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HomeMy WebLinkAboutBLD-22-007476 ONE & TWO FAMILY ONLY- BUILDING PERMIT Town of Yarmouth Building Department oif '")-4- 1146 r1146 Route 28,South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 41-1—�* li Massachusetts State Building Code,780 CMR Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling This iSection For Official Use Only RECEIVED Building Permit Number: -22-,�1`i 9 Date Applied: , c 5 — a,J, N 2 21 Building Official(Print Name) ignature D SECTION 1:SITE INFORMATION BUILDING PARTMENT Rv 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers FRECEIVED nChipping grl-i ? rc /.e. 610 8(0 1.1a Is this an accepted street?yes ✓ no Map Number Parcel Number Z 1.3 Zoning Information: 1.4 Property Dimensions: t 1 i JUN 2 7 2022 /3) 250 J . 2 i _ Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) :`�? ' I1ILDING DEPARTMENT 1.5 Building Setbacks(ft) !ll Front Yard Side Yards Rear Yard 9 D i° Required Provided Required Provided Required Provided ((/ L -22. z l 34. 3' Com' 1.6 -Water Supply: (M.G.L c.40,I54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: � � 1 L Public I Private❑ Zone: _ Outside Flood Zone? Municipal 0 On site disposal system ,$ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Rat mond, ..J. Srown *Jr Uxbr,'dci /14/1 015109 Name(Print) City,State,ZIP 10 ,4r1 d_r z w,s (br i r e. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction le-Existing Building OK~Owner-Occupied 0 I Repairs(s) 0 Alteration(s) 0 I Addition Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: - Brief Description of Proposed Work2: Reno v a ion o f QY1d- ctol cLL,f-i O rt., vc i sf-i n3 hoe-ne... SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) . I.Building $ 27 .,-7 5 0 1. Building Permit Fee:S VO Indicate how fee is determined: 2.Electrical $ IR Standard City/Town Application Fee gig d0 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ /Qi 000 2. Other Fees: $ (D() -i3, 4.Mechanical (HVAC) S 7 SOO List 5.Mechanical (Fire • . Suppression) $ Total All Fees:$ Check No. Check Amount Cash t: /. 6.Total Project Cost: $ 3o 3, 0.50 ❑Paid in Full ®Outstanding Balance Du :`'t'4 0 SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) CS — 0(e, (..Q g 3 -22 .2- Li Jelin G Kra/7Lo/'L_f 1 I1 License Number Expiration Date Name of CSL Holder 18 Jan Se-Lacs-1i hJ.e 3 List CSL Type(see below) U A5i'4r� r�v e No.and Street Type Description Sa/rid (.2)ick , /IIIA 02.5 ( 3 U Unrestricted(Buildings up to 35,000 cu.ft.) R Restricted l&2 Family Dwelling City/Town,State,ZIP M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 03.42 a.c j,Qo KW 1)LL C e CO/rlcas- .hef I Insulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(HTC) Kra-140n WOOctwo/JCS t DHIC Registration Number Expiration DateLSlyns LLC 6, `o 2 8 5, 2 3. 2ote HIC Company Name or HIC Registrant Name. I$Jan 5Lba5tan on-twz, Su,i ,e, 3 KWOLLC @ Com casf.rei. No.and Street , Email address cpn d�.0ch/Yin O.Z 5&3 SO8•-12e. S toa o City/Town,State,ZIP Telephone SECTION 6:WORKERS'COMPENSATION INSURANCE AFFIDAVIT(A!I.G.L.c.152.