HomeMy WebLinkAboutApplication sigh off 5/18/23 � o11 TOWN OF YARMOUTH
HEALTH DEPARTMENT
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''? c0165� PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
To be completed by Applicant: ,\
Building Site Location: -3*''ES 1,660b. 12o 500.7- 34ctl�I (L ,-1-
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Proposed Improvement: A-D /C, 'x 12.1 i fU2 s ASc> ' 5u., RZc:e-nk ex TEA-i�l ► c;i!
l 2` To ecru er tic'ram' 5 cwt. .
Applicant: .Qj 4col ' Tel. No.: . 06 '1 Z .&3
Address: Date Filed:
**1Jyou would like e-mail notification of sign off,please provide e-mail address:
Owner Name: J fr'VCS D&U-00 ey
Owner Address: 117 tv Owner Tel. No.: So:/ - L -I'C _S
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.
�_._.� u..:«= .w Please submit three (3) copies of plans, to include:
Gal ic�(�a;(]���o
(1.) Site Plan showing existing buildings, water line location,
APR 1 4 2023 and septic system location;
(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: C /,( -
PLEASE NOTE
COMMENTS/CONDITIONS:
Bu1th Photo
Grade: !Average j ® ^9
Stories: 11 3/4 Stories
Occupancy 1
Exterior Wall 1 Wood Shingle
Exterior Wall 2
Roof Structure: Gable/Hip
Roof Cover Asph/F Gls/Cmp
Interior Wall 1 Drywall/Sheet
Interior Wall 2
Interior FIr 1 Hardwood
(http://images.vgsi.com/photos2/YarmouthMAPhotos//\00\03
Interior Fir 2 \24/11.jpg)
Heat Fuel Gas 1 Building Layout
I Heat Type: 4 Hot Water
TACT _��
ype: None
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ITotal Bedrooms: 14 Bedrooms }
I it .41f'
!Total Bthrms: 2 ,a e -,
1 Total Half Baths: 1 IPP
ITotal Xtra Fixtrs:
Total Rooms: Tn� TBAS
Bath Style: Average a UUN `;
Kitchen Style: Modem
(http://images.vgsi.ccoom/photos2/YarmouthMAPhotos//Sketches/
Building Sub-Areas(sq ft) Legend
Gross Living
Code Description Area Area
BAS First Floor 1,153 1,153
TQS Three Quarter Story 624 468
FOP Porch,Open,Finished 108 1 0
UBM Basement,Unfinished 624 0
,2,509 1,621 j
,��ha ;gs atre74..,#�x�t:P;tiZ »?v 'W1 Y .41t�. �rJd; .... ... >
Extra Features
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Extra Features Legend
No Data for Extra Features
Land
Land Use Land line Valuation
Use Code 1010 Size(Acres) 0.27
Description SINGLE FAM MDL-01 Frontage 0
Zone Depth 0
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1.,,t Commonwealth of Massachusetts
itj =t„ Title 5 Official Inspection Form
0 Subsurface SewageForm-Not for Vet A�
1/4_ 7 Wood Rd
Susan and Chester Coggeshan
Owner Owner's time
information i t_S.Yar of MA Q_2664 3-13 201 J
esquied for everyPags• State Zip Cale f]aie atInspection
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D. System Information (cunt.)
14. Sketch Of Sewage Disposal System:
Provide a view of the sewage disposal system,including fees to at least two permanent reference
landmarks or benchmarks.Locate all wens wig 100 feet Locate where pub supply enters
the building.Check one of ftw boxes below:
2 hand-sketch in Vie area below
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