HomeMy WebLinkAboutImage_002.pdf - BLDX-23-15562 22496Office Use only
tA/tA-
.Permit.xpires 180 days from
issue date
RECE!VED
Nov 0 t 2023
BUILDING IJE PARTMENT
CONSTRUCTION ADDRESS:
ASSESSOR'S [tiFOtu\LA.TION ;
TO\[,N OF YARI,{OUTH
Yarmouth Building Department
I 146 Route 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
a\ (o"f,orn S\qn \r or U
Y
N{ap Parcel
c\it (5 \r ), FLtr 9 tl)bqqq
NA.\IE P .qDDRESS TEL +a
ivL{lLNG ,ADDRTSS TEL, #
I Commercial Est. Cosr ofConsEuction S 4o 00
HomeImprovementcontractorLic.#-coostructionSupervisorLic.#-
NAlvlE
desiaqrtia
Workmag6 Compensation Insuranee: lcheck one)y'l a. th" horneo*ner f I am the sole proprielor
CONTKACTOR
Tent _ Duration
Siding; # ofSquares
icy4-
ben o /; rtuL;i l'tr
r--e{kriadu-10
wooaxoie Ei_(dlrylc_
Reptacement door' n l"tkr'Ot- -
Insurance Company Name: _Worker's Comp. Pol
a I have Worker's Cornpensation lnsurance
(Fire Retardant Certificate attrched?)
Replacement rvindorvs: Itro
Roofing: # of Squu... tt ,
_ Old Kings Highwav/Historic Dist.
'The debris will be disposed ofat
Applicant's S ignaturc
/onrr* sigo
Approved By
Building Oflicral (or designcej
) Remove existing* (mar.2layers)
( ./Replacing like for tike
Location of Facilirr_
EIVL{IL ADDRESS
Insulxtion
Pool fencins
I declare under penaltics ofperjury th the statcments herein contained are uue and correct to rhe best ofmy knowledge and belief. I undersBnd that ary false answer(s)will be just cause for deDial or revocation of my license and for prosccution undcr M. G.L Ch. 258, Section I
Dale
ature (or !ttachment)Drta:
Date'
Zoning District
Historical Disricr: : Yes _ No Flood Plain Zone: - Yes ,l1q- 3A-7 -
E3ET
Dauiat-
o\
Within 100 ft. of Wetlands- Ycs I No
lvater Resource Protection DistrictI Yes lNo
dst'rlmgns (qe 1ffi, il/r\
EXPRESS BUILDING PERMIT APPLICATION
By,
OW}iER:
\I'ORK TO BE PERFOR\IET)
11 <*,. Ao\I1
(\*uut ,no\It
(b^*., ,, ,1q\5ru(
f\,,,\^ W\
^tJ lacz u)h rro't
)u 1tJ\ o"')
rn J q\rn\,0$
Los q^)
j I wL./{rplo c<c*/ t
,r(
t{(),, l, h r<L)a(L
4
n(,J \vul1rl ,rJ loc r- ,, I h rc<,)
pawrta- V*n)-d \\n'r ur.J u,,\^c< .,-,'ih tukJ
fhun",.-
Nv"t*
0+tolrli-,L
(l-nnruouc
{L1*.\A
e$nt'(
\ q' uA\ \\^\ 1'
,{..V\.^ o,nJ ur g\r'c<
Jows p4,5tlv'b 0d ai ?
5o*S< )oo'r o',) n [(
L "ilJs"S ot.< ,,tlJaul
e n [t1 ]oor5 !. rr,.
M ^ - >Itc tt""a (
trbrrck <rtLl n-,na
(zr- u(lh lYl <Jt
(e,'-t ! f' l\4 4
^,t l,.rcf
\,r-t )4rAaXa*.