HomeMy WebLinkAboutBLDC-24-11- Town of Yar ,x`x r� .
414 Department
1146 Route 28, � mtel
South Yarr� o °" `� � `�``
� � ;�� . 508-398-2231 ext.1261
Use and 06 ups t _ ,i ppiication
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In accordance with the provisions o; i h ;Cr e� �1
ass us tits State Building Code, section 105.1
Application for a certificatewse and occupancy permit
Name of Business , A ck c ®�� q c�
Phone # 7?y-Z(o� ID
Type of Business CZ-e
Email
Property Address// (-TA, 4 Z r/4'2- - 0 /,. z £-4C
Unit # 2
*Square Footage to be occupied
attach floor plan Fee. $60
The applicant is required to obtain approval sign-offs from the following departm:.checked off below:
X Health Department—508-398-2231 ext. � `._
1241 � JAN 3 01024
BUILDING uEPARTMENT
Fire Department— Fire Prevention, 96 Old Main Street, 508-398-2212 By
Other
Building owners Signature
g e Applicant Signature
Please note: this permit is for use and occupancy only. Any work requiring a bui
will require a licensed contractor to submit an additional application with all ldi q permit
th
information based on the scope of the project. e required
**Office use onl **
Zoning District
Proposed Use \L Change of Use: Yes
Allowed Use: Yeses' No No
APD Waiver: Yes No N/A
Building Officials Signature
Date
Updated 3/21
4T,7-1
o -Y-A`t TOWN OF YARMOUTH
HEALTH DEPARTMENT
= '`` PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location: L t, I f,f t o 816 9 rt Z 3-a c/Ls (- <
Proposed Improvement: 5 r€ 4XX-l S 1' CA.A. ()kg c 11 IV t tni 0 w t1 t f
Applicant: L ti 5 CA LLC Tel. No.: / ,l 168 1 8oO
Address: 1 6 1 k A- Date Filed: 0/ le -204
**If you would like e-mail notification of sign off,please provide e-mail address:
Owner Name: G V, Cat j Z
Owner Address: 5a m &s rig,be of Owner Tel. No.: 77i 2 6$ 1800
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: DATE:
.///, /,9k.'
PLEASE NOTE
COMMENTS/CONDITIONS:
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