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Home My WebLink AboutBLD-23-003298 (2) PM 1 - t1l3 - : "i WO FAMILY ONLY- BUILDING PERMIT R E C E I Town of Yarmouth Building DepartmentiNt.i. 1 46 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 DEC 13 20z2 _ `~� assachusetts State Building Code,780 CMR ,,,: Construct, Repair, Renovate Or Demolish i� err �it Application To p _-. BUILDING D_ a One-or Two-Family Dwelling B._---- This Section For Official Use Only /�1�,Building Permit Number: a3-12632gd Date Applied: I )ram SeArs /- y-�3 Building Official(Print Name) S na e Date SECTION 1:SITE INFORMATION • 1.1 Property Address: �+ 1.2 Assessors Map&Parcel Numbers 43 CA R i>✓ lu SOOTa R s-rt•-1 1+3 4 3 1.1a Is this an accepted street?yes ✓ no I Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: • c P,•t=c L Tr,. 211 1J5_e_cv_ 1 t,•7-S d5 12•S' Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) , 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard i Required Provided Required ! Provided Required I Provided 3 e .31 1S j ,Z8. 4q V0 21 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Zone: Outside Flood Zone? Municipal 0 On site disposal system Public L� Private C Check if yes❑ pp 7 1 SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: SbUT14- tiAt\1Yln.trH O2>4 4 1cR�l7 5'' MQ'[�•DT l:E4iY3C�l�— /I"`.' Name(Print) City,State,ZIP 21-17, PLE.A-5 .STY Sr. IZ-3q'-1'-fo5Z3 ;c cANurcin‘ligcorrcaaltre. No.and Street Telephone Email Address SECTION 3:DESCRIPTION OF PROPOSED WORK2(check all that apply) New Construction Lel Existing Building❑ 1 Owner-Occupied 0 I Repairs(s) 0 1 Alteration(s) 0 Addition 0 Demolition 0 1 Accessory Bldg. 0 I Number of Units Other 0 Specify: Brief Description of Proposed Work': Cis Liz ',Jo...el *►tt.1 3- t bi.r i,o'i N.A®tn ir..— I SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) . 1yix \g S bq:5(... ,e o. 1. Building Permit Fee:nt.CX3Indicate how fee is determined: _ 1 Standard City/Town Application Fee $ �j,et 0 0 0 Total Project Cost3(Item 6)x `lt'plier x $ 1$.0 o 0 2. Other Fees: S 6,1C SI, _1 TVAC) $ 12 eE'o o List: ,eq, $ Total All Fees:$ . Check No. Check Amount: Cash ', i $ ke 5 •oco 0 Paid in Full fil Outstanding Balance u I I (4 a3 S .17 :_,% t. ;str�. ui:rfeff!$iJ zi . . .. _ -T ram,. ;i„ =* -Z__�t a . Its Z:a444,1 tom. �� . � ,.„ :...�- . .....•�,.__ .� .. 4 - .,;,,Z.T. fC f ice, itv .. II ')ta• ,.,,..a . . . r .- _ . i ". } tom; w R tcr' r fF mste it pr!$vOtlt`fit:O. mt::1401:Lir t,' tC a w.. ..�.._ .�. -..., �. .. - -. s tu' 4 :i NAllt}.p-'1, t A'4_v:.a. - .. t :.+.' i' ''' ir„t;' ?", -''.' i€"t t'Y: t_[it #` % RX rR T c 'F.i" i.'MsA i i!7 _ kA �� ` N(TT �.. . }} • qy _ W 4*-gam i+ '°-tt,t k -m : *t:',cl. - -1 y r L per` � "'1: r'$ c '�3� s4 r#'3i'� wXL*�"k'`YC`T#�'°iy�= ��i 3,s;�:.'4`�` zt*,f,F. 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Nr'•wt60 , '- - _.4 i ';t3 ^ t' fit. . , The Commonwealth of Massachusetts v_• _-t Department of Industrial Accidents I Congress Street, Suite 100 =. _i_ • Boston, MA 02114-2017 www.mass.gov/dia Nig Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): '—j"-tmgj Address: 3o w or,rJ cr_jl-r up City/State/Zip: +}17,,,I z t.44. (3 ,yL Phone #: 5o6 -z37- g o Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(fell and/or part-time).• 7. 'New construction 2.0 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp. insurance required.] 