50 Park Ave Intent to Demo 03.22Yc TOWN OF YARMOUTH
O
O .. 1146 ROUTE 28, SOUTH YARMOUTH, MASSACHUSETTS ,02664-4451
x Telephone (508) 398-2231 Ex 1292 Fax (508) 398-0836
YARMOUTH HISTORICAL COMMISSION
NOTICE OF INTENT TO DEMOLISH A HISTORIC BUILDING
To be submitted to the YHC along with Demolition Permit Application
Please Include with application:
• Color photographs of all si es of the structure being proposed for
demolition 0ndudcd )
• Map showing location of property (.Ihclurled)
• History of the buildinglproperty (if known) [lJ`nknt>Wn�
Date of Application:
Building Address:
Demolition: (circle one): Partial or Total
L 'win =- -11MUM M
Assessor's Map #--dQ Parcel # -73 Year built: I�
Reason 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
Owner. D-.v--, C i,,A-6 i
Address:
yityt i own: W . y�,r�� State: NIA Zip Code:
Phone#: Cell#
Email: C�'�-eSC►Vti-Ci.11 •`- • 535R
Col_ Amain, . c _vrn
Date: 3
Address: TO j5k�,(,
CitylTown: (VekZ-j•py\ State:MA Zip Code: pate
Phone#: 1pl-1 q��• 14-1 �i- _ Cell#.(D 1- • 4 LAt.
Email: i cv ,f c.}lc�� ail. •CSLW
Reason for demolition request: T ('+ Ingle-• j
Proposed reuse of property: Q 2
Description of structure to be demolished: -!„ ^-k ; L , ! 9 .1.1%
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•o.Y� TOWN OF YARMOUTH
0 _ " y BUILDING DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664 508-398-2231 ext. 261
BUILDING DEPARTMENT
TOTAL DEMOLITION SIGN -OFF FORM
State Building Code (780 CMR) Chapter 33, Section 3303.6-Service Connections
"Before a building or structure is demolished or removed, the owner or agent shall notify all
utilities having service connections within the structure, such as water, electric, gas sewer and
other connections. A permit to demolish or remove a building or structure shall not be issued
until a release is obtained from the utilities, stating that their respective service connections and
appurtenant equipment, such as meter and regulators, have been removed or sealed and plugged
in a safe manner."
"All debris shall be disposed of in accordance with 780CMR 111.5,"
Building or Structure Pcation:,5 OparK ftue- Map: c2 Lot: 7 3
Owner's Name: Ci04c-4' Address :3)Parg IhVf_ Phone: rot7.3Y7.5357
Contractor's Name:'?)ne_CWAddress: 59()(ovO Phone: fo/7 9tcS• I97 $
F_f Eversource: Date:
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National Grid: Date:
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Water Dept,: Date:
By:
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Board of Health: Date:
By:
Title:
Condition:
Fire Dept.: Date:
By:
Title:
Historic Commission: Date:
By.
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{ Conservation: Date:
By:
Comcast: Date:
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