HomeMy WebLinkAbout136 Wimbledon Dr Express Building Permit for Demoo� ,Y*`t�4 r ` -
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!Permit expires 180 days from
{issue date
EXPRESS BUILDING PERMIT APPLICATION.,'
TOWN OF YARMOUTH --- r
Yarmouth Building Department
1146 Route 28�� `� 71�1
1
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS:
ASSESSOR'S NFOR1vIATION:
Map: 71- Parcel: 711'3CJ
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OWNER:
PRESENT ADDRESS TEL. 4
CONTRACTOR: 6�� {
PAIVIEt MAILING ADD SS TEL, 9
YResidentiai ❑ Commercial Est. Cost of Construction S
Home Improvement Contractor Lic. # Construction Supervisor Lie. #�E.�3b33�
Workman's Compensation Insurance: (check one)
C I am the homeowner 17 I am the sole proprietor have Worker's Compensation Insurance
Insurance Company Name; ^ktapft"Y�ll' Worker's Comp. Policy#
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
Duo
*The debris will be disposed of at:54
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Location of Facility
I declare under penalties perjury that 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 den a r revocati of my license and for prosecution under M.G.L. Ch. 268, Section 1. V
Applicant's Signature' Date;
Owners Signature (or attachment Date:
Approved By
Date:
Building Official (or designee) EMAIL ADDRESS:
Zoning District:
Historical District: ❑ Yes ❑ No Flood Plain Zone: ❑ Yes ❑ No
Water Resource Protection District: Within 100 ft. of Wetlands:
❑ Yes ❑ No ❑ Yes No
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