3.0 I am a homeowner doing all work myself.(No workers'comp. insurance required.]t 9. ❑ Demolition 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12. J Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-cen-sactors lis:ed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.: 1 •Q Roof repairs 6_0 We are a corporation and its officers have exercised their right of exemption per MGL c. 1 Other 152,§1(4),and we have no employees. [No workers'comp.insurance required.] 'Any applicant that checks box#: must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing aL 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. Insurance Company Name: Policy r or Self-ins.Lic. : Expiration Date: Job Site Address: City/State/Zip: 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: �11c�..... _ Date: Izjb/ice Phone T: Spii=23T—g4f05 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 4: 12/16/22,2:36 PM Mail-Sears,Tim-Outlook 43 Carrie Ln Sears, Tim <tsears@yarmouth.ma.us> Fri 1 2/1 6/2022 2:36 PM To:tgdeveau@comcast.net <tgdeveau@comcast.net> Terry, I have reviewed your application and there are some items needed. t4 sets of plans in 1/4" scale size . ,410mph checklist or stamped plans Li. specs on any beams !HERS Certificate (pre-construction) N N, .,.(t .e � 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 fora 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 CB0 Deputy Building Commissioner Town of Yarmouth 508-398-2231 Ext. 1259 mailto:tsears(Wyarmouth.ma.us https://outlook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAJGgFFs6mCRGuX5gNb... 1/1 Commonwealth of Massachustets 7 Division of Professional Licensure Beard of Building Regulations and Standards C o ns�ftl§iS*visor 'f CS-091622 ' ', t,' 1pires:06/10/2023 TERRY G DEVEAU Ifi 30 WOONCEPIT RD ,,1 .. ti ' HARWICH PORT MA 02S45 ? Commissioner 21 R. s" ! 4 • Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE:Individual Registration Expiration 201067 03/01/2023 TERRY DEVEAU TERRY DEVEAU 30 WOONCEPIT RD G I J'-t` HARWICH PORT,MA 02646 Undersecretary 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 43 CAtztz+ ki • Sc,. y•4 R t--‘ Work Address Is to be disposed of at the following location: e-(A 1: 1AC TCI-4 Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Chapter 111, Section 150A. i /zz Signs ure of Applicant Date Permit No. k ,.� �. TOWN OF YARMOUTH 0 ..e4l .' 1146 ROUTE 28 SOUTH YARMOUTH MASSACHUSETTS 02664-4451 TM�`� ~ s rd Telephone(508)398-2231,Ext. 1250—Fax(508)760 4830 Engineering and Surveying Division Building Permit Review Residential and /or Commercial Buildings Name of Applicant: I-if1 /V t 1 ctJ(L Telephone or Email Address: �'Q - 7 ' • ,(S 3 Pe. a � / Lac ` Proposed Building Location: '- 3 e Il j ALP L dive Date Submitted: I ( / 2/ - Requirements for review: Please submit one(1) copy of plans, to include: 1. For Residential: Site Plan showing proposed and/or existing buildings, proposed contours with bench mark, water service location, and septic system location. For Commercial: Site Plan showing details required by the Zoning By-law and revisions required by Site Plan review, if any. Note: Site plans must be signed and stamped by a Licensed Professional Land Surveyor and Engineer or Sanitarian. 