HomeMy WebLinkAbout2023 Sign off Transmittal - Bring existing basement to code and new bath ° it
' TOWN OF YARMOUTH
x ;„, c HEALTH DEPARTMENT
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`',c"``" PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: 1-,-q m OCR•-ki ,,1 ' .G Lk '1 N/1 al(DLI ill
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Proposed Improvement: '� {h( — — .T O . F-
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� /,,-Applicant: ,4 ` ilLinP,2'10
Tel. No.: 1�C/i ---)g:--
Address: y� I
f2 i l ,511,k jail/.3 t1J Date Filed:
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**If you would like e-mail notification of sign off please provide e-mail address:
Owner Name: f//kivi �4 Owner Address: ) /, Gk j� yj� T ryc p 6 J
- � (' ��/ !J Owner Tel. No.: 1J. / y
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,
RECEIVED and septic system location;
(2.) Floor plan labeling ALL rooms within building
JUN 0 8 2023 (all existing and proposed) —
HEALTH DEPT. Note:Floor plans not required for decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BYE ✓,i4 � :, DATE: 3 " L�
PLEASE NOTE
COMMENTS/CONDITIONS:
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R E C E 1 VED1
ONE & TWO FAMILY ONLY- BUILDING PERMIT / fl 1 Town of Yarmouth Building Department
1146 Route 28, South Yarmouth,MA 02664-4492 '` R 25 2023
508-398-2231 ext. 1261 Fax 508-398-0836 L
Massachusetts State BuildingCode,780 CMR `` "�' (C =PART ��
MENT
Building Permit Application To Construct, Repair, Renovate Or Demolish j --—
a One-or Two-Family Dwelling
This Section For Official Use Only
Building Permit Number: 13 4 ,00
S/ Date Applied:
Building Official(Print Name) • Signature Date
SECTION 1:SITE INFORMATION
•
1.1 Property Address: 1.2 Assessors Map&Parcel Numbers
'LI I`tOriL 'U9. DrtVi.,
1.1a Is this an accepted street?yes no _ Map Number Parcel Number
1.3 Zoning Information: 1.4 Property Dimensions:
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
1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System:
Public 0 Private 0 Zone: _ Outside Flood Zone? 123
1. c--.---Check if yes❑ Municipal 0 On site disposal system 0 ili
SECTION 2: PROPERTY OWNERSHIP' 73
2.1 Owner'of Record: 5 cD IIIUzi e, Cointivc �n L� wco t y� at- -s L
Name(Print)�f City,State,ZIP O
`�/ ►"lQl'l1-Q j)rik0 p/`tll(L SO -561,- `)' Ua6v 5 Xt l e,,,,�1 -.-11
No.and Street Telephone Email
SECTION 3:DESCRIPTION OF PROPOSED WORK=(check all that apply)
New Construction 0 Existing Building El Owner-Occupied ❑ 1 Repairs(s) )1. Alteration(s) 0 Addition 0
Demolition ❑ Accessory Bldg.0 Number of Units Other ❑ Specify:
Brief Description of Proposed,Work2: I f f f
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rO E.10'- lV�5 Y- mQ.J,•C, k-O CoAQ ``J 0C�9o,�is UJith. f. Ti(11c�I , I be, a. r wolf\ I1-)D..�Q.t 19 A , Cl n. .1
SECTION 4:ESTIMATED CONSTRUCTION COSTS.
Item Estimated Costs: Official Use Only
(Labor and Materials)
1.Building $ zy) 1. Building Permit Fee:$ Indicate how fee is determined:
0 Standard City/Town Application Fee
2.Electrical $ /
❑Total Project Cost3(Item 6)x multiplier x
3.Plumbing $ / 4 D J 2. Other Fees: $
4.Mechanical (HVAC) $ List:
5.Mechanical (Fire •
Suppression) $ Total All Fees:$
Check No. Check Amount: Cash Amount:
6.Total Project Cost: $ 20, ❑Paid in Full ❑Outstanding Balance Due: