HomeMy WebLinkAboutBLD-23-001558 #48II
C z pU // - i' 2�
REQ .EIVE0
o:isv-;4 BUILDING PERMIT APPLICATiON
SSP 2 2 l i ,:,.„ O APPLICATION TO CONSTRUCT REPAIR,RENOVATE, CHANGE THE USE,OCCUPANCY OF,
c Lit C OR DEMOLISH ANY BUILDING OTHER THAN A ONE OR TWO FAMILY DWELLING.
O ~" `—,� Town of Yarmouth Building Department
BUILDING DEPA' j`�
_ 11-fEi Route 28 Yarmouth, 1•I:1 E)2Eiti-t-f-l9`�
sy Tel:
` 508-398-2231 ext. 1261 Fax 508-398-0836
6 t� Office Use Only Planning Board Information Assessors Department Information:
Permit NOu 23 SS ate Plan Type Map Lot
Permit Fee $C Endorsement Date /
Recording Date New
Deposit Recd. $(,D�Da �(� Plan No. 1.4 Property Dimensions:
Net Due $ fel 0 1iv_ Other
Lot Area(sf) Frontage(ft) Lot Coverage
This Section for Office Use Only
Building Permit Number: 1 Date Issued: •
•
Signature: 11-1:_44.1 i Certificate of Occupancy_
Building Official • `DDaata is Is not required
Section 1 -Site Information I
1.1 Property Address:
1.2 Zoning Information:
Lig RA- g k)e t1lrn D t .
Zoning District Proposed Use
1.3 Building Setbacks(ft)
Front Yard I Side Yards
Rear Yard
Required I Provided Required I Provided I Required Provided
I 1 I
1.4 Water Supply(MQ.QL c.40.S 54) 1.5 Rood Zone Information: Comments
Public Private Zone: EWE
Section 2- Property Ownership/Authorized Agent I
2.1 Owner of Record: I
(4-R - C6rI(��1 SImPctdOW Yeitr79CitrVe FsscvdL ti_.
Name(print)/ Mailing Address:
5 na, re Telephone Telephone
Email Address:
2.2 Authorized Agent:I
•
Naimo(print) Mailing Address:
Signature Telephone Fax
Entail Address: ,
Section 3 - Construction Services I
3.1 Licensed Construction Supervisor: Not Applicable ID
DOO*S (.) ,SOrfQt'e
License Number
Me Circle f )4-tpotsmuOi
A Sg____ Cs- 11S2
4S-a
L- flV 7 oak
JVre4p t,• Expiration Date ✓sure Telephone Email Address: (d 6,. -a k
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•
SECTION 10b OWNER/AUTHORIZED AGENT n DECLARATION • •
� COC
I, I" (V V— Cr t ,as Owner/Authorized Agent
hereby declare that the statements and information on the forgoing application are true and acurate,to
the best of my knowledge and belief.
Signed under the pains and penalties of perjury.
Mark Co,-L
Print Name
/i of Owner/Agent Date
Section 11 - ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollars)to be
completed by permit applicant
1.Building :p-�
V
a Electrical
9.sco
3.Plumbing I Gas 7ScD
4.Mechanical(HVAC)
5.Fire Protection l S CO
5.Total_(1+2+3+4+5) + ``�C
" 7.Total Square Ft.psnew smm
ts&addit s) l
Check Below
❑ Conservation-Commission Fling
(if applicable)
❑ Old Kings Highway&Historical
Commission approval
(if applicable) •
§TOWN OF YARMOUTH
1146 Route 28, South Yarmouth, MA 02664
508-398-22311 ext.-1261 Fax 508-398-0836
Office of the tY uiiding Commissioner
BUILDING DEPARTMENT
DEMOLITION DEBRIS DISPOSAL AFFIDAVIT
Pursuant to M.G.L. Ch. 40, §54 and 780 CMR- Section 105.3.1. 44.
I hereby certify that the debris resulting from the proposed work/demolition to be
•
conducted at ( k wesQUk
Work Address ikia -CASe_4
Is to be disposed of oat the following location: �� ( i
Said disposal site shall be a licensed solid waste facility as defined by M.G.L.