§ 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes 0 No 0 SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize JGhi? Kra a IL__ to act on my behalf,in all matters relative to work authorized by this buil inpermit application. R a m,nd I. en,wnJr. Print wner's Name(Electronic Signature) Date • SECTION 7b: OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. John t Kra{-ion.111 Print Owner's o"Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142k Other important information on the HIC Program can be found at www.mass.siov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq.ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count "7 Number of fireplaces 2 Number of bedrooms _ 2. Number of bathrooms 2 Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" - • `� The Commonwealth of Massachusetts c.., . 9� t Department oflndustrialAccidents = w 1 Congress Street, Suite 100 'eel,-1 Boston,MA 02114-2017 ...r, www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): K ra{fpkl i li'cccu,u0r�5 4- Z.)2,5 /3 ji 5 LLC.. Address: le Jan Sc-ba641a r1, . r tie. Sui+e 3 City/State/Zip: San d,(..0 i ci-1 M A 0 2 56 3 Phone#: 5 0 $ . 4 2 . Co 0 0 Are you an employer?Cheek the appropriate box: Type of project(required): I.Eriam a employer with .3 employees(full and/or part-time).* 7. alciew construction 2.0 I am a sole proprietor or partnership and have no employees working for me in 8. aRemodeling • any capacity.(No workers'comp.insurance required.] 3. I am a homeowner doingall work myself. t 9. ❑Demolition ❑ y [No workers'comp.insurance required.) 4.0 I am a homeowner and will be hiring contractors to conduct all work on m property.YI will 10 uilding addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.0I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box All must also fill out the section below showing their workers'compensation policy information_ f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / / Ale Insurance Company Name: H U 8 in i "/')OC-7 one / e 1 v Enq la v 4 Policy#or Self-ins.Lic.#: 1 S.0 g Co 2.... Expiration Date: /q- 3O. 2. 0 2.2. Job Site Address: 3 2 (-h ipp)n1 6r2.e.n L ri'V.e.. City/State/Zip: \lCQrrnOV 4-h /n,4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties o perjury that the information provided above is true and correct Signa ,=,‘'; _ ,___. - / Date: 6 • L re Phone . % : .1-122'. . to 0 0 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# - Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other - Contact Person: Phone#: .01 Y ,, = TOWN OF YARMOUTH Sr' os o _ ;, v - i BUILDING DEPARTMENT e, ""+'..,ror,, 1146 Route 28, South Yarmouth,MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: 5. 221 . 2 69 2 2 JOB LOCATION: Brow n g 2 (-hi ��i re r dir6Ie m aro u+1,-)NAME S1 ,EET ADDRESS SECT3N OF TOWN "HOMEOWNER" R yr70nd Brown AME HOME PHONE WORK PHONE PRESENT MAILNG ADDRESS in Ance.,v'-e w e ()X bridge_ /Vt i4 C7lS Co CITY OR TOWN STATE ZIP CODE The current exemption for `Homeowner' was extended to include owner--occupied dwellings of one or two units and to allow such homeowners to engage an individual for hire who does not possess a license,provided that such homeowner shall act as supervisor. (State Building Code Section 110 R5.1.3.1) Definition of Homeowner: Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is or is intended to be, a one or two family attached or detached structure assessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner;such"homeowner"shall submit to the building official,on a form acceptable to the building official,that he/she shall be responsible for all such work performed under