HomeMy WebLinkAboutImage_003.pdf - BLDX-24-28 33078Office Use Only
Pcrmit* I p
,tD"'
rPermit cxpires 180 days from
iissue date
EXPRESS BUILDING PERMIT APPLICATI
TOWN OF YARMOUTH
Yarmouth Building Department
I 146 Roure 28
South Yarmouth. MA 02664
(508) 398-2231 Ext. t26l
)S \, OAJZ 3x1rt/-- 1vtfi ol-bvcaJo
JAN 0e 202{
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By
CONSTRUCTION ADDRXSS:
ASSESSOR'S TNFORN{{TION:
OWNER: -nP\
l\lap Parcel
PeFL a,s tE,-E+Joct\>0p€ 21'4->-)o' %35
N,{\IE gR-ESE)_T ,l.DDRISS TEL. #
CONTR{CTOR *tT *owvt6 @ fuv 3> >Cp..,,rS tl+4 g)6'ago gtrll
\,{\IE NL{ILNG ADDRESS o&36 TEL ;
Est. Cost ofConstruction $5xo
csfrA- o9 fl6l
Wood StoYe_
Replacement doors: #_
Itrsulation
Pool fencing
Tent
i Commercial
Home lmp rov€ment Contractor Lic. #
Insurance Company Name Gr,./t 'JS . co.
fiqqrt Construction Supervisor Lic. #
workman's Compensation lnsurance; lchack one)
I t amthe homeowner 1$ am thc sole proprietor - I have Worker,s Compensation Insurance
Worker's Comp. Policy* _
\\.ORK TO BE PERFO RJIED
Duration (Fire Retardant Certificate attached?)
Siding: # ofSquar". 3 Replacement windows: #_
'The debris will be disposcd ofat rfffYz*au'/Y+aFA.5 +llLL-
Location ofFacilitv
I declare und€r penalties ofpedury rhat the statements herein contained arc true and conecr to the besl of my knowiedgc and belief. I undersrand that any false answer(s)lvrll bejust cause for denlal or mv Iicense and for prosecution under Nl.G L.Ch 258. Section Ino
Appftcant's Signarure
Owoers Signature lor attachment)
Date /.1 >r/
Di te:t-1-nq
Approved By DaleBuildhg Officral (or designee)E!L{IL ADDRESS
Zoning District
Historical Disticr: a yes I No
lvater Resource Protection District:a Yes -r No
Flood Plain Zoner - yes I No
Within 100 ft. of Werlandsi Yes I No
)2. +)o4-^465230 cdMcAli per
(@sia'ttiat
Roofing: # of Squares_ ( ) Remove eristing* (mar. 2 layers)
_ Old Kings Highwav,/Historic Dist. ( ) Replacing like for like