Ch. 111, §150A.
ate- 9,
i_liriure of Application Date
Permit No.
Sears, Tim
From: Sears,Tim
Sent: Thursday, September 29, 2022 11:06 AM
To: surette85@gmail.com
Subject: 44 &48 Route 28
Attachments: Existing Building Code Checklist.PDF; existing building evaluation.PDF
. Douglas,
I have reviewed your application and there are some items needed.
\ . Health Department sign off(under review)
2. Fire Department sign off
3. This building is over 35,000 cubicfeet and falls under Construction Control All plans are required to be stampe•
v Registered Design Professinnal�-1 .~- '�'�`
"..._
xisting building evaluation and attached checklist needs to be submitted along wit construction contra
a fidavit
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:tsears@varmouth.ma.us
1
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Initial Construction Control Document
1 Ict To be submitted with the building permit application by a
w Registered Design Professional
'' for work per the ninth edition of the
Massachusetts State Building Code, 780 CMR, Section 107
Project Title: Interior Remodelling of Commercial Space Date:10/15/22
- Property Address: 48 Main Street(Route 28)Yarmouth,MA 02673
Project: Check(x) one or both as applicable:X New construction X Existing Construction
Project description:Interior rearranging of non structural partition walls,rerouting of plumbing and electrical
lines.
I Fergal Brennock MA Registration Number: 46244 Expiration date: 06/30/24 , am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
specifications concerning1:
Architectural X Structural Mechanical
Fire Protection Electrical Other:
for the above named project and that to the best of my knowledge, information, and belief such plans,
computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780
CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my
designee) shall perform the necessary professional services and be present on the construction site on a regular
and periodic basis to:
1. Review, for conformance to this code and the design concept, shop drawings, samples and other
submittals by the contractor in accordance with the requirements of the construction documents.
2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Be present at intervals appropriate to the stage of construction to become generally familiar with the
progress and quality of the work and to determine if the work is being performed in a manner consistent
with the approved construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
When required by the building official,I shall submit field/progress reports (see item 3.)together with pertinent
comments,in a form acceptable to the building official.
Upon completion of the work,I shall submit to the building official a'Final Construction Contr.1.Document'.
�ll Cr trAJ,'
Enter in the space to the right a"wet" or
electronic signature and seal: FEFiGAL D.
r+ � ERENNOCK =1
No.46244
Phone number:617 828 0376 Email:fergalbrennock@hotmail.com = , ' �'c('N GT
Building Official Use Only '.f'"A .f '�
SELL
Building Official Name: Permit No.: Date: (
Note 1.Indicate with an'x'project design plans,computations and specifications that you prepared or dire ly supervised.If'other'is
chosen,provide a description.
Version 01_01_2018
4
FERGAL BRENNOCK P.E CONSTRUCTION & ENGINEERING SERVICES
/,1 ---y-,----- 1\\
fcfvED
OCT 25 2022
EXISTING BUILDING CODE REPOR 8u��617\iG DE��
________ AR FMENT
• Commercial Building, 48 Route 28, West Yarmouth, MA
October 24, 2022
Background:
The existing building, located at 48 Main Street (Route 28) in West Yarmouth, Massachusetts, is an existing
commercial building (locally known as"The Treasure Chest"). The proposed work involves fitting out the first floor
of the building for use as a tattoo artist studio,where the approximate cost of the work is$50,000. The following is
a list of applicable codes referenced in this Existing Building Code Report:
Building: 780 CMR MA State Building Code 9111 Ed., (Amended International Building Code 2015 & Amended
International Existing Building Code 2015)
Fire Prevention: 527 CMR 1 MA Fire Prevention Regulations(Amended 2015 NFPA 1) M.G.L. Chapter 148 Section
26G- Sprinkler Protection
Accessibility: 521 CMR MA Architectural Access Board Regulations
Electrical: 527 CMR 12 MA Electrical Code (Amended 2020 National Electrical Code)
Mechanical: 2015 International Mechanical Code (IMC)
Plumbing: 248 CMR MA Plumbing Code
Energy Conservation: 2018 International Energy Conservation Code (IECC)
References:
Proposed Floor Plan dated 10/13/22 and Initial Controlled Construction Affidavit dated 10/14/22.
