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HomeMy WebLinkAboutBLD-23-005719 ONE & TWO FAMILY ONLY-BUILDING PERMIT Town of Yarmouth Building Department 1146 Route 28, South Yarmouth,MA 02664-4492 508-398-2231 ext. 1261 Fax 508-398-0836 i 1 Massachusetts State Building Code,780 CMR .4.....00 Building Permit Application To Const,�•uct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling NO-' 3 -0V17 L' This Section For Official Use Only Building Permit Number: 0l4J-�3-b�1 1 Date Applied: ' /� —6— Building Official(Print Name) 'Signature e3 Date SECTION 1:SITE INFORMATION 1.1 Property 1.2 Assessors Map&Parcel Numbers ':y>, //�r 6.,4av A. - R � CEI Vc ® Address: ------ —i 1.1 a Is this an accepted street?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: APR 112023 Zoning District Proposed Use Lot Area(sq ft) Frontage(ft BUILDING C---' q2TMENT 6v. 1.5 Building Setbacks(ft) Front Yard Side Yards /j t Rear Yard 2; ' Required !I Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public SI'r Private 0 Zone: './ Outside Flood Zone? Check if yesO Municipal 0 On site disposal system CJ SECTION 2: PROPERTY OWNERSHIP' 2.1 Owner'of Record: Name(Print) City,State,ZIP t f 7`✓l fif..e 4.40,Jre. /4) `1tl�'40 f..s9r%. - A.i Er;..�.i, tie.teT n w.�. .Ur+� No.and Street Telephone Email A!tddress �� SECTION 3:DESCRIPTION OF PROPOSED WORT 2(check all that apply) New Construction 0 Existing Building❑ Owner-Occupied 0 ( Repairs(s) 01 Alteration(s) 12.'Addition 0 Demolition © 1 Accessory Bldg. 0 Number of Units l Other El Specify: Brief Description of Proposed Work2: 1. 1 imr/..rit _ 43s..14 .da...t 11... 1iE jn.4....g...JA '1'' t 174.4.4 :+— J u w-—- WA 4 t C ) ( SECTION 4:ESTIMATED CONSTRUCTION COSTS. 130 fA . 49 x Item Estimated Costs: (Labor and Materials) Official Use Only I.Building S /t7,raw . 1. Building Permit Fee:$u'.. I Indicate how fee is determined: 2.Electrical $ 0 Standard City/Town Application Fee '141 `� ElTotal Project Costa(Item 6)x multiplier x 3.Plumbing $ s,�A c)4• 2. Other Fees: $ 4.Mechanical (HVAC) $ towList; (C® CD L&-W 11 C 5.Mechanical (Fire Suppression) $ Total All Fees:$ 6.Total Project Cost: $ Check No. Check Amount: Cash Amount: 0 Paid in Full 0 Outstanding Balance Due: r '` SECTION 5: CONSTRUCTION SERVICES ! ✓ 1 5.1 Construction Supervisor License(CSL) AP License Number Expi do Date Name of CSL Holder Y.5 A7. 1 List CSL Type(see below) No.and Street Type Description / � ? -�j `. Unrestricted(Buildings up to 35,000 cu.ft.) City/Town,State,ZIP R Restricted 1�fc2 Family Dwelling Ivl Masonry RC Roofing Covering WS Window and Siding T-7.2e-3I > SF Solid Fuel Burning Appliances 5 �r, .k/(cr (i i& ,t(,- •. I Insulation Telephone Email-address D Demolition 5.2 Registered Home Improvement Contractor(HIC) HIC Company Name or HIC Registrant Name Con Number Expiration Date No.and Street -144.%lt i#ll t. � , M4 Eifiail 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 Issuance of the building permit. Signed Affidavit Attached? Yes le.- No Cl 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 ft ./v. to act on my behalf,in all matters relative to work authorized by this building permit application. /11.,e___. 11-4 gA/23 Print 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 application is true and accurate to the best of my knowledge and understanding. Print Owner's or 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. 142A.Other important information on the HIC Program can be found at www.mass.gov/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.) f Number of fireplaces Habitable room count Number of bathrooms Number of bedrooms Type of heating system Number of half/baths Type of cooling system Number of decks/porches • Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" /410 400 . • The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 It �' Boston, MA 02114-2017 vie'. www.mass.gov/dia \porkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY• A Iicant Information PIease Print Leib[ Flame (Business/Organization/Individua1): Address: • City/State/Zip: S�y.;� r { V .0AZ 3 Phone#: 4j Are you an employer?Check the appropriate box: 1. I am a employer with Type of project(required): ❑ employees(fail and/or part-timed.* 7. 