HomeMy WebLinkAboutHealth sign off 5/18/23TOWN OF YARMOUTH
o HEALTH DEPARTMENT
PERMIT APPLICATION SIGN OFF 'TRANSMITTAL SHEET
To be completed by Applicant:
Building Site Location:
Proposed Improvement:
Applicant: �� �ir, -T-�19AJ Tel. No.:
Address:-2011fll(f j�ilj /�� (�� ` _Date Filed: &% y
"Ifyou would like e-mail notification ofsign of, pleaseprovide a -mail address:
Owner Name:
Owner Address: `f
�� Owner Tel. No.:
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.
RECEIVED Please submit three (3) copies of plans, to include:
(1.) Site Plan showing existing buildings, water line location,
MAY 15 2023 and septic system locution; _
(2.) Floor plan labeling ALL rooms within building
HEALTH DEPT, (all existing and proposed) —
Note: Floor plans not required far decks, sheds, windows, roofing;
(3.) If necessary, Title 5 application signed by licensed installer
with fee.
REVIEWED BY:
DATE'
PLEASE NOTE
COMMENTS/CONDITIONS:
May 13, 2023
Town of Yarmouth
RECEIVED
Board o health MAY '15 2023
�J AP.. H DEP r.
Greetin I
s,
We request a building permit for 119 Highbank Road. We are NOT adding any
additional bedrooms, the current floor plan has two bedrooms on the first floor
and no other bedrooms.
Our request is to add a 15 by 15 by 16-foot addition to one of the existing
bedrooms. This will allow for a master bedroom with a closet and new bathroom.
The only other add on is an i foot byes foot space on the second floor which will
be a home office. It will have no closet; my wife works remotely as an RN Medical
supervisor and needs more office space.
This 8 by 8-foot space will encompass the entire second floor, there are NO other
rooms existing or to be added to the second floor.
I am providing our building permit request, the stamped architect plans, the sign
off sheet from the water department, the stamped plot survey indicating the
requested new addition and the second -floor space. (Highlighted in Yellow)
am also adding the Title 5 survey which shows the septic system in the back yard
on the opposite side of the house from the addition. Of course, the stamped
survey also shows the location.
Thank you for your time and consideration,
Respectfully,
Daniel and Kathleen C%hhaarette
774-230-1588
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jax Commonwealth of Massachusetts
Title 5 Official Inspection Form
Subsurface Sewage Dltpo4l system 'Form - Not lb,'r Voluntary Assessments
19 Hiahbank Rd
Property nmress I
Owner Otivners Flame
wMation is
TGOired for everySouth Yarmouth Ma. 026CA
page. cayfrmffi
stme ZO Code Data of inspection
D. System Infor a "on (cont.)
14. Sketch Of Sewage DiSppW System,,
Provide a view of the.sev age disposal system, including ties to at least two permanent reference
landmarks or benchmarki. Locate all wells within loo feet Locate where public water supplyentPrs
the building. Check one of the boxes belaw.
PR 51',
hand -sketch in the area below
E C E VE
drawing attached separately
MAY -j,5 2023
HEALTFIi DEPT,
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