Building: (Reference International Existing Building Code 2015)
The 2015 International Existing Building Code with Massachusetts amendments allows for 3 separate compliance
methods,the Work Area Method(level of compliance is based on the classification of work),will be used in this report.
Work Area and Classification of Work:
Level 2 Alterations include the reconfiguration of spaces, the addition or elimination of doors and windows, the
reconfiguration or extension of systems, and/or the installation of additional system. Level 2 Alteration applies where
the work area is less than 50% of the aggregate area of the building.
This proposed work includes fitting out the first floor within the building for use as a tattoo artist studio with non-
structural walls,ceilings,flooring, electrical and plumbing work. This work is classified as a Level 2 Alteration.
Occupancy Classification:
B (Service Transaction)
Construction Type:
Since the project does not include a change of occupancy classification or an addition, the IEBC does not contain any
requirements mandating compliance with the minimum construction type based on the height and area limitations of
780 CMR Chapter 5. Therefore,the new construction is only required to maintain the current construction type.
Fire Resistance Ratings:
The project does not include any new building elements that must be fire resistance rated.
Interior Finishes:
All newly installed wall, ceiling and interior trim finishes to comply with 780 CMR Table 803.11.
71 LOVELL ROAD WATERTOWN MA 02472 FERGALBRENNOCK@HOTMAIL.COM 617 828 0376
FERGAL BRENNOCK P.E CONSTRUCTION & ENGINEERING SERVICES
/7 . \\
. Means of Egress:
The means of egress including the exit signs, egress lighting, number of exits and egress capacity must be sufficient
for the number of occupants on all floors (780 CMR 102.6.4). The calculated occupant load for the proposed floor
plans,the corresponding required number of exits,the provided number of exits, and the provided egress capacity
is summarized below (780 CMR Table 1004.1.2, Table 1006.3.1, and Section 1005.3). Mercantile Occupant Load
Factor 60 for 4,150sf= 69,where 2 exits arerequired and 6 are provided. The exit signs and emergency lighting will
be updated as required by 780 CMR 102.6.4
General Egress Requirements
The means of egress throughout the work areas are required to comply with Chapters 7 and 8 of the existing building
code. Since the building contains a single tenant,the renovations are only required to maintain or improve the current
level of egress (IEBC 704.1, 805.1, & 905.1).
Required Fire Protection Systems:
The following existing fire protection systems must be maintained and updated as needed to accommodate the new
floor layout (IEBC 703.1):
Heat Sensors and Fire Alarm
Fire extinguishers: Fire extinguishers must be located throughout the building so that the maximum travel distance to
an extinguisher is less than 75 feet.
Energy Code Provisions for Existing Buildings:
The building is subject to the 2018 International Energy Conservation Code (IECC) or ANSI/ASHRAE/IESNA 90.1
with Massachusetts Amendments (Massachusetts Energy Code). Level 2 alterations to existing buildings are
permitted without requiring the entire building to comply with the energy requirements of the International Energy
Conservation Code (IECC). The alterations (new elements) shall conform to the energy requirements of the IECC
as they relate to new construction only (IEBC 811.1).
The Massachusetts Stretch Code as adopted by the Town of Yarmouth does not apply to existing buildings (780
CMR Appendix AA 104).
Structural Provisions for Existing Buildings:
Structural alterations to building, if any, must be evaluated by a registered structural engineer to determine
compliance with the IEBC. There are no Structural Alterations being made to the building.
Accessibility for Persons with Disabilities:
Massachusetts Architectural Access Board Regulations
Alterations to the building must comply with the requirements of the Massachusetts Architectural Access
Board Regulations (521 CMR). For existing building alterations, the requirements of 521 CMR are based on the
cost of the proposed work. As the cost of the proposed work is less than $100,000 then only the new work is to
comply.
Permitting/Compliance/Sign Off:
All applicable permits required by Local, State and Federal Laws are the responsibility of the owner/applicant.
Compliance of said permits are the responsibility of the applicant. Final Controlled Construction Affidavit is provided
upon completion and final sign off of aforementioned permits, inspections.walkthru's, testing and warranties.
Fergal Brennock PE �� tH���
FERGAL D.