the building permit. (Section 110 R5.1.3.1) The undersigned `homeowner' assumes responsibility for compliance with the State Building Code and other applicable codes,by-laws, rules and regulations. The undersigned 'homeowner' certifies that he / she understands the Town of Yarmouth Building Department minimum inspection procedures and requirements and that he / she will comply with said procedures and requirements. HOMEOWNER"S SIGNATURE APPROVAL OF BUILDING OFFICIAL INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent, which meets the requirements of MGL Ch.142. 4 No If you have checked ves,please i care the type coverage by checking the appropriate box. A liability insurance policy Other type of indemnity Bond OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass. General Laws and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner Agent h:homeownrlicexermp §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-22311 ext.-1261 Fax 508-398-0836 Office of the Building Commissioner • BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. #4. I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 2 C-h 1 p pi nv-Q-e r C l rG/-e,, yarn-D u+h Work Address Is to be disposed of oat the following location: , 6 :w v► ds A . Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. , Z0 , 2022. , <ture of Ap,• ication Date Permit No. .___:z...r` KRAFWOO-01 DKULICK .ALC-CPRE). CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 5/26/2022 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRooucER License#1780862 TACT HUB International New England Ext):(508)945_0446 I jai 2855 Orleans Road ,No{:(508)9454136 North Chatham,MA 02650 Ate: INSURERS)AFFORDING COVERAGE NAIC I INSURER A:Selective Insurance Company of South Carolina 19259 INSURED INSURER B: Krafton Woodworks and Design LLC INSURER C: John Krafton III 18 Jan Sebastian Dr#3 INSURER D: Sandwich,MA 02563 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NO1WTHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBRPOLICY EFF POUCY EXP LTR TYPE OF INSURANCE INSD WVD POUCY NUMBER (MM/DDJYYYY) (MM/DD/YYYYI UNITS A X COMMERCIAL GENERAL LIABILITY 1 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR S 2394083 9/30/2021 9/30/2022 DRAMGEEaEoaDence{ $ 500,000 MED EXP(MY one Person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPUES PER GENERAL AGGREGATE $ 3,000,000 X POUCY jEt& LOC PRODUCTS-COMP/OP AGG $ 3,000,000 OTHER: $ AUTOMOBILE UABIUTY (Es c i EDen SINGLE UMri $ ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOSpONLY _ AUUTNOpSyyN p AUTOS ONLY — AUTOS ONLY P�teOPERYtDAMAGE $ )) $ UMBRELLA UAB OCCUR 1 EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION 1 STATUTE I ER AND EMPLOYERS'UABIUTY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L EACH ACCIDENT $ OFAERIMEn EXCLUDED? N/A (M i EL DISEASE-EA EMPLOYEE $ If yes,desarbe under $ DESCRIPTION OF OPERATIONS belowEL DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLESACORD 101,Additional Remarks Schedule,may be attached It more space is required) Certificate holder Is listed as Additional Insured when required by written contract CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE • THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Y19- 1.14'. - 1 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ' / i . SHED 117.55 LOT 20 :• ,% / .tet/ 13,250 ± S.F. '',A --. Iii /°"` "' O °POSED /;:. IA pR`�E !