HomeMy WebLinkAboutBld-20-000709 FEMA Flood Zone RECEIVED !
TOWN= ' AR OUTH
1146 Route 28 S.P 1 i �
�` th, MA 02�6�
508Q (gyp (�Q (�Q Q _�. �.-.__-. _. ._.
—398-223t \~ �' 08-398-08 6,t _DING DEPART'ENT
Office of theM � s `,, missioner
£4 1 Al S •
FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE
To the Building Commissioner,
In accordance with 780 CMR Section 109 of the Massachusetts State Building Code, the total estimated cost of
construction, including all related costs* of the building at 114 - 1(0 _ 1
and constructed,reconstructed, altered,repaired, or extended under building permit no. ({.-) -Q1O -
amounts to $
I, b-Pl ikk s k-e4 LA ,being referred to as the owner/agent identified below,do solemnly
swear that the statements made herein are strictly true, correct and made in good faith
*Related construction costs include all work done with or concurrently with the work contemplated by the building
permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Furnishings and portable
equipment are not part of the total construction costs.
ignature of owner agent
BEAR KROSEL.
' 1 Nct ry Publ c
°\ i i.:C,T,r— to Of C'1,lSSl?S
1
4 `` My Camrrrssieri moires Aprii 16.2021
Notary Publ Signature My Commission Expires
Notary Seal: