HomeMy WebLinkAbout2023 Sign off Transmittal - Coverting Garage into a private gym (for buisness purposes) TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: tD Co 2 P O Q A-v,V 'U, 1t/l'o rtePo er, MR 02 5
Proposed Improvement CONUE 2 771VG 6/121JEog SPACE livr0 /f- pet ufiLTE
/7 Po,✓1 rni C,,7 517Zfub T7' -4/f 7
Applicant: CLiSC f fZlEA ( ThN,ftj)i J Tel. No.: 77L-1 • CjC/H C'l08
Address: pS M��L ! � tit= C'flu ai , p (7 inri- 6Lk ?2- Date Filed:
**Ifyou would like e-mail notification of sign off please provide e-mail address: E FI 2 t i? < (T)ArCH C`a) 541Ci1/'(04-1
Owner Name: (thol c.EY Jii/L,'C, , ROge72 r 8E Cbi Nf)2
Owner Address: 119 I 0(./0 5i - C CO • Owner Tel. No.: 506 .73 74)S80
;etaC,e1 ) l f,(,c F /1'1 II
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
(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: � C - DATE: `_ / J
/ PLEASE NOTE
COMMENTS/CONDITIONS:
Town of Van:13406BAtitlg Department
icz1146 Route 28, South Yar,�`. . tel F a stet. 508-398-2231 ext.1261
ti °
Use and 4curp � application
I ATTACP1 SE/�- ',
In accordance with the provisions o e is tts State Building Code, section 105.1
Application for a certificaf'"afuse and occupancy permit
Name of Business I WJI ('rn',IS i An3JLL <: , c' Phone # 7 7'-I - Rg1-1 - 0108:
ELISEFR/}ZIER• CDR CH
Type of Business 6Ym Email C j Inglis/Ann
Property Address L CoRao12 -nO,nl aoqi y Agin M TT/ Po,r, MA Unit It
*Square Footage to be occupied *attach floor plan Fee: $60
The applicant is required to obtain ap
proval q sign-offs from the following departments as
checked off below:
X Health Department— 508-398-2231 ext. 1241 I
X Fire Department— Fire Prevention, 96 Old Main Street, 508-398-2212
Other
. at.v4.., 1--)_.:_3-- Advr•ct . —
cy
Bu Idi owners Si nature
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
Updated 3/21
VI 70
t/SLA t/►
0
0
7G
Z
.3
g
N / / / A
N
3 SN-J�1j '119E.�9WilQ
ioit
A
a
0
3
d 0
o .a
m
F
Z.
U
n
a mcn
a
O p G
8
7J = m
cj