/ 2 710Ni � %. PATII' %-' m 0 %% BOX i a Z •' r \\43.2' 111 O •' , % '% 1500 GALLON % SEPTIC TANK ,, A 1....4 '/% o /% j cri %, _ \ , �%" cl\ ' 0\ it%/ cl \ c, I'M\ tll tt \ \ w �,` w • C.P , ,.. Ia9.2 CI,4, �_Y ; • ARE �&. f, ,.1 .,`:�r 1 /'! i� to WILLIAM 4r'`t--,---:,71.,. INV , #(-). '� Ipp ,-- 3114�fLCt.�Y No ��.), ^�. ~ o, sTr pls`rn4 vii : TO THE BEST OF MY INFORMATION, "PROPOSED" PL � . , KNOWLEDGE, AND BELIEF THE SOUTH YARMOUTH, MASS. STRUCTURES SHOWN ON THIS PLAN LOT 20, PL BK. 199, PG. 11 HAS BEEN LOCATED ON THE GROUND DATE 2/18/2022 SCALE 1" = 20' AS INDICATED. JOB 7366-00 CLIENT MULDOON 4/25/2022 _ �-r7 SWEETSER ENGINEERING 203 SETUCKET ROAD DATE PROFESSIONAL LAND SURVEYOR PO BOX 713 SOUTH DENNIS, MA 02660 off. 508-385-6900 fox. 508-385-6991 C: \S8\PROJI7366-OO\dwg\7366-PPP1.0WG ©2022 SWEETSER ENGINEERING ' Commonwealth of Massachusetts Division of Occupational Licensure 9 Board of Building R lations and Standards .rte- d CS-067698 v * -11ires:03/2212024 JOHN E • t, !itirm 18 JAN =* SANDWICH lit I ____' 4bi-J.vaCO Commissioner Y2 p• %.t..�. Registration valid for individual use only before the expiration date. if found return to: Office of Consumer Affairs and Business Regulation 1000 Washington Street -Suite 710 Boston,MA 02118 t - � .mow. Not va , ut signature • THE COMMONWEALTH OF MASSACHUSETTS Office of Consumer Affaut&Business Regulation Registration valid for individual use only before the HOME IMPROVENT CONTRACTOR expiration date. If found return to: T1(PE`1 C__ :. Office of Consumer Affairs and Business Regulation ittgiglitiMit 1.—ii "EXpbatiop 1000 Washington Street -Suite 710 f '-105 029 Boston,MA 02118 KRAFTON WOODWORKS:_ S ,ILLC: JOHN KRAFTON III . :, _ 18 JAN SEBASTAIN DR 6TH CG.�. k" d^:� �iqga SANDWICH,MA 02563 4 t Undersecretary Not valid ' signature Sears, Tim From: Sears, Tim Sent: Tuesday,August 23, 2022 4:17 PM To: 'kwdllc@comcast.net Subject: 82 Chipping Green John, I have reviewed your application for the addition and using the 110mph checklist requires a full foundation.The use of pier footings will require the plans be reviewed and stamped by a Registered Design Professional. Please update the plans and submit for review. This email is considered a written denial of your permit application per Section 105.3.1 of the Massachusetts State Building Code. Section 105.3.2 states in part that "an application for a permit for any proposed work shall be deemed to have been abandoned 180 days after the date of filing, unless such application has been pursued in good faith" You may appeal this denial to the Building Code Appeals Board in accordance with M.G.L. c. 143 §100,within 45 days of this notice. Timothy Sears CBO Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears@yarmouth.ma.us 1 KLi£ U.c CaCorncOat, ne.1- ���.1744,_ TO \'\ OF NAR,\tt)tUTi I ktgi . :o WATER DEPARTMENT ` 999? Buck Island R+)ad �\ °""'°� \\'e>t larmouth, k1A ON—I a . k,If1014wl •'SIM '-I- 92 I • fax: t,Ofi. ?'1-'")r)I$ BUILDING PERMIT APPLICATION FOR WATER DEPARTMENT SIGN OFF TRANSMITTAL FORM J BUILDING SITE LOCATION: Fc? Chi . ® gj"4+n cir 4j e PROPOSED WORK: add t-1-i0n ait eva, ial -fUa ci h . APPLICANT:enthey7 wood.Ivo rE Ae &nS _ ADDRESS: /B Jon Seta644cr, I've, Sandwich_44 i ELPHONE: 5DI • t#a.tr. _gto a0_,_ RESIDENTIAL AND OR COMMERCIAL BUILDING Water Department: Determines