HomeMy WebLinkAboutBLD-19-001346 TS ..;c:,,1'11:444:4„- office Use Only
., 0 i,Permit# 1
p' � ,it—H' )Amount 50
• . Permit expires 180 days from Pc
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���— I � �( �� � a issue date `
RECEIVED
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH SEP 05 2018
Yarmouth Building Department
1146 Route 28 BUILtprN r. !t"_� :"'l
By:
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261,( _�
CONSTRUCTION ADDRESS: /OD JCl/// u:6610u:6610 / �-(///J' hi I- ittd v in
'
ASSESSOR'S INFORMATION:
Map: Parcel:
I
.........-•OWNER::M&//J4V042— /I iowe, "c5flN ,6-06- 71,5 -37y,�
NAME PRESENT ADDRESS TEL # ail Address:
cc, -f /JO'ca�
CONTRACTOR: c/�/OI'� �Ja /H� Alt) .f7�• . ijJt91
NAME MAILING ADDRESS TEL# Email Address:
Residential /.7.--. Commercial Est Cost of Construction VO ‘90 O .
U J
Home Improvement Contractor . Construction Supervisor Lie.# L.So° la
Workman_g.Sommn psatican Insurance: (check one)
\ I am the homeowne I am the sole proprietor I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
WORK TO BE PERFORMED
Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: #of Squares /V Replacement windows:# Replacement doors: #
Roofing: #of Squares _ ( )Remove existing* (max.2 layers) Insulation
Old Kings Highway/Historic Dist. ( )Replacing like for like
*The debris will be disposed of at: /4ftfo Cl/i O P/ ? s
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for denial or vocati my license and for rosecu'in under MG.L Ch.268,Section 1.
Applicant's Signature ���� .4„3Date: p.
At
Owners Signature(or attachment) -*'-G- Date: ��/(�
Approved By: - " —.Z. Dare: a c � /P
Building Official(or designee)
Zoning District
Historical District Yes No Flood Plain Zone: Yes No
Water Resource Protection District Within 100 R of Wetlands:
Yes No Yes No
i IT: Division of Professional Licensure
., I - Board of Building Regulations and Standards
ConstructionSupervisor
i CS-005609 - Expires:03/08/202
, f
• LAWRENCE K KENNEY'#
•
100 SULLNAN ROAD r
WEST YARMOUTH MA 02673 '• ` ' 'e°
`CJI(' .-{}.1\� 'Ak,, „
. . Commissioner .
r :— . - Glia Wails xanweald o/CY,rouneMufe(
1 " Office of Consumer Affairs&Business Regula
HOME IMPROVEMENT CONTRACTOF
(Type: Individual ' '
" ; "i'registration Expiration
I
�F ' 101413 10/05@018
f , „-ia--, I
Lawrence K.Kenney-K,_ ;i.,
Lawrence Kenney.'I.1-•:,• t_- .t7
100 Sullivan Road "•,: 1 � Q--
v. W.Yarmouth,MA,02673.',- _U
,pndersecretar
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