HomeMy WebLinkAboutBLDC-24-63 Unit 2 Town of Yar x �Bju I4i�._ � Department
1146 Route 28, South Yar.{`o ,', °" ` V
;. j, el. 508-398-2231 ext.1261
Use and C ccu•" 41
jit Application
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In accordance with the provisions ofthii assach Massachusetts State Building Code, section 105.1
Application for a certificate of rse and occupancy permit
Name of Business J3d P yCO d t- M ( lf Phone # S G sb r 7 I-c- 7C0 7
Type of Business vi 126/ FI LM eg °k (/ C. IN 1" Email Altd-0J Y(d1LMf914'61N
Property Address 6- ' S T Yaivtvvi lq- Pate r Unit # 2--
• *Square Footage to be occupied i 0 0 ° *attach floor plan Fee: $60
MCIAN %N6 3ocYcoL- M 'kcoM
The applicant is required to obtain ap
proval pproval sign-offs from the following de. . r>t -nts as
checked off below: r.;?, RECEIVED
cA•\''' ___X Health Department— 508-398-2231 ext. 1241 I MAY 28
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X Fire Department — Fire Prevention, 96 Old Main Street, 508-398-2212 BUILDING DEPARTMENT
Other
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Building ownitsS nature Applicant Signature
Please note: this permit is for use and occupancy only. Any work requiring a building permit
will require a licensed contractor to submit an additional application with all the required
information based on the scope of the project. O
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**Office use only**
Zoning District \L- Proposed Use V. -1° Change of Use: Yes `- No
Allowed Use: Pest- No APD Waiver: Yeses No N/A
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Building Officials Signature Date
Updated 3/21
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:J Yqk TOWN OF YARMOUTH
'74 ){.. ° HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
2 /1 1/1-,Pli 1 1, 4
U�� � Vi C f Y ncri'&'v .Proposed Improvement: V O � ( c
Applicant: M ( c tfi vr E LIiN$E Tel. No.: cd (r 6 o
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Address: 14 C ( Date Filed: 1 "I
**If you would like e-mail notification of sign off, please provide e-mail address: Num- 5C N 6 60,Hco d�'M�d r4 • C o 1
f�yL .� t,./ o-e- � , v
Owner Name. W �''712
Owner Address: 2 c r (?1-- POwner Tel. No.: 5 0 S 3'z 7 5o 7Uplir C�
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fiViV( f r /14 At- 01
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: Ca fatikiCAA.4DATE:
t PLEASE NOTE
COMMENTS/CONDITIONS:
I3u3ine53 aw' Per. rr) k-s e. co -to c
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YIiThe I (60-13r -Far- cG^7 ' ')a' or"
p1.y^R TOWN OF YARMOUTH BUILDING DEPARTMENT
�: o APPLICATION FOR DETERMINATION OF NON-APPLICABILITY
•
\% ....' .'� AQUIFER PROTECTION BYLAW 6 540 5 1 I
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Applicant/Business Name: (C L CIiti>'GW ,�' Z J - Z y
�"/ Date: 'I
Property Owner: W r^ w Q-e J
Property location: 2 LI e Y sr 24 A unit*
Map&Lodi_
Proposed Use: V t
1. Has applicant has fully complied with the Submittal Requirements of§406.5.2? r
(Attach copy of Hazardous Materials list)
2. Does the proposed use meet all of the Design and Operation requirements of§406.5.7, K
3. Are the chemicals,pesticides,fuels and other potentially toxic or hazardous materials used or
stored at the site,or produced by the proposed use,in ualities not greater than those
commonly associated with normal housr.hold use, 1
4. Does the proposed use meet all of the objectives and water quality criteria of the bylaw:
The above applicant hereby acknowledges that the Building Inspector may require the applicant to submit the
matter to the Health Agent or Board of Health,and may require the applicant to demonstrate that he/she has
received a favorable report from the Health Agent or Board of Health. The Determination,if made,shall apply
only to the individual applicant and proposed use and shall automatically expire upon any change of use or
transfer of ownership of the business. There shall be no appeal from an unfavorable Determination ofany such
application,nor from a failure to act,except for filing by the applicant for Special Permit from the Board of
Appeals as otherwise provided herein.
S'2Lf—Z(1
A licant Date
M r rt-�-� s �PJ
Print Name
DETERMIN IN: The Building Inspector, ba:;ed upon a review of this application and information
supplied b e•ppli t,hereby determines that the proposed use satisfies the requirements of§406.5.I.I and
at the ppl.nt not apply for a Special Permit under§406.5
i ,lif /'', "" :5' 75' 27" a+g- (Lti-d0,0 Building;!!tor t+ate � r`�'
Health Agent D e
Form must be filed with the Town Clerk and copies of this form must be sent to the following
departments(as listed in§406.5.4);Water,Engineering,Fire,Health,Planning,Consematton,Board of
Appeals.
Aquifer Protection District Waiver 05/08
SCANNED
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TO: Commercial Applicants in the APD
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Department
FROM: Yarmouth Health
.
SUBJECT: Hazardous Materials
As part of the application process fora Board of Appeals hearing or Determination of Non-Applicability,
please complete this form and return it with your application. For further information concerning hazardous
materials regulations, contact the Health Department Office.
In the conduct of your present and/or proposed business, do you store, use, generate any of the
following types of products? Please check all which apply and list quantities.
Antifreeze, Engine & Radiator Flushes / "�' J J"
Motor Oil
Hydraulic, Brake, Automatic Trans. Fluid Gasoline/Fuels 1 6i 11f',
Grease, Lubricants Degreaser/Cleaners
Floor/Driveway Degreaser Battery Acid
Rustproofing/Undercoating Vehicle Detergents
Vehicle Waxes, Polishes Asphalt, Tar, Sealers °
Paint, Varnishes, Stains, Dyes, Thinners ,5 6V L Wood Preservatives a
Dry Cleaning Solvents, Carbon Tetrachloride 1 Floor/Furniture Strippers
Other Cleaning Solvents rr Rock salt, Road salt
Drain, Toilet, Cesspool Cleaners i Refrigerants
g
Bug & Tar Removers Photo chemicals
Printing Inks & Dyes
Pool Chlorine
Pesticides, Insecticides, Herbicides Rodenticide, Fungicides
Nitrate Fertilizer i Jewelry Cleaner ,a
Leather Dyes PCB=s
Electroplating Sludges Others (List)
Applicant Signature: ' Z
Date: S
r
EIEALTAPDDETER 10-99