HomeMy WebLinkAboutImage_003.pdf - BLDX-23-15505 21393EXPRESS BUILDING PERMIT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
I 146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
Offc. Usc Or y
Pcrmit#
Amounl
Pcnhit cxpirB 180 d8,5 fiom
issuc datc
RECEIVED
BUILDING DEPARTMENT
By
--
-'.- =-_-CONSTRUCTION ADDRESS:
ASSESSOR'S INFORMATION:
0&r+A.Q"t c*L
Map Parcel
OWNER:iY,".
NAME
(o S/oo
ADDRESS TEL #
coNrRACroR: P^{^.L Sa*Vr 20. gor j4,t y--17.1-?174 0s)-
NAME TEL. d
Est. Cost ofConstuction S
Construction Supervrso rLic.* CS-friaqo
! t have Worker's Compcnsation Insurance
WORK TO BE PERF'ORMEI)
MAILINC ADDRESS
ER€sidcntial
Homc lgDrovcm.llt
Tent Duration
Siding: # ofSquares _
Roofing: # ofSq uares
al
Contrsctor Lic. #/b{aDbAo.r"r"i
Workman's Compensarion Insulang(: (ghcck onc)
E I am the homcowner @(am tte sole proprietor
Insurence Compary Name: _ Workcr's ComD. policlc
(Fire R€tardstrt Certificlte attached?)
ReplacemeDt wind ows: *-3)-
(fl) Renove existing+ (max. 2 layers)
Wood Stove
Replscement doors: #_
Insulation
Pool fencin O,O onrr Highwry/Historic Disr l@.ephcing like for tike
h^r,,.Thc dcbris will bc disposcd of at:
I declarc undcr pcnaltics ofpcrj
will bc just caus. for denial
Applicanl's Sigrature
Owncrs SignriurG (or
Locitiotr of Frcility
th81dlc statcmcnls hqEin containcd 0r! trrrc &rd conlc.t to lhc bqst ofmy lorcwledtc and bclicf I undcntand thar ony falsc rns*!(s)of liccnse and for prosccution unda M.C.L.Ch. 26t, Scction I
a-f{a
Darc: /0 *n
tc: /6
Building Official (or dcsignec)EMAII- ADDRESS
Zoning District
Histo cal District: Yes No
Water Resource Protection DistrictYes No
flood Plain Zone: Yes No
Within 100 ft. of Wctlards
a Yes No
Approvcd By
U. AhlL-
L;1',,{
Datc:
Bellew Tile & Marble
280 Route 28
West Yarmouth, MA 02673
To Whom lt Concerns:
lgive Pat Jacobs permission to work on our building at 280 Route 28, West Yarmouth. Please reach out
if anything further information is needed.
Sincerely,
mes Bellew
iimmv@bellewtile.com
508-375-5100