Compliance of Water.N%ailabilit) and or existing location Engineering Department: Determines Compliance for Parking and Drainage ('onseilation Commission: Determines Compliance to Wetlands Net. i eII'lot(s)border any type of m edam's. streams.ponds.rivers.ocean. hogs, boys.marshland. ETC, Ilcalih Department: Determines Compliance to State and limn Regulations, i.e. requirements tnr Septage Disposal and other Public health Actin ices Fire Department: I)etcrmines I`ompliance to State and`fo%%n Requirements for Personal Safety.Property Protections. i.e. Smoke Detectors,Sprinkler Systems,etc , PLICANT SIGNATU� A 6). 0 /. ‘Ra WVIE OFFICE USE: COMMENTS ON PERNII"1'APPROVAL OR DENIM. X7e0„,/) y.er REVIEWED BY WATER DIVISION(SIGNATURE) DATE I ...::\,:. ::: 1,i,c:.• ;?ini.._ --.... 117.55 _ - ..,... ...IS - 01 r LOT 20 !.).. 13,250 ± S.F. P• '..... Cln. $PROPOSED , °ADDITION D. 66'' I BOX ___________-----."-- ;:"i.- 11 .5--. 111% 43.2 1::-..,,, (-...CL- ,:., cr .t\) '''' .•'-',• 0 • b • . , ,... ,„ ; ' ,, , 1500 GALLON CI ' '-. , ,., SEPTIC TANK IX% ' . „ . , c , :::,: =---` •,...). ''\ ;-."-- ---, \ \ \ , c..4 _ \ HEALTH DEPT , -.v. , trA 1 Z I . „ CLE , . v......, Gf? -1•-i N G ,-,.tif,;. C"3/41 %•;r7 ,__.-- zr,,,57 1'' ' f:•Ae1 \'•-,.. •74, P I — \Id! a,. k_f TO THE BEST OF MY INFORMATION, "PROPOSED" PLCit --1P;LAN: KNOWLEDGE, AND BELIEF THE SOUTH YARMOUTH, MASS. STRUCTURES SHOWN ON THIS PLAN LOT 20, PL. BK. 199, PG. 11 HAS BEEN LOCATED ON THE GROUND DATE 2/18/2022 SCALE 1" = 20' AS INDICATED. - JOB 73667_00 MIEN T MULDOON 4/25/2022 -.-_- .G,Z___ -, --- SWEETSER ENGINEERING 203 SETUCKET ROAD DATE PROFESSIONAL LAND STRVEYOR PO BOX 713 SOUTH DENNIS, MA 02660 off. 508-385-6900 fax. 508-385-6991 C: \S8\PROJ\7366-00\dwg\7366-PPP1.DWG 02022 SWEETSER ENGINEERING I .. ,,, , {,quo TOWN OF YARMOUTH .r4,,,,,, HEALTH DEPARTMENT k-... ' PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: I `.Building Site Location: ga CJ "Ty) 1,-73 re.e ti a rc e. , y lar m d U-iln . J1/1 4 Proposed Improvement: Q/)0 VaJ7O t_ de i,r L a-oies/x: -ro,t, It) Q' - 1 6- Pic)/-1-) £- 0IJ Soh ` L. ?-r-S { < Kra --for, . elckit vor y. Oes/frri , Applicant: �-i.fi. ••e i . Tel. No.: 5O 8, `'/cc 8. ?4,66 4;. 1 •`,;027 .7 ;ve. r.,5-te 3) Sa, u)i ci1i 1 - Address: -i`YYt 7.21 O a 5 6 3 Date Filed:(o ,010?. a .D, ' **.(f you would like e-mail notification of sign off please provide e-mail address: K LA)Z11, L LC l C UM C a j i*, i- ) G� - Owner Name: Ray r'i`d r7A.. J. 13 r'O ex) n 1 ‘7 r. Owner Address: /0 (1"Yi o!/1-..e, ' 5 Lr t V C. Owner Tel. No.: RESIDENTIAL AND/OR COMMERCIAL BUILDING' HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requt ements 4. For Septage.Disposal and other Public Health Activities. Please submit three (3) copies of plans, to include: `cf.) Site Plan showing existing buildings, water line location, and septic system location; Ts:-:„7-.=-N&-_-c) (2.) Floor plan labeling ALL rooms within building (all existing and proposed) - + JUN 2 / 2072 Note: Floor plans not required for decks, sheds,windows, roofing,,,.-- ,-13.) If nec ssary,.1 itle 5 application signed by licensed installer HEALTH 'DEPT. with fee. da ._________REVIEWED BY: V DATE: 3— ( ?T c ' .- , . ,... , PLEASE NOTE COMMENTS/CONDIT OqNS: a 6C 1- cA,v C v1 5G vi 1---cg--S t•f 'J ( 0 !- r. 7 _ // —,), ? c 'c/(- c'. (��,<t 1 eV,— F-�,.tJ Yr c- tc,cC "j cst-G 1�, L