2. House or Building- Floor Plan(s) and Elevation Plan(s) 3. One (1) copy of application. Amanda ON a" ` ,. Lima 11/16/2022 ., ��s oat°aorta is'o"osao Reviewed By: Date: PLEASE NOTE Comments/Conditions: Retain stormwater on site during and post construction Discharge gutters to drywells. Fill out ROP for new driveway. If existing fencing is reused, relocate out of road right of way. Pnnted on Recycled Pew fre \ Town of Yarmouth Conservation Office C �y bdirienzotiyarmouth.ma.us `F� _.o-r CSG' ' Conservation Commission Building Permit Sign-off Application TO BE FILLED OUT BY BUILDING PERMIT APPLICANT: Building Site Location: l-}3 c_ tL;u r,— (.—t So . N/d,,,.n..c ,s-c--44-- Map # 1-1 Lot(s) # 2 - Property Owner: Fh-r-r- c3 - v-n -r C ,,roc t_L Date filed: t 2-71,3/Z2 *Applicant: 1 t.f1JUI -�v�4-4, ) Applicant Address: vJc�c�,„‘c ttt_ t P,o- --r-i1tt,_,. -4-`�c�A=' 62-6Lf 6n Email: :, '---1c:an.r!t5 th t `Telephone: . i-\ --?7.>7-2'.,-4a s Please note:-b GN C-y submitting this application,the applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Proposed Project Description: Site Plan Title/Date: S --Tkr_ e_k, -T , fj-r r„1 • c--(9 p ,p ,,1 C. (3,1 (Q)/ -5/,-Z., TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the proposed project require a permit?_AJO Refer to: SE83- or DOA permit Comments from Conservation CommissionApproved ' Conditionally Approved Rejected Conservation Commission Sign-off Signature: D///1/1/ - Date: 12 l 13 I 21 *TO APPLICANT: All work-related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre-construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on-site during construction. Please refer to the Order of Conditions for further details. -tC..c. rrc t,,,( l e c c vt c cc sf_ tie_ WATER DEPARTMENT y;i s' 2. BUILDING PERNIIT APPLICATION FOR WATER DE PARTIIENT SIGN OFF TRANSMITTAL FORM. I3t'ILDI\(a SITE LOCATION: ! :. ` L PROPOSED WORK: r)r ew tAl At'PI_ICANT: I i 1il 1 t t..Y 4. t IADDRt_ss: -1 J ? - '.! r 1 ,) 04 IAA /4 _ r 2-Y16", RESIDENTIAL AND OR COMMERCIAL I:AI. BUILDING tt ater Ikpatlntent: I)etcrtuine,Compliance of Water tcailahi i v and Etr existing Ioeation I{ticineeriiig Department: I)ctcrntine:Compliance for Parking and I)raina~:c ('t'nscrcatton Commission: Determine.Compliance to Wetlands act: i.e. lt'Iritts)border any type of y,et laic k.,trcams.ponds.ricers.ocean.hogs. huy s. marshland. ETC... Ilcalth Ikpartment: I)ctenntnes C`omplianee to State and Town Regulations.i.e. requirements for Septage Disposal and other Public I Icaith Activites Fire I)cpartntcnt- I)etcnnines(`ompliance to State and town Requirements for Personal fety.Pro,erty Protections. i.e.Smoke Detectors.Sprinkler Svstems.etc lF 4/11.3i/Z. 1PPLIC: NT. IGN:1 E I)Al"t: OFFICE USE: COMyIF:NTS ON PI RJII I ;1PPROI'AI.OR I)ENIAI. t2.� (,tt I L)�I tA!( pL)1,.a 1 O 1 ' r,-t,c LL rz - 1,u k te..t'r... s\I �.�t ) I l 1 c Arc p (Ai)41-c2 E s o-w P LE-It AIN'T T (tea ram., • ' RFvIEWEI 1'WATER DIVISION(SIGNATURE) DATE AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 X Check Compliance 1.1 SCOPE Wind Speed (3-sec.gust) 110 mph _X_ Wind Exposure Category B _X_ 1.2 APPLICABILITY Number of Stories 1 1/2_stories <_2 stories _X_ Roof Pitch (Fig 2) _10_ 5 12:12 X Mean Roof Height (Fig 2) _29_ft 533' _X_ Building Width, W (Fig 3) 38 ft <_80' _X_ Building Length, L (Fig 3) 40_ft <_80' _X_ Building Aspect Ratio(L/W) (Fig 4) _1.00 53:1 _X_ Nominal Height of Tallest Opening2 (Fig 4) 