HomeMy WebLinkAboutFema floodZone Affidvitt TOWN:OF.YARN1OUTH
1146 Route 28(,-SOittlaltrittouth, MA 02664
508-398-2231 eie 1ra .508-398-0836
Office of the Ball
RECEIVED !
31 ii Diwd DERARTML=ti'
FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE
To the Building Commissioner,
In accordance with 780 CMR Section 109 of the Massachusetts State Buildin CodeI the total estimated cost of
construction, including all related costs* of the building at /0 CA/kJ? Woad
and constructed, reconstructed, altered,repaired,or extended under building permit no. -DOSO 2 9
amounts to $ /05 -5<00. 00
'q6L a
I, �(u2 � o ,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. Z171-')1"etA°
ch
Signature of owner/agent
a13
Notary Public Signs e Commission Expires
DONNAMARIE E FUSCO
Notary Seal: State of Connecticut
My Commission Expires
June 30,2023
alp- Ict- 005-0