87 River St Notice of Intent to Demo 2016o TOWN OF YARMOUTH ���Ii
o
1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS 02664-445 r ►. ����
Telephone (508) 398-2231 Ext.1292 Fax(508)398-0836 ",
YARMOUTH HISTORICAL COMMISSION YA'r';��. r
HISTOR,
NOTICE OF INTENT TO DEMOLISH A HISTORIC BUILDING M rssror
To be submitted to the YHC along with Demolition Permit Application
Date of Application: Demolition: (circle one): Partial or Total C r
Building Address:_
Ito U
Assessor's Map #_qj__ Parcel # F Year built: 9i (7
7Rea on Building is Considered Historic (check all that apply):
Over 75 Years Old
„Located in the South Yarmouth/Bass River National Register Historic District
Listed on National Register of Historic Places
Resource for historic listings: Massachusetts Cultural Resource Information System: www.mhc-macris.net
Property Owner -
Address: MAW =611
City/Town.- State: ZipCode:
Email:
AgentlContractor:
Address: c 0 r
Reason for demolition
1 it a (70L
Proposed reuse of property:
Description of structure to be demolished:
Please include with application:
• Color photographs of all sides of the structure being proposed for demolition
• Map showing location of property
• History of the building/property (if known)
Updated 9!2015
9
ONE & TWO FAMILY ONLY - BUILDING P -
APPLICATION TO CONSTRUCT, REPAIR, RENOVATE OR DEMOLISI[ A ONE OR TWO AIMILY DWLI*I }Nk(
Town of Yarmouth Building Department tD
1146 Route 28 - South Yarmouth, MA 02664-4492 Av 17
508-398-2231 ext. 1261 Fax 508-398-4836 4�'`�
HISTORYaR,I4pUri, .
Otflce Use Only Planning Board Information Assessors Department Infarmabon_ UM�S.SIfj
Permit No. Date Pian Type AFap tDr
Permit Fee $ Endorsement Data
Recording fate New
Deposit HeC'd. $ pate Plan No. 1.4 Property Dimensions:
Net Due $ Other III Lot Area( Frontage (ttj Lot Gaveraga
-
&ifiirr� tom; 1119 Fs nate regt,trerk
season 2 - tarty Ownership/Authertzed Agen
Z ! ed ReC
ri 1 ,
Name�Pri� j
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Signature
2..2 A+tU"wfted Agents
Namt(prin�
Signature Telephone
Stadion 3 - Cortahixiiw Sarvirsa.
s.i E3een"d cansteuatloea &*ervieors
co ro-e. N-yc�p_
Mailing Address W6_jY4-� jk6 0jk jZq 0 j(,
Telephone
13
Meiling Address
Fax
Not Applicable a
License Number
Expiration Date
3-2 Registered
Home Itn
ovement Contractor:
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Not Applicable]
Address
Signature
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Telephone
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License N� t
Expirasion D to
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Av 1
Work8M CGMVG0 of n IMPUMMS E 2ylt must bg cmM Steil armbmfried v0th tiff
!hash
to provide this affil vit w;0 msuR In ftD dwfaf of the i� of the building permit.
�Plkatt
ory
S1g1 ied Afdavd Attached Yes ..."'L. >qo ..........
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3. Pkwnbkq /Gas
Now CWSO�cse ❑ Na rd ffedmoM Na at Ukomm
5. Mrs Protection
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AccesacqFildc, ® [� int other
Sps-fsSy:
i. rotas ggmm Ft. l = hasps a moo*
Sadk i X • tufa d Cdrignctico
ttatst
Estimated Coat 10ol4tm) to be
cor VWt d by parmif applicant
1. Bulk*q
civ
2. Etechicel
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3. Pkwnbkq /Gas
4. Mechankmi (HVAQ
5. Mrs Protection
--
8. Total:(f +2+3+4+5)
i. rotas ggmm Ft. l = hasps a moo*
i. ClUft w AadPwir17a+k m.
or Coritract+cr ADviles for Mjlkmct Permit
j
I Check Below I
❑ Conzmva*wv-CommFsaiar► Fling
(N am kable)
❑ Otd Klrrgs Hlghtaey & Htakrisal
Commission appmel
(N applicabl®)
, as owner of tate subpd prnparl�i
hereby auftrize _ - l ICfAY( I C., �,V()y (, l' to act on
my behalf, in all matters retative to work a(dthoriaed by this building p®rMR appti n.
� .P. -t& c t✓ , i j i t
Sem 7b - Qwnsr/Auftdasd Agarrt 0�9 -
, as OwedAulhorfaef Agent
Nreby declare 1114 the statements and in.arF'--a art On the lors9cing applCation a f, Irene and accurats,
to tate bast of my know(odge and ball -0.
Signed under the gauss and penalties of padcvY.
Signature al 04-,w1Agz1! `oats,
9-13-99 2 c42