6'8" <_6'8" _X_ 1.3 FRAMING CONNECTIONS General compliance with framing connections (Table 2) _X_ 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete _X_ Concrete Masonry 2.2 ANCHORAGE TO FOUNDATION'3 5/8"Anchor Bolts imbedded or 5/8" Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing—general (Table 4) _70 in. _X_ Bolt Spacing from end/joint of plate (Fig 5) _12_in. 5 6"— 12" _X_ Bolt Embedment—concrete (Fig 5) .7_in. >_7" _X_ Bolt Embedment—masonry (Fig 5) in. >_ 15" N/A Plate Washer (Fig 5) ?3"x 3"x'/4' _X_ 3.1 FLOORS Floor framing member spans checked (per 780 CMR Chapter 55) _X_ Maximum Floor Opening Dimension (Fig 6) 11.2_ft<_ 12' _X_ Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall (Fig 6) _X Maximum Floor Joist Setbacks Supporting Loadbearing Walls or Shearwall (Fig 7) _ft <_d _N/A Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall (Fig 8) _ft <_d N/A Floor Bracing at Endwalls (Fig 9) _X_ Floor Sheathing Type (per 780 CMR Chapter 55) _X_ Floor Sheathing Thickness (per 780 CMR Chapter 55) _3/4_in. _X_ Floor Sheathing Fastening (Table 2)_8_d nails at_6_in edge/_12_in field _X_ 4.1 WALLS Wall Height Loadbearing walls (Fig 10 and Table 5) _9_ft <_ 10' _X Non-Loadbearing walls (Fig 10 and Table 5) _9_ft <_20' _X Wall Stud Spacing (Fig 10 and Table 5) _16_in. <_24"o.c. _X_ Wall Story Offsets (Figs 7&8) _ft <_d _N/A_ 4.2 EXTERIOR WALLS3 Wood Studs Loadbearing walls (Table 5) 2x_6_ 9_ft_0 in. _X_ Non-Loadbearing walls (Table 5) 2x_6__9_ft_0 in. _X_ Gable End Wall Bracing' Full Height Endwall Studs (Fig 10) X_ WSP Attic Floor Length (Fig 11) ft zW/3 _X_ Gypsum Ceiling Length (if WSP not used) (Fig 11) _43_ft>_0.9W _X_ and 2 x 4 Continuous Lateral Brace @ 6 ft. o.c. .. (Fig 11) or 1 x 3 ceiling furring strips @ 16"spacing min. with 2 x 4 blocking @ 4 ft. spacing in end joist or truss bays_X_ Double Top Plate Splice Length (Fig 13 and Table 6) _12_ _ft X_ Splice Connection (no. of 16d common nails) (Table 6) 4_ _X_ AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral (no. of 16d common nails) (Tables 7) X_ Non-Loadbearing Wall Connections Lateral (no. of 16d common nails) (Table 8) _X_ Load Bearing Wall Openings (record largest opening but check all openings for compliance to Table 9) Header Spans (Table 9) _6_ft_in. <_ 11' _X_ Sill Plate Spans (Table 9) _6_ft_in. <_ 11' _X_ Full Height Studs (no. of studs) (Table 9) _3_ _X_ Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans (Table 9) _5_ft_in. <_ 12' _X_ Sill Plate Spans (Table 9) _5_ft_in. s 12" _X_ Full Height Studs(no. of studs) (Table 9) _3_ _X_ Exterior Wall Sheathing to Resist Uplift and Shear Simultaneously4 Minimum Building Dimension,W Nominal Height of Tallest Opening2 _6'8" 5.6'8" Sheathing Type (note 4) _X_ Edge Nail Spacing (Table 10 or note 4 if less) _6_in. _X_ Field Nail Spacing (Table 10) _12_in. _X_ Shear Connection (no. of 16d common nails)(Table 10) _ _X_ Percent Full-Height Sheathing (Table 10) _33_% _X_ 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts) _X_ Maximum Building Dimension, L Nominal Height of Tallest Opening2 6'8"_<_6'8" Sheathing Type (note 4) _X_ Edge Nail Spacing (Table 11 or note 4 if less) _6_in. _X_ Field Nail Spacing (Table 11) _12_in. _X_ Shear Connection (no.of 16d common nails)(Table 11) _ X Percent Full-Height Sheathing (Table 11) _33_% _X_ 5%Additional Sheathing for Wall with