2.0 I am a sole proprietor or partnership and have no employees working for me in ❑New deljn construction any capacity.[No workers'comp. insurance required.] 8. remodeling • 3.0 I am a homeowner doing all work myself.(No workers'comp.insurance required.]t 9. ❑Demolition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 C BuIldjns addition ensure that all contractors either have workers'compensation insurance or are sole l 1. Electrical repairs or additions proprietors with no employees. 5• a general contractor and I have hired the sub-contractors listed on the attached sheet, I2'❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp. insurance.: 13,0 Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per,MGL c. I4,❑Other 152,§1(4),and we have no employees. (No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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. Insurance Company Name: .;, , Policy or Self-ins.Lie.#: LtJP i q M,J ciZ Expiration Date: 4/0j Job Site Address: /tl�—/�iii•c. ,, City/State/Zip: 4,4,. 4,N , twin- e.::c<</ 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. I52, §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. .f do hereby Certify under the palltS alid penalties of perjury lhat the F)lfOrntatiot!prOVidefi above FS true and Correct Sitrnature: %G: ~ 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): I.Board of Health 2.Building Department 3. City/Town Cleric 4. Electrical Inspector 3. Plumbing Inspector 6.Other Contact Person: Phone#: §TOWN OF YARMOUTH 1146 Route 28, South Yarmouth, MA 02664 508-398-223!1 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 /7; . Work Address Is to be disposed of oat the following location: oit.. s f �i. .vl�),t.•,►�- Said disposal site shall be a licensed solid waste facility as defined by M.G.L. Ch. 111, §150A. ci1/467.A 5 Signature of Application Date Permit No. ® A�RD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 04/05/2023 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). PRODUCER CCINTACT Lisa Fonseca NAME: C&S Insurance Agency,Inc. PHONE HO N Ext1. (508)339-2951 FAX (508)339-4811 190 Chauncy St E-MAIL (AIC,No): ADDRESS: Lisa@Candsins.COm INSURER(S)AFFORDING COVERAGE NAIC# Mansfield MA 02048 INSURERA: All America Insurance Company 20222 INSURED INSURER B: Central Mutual Insurance Company 20230 Shawme Hill Corp INSURER C 43 Water St INSURER 0: INSURER E: Sandwich MA 02563-2320 INSURER F: COVERAGES CERTIFICATE NUMBER: 2022 Cert of Liab 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. NOTWITHSTANDING 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MMIDDlYYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE [XI OCCUR DAMAGE TO RENTED 300,000 PREMISES(Ea occurrence) , $ MED EXP(Any one person) $ 5,000 A CLP 8690649 08/05/2022 08/05/2023 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 00 X POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 2,O0" $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ B OWNED ^) SCHEDULED BAP 8690650 08/05/2022 08/05/2023 BODILY INJURY(Per accident) $ _ AUTOS ONLY X AUTOS X HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY X AUTOS ONLY (Per accident) $ $ X UMBRELLA LIAB — OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE CXS 8690651 08/05/2022 08/05/2023 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION MUTE EMPLOYERS'LIABILITY Y/N X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE N NIA WC 8690652 08/06/2022 08/06/2023 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 --i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Michael&Deborah Farrell ACCORDANCE WITH THE POLICY PROVISIONS. 175 Pine Grove Rd AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 . - �� ©1988-20'15 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD N ?. Q .� co _N _ cn O N lig �a�N - C , r ces '� in c y L CC vCO Cn �04 ,t g i U y V n L U C N Q.. .. �I Q N� N `� U:j m j Nil�1SIO1' " c I- c• �v N m c 2m 0 e m V3 , 0 2 e. 3oc WN NZ' `-> E �� �c°'o c v N11. 2w ,` 3 o N x ._c6 a E 0 w N g >ca to ct0s L. �U $ UO o 3 S U0B 2WV O wy 46 = -i J1- o M 2Q0 H X.0 _ 2�i S'� 2 111 QwU CO YvH _ > z 0 0 Yv0Q) 0 4/11/23,8:53 AM Fwd:No Gas Ltr-175 Pine Grove Rd.Yarmouth-shawmehillcorp@gmail.com-Gmail Mike Farrell to me,Deborah FYI Mike Farrell Sent from my iPhone Begin forwarded message: From:"Whelan,Ellen T."