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HomeMy WebLinkAboutBld-20-002884 .t ' G•t r, . w41,/6- Amount `C .A74, n1((�. �f �`,,'"°°°°° Ems,: Pennit expires ISO days from = �' ''' issue date J EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 South Yarmouth, MA 02664 7 (508)398-2231 Ext. 1261 CONSTRUCTION ADDRESS: 71�G kr /,(/5"4, /4/ Cl,-"rl)/ .mod' ASSESSOR'S INFORMATION: Map: Parcel: F 4 D n-e' OtiWi ER: fl?%/1 h? V/9JLIl d/S j Z /�� J I .SZ 7/ 7 3 ©�6�OS-- NAME PRESENT ADDRESS TEL, # CONTRACTOR:4Pp G;J AV.5a 7-/a/(I /,P'JZ� f , .e7J11Z7L2 rk J P 2 7i 1 Z TEL.# Residential 0 Commercial Est. Cost of Construction$ / 4 D i b Home Improvement Contractor Lie.# /`.j<y,5 7 Construction Supervisor Lic.# / S Q r 8 Workman's Compensation Insurance: (check one) 0 I am the homeowner 0 I am the sole proprietor AfI have Worker's Compensation Insurance Insurance Company Name: )91'l/9A/7iC C-44/7 /C Worker's Comp.Policy# 41 C'/ 9 0/,3 Z., 9 Q Cj 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 J Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing *The debris will be disposed of at: 74/0,74/p : 12'J7 Location of Facility .a^ 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.263,Section 1. i1 i Applicant's Signature: 43, Date: 7//1 5// ` Owners Signature(or attachment) Date: Approved By: _� �/ 0—'Date: 11 — ) i C1 Building 0 tcial(oresrgnee) EMAIL ADDRESS: Zoning District: Historical District: 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No 1.3-44-S. • Water Resource Protection District: Within 100 ft. of Wetlands: 0 Yes 0 No 0 Yes 0 No