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HomeMy WebLinkAbout2022 Sign Off Transmittal - Deck Replacement TOWN OF YARMOUTHaCgLIOV7LD, ftHEALTH DEPARTMENT MAY 2 5 2022 PERMIT APPLICATION SIGN OFF TRANSMITTAL SHTH DEPT. To be completed by Applicant: Building Site Location: CIC W ec-,\ Proposed Improvement: (Z,6-kit— b (c. Z�✓ Lt Alan-t . Stcm r -1,-)T l 11��� Applicant: ,S' Ue (lei(��C (h lM (.t,'W 1 s 611 No..5a—L c q -$2-5e ui4iT //1��� Address: 2 oCCowt M un t%Ilan U444/ / 1-t y t'r,/VS X71 L;o/ Date Filed: 541.1772— **Ifyou would like e-mail notification of sign oft;please provide e-mail address: LI • (,• Cept, Owner Name: LIS C SM C-0 O('. Owner Address: IN &X,/'er" P44 /14Awme3A- C tll Mll Cli/06 Owner Tel. No.: Si I3—S'3 f--/ 3 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: Commonwealth of Massachusetts Title 5 Official Inspection Form h 77= Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 21 Berwick Road Property Address Lise Saintlouis Owner Owner's Name information is required for every Yarmouth Ma 02664 1-11-17 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 ❑ drawing attached separately LEFT SIDE HOUSE A 8 Al- 15' 81-26' A2.22' 82-24' A3.27' 83.28' 0 E1 0 0 lSins•3/13 Title 5 Official Inspection Form Subsurface Sewage Disposal System•Page 15 of 17 Building Attributes Building Photo Field Description Cape Cod - , Model Residential Grade: Average+20 I Stories: 1.75 ' IOccupancy 1 13 Exterior Wall 1 1 Wood Shingle - 2- I 1 Exterior Wall 2 I Roof Structure: Gable/Hip I _ __ — _ Roof Cover Asph/F GIs/Cmpr �^ -- I Interior Wall 1 https:/lima es.v si.com/ hotos2NarmouthMAPhotos/A00\03\26\0 Drywall/Sheet ( 9 9 p 0 Mpg) I Interior Wall 2 Building Layout Interior Fir 1 Hardwood28 FSP work i 10 Interior Fir 2 i 1414 24 WOK 14 4 I Heat Fuel Gas I WDK 12 4 12 44 WDK pa)) 24 4 14 13 12 16 ( CTH Heat Type: Hot Water BAS 1 - I 16 1618 UAT 22 AC Type: None FOR zs BAS TQS i i Total Bedrooms: 3 Bedrooms BUEtMAS 12 ___ -_.__.__ I4 ITotal Bthrms: 12 10 14 I Total Half Baths: 1 41 6 18y 21 I Total Xtra Fixtrs: 1 UBM (ParcelSketch.ashx?pid=520&bid=553) ITotal Rooms: I I -— ------ --- 1 Building Sub-Areas(sq ft) Lagend I Bath Style: Average — I Gross I Living i Code Description j 'i Kitchen Style: Modem I Area Area 1 Num Kitchens 01 i i BAS First Floor 1,276 I 1,276 I -- I Cndtn I I TQS 1 Three Quarter Story 1,066 I 800 Num Park 1 I CTH j Cathedral CingI 192 I 0 --- 1 1 I Fireplaces 1 j j FGR Garage 308 0 I Fndtn Cndtn _ I FSP Porch,Screen,Finished 168 I 0 Basement II I UAT Attic,Unfinished 1 308; 0 i ! j t _ UBM Basement,Unfinished 1,084 I 01 K_ _1�]v� D I II j WOK I Deck,Wood 592 I 0 i i rIAY Z a 2022 I I I 4,994 2,076 HEALTH DEPT. Extra Features I Extra Features -7 Legend I Code 1 Description Size Value I Bldg# I FPL3 12 STORY CHIM 1.00 UNITS $2,40011 EOS 1 End Outs Shwr 1.00 UNITS $0 I 1 DEALER NAME COUNTERTOP ORDER DATER PAGE OB DATE WANTED DESIGNER SHIP TO 1 j� �'t eI c(I� ©f PRODUCT CORE MATERIAL ( BACKSPLASH TYPE TYPE DECK COLOR ACCENT COLOR EDGE MATERIAL EDGE FINISH SHAPE Q.) rh 111 00 -�' MAY 2520 22 A) HEALTH DEPT t7( 1-800-982-3533 MA NE (cpu N TER WE R K DIRECT 1508-4 -82 9377 NUFACTWERS OF CUSTOM COUNTERTOPS Ely DESIGN TP4I Ill