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HomeMy WebLinkAboutBLD-23-003297 (2) • piA I JZ ONE & TWO FAMILY ONLY- BUILDING PERMIT E own of Yarmouth BuildinCEIVEDg Department ;: "� ,4 Route 28, South Yarmouth,MA 02664-4492 08-398-2231 ext. 1261 Fax 508-398-0836ar DEC 4 �fl�� M ssachusetts State Building Code, 780 CMR `� Articling Per tit ppltcation To Construct, Repair, Renovate Or Demolish -..::_ :;,.-.. a One-or Two-Family Dwelling 1 BUILDING DEPARTMENT }' Rv: This Section For Official Use Only Building Permit Number: (30_.. b)g 17 Date Applied: i5rsr, 1RACS .i 4— ),). Building Official(Print Name) Signature Date SECTION 1:SITE INFORMATION 1.1 Property Address: 1.2 Assessors Map&Parcel Numbers G 54-; Ail ko�' Sa 913 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: inJ lit 2 Zr Io'0 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 0 34, . Zo ic.. 7�Ii.l 2.0 2-7.3 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public Private❑ Zone: _ Outside Flood Zone? Check if yes❑ Municipal 0 On site disposal system 0 SECTION 2: PROPERTY OWNERSHIP' 2.1wner'of Record: JU AlAA nivt S Ioft''"vc-A`�1P "A OUG9 Name(Print) City,State,ZIP (o 5 v. ,,i J Ao-32Y--oI9i 1-0cvAA .,P,,,,,t. C ezvc,,A.tPr No.and Street Telephone Email Address SECTION 3:DESCRIPTIION OF PROPOSED WORK2(check all that apply) New Construction 0 1 Existing Building Cl/ Owner-Occupied 0 I Repairs(s) 0 Alteration(s) l/ Additioir-6 Demolition 0 Accessory Bldg. 0 Number of Units Other 0 Specify: Brief Description of Proposed Work2: j44. a M'i )`ti-p- h t,A„e.s..-^ i `eM*3 '._...0 t,- Imo-, 4 CtaseVi' SECTION 4:ESTIMATED CONSTRUCTION COSTS. Item Estimated Costs: Official Use Only (Labor and Materials) 1.Building $ '1•:1 K 1. Building Permit Fee:$5 bQ Indicate how fee is determined: 2.Electrical $ p K . Standard City/Town Application Fee 0 Total Project Cost3(Item 6)x multiplier x 3.Plumbing $ 2° K 2. Other Fees: $ Q ce r� . 4.Mechanical (HVAC) $ s lC List: �3�1 , 5.Mechanical (Fire Suppression) $ _ Total All Fees:$ Nr� 6.Total Project Cost: $ Check No. Check Amount: Cash • le stint: ZSd' ' �� l✓ 0Paid in Full ED Outstanding Balance D e:y-3 5 zl29 . SECTION 5: CONSTRUCTION SERVICES 1.5.1 Construction Supervisor License(CSL) � *� (�� \ CS o 333 go 3//j/2,4 j 1 'c'/y"t.0 4 e�" ` l-k.-nte\43 License Number Expiration Date Name of CSL Holder p• 0 )3 >‹ �53-1-- List CSL Type(see below) No.and Street Type Description S. 62,j4,,i.1/ ,,t A 07,r U Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1&2 Family Dwelling M Masonry RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances .563 J ''`I f337 Sct gj' e OSCev,1X„,,,� • e„,.,,, I Insulation Telephone Email address D Demolition . 5.2 Registered Home Improvement Contractor(HIC) ILEu p .5-c au-q ),,,,, HIC Company Name or HIC Registrant Name HIC Registration Number Expiratio Date P,v (.1•Q-,‹ /5-4 z S a s � t t 3,41 1 -41. dors lia,and Street , ) • 0-P A,A r 1 /'-IA07-G c j?y7.9 31 0-332 Email address City/Town, State,ZIP Telephone SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.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 Issuaytce of the building permit. Signed Affidavit Attached? Yes 6/ No ❑ 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 17,) /c 7 I ?4,+'..•-7 to act on my behalf, in all matters relative to work authorized by this building permit application. 1' Com_ 'zit 2.12.