HomeMy WebLinkAboutbld-20-004483 umce use unit'
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Permit expires 180 days from
issue date
EXPRESS BUILDING PERMIT APPLICATI l ' ' ECEIVED
TOWN OF YARMOUTH
Yarmouth Building Department ' FEB 1 3 2020
1146 Route 28 !=
South Yarmouth, MA 02664 1-49Ci NAR NT
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 5-S° (s4' t-t,.c y'
ASSESSOR'S INFORMATION:
Map: Ci"Z Parcel: k
OWNER: tArL`rti v2 "ee-. 7 e) 5€' 8 Z- 3 S
NAME PRESENT ADDRESS TEL. #
CONTRACTOR:
NAME // MAILING ADDRESS TEL.#
Commercial Est. Cost of Construction$ 36 0O*`')
Home Improvement Contractor Lie.# Construction Supervisor Lie.#
Workman's Compensation Insurance: (check one)
A I am the homeowner ❑ I am the sole proprietor ❑ I have Worker's Compensation Insurance
Insurance Company Name: Worker's Comp.Policy#
WORK TO BE PERFORMED
Tent Duration i fro (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:
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 vocal. of my license and for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature: Date: Z" i �w24p
Owners Signature(or attachment) Date: 2 t'3"`Z-'0
Approved By: Date: `lt\ t\O
Building Official(or designee) EMAIL ADDRESS:
Zoning District:
Historical District: ❑ Yes O. No Flood Plain Zone: ❑ Yes ❑ No
Water Resource Protection District: Within 100 ft.of Wetlands:
0 Yes 0 No 0 Yes ❑ No
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