<Ellen.Whelan@nationalgrid.com> Date:April 10,2023 at 2:5.8:53 PM EDT To:-ii�:YtaelffalLe- l ril4rn it,yom Subject:No Gas Ltr-175 Pine Grove Rd.Yarmouth Michael Farrell 87 Browns Beach Rd. Bristol,NH 03222 TO WHOM IT MAY CONCERN: RE 175 Pine Grove Rd, Yarmouth, MA This email is to confirm that there is no live gas at this property. This letter DOES NOT preclude the excavator or homeowner from calling Dig Safe at 811 before commencing any work. State law requires anyone planning underground excavation work to notify local utilities by calling 811 to get your underground utilities identified for you prior to doing any digging. The call to 811 is the LAW and must be mode in advance of starting work. This confirmation letter of a gas cut-off DOES NOT relieve the excavator of making the call to 811. It is a State Law requirement. (can be reached directly at 508-760-7439 should there be any further questions. Sincerely, Ellen Whelan Residential Gas Connections (508)760-7439 nationalgrid 127 Whites Path South Yarmouth,MA 02664 EIIen,Whelan(iinationaigri m This e-mail,and any attachments are strictly confidential and intended for the addressee(s)only.The content may also contain legal,professional or other privileged information. If you are not the intended recipient,please notify the sender immediately and then delete the e-mail and any attachments.You should not disclose,copy or take any action in reliance on this transmission. You may report the matter by contacting us via our UK Contacts Page or our US Contacts Pagg(accessed by clicking on the appropriate link) Please ensure you have adequate virus protection before you open or detach any documents from this transmission.National Grid plc and its affiliates do not accept any liability for viruses.An e-mail reply to this address may be subject to monitoring for operational reasons or lawful business practices. For the registered information on the UK operating companies within the National Grid group please use the attached link:https://www.nationalgrid,com/grggp/abot�t- us,corporale_reg i stra tia ns https://mail.google.com/mail/u/0/?tab=rm&ogbl#inbox/FMfcgzGsltSgdGVg WVZmkLssDsPaiNvX 1/1 TOWN OF YARMOUTh 1 IVISION N,. 4y WATER DIVISION y 1y 99 Buck Island Road na�NEE E ' '' West Yarmouth,MA 02673 Telephone: 508-771-7921 Fax: 508-771-7998 April 5, 2023 Mike Farrell 87 Browns Beach Road Bristol, NH 03222 RE: 175 Pine Grove Road, South Yarmouth —Cut and Cap complete and inspected The Yarmouth Water Department performed a cut and cap of the water service at 175 Pine Grove Road, South Yarmouth on 4/5/2023. This service has been invoiced. If you have any questions please don't hesitate to give us a call 508-771-7921 Sincerely, Yarmouth Water Department H:\Water\NARY DESKTOP\WORD FILES 175 Pine Grove Road-cut and cap.docx Town of Yarmouth UB Work Order Date Entered: 03/27/2023 District: 02 Account T Entered By: 3164mcfranklin Ype:RS WO#: 83356 Account #: 02002222 FARRELL DEBORAH R CID: 218701 FARRELL MICHAEL F Default route:26 87 BROWNS BEACH ROAD Read Seq: 540 Parcel : 025.200 BRISTOL, NH 03222 Location: 175 PINE GROVE RD Desc: Subdiv: Lot: Service : 100 -001 WATER CONSUMPTI Meter Info. Manuf/Serial Manuf/Serial Read Meter IP 90936438 Other Meter Installed Date 05/27/2022 # of Dials: 4 Size: .625 Remote ID 11097204 Read Info. Service Comment: AMR LEFT Year/Mo R Reading Billed Usage Year/Mo R Reading Billed Usage 2023/ 2 A 9 2022/ 2 A 35 2022/11 A 9 4 2021/11 A1 34 2022/ 8 A 5 5 2021/ 8 A 2 2022/ 8 39 1 2021/ 5 A3 2022/ 5 A 38 2 2021/ 2 A 31 3 23 2022/ 2 F 36 1 2020/ 8 A5 23 9 Reason Code: C&C CUT AND CAP Sery Order Type: MISC MISCELLANEOUS SERVICE Assigned To: WETH PAUL WETHERBEE Date Scheduled: 2023-03-30 00:00:00Time Scheduled: Addl services: Manuf/Serial Reading Comments: CUT AND CAP OF WATER SERVICE FOR DEMO OF HOME DS# 20231301091 GOOD 3/30/2023 10AM REMOVE METER AND AMR Add'l Info: BILL & JON WITH PAULREAD 0009168.71METER AND AMR IN METER ROOM[202 3-04-04 14:52:05 31641foss] : Work Completed By: PW Date Completed: Completed Reason: Report. generated: 04;'05;2023 07:17 user: 3164mcfranklin ?rogram ID: utworkor Page 1 j{. 