-'1— Pr;Owner'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 applicati • e and accurate to the best of my knowledge and understanding. ,. - -- .-- ._.---/------- /2// 7- i 2.. Print 0 s or Authorized Agent's Name(Electronic Signature) ate 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. 142A. Other important information on the HIC Program can be found at www.mass.Qov/oca Information on the Construction Supervisor License can be found at www.mass.eov/dos 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 Number of fireplaces Number of bedrooms Number of bathrooms 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" o� YAR- TOWN OF YARMOUTH ( u.1/�-° BUILDING DEPARTMENT ccse•'1 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 HOMEOWNER LICENSE EXEMPTION PLEASE PRINT: DATE: JOB LOCATION: NAME STREET ADDRESS SECTION OF TOWN "HOMEOWNER" NAME HOME PHONE WORK PHONE PRESENT MAILNG ADDRESS CITY OR TOWN STA'1'h 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 perfomued 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. Yes No If you have checked ves, please indicate 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:homeownrlicexemp TOWN'OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 1261 Fax 508-398-0836 Office of the Building Commissioner BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G. L. Chapter 40, Section 54 and 780 CMR, Chapter 1, Section 111/5 I hereby certify that the debris resulting from the proposed work/demolition to be conducted at ( 1(0, 4- z7 c1L`.v'i Work Address Is to be disposed of at the following location: S c ) Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. &//3/ 22 Signature of Applicant Date Permit No. 12/16/22, 11:40 AM Mail-Sears,Tim-Outlook 6 St. Andrews Sears, Tim <tsears@yarmouth.ma.us> Fri 12/16/2022 11:40 AM To: Raymond Caterino <sales@rjcbuilding.com> Cc:Water Department <WaterDept@yarmouth.ma.us> Raymond, I have reviewed your application for the addition and there are some items needed. . 21. Water Department sign off " Pt5Z,s' C'a`K checklis]or stamped plans V3. the use of sonotubes for footing will require stamped plans Please submit these items 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:tsearsfyarmouth.ma.us https://outlook.off ce.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAJBbFswyFspEnQE4PW... 1/1 -F ) , ,,i-Ar5id . 6, „5-r-, pik I A 14'C Gui?e to Wood C011Strucion in High Whid Areas: IIjt�mph Wind Zone 0r et Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 • heck Com.liance 1.1 SCOPE , Wind Speed(3-sec.gust) 110 mph Wind Exposure Category B 1.2 APPLICABILITY Number of Stories (Fig 2) *.. i stories s 2 stories • Roof Pitch (Fig 2) biz;2.512:12 Mean Roof Height (Fig 2) 4 ft s 33' Building Width,W (Fig 3) '" ft 5 80' — Building Length,L (Fig 3) ft s 80' Building Aspect Ratio(UW) (Fig 4) ;(s 3:1 Nominal Height of Tallest Opening2 •(Fig 4) 443,.<_6'8" • 1.3 FRAMING CONNECTIONS General compliance with framing connections (Table 2) 2.1 FOUNDATION . Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete Concrete Masonry 2.2 ANCHORAGE TO FOUNDATION1.3 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in ncrete only • Bolt Spacing–general (Table.4). V.:iat!!