HomeMy WebLinkAbout38 Ancient Way OKH 2018 Windows 3 Anne.ea-I- ua1
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EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth,MA 02664 .
(508) 398-2231 Ext. 1261
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CONSTRUCTION ADDRESS: S -e-"lfi ()a / •
ASSESSOR'S INFORMATION:
Map: Parcel:
OWNER: ?aa I 7 U; 1'O if Pond SI- cog—Saab' G3 60
NAME PRESENT ADDRESS TEL. #
CONTRACTOR:
NAME MAILING ADDRESS TEL.#
@'residential 0 Commercial Est.Cost of Constructions 7CD1-1 e0
Home Improvement Contractor Lie.# Construction Supervisor Lie.#
Workman's Compensation Insurance: (check one)
0 I am the homeowner 0 I am the sole proprietor 0 I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy •m
WORK TO BE PERFORMED
Tent _ Duration (FIre Retardant Certificate attached?) Wood Stove
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Siding: #of Squares Replacement windows:# / 2d Replacement doors: #
Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation
v / 'Old Kings Highway/Historic Dist. (t4Replacing like for like Pool fencing
?et/t ioei'/,a &(c .
*The debris will be disposed of at
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 revocation of
my license and for prosecution under M.G.L.Ch.268,Section 1.
Pleb Applicant's Signature: SC ire Date:
Owners Signature(or attachment) _ �.0 � r/ Date:
Approved By: Date:
Building Official(or designee) EMAIL ADDRESS:
Zoning District:
Historical District: ❑ Yes 0 No Flood Plain Zone: C Yes C No
Water Resource Protection District: Within 100 R of Wetlands:
0 Yes 0 No ❑ Yes 0 No