8 BRENNOCK
No.4.
`' •,1/4V
frrnmilql,
71 LOVELL ROAD WATERTOWN MA 02472 FERGALBRENNOCK@HOTMATL.COM 617 828 0376
❑ Repairs ❑ Repairs: Chapter 5 0 Repairs
❑ Alteration 0 Alteration: (check only one box) 0 Alteration
❑ Addition 0 Level-- 1: Chapter 7 0 Addition
❑ Change of Occupancy [le-Level 2: Chapter 7 & 8 0 Change of Occupancy
❑ Level 3: Chapter 7, 8 & 9
❑ Change of Occupancy: Chapter 10
❑ Additions: Chapter 11
❑ Historic Buildings: Chapter 12
❑ Relocated or Moved Buildings: Chapter 13
Note: Chapter 15 applies to all compliance methods.
Applicant's Name: (print) b 6 oylc-S ,Sb rQ-
Signature: Date: /D-3( --27
COMP� ANDFIRELIANCE.
YARMOUTH
A ONS DO NOT REliEVE
1404 THE RESPONSIBILITY
ANIS.
)(- Z-22
ECTOn
YARMOUTH FIRE PREVENTION
Commercial Construction Building Transmittal
Project Name: Spilt Milk Tattoo Address:44-48 Rt.28
Contact Name: Surette Phone: Surette85@G-Mail
Y NO NA Subject Regulation
S
X Access for Fire Apparatus 527 CMR 1; 18.2.4.1
X Building Numbers MGL Chapter 148;sec 59
X *Flammable gasRiquid storage 527 CMR 1;42 22.1
X Fire Lanes 527 CMR 1;22.3
X *Service Stations 527 CMR 1 ;16.2.3,16.2.3.1,30.3.2
X *Hazardous Materials Storage 527 CMR 1;60.1
X *Kitchen Exhaust Systems* 780 CMR,527 1;50.1
X Extinguishers 527 CMR 1; 13.6,Chapter 148;sec 28
X Fire Alarm Systems/CO detection* 780 CMR,Chapter 148;,527 CMR 1; 13.7
X *LPG Storage Chapter 148;sec 9,10,28&527 CMR 1;69.1
X Use and Occupancy 780 CMR;302.1
X Sprinkler Systems* 780 CMR&Chapter 148 sec 26 A-I
X Storage inside/outside Buildings 527 CMR 1; 10.19.4,4.4.3.1.1,19.12,34.1.1
x *Upholstery 527 CMR I;20.6.2.5
X *Trash Containers 527 CMR 1; 19.1.1, 1.12
X Any Hazard to the Public Chapter 148;sec 28
*Curtains,Draperies,Blinds 527 CMR 1; 12.6.2
*YFD permit required-depending on occupancy and submittal
*Per 780 CMR 901.5,contact Yarmouth Fire Department for acceptance test.
*Per 527 CMR 1 13.1.8,a permit is required from the Fire Department to shut down any
fire protection system.
Description of planned project/other requirements: 527 CMR I Chapter 16"Safeguarding
Construction,Alteration,and Demolition Operations."780 CMR Chapter 33,NFPA 24.
Per 527 CMR 1 16.1.2 "A fire protection plan shall be established and submitted"This
plan shall include the following: 16.3.1 Fire safety program, 16.3.2 Owners designated
fire prevention program manager, 16.3.4.1 A suitable location at the site shall be
designated as a command post and provided with plans,emergency information,keys,
communications and equipment as needed.