�. -i "`P ' -• in. Bolt Spacing from end/joint of plate (Fig 5) f i £42— in.s 6"–12" Bolt Embedment–concrete (Fig 5) In.a 7" Bolt Embedment–masonry (Fig 5) -- in.a 15" Plate Washer (Fig 5) >3"x 3"x W 3.1 FLOORS Floor framing member spans checked (per 780 CMR Chapter 55) Maximum Floor Opening Dimension (Fig 6) ,,4 ft 5 12'or 1./2 or W/2 Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6) Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall (Fig 7) =ft 5 d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall (Fig 8) hht.ioi.N.. ., l,... ill,ft s d Floor Bracing at Endwalls (Fig 9) • Floor Sheathing Type (per 780 CMR Chapter 55) Floor Sheathing Thickness (per 780 CM • Chapter 55) .3* in. Floor Sheathing Fastening (Table 2).. d nails at 4 in edge//2„. field 4.1 WALLS • Wall Heighttri Loadbearing walls (Fig 10 and Table 5) ft <10'Non-Loadbearing walls (Fig 10 and Table 5) Lft s 20' Wall Stud Spacing (Fig 10 and Table 5) in.s 24"o.c. Wall Story Offsets (Figs 7&8) F4_ft s d 4.2 EXTERIOR WALLS3 b Wood'Studs Loadbearing walls (Table 5) 2x..4.! / ft in. Non-Loadbearing walls (Table 5) 2x ft...in. Gable End Wall Bracing Full Height Endwall Studs (Fig 10) WSP Attic Floor Length (Fig 11) – ft?W13 Gypsum Ceiling Length(If WSP not used) (Fig 11) ft z 0.9W 2 x 4 Continuous Lateral Brace @ 6 ft.o.c... (Fig 11) _ f/ -- ' .cev ^.8 n' 13 and &fate�T.. L Witt / - /7.0,2E. �, MICHELE -c- g' - .g�j r �L' R{{''9 OMAN�G 1Z 7� WC uae to Wood Ct'nstrafrtivn in 1gi ,Wind Areas: 110,ndiz Vilma Zone • or 2F� Compliance (78a cNiii 531.31.2.i. ): Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails) (Table 7) 2- Non-Loadbearing Wall Connections Lateral(no.of endnailed 16d common nails) (Table 8) Zi Load Bearing Wall Openings(record largest opening but check all openings for complianpe t Table 9) Header Spans (Table 9) c3 ft`In.5 11' Sill Plate Spans (Table 9) ft_in.s 11' Full Height Studs (no.of studs) (Table 9) ("I J 1 Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans (Table 9) . 4 ft —in.s 12' • Sill Plate Spans.... (Table 9) ..4--tit_--in.s 12" Full Height Studs(no.of studs) (Table 9) r•t Exterior Wall Sheathing to Resist Uplift and Shear Simultaneous!? L Minimum Building Dimension,W Nominal Height of Tallest Opening2 'C5 @,:p.. Sheathing Type (note 4) s Edge Nail Spacing (Table 10 or note 4 if less) "2 in. Field Nail Spacing ,.(Table 10) • Shear Connection(no.of 16d common nails)(Table 10) Percent Full-Height Sheathing (Table 10) t r% r 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) ' ` ' Maximum Building Dimension,L Nominal Height of Tallest Opening2 kgs Sheathing Type (note 4) Edge Nail Spacing (Table 11 or note 4 if less) 3 in. Field Nail Spacing (Table 11) y i Shear Connection(no.of 16d common nails)(Table 11 • Percent Full-Height Sheathing (Table 11) pr..iYioo 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) Wall Cladding Rated for Wind Speed? r 5.1 ROOFS Roof framing member spans checked? (For Rafters use AWC Span Tool,see.BBRS Website) Roof Overhang (Figure 19) .1--2-ft<_smaller of 2'or L/3 Truss or Rafter Connections at Loadbearing Walls 1 i Proprietary Connectors l"( S PATI1 sl Uplift (Table 12) U= a, I e S/1 Lateral (Table 12) L= ], Shear (Table 12) S= 4f Ridge Strap Connections, i ar ti no super page 21.. .. (Table 13) T= -- Gable Rake Outlooker (Figure 20) ft<_smaller of 2'or L/2 Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors • Uplift (Table 14) U= ` lb. Lateral.(no.of 16d common nails)...(Table 14) L= ` Ib. Roof Sheathing Type (per 780 CMR Chapters 58 and 59) Roof Sheathing Thickness ,t� 7/1„(4.in.a 7/16"W P Roof Sheathing Fastening (Table 2)..ud4e.::4Lt. �/�, ep. . .. �'t,ij, Notes: t 1. This checklist must be met in its entirety,excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 c. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a 2. Exception:Opening heights of up to 8 ft.shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in.nominal thickness. pressure treated#2-g ade. .1.-–"4605.– ' //( toW v OF 444s . //7" / 2, ,,,, „,,, /Or LG/ o' • •HELE n, V H • -o 34774 -- (t. e S/ONALEN�''R� , . • . , • 9F et -f------2--N i\-, k , - bd. Pipit, 1 , 1 t . a t... o.c. . , ,5 . , e viol. 14 i. .f. — ad tu.4 W5P E.O&E, . e 12, 04. • If e ittrepotthfe I I 'PIO&klira i I I I NITAMAINTE ;,:pgrk, '‘-.--• tiLiktA IN G, rp.mtii G I 1 0 ittbEtk,TY?. 015.11tbe44,TIP,-7 li I I I V '1 i I 1 I . I 1 i 1 1, i .„- 694.41t4L u 341 ) ; 11 1. ,. j 72 u m tg. — • ,.. ".atm. IF I . P° -- L'-----1---.1Li! 1 1.-- - - I . - Pidiite, Drire. .. iv 14 eip . 0 ik i - - , Pi 4,- .. - + . o 6 t• rtYik VEIZT• Ab Aoitlz. krukcairittaT , NOTES: • . ...___ _ Wood Structund Panels shall be minimum thickness of 7116r and be installed as follows: i. Panels shall be insOdled with=nth axis parallel to studs • -- U. All horimmodjoints'shall occur over and be nailed to framing. tti,. on siotle story const.nletiOn.pirwils shall be attached to bottom plates and top cocanbcrpf the double Lop-. iv. On two story committal;tops panels shall be attached to the topmember of the awes double too plate and to band joist at bolpletof panel.Upper attachment elknver paneleball be made to band joist and • lower attar-Woe=ma&to-linvest pbokijkarst floor framing. v. Hod:mood nail spnpktg at dcablelt4*lex.band Joists,and girders avail be a doable tow of sa staggered at 3 inches on center per fivares below:Vertical and%dap' ntal itaRiog for Passel Attachment co.k.s‘—r r 7., eF i . . . . ' I - ' 11WRILC46201. riltm:46°:1_66 17--- . T . i 1 i 3-- - - m 7— --- 1 I --- ' (1 . ii 4 • . I 1 1 1 • i • I I .i 1 1 I L. tti . • • 4 ‘")., 1 I •A i c. 21 I I .1 ' 1. d3 tI r; 1 . . • Ut • • j 1 1 -4 I.... I 1 teiL 1 I. to • 1-1 • ts I• 1 1 1 . 4- <5 I g 1 fril . • — . :t I 'i a It I. ...--e 1 I c7). [ 1 - -d I . _6,1 ' •4. 8 1 t. 1 • ( . I 1 1 id • .•+-•• 1-71 .771-• '..':: ; .-47----."r"."\•-77". r":"-;:77; .77: .-.-,-,4. . r.7 / Iti OOD STAUCTURM. MI43E1 \ ( 106P) ‘34144,1-41140 • YVSP ATTACHMENT 0 - Met ID C/stki• . • • _ 0012, VNZTI.C44Libit4D +10RIZO4TAL XTTAt C.4s1 1441.514T • . rigrrc caolz W. -- • b +l f � GENERAL NOTES AND MATERIAL SPECIFICATIONS: FOUNDATIONS • 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2. For site location and grading information,see Site Plan,by others. 3. Assumed net allowable soil bearing capacity,q=3000 psf,for a medium sand/gravel composition. Other soils encountere., contact the Engineer of Record. 4. Concrete: Minimum 28 day strength,fc=3000 psi,3/4"aggregate,designed per American Concrete Institute Code,latest issue,maximum slump=4". a.) Anchor bolts ASTM A307 galvanized,min.5/8"diameter,12"long,w/2-1/2"hook spaced 4'o/c,pr in concrete piers wl Simpson ABU-series base;SPACED 2'o/c for slab-on-grade construction(i.e.Garage). I"' FRAMING 1.All workmanship to conform to the requirements of the Massachusetts State Building Code,latest edition. 