HomeMy WebLinkAbout023 Sep 12 - Sigh Off Transmittal - Use & Occupancy Change �• TOWN OF YARMOUTH
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HEALTH DEPARTMENT
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PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: v +l Q
Proposed Improvement: '
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Applicant: h Ll2 3--4 I
Tel.No.:
Address: •
1 Date Filed: —1
*•If you would like e-mail notification of sign off please provide e-mail ackl ess:
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Owner Name: Ei
Owner Address: `1 2
Owner Tel.No.:5-08'1-03- 3
RESIDENTIAL AND/OR COMMERCIAi 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
SEP 1 �� (2.) and septic system location;
23Floor plan labeling ALL rooms within building
HEALTH DEPT (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.
REVIEWED BY: DATE:
COMMENTS/CO MONS: PLEASE NOTE
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Town of Yam,. 3�.,_r
Department
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1146 Route 28, South Yarr i�• ;�%` , ' m :+t, ;- el. 508-398-2231 ext.126J.
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Use and Oct' i. . •7 rApplication
In accordance with the provisions o'f,t*:44AssacAu4tis State Building Code, section 105.1
Application for a certifica se and occupancy permit
Name of Business Phoenix Landscaping owner Felipe Ribeiro 508 827 0254
Property Address Sunflower Market Place 923 Rt 6A Yarmouth Port Unit# Building 6 Unit Z
Type of Business Landscaping Business Office
*Square Footage to be occupied 950 *attach floor plan Fee:$60
The applicant is required to obtain approval sign-offs from the following departments as
checked off below:
X Health Department— 508-398-2231 ext. 1241 -
X Fire Department— Fire Prevention, 96 Old Main Street, 508-398-2212 SEN l '+ 2023
Other HEALTH DEPT.
Chapter Two LLC James Basler Manager
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Building owners Signature Applicant Signature
Please note: this permit is for use and occupancy only. Any work requiring a building permit
will require a licensed contractor to submit an additional application with all the required
information based on the scope of the project.
**Office use only**
Zoning District Proposed Use Change of Use: Yes No
Allowed Use: Yes No APD Waiver: Yes No N/A
Building Officials Signature Date
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