HomeMy WebLinkAbout090320 Demo ApplicationO�.,Y�R ,lvu14.c u!.c vary
O Permit#
0.lAmount
` .ATTACH Est
4a --roto* ('
(Permit expires 180 days from
issue date
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
rDEVELOpMe14T Yarmouth Building Department
1146 Route 28 SEP $South Yarmouth, MA 02664 RECD(508)398-2231 Ext. 1261 COMMUNITY��ee
CONSTRUCTION ADDRESS: LOU Cj4_ 2Z
ASSESSOR'S INFORiMATION:
OWNER:
CONTRACTOR:
❑ Residential )aommercial
Home Improvement Contractor Lie. #
Est. Cost of Construction $—ago sk, ft;�
Construction Supervisor Lie. # CS ze (a -.I—
Workman's Compensation Insurance: (check one)
D I am the homeowner �_- I am the sole proprietorave Worker's Compensation Insurance
Insurance Company Name: -e CA- Worker's Comp. Policy# 'q JUn�3(0
WORK TO BE PERFORIMED
Tent Duration (Fire Retardant Certificate attached?) Wood Stove
Siding: # of Squares Replacement windows: # Replacement doors: #_
Roofing: # of Squares( ) Remove existing* (max. 2 layers) Insulation
L( -7-S 12
Old Kings Highway/Historic Dist. ( ) Replacing like for like Pool fencing
'The debris will be disposed of at:0 - L'i
LoRation of Facility
I declare under penalties of ry that the ate ents herei contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will bejust cause for dent or evocatio m license an for prosecution under M.G.L. Ch. 268, Section 1.
Applicant's Signature: I Date•
Owners Signature (or attachment) �, �� �- Date:
Approved By: Date:
Building Official (or designee) EMAIL ADDRESS:
Zoning District:
Historical District: ❑ Yes E_ No Flood Plain Zone: :1 Yes -j No
Water Resource Protection District: Within 100 fr. of Wetlands:
D Yes 0 No 0 Yes , No