2.Structural Design Loads: Dead Loads:Actual Weight of Building Components Live Loads:Snow Load =30 psf(plus drift)with applicable reduction ATTIC Storage=20 psf Living Floor=40 psf Sleeping Floor=30 psf Decks and Balconies=60 psf Wind Load: Criteria used for 110 MPH Exposure B 3. Structural Steel: (as required) a. ASTM A572 Grade 50;shop paint with rust inhibitive paint.Thru-Bolts: ASTM A307, 1/2"diameter;punched holo,: 9/16"diameter. b. Welds: Shop weld cap and base plates to columns;shop weld bearing plates to beams;use E70xx electrodes. Alternatively,field weld by certified welders. c. Deflection Criteria: L/360 total load deflection. 4.Timber Framing:. a.All new timber framing:Spruce-Pine-Fir No.2 with Fb=1000psi,E=1,300,000 psi,or better. b.Pressure treated timber(P.T.):Southern Pine with Fb=1300 psi,E=1,600,000 psi,or better. c.Laminated Veneer Lumber:All L.V.L.shall be 1.9E L.V.L.with Fb=2925 psi,E=1,900 ksi,Fv=285 psi,Fcjer=750 p'i, Fc_par=3035 psi. Parallam(PSL):All PSL shall be min. I.9E ES with Fb=2900 psi,E=1,900 ksi,Fv=285 psi,Fc_per=756 p , Fc_par=2900 psi. Note that Microllam and Parallam may be used interchangeably. 1. Deflection Criteria: L/480 Live Load,L/360 Total Load . 2. Optional: Provide shop drawing submittal of engineered lumber systems for approval prior to materials purchasing. 5.Metal Connectors: As manufactured by Simpson Strong-Tie Co.shall be handled and installed per manufacturer requirements,with all na I . holes filled,with the size nail as specified by mfgr.or herein. a. Rafter to Ridge Beam: Simpson LSSU-series,or Simpson Straps over top of plywood,spaced 48"o/c; Rafter to Ridge Plate: Collar ties min. 1x6@ 48"o/c at top or Simpson Straps over top of plywood spaced 48"o/c b. Rafter ends to top plate: Simpson 1-12.5A c. Band Joist: Simpson straps at 48"o/c 6.Bolts: Bolts in wood framing shall be standard machine bolts unless noted otherwise.Bolt holes in wood shall be 1/32"larger I is bolt diameter.Bolt heads and nuts shall bear on standard malleable iron washers,or square plate washers.All nuts shall be retightened at completion of job. 7.Blocking: a.Blocking shall be solid blocking,2x minimum,and full depth of member. b.Stud Walls:provide blocking at 8'-0"o/c,maximum height. Corners to be blocked at 48"o/c with plywood edge na li g to this blocking for the first 48"of these building corners. c.Nailing Schedule: Solid Blocking to Bearing 2-8d toenails ea.side Blocking Between Studs 2-1Od toenails ea.end,or 2-16d end-nails ea.End d. New Framing:Provide 2x blocking for 2 joist/rafter bays and spaced 48"o/c in joist and rafter plane at all edges;attacl plywood edges to this blocking 8.Nailing Schedule; All nailing shall be in accordance with Appendix 120.Q,unless noted herein specifically. Multiple Studs 16d @ 12"staggered a.All nails shall be common wire nails. b.Sub-bore where;nails tend to split wood. 9. Headers less than 4'-0",use 2-2x6;all others per MA State Building Code Table 5502.5(1)and(2). TOWN OF YARMOUTH HEALTH DEPARTMENT 3 '�•` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: C, •/\ �, s UJ Building Site Location: GC, , -c . \-1 a_, Proposed Improvement: .0 cr, ' Applicant: `} s,n.7 :>, ti nnc`,1 vcTel. No.: S153 .S-- Address: cx-VD f L``' U'\ 2 ' IN . C M Date Filed: / a/G / 2 Z. **lf you would like e-mail notification of sign off please provide e-mail address: Owner Name: U An D e v Owner Address: (,) /A "h tiNy U Q,/ ? Owner Tel. No.:T;(1 �f'fi 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.) FIoor 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. J., REVIEWED BY: f j`�� ✓', DATE: f /6: I 1 '� �.�- { V PLEASE NOTE COMMENTS/CONDITIONS: