HomeMy WebLinkAbout2014 Oct 21 - Sign Off Transmittal Sheet, Floor Plan 4
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OF�"-,Y-fA�',y, TOWN OF YARMOUTH
o� � '=��y HEALTH DEPARTMENT
���<=•`� x PERMIT APPLICATION SIGN OFF TRANSMITTAL SHEET
4 � To be completed by Applicant:
II ,r Building Site Location: � � V �� Y�O ^ s� � V"v S �- �� r Y�^ o V��
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Proposed Improvement: �� K-Q C� � � o N dr � O � � b�p. r ; r-�
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Applicant:T D �� 1'Y1 Q�� 2����—Tel. No.:� � �Z�i � -9 �S�
Address: G � C pa• �r S� , U r . � 2- � � 0 en� .S �dr �-- Date Filed: �O�Z- � ( y
"Ifyou would like e-mail nodfication ofsrgn o,�;please provide e-mail address:
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Owner Name: 1 ►" �.. �`7 P -� — {Gc h � r�
Owner Address: � � • M,` �� S � • ���i'��e ��r k Owner Tel. No.: S6P, — S�'3�.Z$SG
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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.
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REVIEWEDBY: DATE: �`'�dt�/�`Y '
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PLEASE NOTE
COMMENTS/CONDITIONS:
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Location: 31 Vernon st, West Yarmouth, MA
. Proposed Flaor Plan �converting fram 2 famiiy to 1 family)
i Owner: Mir Enayet-Karim, 6 W Miltan st, Hyde Park, MA 02136
� Owner's 5ignature: �� Mobile: 508-577-2830
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