HomeMy WebLinkAboutBld-20-002883 c
" et.:411-33
';�°�.6•-�r�r.P y, ',Amount• :'Permit expires 130 days from
issue date
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508)398-2231 Ext. 1261
CONSTRUCTION ADDRESS: kc4. 7:di::71 ✓/ ,:c /7/
ASSESSOR'S INFORMATION:
Map: 6c Parcel: ,7
OWNER: ,ti f� 7AI/ �� e / �//7a''z/77p .
NAME PRESENT ADDRESS � TEL. #
CONTRACTOR:Opp �ri ./.vsv e/9,7-,e941 � lievera.C.e, C�r/e /�1 LILJ7L \.1 P27--J% 2
NAME MEWLING TEL.0
Residential 0 Commercial Est. Cost of Construction$ 7,0 d 0
•
Home Improvement Contractor Lie. # /f<` 5- 7 Construction Supervisor Lie, t# / S Q r � 87
Workman's Compensation Insurance: (check one)
0 I am the homeowner 0 I am the sole proprietor etsfI have Worker's Compensation Insurance
Insurance Company Name: "9-719'A(/7IC C-44//7< Worker's Comp.Policy# /i r/ (y/3 L. 9 O
WORK TO BE PERFORMED .
''' Tent Duration (Fire Retardant Certificate attached?) Wood Stove
"Siding: # of Squares Replacement windows: # Replacement doors: #
Roofing: #of Squares ( )Remove existing* (max. 2 layers) Insulation ✓
Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing
*The debris will be disposed of at: /44.41X j"Jd 2LjJ/di_
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 revoc .on of my license an for prosecution under M.G.L.Ch.263,Section 1. it
r
Applicant's Signature: �� Date: ///J.5 77
Owners Signature(or attach n ia t. —_-_,
Date:
Approved By: Date: \I'1 �) ! 6 , ,c' V
icial
Building O (or designee) EMAIL ADDRESS: i
Zoning District:
/ Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No 37 1 c
Water Resource Protection District: Within
100 ft. of Wetlands:
0 Yes 0 No 0 Yes 0 No