HomeMy WebLinkAboutShields MRI Health Department Sign Off Transmittal - 1.6.21TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:______________________________________________________________________
Proposed Improvement:______________________________________________________________________
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Applicant:________________________________________________________Tel. No.:__________________
Address:____________________________________________________________Date Filed:_____________
**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,
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:___________________________
PLEASE NOTE
COMMENTS/CONDITIONS:
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2 Iyannough Road West Yarmouth, MA 02673
Interior renovation of an existing building to accommodate the installation and
swap of a new MRI machine from the existing. Renovation includes relocation of partitions, FP heads,
new HVAC equipment, electrical, and finish upgrades.
Spencer Cleary (Dellbrook JKS)774-602-0630
15 Research Road East Falmouth, MA 02536 12/18/2020
scleary@dellbrookjks.com
Realty of Cape Cod LLC Rep: Lisa Mann (Shields MRI)
55 Christy Drive Brockton, MA 02301 508-728-9050