HomeMy WebLinkAboutHealth sign off 71821 14422-
'Y, led,. TOWN OF YARMOUTH
HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: I Li kk V bui f 41 bC -i- C --6 7,3
Proposed Improvement: -7 ,SC 5 I'" Lj itt 0'/' G A S y i c r, i t
QV LT , B
Applicant: V Ll Tel. No.:c -3.-3 S
Address: 1 `I P1 V ,t,Li tou . 6-0 D ork) Date Filed: `j Ji
ed- ,13 J
**If you would like e-mail notification of sign off,please provide e-mail address: Ai tor, (. //4 E-1 ,M , il-c `
Owner Name: )S A- V 1 (e. -j
Owner Address:) ki DC, ( 1 4 I=5---1 dit,M 1 t Owner Tel.No.VMS 'a--11 — 7S
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:
Site Plan showing existing buildings, water line location,
JUL 18 zOZ1 and septic system location;
V(2.) Floor 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:
PLEASE NOTE
COMMENTS/CONDITIONS:
Less Depreciation: $108,000 Building Photo
Building Attributes
(..... .__ Description
Field
Style: Ranch
Model Residential .._
Grade: Average .
Stories: 1 Story
Occupancy 1
Exterior Wall 1 Vinyl Siding
Exterior Wall 2 °
Roof Structure: 1 Gable/Hip
Roof Cover Asph/F GIs/Cmp (httpJ/images.vgsi.com/photos2/YarmouthMAPhotos/n00\03\07137.jpg;
Interior Wail 1 Drywall/Sheet Building Layout
Interior Wall 2
,.v
0 26
Interior Fir 1 'Carpet 4
Interior Fir 2 7
i I UST
Heat Fuel Gas WOK 12
Heat Type: Hot Water 8 8
AC Type: Heat Pump
-- _ 7 19
Total Bedrooms: 2 Bedrooms
BAS
Total Bthrms: 1 i
Total Half Baths: 0
i
Total Xtra Fixtrs
Total Rooms: t
...0Bath Style: Average - j
Kitchen Style: Average
Num Kitchens 01 ; ce i
Cndtn
Num Park ��--^
Fireplaces IN � �� �TJt
1 tom"
Fndtn Cndtn
Basement 26
(ParcelSketch.ashx7pid=4106&bid=4282)
Build'aig Sub-Areas(sq ft) Legend
EL.-310 V LEIIJ Code I Desc1 gon Gross Living
Area Area
J U l 1 6 2021 BAS I First Floor 1 650 6501
UST I Utility,Storage,Unfinished 56 0
HEALTH DEPT
WDK Deck,Wood 256 0
962k 650
Extra Features
http://gis.vgsi.com/yarmouthma/Parcei.aspx?pid=4106 7/16/21,10:32 AM
Page 2 of 3
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S3527 31"W
65.00
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•
HEALTH DEPT
a 45.5' LOCUS INFORMATION
NSF CURRENT OWNER:
THE
N 'Q RUFFINO IRREVOCABLECORI AMILY
INCOME ONLY
QUIRK o GARDEN GARDEN TRUST
DECK
OWNERS REFERENCE:
P 1SN .1 BOOK 32291 PAGE 82
rW -do STORAGE
IN 16.5' r wi PLAN REFERENCE:
w� PLAN BOOK 91 PAGE 41
Int
id o
h EXISTING o `t ASSESSORS REFERENCE.
11 DWELLING z MAP 32 LOT 24
NO. 14 LOT AREA:
21.7'
6,500 S.F.
e / \ ZONE:
CANDSC. LS. j ( j p R25
CESS - - -
POOL \ /
/—.1 I FEMA REFERENCE:
\�/ ! 29.5' ZONE X
FIRM 25001C0588J
DATED 7-16-14
CRUSHED
STONE
DRIVEWAY
1— 1 65.00' —A
,- SEPTIC NOTE:
N3527'31'E a THE LOCATION OF CESS POOL
i AS SHOWN WAS PROVIDED BY
t M ROAD
HOME OWNER. ME YARMOUTH
NO
V -"- OLL Y s +'v AD FOR THE PROPERTY HEALTH DEPARTMENT HAS IO
RECORDS OF SEPTIC LOCATION
I CERTIFY.-
��0 OF wlss'cy
1. THIS PLAN IS THE RESULT OF AN ACTUAL
ON THE GROUND SURVEY. 4 PETER Gri
U HOYT Z
;`' No. 41609 PLAN OF LAND
�' 3' '�Fcrs1�R�° 14 MOLLY ROAD
PETER1---9
YT P.. . AL LAO YARMOUTH, MA
SCALE 1 = 20' DATE. 5-04-21
20 10 0 2040
f t(�YT' SURVEYINGLAND
mom ' ammommemo 1287 WAS11[NGTON STREET
GRAPHIC SCALE SCALE: 1`.•20' W'EYM()[1T1 I MA. 02189
781-682-9192
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SERVICE NO.
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STREET / /172,,-."41 e742 al / -
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JUL 1 6 2021
HEALTH DEPT.