Plan Reviewed By: Captain Huck Date: 11-01-2022
Copy for Applicant Cl Copy to Building Department Copy to Fire Prevention
Entered in Firehouse 0 Final Inspection
1/24/23,9:13 AM Mail-Inkley,Brad-Outlook
Brad here is the letter from the fire engineer and original letter from engineer Thanks so much. mark
04ita'sytipratl Ey Tobin
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}WWII W s bin M Brown cn._ in M 13"'" Fire Protection Design Services.ULC
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BROWN a 1 thea dactmtsnt
No. 57102Data,2122.1207
," Split Mill
48 Main Street(Route 281
West Yarmouth.MA 02673
Fire Protection Narrative Report
Date:12/0712022
SECTION 1—APPLICABLE LAWS,REGULATIONS,CODES,AND STANDARDS USED IN THIS REPORT
1) Building:
a. Existing Building Code of Massachusetts
b. 780 CMR: Massachusetts State Building Code,9th Edition
2) Electrical:
a. National Electrical Code(NFPA 70,'2017 Edition)as adopted and amended by 527 CMR:12.00
3) Fire Alarm:
a, NFPA 72,National Fire Alarm and Signaling Code,2013 Edition
4) Fire Prevention:
a. 527 CMR: Massachusetts Fire Prevention Regulations
b. NFPA 13,Standard for the Installation of Automatic Sprinkler Systems.2013 Edition
5) Other Applicable Standards
a. Standard for Safeguarding Construction,Alteration,and Demolition Operations(NFPA 241,2013,
Edition)
b. Other NFPA standards,as referenced by the applicable codes
SECTION 2'-EXISTING BUILDING DESCRIPTION
1) Building Use:M.B,S2
2) Building Area:Approx.6,200 sq.ft.
3) Building Height: Approx.19'11'Above Grade
4) Construction Type:V(Wood Frame)
5) Number of floors above grade:2
6) Number of floors below grade:0
7) Hazardous material usage and storage:None known
SECTION 3—PROPOSED BUILDING DESCRIPTION
1) Building Use:B,52
2) Building Area:Approx.6.200 sail.
3) Building Height:Approx.19'11-Above Grade
4) Construction Type:V(Wood Frame)
5) Number of floors above grade:2
6) Number of floors below grade:0
7) Hazardous material usage and storage:None anticipated
https://outlook.office.com/mail/junkemail/id/AAMkADIzZTE1 YWJiLTEOMmQtNDRjOCO5N2U4LWRmYmJmOTIIYWQ1 MABGAAAAAADInSQ4QY%2Fq... 2/4
1/24/23,9:13 AM Mail-Inkley,Brad-Outlook
•
H �.SBS
Fire Protection Design Services.ELC
SECTION 4—DESCRIPTION OF CONSTRUCTION
The owner intends to convert the building from a retail store(Use Groups M,B,S2)to a tattoo parlor(Use
Groups B.52),and In the process,renovate the Interior accordingly.This work constitutes a partial Change
of Use,as well as a Level 3 Alteration,triggering the requirement for the Fire Protection and Life Safety
features of the building to be brought fully up to the fire protection code requirements of a new building.
SECTION 7—FIRE PROTECTION SYSTEMS
1) Fire Sprinkler System:
a. A fire sprinkler system shall not be required in this building(Non-residential structure with loss
than 7,500 sgft.aggregate area)In accordance with MGL Chapter 148 Section 26G and 780
CMR 9'"Edition 903.2.
2) Fire Alarm and Detection Systems:
a. A fire alarm and detection system shall not be required in this building(Group B aggregate
occupant load of less than 500,Group B occupant load less than 100 above the lowest level of
exit discharge,no ambulatory care facilities)in accordance with 780 CMR 9^Edition 907.2.
Carbon monoxide detection shall not be required in this building In accordance with 780 CMR
9",Edition 915.1.1(Group B&52 occupancies).
b. Despite neither a fire alarm&detection system nor carbon monoxide detection being required
by code,it is recommended that the building be provided with local carbon monoxide detectors
In all rooms containing fuel-fired equipment The owner may also opt to Install local smoke
detectors at his discretion.
SECTION 8 OTHER FIRE PROECTION&LIFE SAFETY FEATURES
Requirements for other fire protection and life safety features,Including but not limited to construction types,
Interior finishes,and means of egress shall be provided in the code analysis of the architectural construction
plans.
https://outlook.office.com/mail/junkemail/id/AAMkADIzZTE1YWJiLTEOMmQtNDRjOCO5N2U4LWRmYmJmOTIIYWQ1 MABGAAAAAADInSQ4QY%a2Fq... 3/4
Final Construction Control Document
To be submitted at completion of construction by a
. {t Registered Design Professional
t
.. s for work per the ninth edition of the
—sYe.