4 fl ;o -; ; y Town of Yarmouth Conservation Office 5 Conservation Commission b�'rfnzoCu !armc� ,tt .rrta.0 Building Permit Sign-off Application TO BE FILLED OUT BY BUILDING PERMIT APPLICANT Building Site Location: /7-S-- J> - i >.* Map# y -°- ) '7 Lot(s)# Property Owner: /f1I4 .. * ?L4 / ,u.f( Date filed: -0/423 *Applicant: X.,..,,L 411"1t,.-: Applicant Address: Y3`, j,045- 5j s6' I&)1LA/ ffiic} ,) -s . Email: S114(y;t.i.. .-/4,llr...oity-)A. &Jwrir/. ‘40.A. Telephone: ,cat- Zi --.,ASS-cr Please note:by submitting this applicatior(,the"applicant grants permission to the Conservation Office to enter the location to conduct a site visit(if needed). Proposed Project Description: i r' 1f!"( r'OP.-, .L i "'1i..t S. 'G.- %.yr s te,.i iv_ .. CtC Site Plan Title/Date: l/3A I ?(op ye ci gip.► ,C I SE k P\ TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: kl Does the proposed project require a permit? {> Refer to: SE83- Z31 I or DOA permit Comments from Conservation Commission: Approved Qonditionally Approved -,t Rejected Conservation Commission Sign-off Signature: C;/1%,-;" / 'c_, - - Date: tJ j 1 j t uZ3 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. 4/19/23,8:09 AM Mail-Sears,Tim-Outlook 175 Pine Grove Sears, Tim <tsears@yarmouth.ma.us> Wed 4/19/2023 8:07 AM To: 'shawmehillcorp@gmail.com' <shawmehillcorp@gmail.com> Kevin, I have reviewed your application and there are some items needed. \ alth Department sign off 2. FEMA Elevation Certificat e based on construction drawings Na The plans have a "full basement" shown on A4. Per section R322.1.5 basements are not allowed i flood zones. n 4. The new Stretch Energy Code went into effect on Jan 1st. Existing buildings are now a part of the new code. It appears that the scope of work falls under the new requirements. A HERS Certificate will be needed 225 CMR 22: Massachusetts Residential Stretch Energy Code R502.1.1 Large additions.Additions to a dwelling unit exceeding 1000 sq ft or exceeding 100%of the existing conditioned floor area, shall require the dwelling unit to comply with the maximum HERS ratings for alterations, additions or change of use shown in TABLE R406.5 R503.1.5 Level 3 Alterations or Change of Use.Alterations that meet the IEBC definition for Level 3 Alteration or the IRC definition for Extensive Alteration, exceeding 1,000 sq ft or exceeding 100% of the existing conditioned floor area, shall require the dwelling unit to comply with the maximum HERS ratings for alterations, additions or change of use shown in Table R406.5 IRC 2015 Appendix J AJ501.3 Extensive alterations. Where the total area of all of the work areas included in the alteration exceeds 50 percent of the area of the dwelling unit, the work shall be considered to be a reconstruction and shall comply with the requirements of these provisions for reconstruction work 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 "ioutiook.office.com/mail/sentitems/id/AAQkADE3MDQ5NWZmLTkOYzItNDIwNi1 iMDQxLWNkMGQyNmE4NzE5NAAQAHC3ggYVXyRDrchbfFT... 1/2 ,A.Yit.tiA TOWN OF YARMOUTH 5 C HEALTH DEPARTMENT f.I.-�,`..,- t94,4 G '--'FM` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET To be completed by Applicant: Building Site Location: / 3's /),.i.�. 6—,4.4,,;„.r 4 . Proposed Improvement: 5ar.44. 44.,,,_ „?...;,rsfr, - d(,Qi,i,_ j' ',rhllL . 2 04,z.. rt.e..II/ tfia a,> Zq,,, s:y s47...a,,.. to-rb f 1N A.4.A.S Applicant: aJ,.�`;,, ii,n_,cy�k.z. Tel. No.:So 3 Address: Vse-thz. _sr sc wiu1.-, f4 ans Date Filed: VA 2 5 **If you would like e-mail notification of sign off please provide e-mail address: -So op.i.�kV 40 Ap, 6-twu( . c.�:r. 6 Owner Name: M'/t0,. /- 144-4 f ( Owner Address: Ifs— A",,,..,` (-;m v, ' yc•Acr44,144 Owner Tel. No.: 97r-"07 —.3,9r. RESIDENTIAL ANIVOR COMMERCIAL BUILDING HEALTH DEPARTMENT: Determines Compliance to State and Town Regulations; i.e., Requirements For Septage Disposal and other Public Health Activities. rr--*-L7i7=Irg � Please submit three (3) copies of plans, to include: APR 0 6 '2023 (1.) Site Plan showing existing buildings, water line location, and septic system location; HEALTH QEPT (2.) Floor 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. 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