbout2020 Mar 11 - Sign Off Transmittal, Plans - Bathroom Addition it
. `� .- TOWN OF YARMOUTH
'._ , . , HEALTH DEPARTMENT
' s 457'' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: gr?.. (111 U we„. J11 G1h iAiz.,,t
Proposed Improvement: it t X II Ad J 1 —t c iNJ .,eG.` le1 ko d) 24-1
nip. C r AAu-►(. ce V)C-¢,.
Applicant: 11 d Q Vt S) 2. Tel. No.:j .73. Uiti 6
Address: C a 0 S (l!e c.,_S :., Date Filed:3 I i` (7
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**/fyou would like e-mail notification of sign off please provide e-mail address:
Owner Name: Io j �" 3 Q�r ^► S` c-o
Owner Address: (.1„,(/“.44 S , vOCC.4t,�=cS e g c,. Owner Tel. No.: 7 %.3 2034
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)— J
Note:Floor plans not required for decks, sheds, windows,roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY: 62\A-7/rDATE: 3 / 1 --
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COMMENTS/CONDITIONS:
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ABL MORTGAGE INSPECTION PLAN
REGISTERED LAND SURVEYORS NAME ROBERT J. SIEMASZKO & JOSEPHINE P. SIEMASZKO t='
P.O.Box 70702
Quineigamond Village Station LENDER
wO 752-80 R,MA(PHONE)
LOCATION 22 CROWE'S PURCHASE ROAD i�
508-752-8050(PHONE) I
508.752.8004(FAX) •
WEST YARMOUTH, MA -Fi
A Division of H. 5. & T. Group, inc. r-'
SCALE 1 " = 30 ' DATE 11 -28-16 1
REGISTRY BARNSTABLE, MA ' v�
eAs o UPON DOGJMENOITION FRONDED. _ ciao eown.=25477/18
MINTS WERE MADE Of TIE FRONOGE AND eUl S) sNO*N 11� OF
VOILEON EAORMA=INSPECTION WIDITS ARE*tom ANO THERE ARE NOLA1 NS itJ �� PLAN eoolyouN 155/51
OF ZONING REQ{APEYENTS RETARDING STRUCTURES TO PROPERTY DANIEL
ME OFFSETS(UNLESS OTlTL7tYTSE NOTED IN CROWD 8E10W) ME CE1WY TWIT THE OUt0NC(S)ARE I♦WITHIN NE
NOT DEFINED ARE ION.THIS I0 POOLS 0p, QTS V SPECIAL FLOOD HAZARD AREA.SEE FEW MMP:
OR � WITH NO FOUNDA110MJ,THIS IS LOIiiG�CE � TIVNAN
INSPECTION PLOW:NOT NI INSTRUMENT SURVEY. DO NOT USE TO NK0047
ERECT FENCES,OTHER eouRaRr mummers.es To now , 5$8J oTo 07-16—14
gimes.LOCATION OF THE srsucT1eRE(S)SHOWN HEREON IS WHO �s1-
IN COMPLWICE TIMI LOCA.ZONING NOR PROPERTY WE OFFSET `� AIa:F� FIAOD MA7JWO ZONE WLS 8ETJ1 OE7ERMiNED el SONE ANDRE013ItERIENTS.OR IS E%QIPF FTMM1 VIOLATION ENFOREDIENT f-; '..�y.1/
ACTION UNDER HASS.G.L.TOLE W.CWP.40A.SEC.7.UNLESS '•.y,;�;'��I4,✓„ " IS NOT NECESSARILY/COATTAIL UNIT,OEFINTNE PLANS ARE •
ODIeRRrsE NOM.SITS cERTIfIG:710N D HON-TIW1SfERAeLL ►•"\_dam •
ISSUED ETT FEMA AND/ON A VERTICAL CONTROL SURVEY E
THE ABOVE CERTIFICATIONS ARE MADE HRH THE-PROVISION THAT
THE NFORMAUON PROVIDED IS ACCURATE AND THAT:INE MfASURE PERFORMED.PROSE ELEVATIONS CANNOT RE MHEO.
HOGS
TUSED RE ACCURATELY LOCATED N Ammo/TO THPROPETY E
NOTE:PROPERTY LOCATED WITH IN
FEMA DESIGNATED FLOOD ZONE
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k!IVEITI NC OFFICE:LAw OFFICE OF STEVEN J. PO2In i DRAWN BYSuB
RCQUESTT BY: • CIUMELD BY:
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Commonwealth of Massachusetts
1'' * , , Title 5 Official Inspection Form
re - Subsurface Sewage Disposal System Form-Not for Voluntary Assessments
22 Crowes Purchace Road,West Yarmouth M-22 P-213
Property Address
John R. Lima
Owner Owner's Name
I required for every 230176'Terrace Dr. Ea,Redington Shores FL 33708 May it 2016
page. City/Town State Zip Code Date of Inspection
D. System Information (cont) .,
Sketch Of Sewage Disposal'System:Provide a view of the sewage disposal system,including ties to
at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate
where public water supply enters the building.Check one of the boxes below:
® hand-sketch in the area below
0 drawing attached separately
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RECEIVED
`1) _ ❑ D `- • [] MAR 1 12020
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t5Ins•3113 'Title 5 OMda1 Inspection Fomx Subsurface Sewage Disposal System•Page 15 of 17