HomeMy WebLinkAboutBLD-23-000084 a - 6
0 £1 ) per Office Use Only
g�
' Y I RR .-1 L i 1 Z� Permit# 0. -i'- '35
r4011;ca \ ► 3 S' Qb
OA 3 Amount
tr` ", : Permit expires 180 days from
issue date
6 --oz 3-WO SI
EXPRESS BUILDING PERMIT APPLICATI 1
TOWN OF YARMOUTH __.:_.._a.•-......_-... .-..—
Yarmouth Building Department JUL 06 2022
1146 Route 28
South Yarmouth, MA 02664 BUILDING DEPARTMENT
(508) 398-2231 Ext. 1261 BY _____________
CONSTRUCTION CONSTRUCTION ADDRESS: 7 c-ffel-Z L . L., `~
ASSESSOR'S INFORMATION: i
Map: Parcel:
OWNER: Ic.i4.._ Co it. J `.'"4,...,_ 'VIc fT (' �$is'trtet ,. 27,f- 5S4 - �3 i t
NAME PRES ND ESS_ e TEL. #
YYYYYY :o"
CONTRACTOR: West Dennis, MA 02670 0 e, -0 C
NAME Cva �) !_659:&4 TEL.#
❑Residential ❑Commercial CSL >"�3 iC st C st9 onstruction$ I!t'
r" ,
Home Improvement Contractor Lie.# j( 1 V7 25 Construction Supervisor Lic.# 3(a 3 3
Workman's Compensation Insurance: (check one)
- I am the homeowner h
} O I am the sole proprietor Whave Worker's Compensation Insurance
h
Insurance Company Name: V, , ,I L..L,1,+y 4• 1-t ft i.,%1 Worker's Comp.Policy# 5_ C Cl 3 1 D- ,
WORK TO BE PERFORMED
Tent Duration (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: .4- -3 e XC L.
Location of Facility
I declare under penalties of perjury th t 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 revd " u y license and for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature:' ' / Date: 7k 1r''
Owners Signature(or attachment)'f t2 Date: ? I,/,^t
Approved By: /'/ t Date: 47— 7-2
Building Officia de . ee) EMAIL ADD S:
Zoning District:
Historical District: I Yes U No Flood Plain Zone: Yes No
Water Resource Protection District: Within 100 ft.of Wetlands:
[I Yes _-; No Yes _ No
ff4- 6/7~,-me,tet7,,telt ,„/A
Office of Consumer Affairs and Business Regulation
1000 Washington Street- Suite 710
Boston, Massachusetts 02118
Home Improve tractortractor RegistrationL1/4F ,, Type: Individual
i MICHAEL MCCARTHY :r,.,. ,i,. •s .. . i..,'f piration. 1615J2
P.O.BOX 52 g:, - - 'A Expiration: 06/15/2023
WEST DENNIS,MA 02670 v; ,i
n I._
- Update Address and Return Card.
Sca 1 a 2rt•O5/17
Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only
TY Individual before the expiration date. if found return to: --
pegist otn gxpiration Office of Consumer Affairs and Business Regulation
06/15/2023 1000 Washington Street -Suite 710
MICHAEL MCQAIMIN-s ;7 Boston,MA 0211( ,
a / 1,1"?.---
---,,MICHAEL F.MC� ,'-r'. � ,
6 RANGLEY LN. n t '= f, f '
SOUTH DENNIS,MAi` s l'/ Not val
Undersecretary / Ifout signature
IPg. Commonwealth of Massachusetts
Division of Professions!Licensors BUILDING PERFORMANCE INSTITUTE, INC.
Board of Building Regulations and Standards 107 Hermes Road,Suite 210
in
Constialk%ifpiTispr Malta,NY 12020
(877)274-1274
CS-058633 ' - `" . spires 04/101202i www.bpi.org
MICHAEL J 1 C Wii`g 1i .1 '. :--
PO BOX 52 y ,,' i j '
WEST DENNIS?MA-, t,,
air °2i Michael McCarthy
'fl 4 BPI BA 5023246
K. V lX+ul.. :�, t- <,, : r^ f '. i"'t"..r Lw',:j;t t i i
Commissioner di t,T c. p .- ,..... .. «..m..,:..."
f r'" (SEE REVERSE SIDE FOR DERONATIONS AND EXPIRATION DATES)
Airthael McCarthy
PO Box 52
West Dennis' A'02670
( o8ô - ?
1 CI` G �k �1 G1 I a `G 0
J Y 5'
R., 4 FCC . -1 -t
RISEaoys4z
ENGINEERING`
OWNER AUTHORIZATION FORM
Elaine H Collins
(Owner's Name)
owner of the property located at:
87 Stratford Lane
(Property Address)
Yarmouthport, MA 02675
(Property Address)
hereby authorize
Subcontractor(to be filled in by office)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
- ignature
6- i 3-aa.
Date
RISE Engineering, a Division of Thielsch Engineering, Inc.
765 Attucks Lane I Hyannis, MA 02601 1508-568-1926
www.RlSEengineering.com