Massachusetts State Building Code, 780 CMR, Section 107
Project Title:Interior Remodelling of Commercial Space Date:01/18/23 Permit No. BLD-23-001558
Property Address: 44-48 Main Street(Route 28),Yarmouth,MA 02673
Project: Check(x) one or both as applicable:X New construction X Existing Construction
Project description:Interior rearragning of non-structural partition walls,reouting of plumbing and electrical
lines.
I, Fergal Brennock MA Registration Number: 46244 Expiration date: 06/30/24 , am a registered design
professional, and I have prepared or directly supervised the preparation of all design plans,computations and
cnnrifiratinnc rnnrnmintr•
Architectural X Structural Mechanical
Fire Protection Electrical Other:Describe
for the above named project. I, or my designee, have performed the necessary professional services and was
present at the l.u1Lst1Ul.Llult site on a regular and periodic basis. lu the best of illy 1.ltuwleuge,infon1lauull, arid
belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved
as part of the building permit and that I or my designee:
1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other
cnhmittalc by the enntrartnr in aernrrian'P with the rarniirampntc of the rnnctrnetinn rine„mantc
2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable.
3. Have been present at intervals appropriate to the stage of construction to become generally familiar with
the progress and quality of the work and to determine if the work was performed in a manner consistent
with the construction documents and this code.
Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107.
Enter in the space to the right a"wet" or - - ff .
electronic signature and seal: e ENNoc �K 4 �E
13. No.4.
Phone number:617 828 0376 Email:fergalbrennock@hotmail.com
Building Official Use Only
Building Official Name: Permit No.: Date:
Version 01_01_2018
Ninth Edition 780 CMR 107.6 Construction Control Document
Construction Contractor Services Certification Pursuant to Section 107.6.3
Name of Contractor: Day 52J/'t''7'1C-
- If a Corporation,name of responsible Corporate Officer:
If a DBA or Partnership,name of individual:
I hereby certify that, to the best of my knowledge and belief, construction performed under permit number
P3--ti015'5a issued on 11-1-2Z has been completed in substantial accord with the approved
construction documents, with all pertinent deviations specifically noted per Section 107.6.3 of the
Massachusetts State Building Code(780 CMR), 9th Edition Base Volume.
S �I
Name of Project: i f, (11 i �cxkto
Address of Project: 2-1(\> RL7tM-. 7 (Yl
T ist of Pertinent Deviations:
Print Name: pUuy
Signature:
Date:
s BRENDAN D. MOQUIN (
Notarized by: Ares Aaon �� ;' _i" ,�onwNotary o�r��
��( � My Comm sstoe Expires
Standard Notary Statement:
This document shall be submitted to the Responsible Registered Design Professional (RDP) and, when
requested, to the Building Official in accordance with 780 CMR section 107.6.3 (9th edition) at the completion of
all construction projects performed pursuant to 780 CMR Section 107.6 Control Construction.
TOWN OF YARMOUTH
;••,14A-p;
r HEALTH DEPARTMENT
•
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To he completed by Applicant: •
Building Site Location: _ (ij°) t ciu ,
Proposed I provement: !(� `�1 k�U l�� ��-c {0c, ki'Zr 0o 1 P ' 0(,.1( `P l�+✓�>
Applicant: Ha (V C c� r i S ` Tel. No.:: C( LI(X) (-003'
Address: S YYV?c,.G1Ui.k.) 5o(-In, J)t U ( )k —C ',I; I--- Date Filed: 9--�-?- aa-
**Ifyou would like e-mail notification ofsign off please provide e-mail address:
Owner Name:
Owner Address: Owner Tel. No.: CV LQO
430649
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.
PIease submit three (3) copies of plans, to include:
G_ :sul Jo (1.) Site Plan showing existing buildings, water line location,
and septic system location;
SEP 2 2 2022 (2.) Floor plan labeling ALL rooms within building
HEALTH DEPT. (all existing and proposed) —
Notetloorpp)ans)not required for decks,sheds, windows, roofing;
(34/ 'If,necessary, Title 5 application signed by licensed installer
with lee.;-k
(r)''REVIEWED BY: DATE: /— a 0— 6 �
PLEASE NOTE
COMMENTS/CONDITIONS:
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