HomeMy WebLinkAbout21-EB0080 108 Main Street ApprovedCEIVED
DEC 2 9 2021
YARMOUTH
EXPRESS BUILDING PERMIT APPLICATI
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: C " 41`17 kr
ASSESSOR'S INFORMATION:
f Map: Parcel:
OWNER:
NAS i' I�+.`t1 S� i/�►�����
A
Office Use Only
Petrnit#
Amount
Permit expires 180 days from
issue date
PROVED
DEC 3 0 2021
YAR vj0u-i r
+' r % 1r.L. rF
CONTRACTOR:�Gc�Jes LV
Residential CiCommercial
MAILING ADDRESS
TEL. # SO � 76'0 270 Z
Est. Cost of Construction $_
Home Improvement Contractor Lie, # J ([ CSS `
Construction Supervisor Lit. # �I�7 3s
Workman's Compensation Insurance: (check one)
13 I am the homeowner 111 am the sole proprietor Q6 have Worker's Compensation Insurance
Insurance Company Name: L A ��
Worker's Comp. Policy# j i3 U t l v
Tent 11 Duration
WORK TO BE PERFORMED
(Fire Retardant Certificate attached?)
Siding: # of Squares _ �Rejplacement windows: #
Roofing: # of Squares 2�_ (®) Remove existing* (max. 2 layers)
12— Old Icings Highway/Historic Dist. Eb Replacing like for like
c& 1 v-vr 1 S i4ie S co,e
"The debris will be disposed of at l Y14 d,) ' f& M
Location of Fariliiv
Wood Stove-0—
Replacement
tove
Replacement doors: #
Insulation
Pool fencin
ylrG�r r+ii ct p r
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 revocatiW of my license and for prosecution under M.G.L. Ch. 268, Section 1,
Applicant's Signature
— Date:
Owners Signature (or attachment)
Date:
Approved BY:
(or
EMAIL
Date:
Zoning Distrito.
Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes 11 No
Water Resource Protection District: Within 100 ft. of Wetlands: 1 _�
❑ Yes 0 No 0 Yes ❑ No
r
CP P- -fil OV FF
'f
-1r . ,y�jl•-
•W �
3�.
�ti- -
a
CP P- -fil OV FF