Opening>6'8" (Design Concepts) _X_ Wall Cladding Rated for Wind Speed? _X_ 5.1 ROOFS Roof framing member spans checked? (For Rafters use AWC Span Tool, see BBRS Website) _X_ Roof Overhang (Figure 19) _.5_ft<_smaller of 2'or U3 _X_ Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift (Table 12) U=203 plf _X_ Lateral (Table 12) L=176 plf _X_ Shear (Table 12) S=77 plf _X_ Ridge Strap Connections, if collar ties not used per page 21... (Table 13) T=0 plf _N/A_ Gable Rake Outlooker (Figure 20) _ft<_smaller of 2' or L/2 N/A Truss or Rafter Connections at Non-Loadbearing Walls Proprietary Connectors Uplift (Table 14) U=417 lb. _X_ Lateral (no. of 16d common nails)...(Table 14) L=148 lb. X_ Roof Sheathing Type (per 780 CMR Chapters 58 and 59) X_ Roof Sheathing Thickness _1/2_in. >_7/16"WSP X Roof Sheathing Fastening (Table 2) _ X Notes: 1. This checklist shall 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 and Figure 18b 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-grade. AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 4. a. From Tables 10 and 11 and location of wall sheathing and Building Aspect Ratio, determine Percent Full-Height Sheathing and Nail Spacing requirements b. Wood Structural Panels shall be minimum thickness of 7/16"and be installed as follows: i. Panels shall be installed with strength axis parallel to studs. ii. All horizontal joints shall occur over and be nailed to framing. iii. On single story construction, panels shall be attached to bottom plates and top member of the double top plate. iv. On two story construction, upper panels shall be attached to the top member of the upper double top plate and to band joist at bottom of panel. Upper attachment of lower panel shall be made to band joist and lower attachment made to lowest plate at first floor framing. v. Horizontal nail spacing at double top plates, band joists, and girders shall be a double row of 8d staggered at 3 inches on center per figures below: Vertical and Horizontal Nailing for Panel Attachment • THE EDGE REM ON Allihh.HWAN. USE aliNAILS AT Bb.c II I1 1/ u i•i 11 11 If 11 11 M II II II •••••••••••••••• pO i t ri I1 u DOUBLE EDGE NAIL$pA� I I„ PANEL v' See Detail on Next Page Vertical and Horizontal Nailing for Panei Attachment AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance (780 CMR 5301.2.1.1)1 • • • • a tt FRAMING MEMBERS EDGE INTERMEDIATE `-"11 •sr- STAGGERED Y t. ?mut NAIL PATIEAN PANEL PANE EDGE DOUBLE NAB_EDGE SPAC14G D€1AL Detail Vertical and Horizontal Nailing for Panel Attachment 7,7 'tk TOWN OF YARMOUTH d'c HEALTH DEPARTMENT ''�• `� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To he completed by Applicant: Building Site Location: '-r • .0 • 1A r r s err Proposed Improvement: , ; ! \ , Q,.( _r CM Applicant: (_�_ , ‘` Tel. No.: 7 ;-'? ? c1`-I -\L Address: vlctir-,_� ,� , t �. , Date Filed: ( /11 /:2.. ,_ **/fyou would like e-mail notification of sign off,please provide e-mail address: Owner Name: t +_+ - 51 N"n 0, Owner Address: �L1 p ! r ,tea r _ . ,- Owner Tel. No.: 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 DEC ► 3 2022 (all existing and proposed) — Note: Floor plans not required for decks, sheds, windows, roofing; HE.' (3.) If necessary, Title 5 application signed by licensed installer with fee. REVIEWED BY: � C( DATE: 42 - /4/ ` 'Z Z. r PLEASE NOTE COMMENTS/CONDITIONS: