HomeMy WebLinkAbout2022 Sign off Transmittal - Finish Partial Basement o -Yak TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:Building Site Location: _3 Ck-/ p0/Z P S7
Proposed Improvement: (l/L 1 St)i L ca nli i 101,1 0 r -I'z-C. S (mi.n,i^ PL) -(--
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Applicant: I I
J,Y /?&AA,V A J/ 06V c I.L C Tel. No.: 7 7L1 I/L J Wc,
Address: 0 Date Filed: /Q - 7- --ZZ
**If you would like e- ad notification of sign off,please provide e-mail address: /`Z DR VI D t7 LI I fYl Aftf3f S M4/L.
Owner Name: (17ñ111u'? A/ pe ? SoA.
Owner Address: C,,Z./17-01? 1) S I Owner Tel. No.: 77 L/ Z/Z I%' /
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:
EU.=;�wIED (1.) Site Plan showing existing buildings, water line location,
OCT 1 1 2022 and septic system location;
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (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: C/'vvfZ.- DATE: 7q?--(7)
PLEASE NOTE
COMMENTS/CONDITIONS:
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Anderson,Pricilla HEALTH DEPT.
3 Clifford St
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CONTR ACT Customer Nan S Yarmouth,MA 02664 Customer Signature` rfst.r T l if ir- .k•
SKETCH Contract Date 774-212-1491 774-810-2066 Sales Representative Gignature
OWENS �
CORNING . ATTACHMENT Customer Pho. Contract Price
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NOTES: representation aof the work uto be done,,iiit is understood that all is all dimgood
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derived from this sketch are approximate,and that all locations of outlets,light
fixtures,plugs,jacks and/or switches are subject to change if necessary.