246A Pleasant St Request for partial demo03/28/2016 14:48 5083983579 WINKIR PRINTING PAGE 01/84
TOWN OF YARMOUTH
1 146 ROUTE 28. SOUTH YARMOUTH. MI ASSACHUSETTS 02664-4451
Telephone (508) 398-2231 Ext. 1292 Fax (508) 39$-0936
YARMOUTH HISTORICAL COMMISSION
NOTICE OF INTENT TO DEMOLISH A HISTORIC BUILDING
To be submitted to the YHC along with Demolition Permit Application
Date of Application.- J (d4 / �' Demolition: (circle on rtial or Total
Building Address: &A �L�QSQ_n4- '�e C_
Assessor's Map # L 1 Parcel # 0 Year built:
Reason Building is Considered Historic (check all that apply):
ver 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
Property Owner,.' [ _
Address: c /an `
City/Town; / C S State:,44 Zip Code: Q a t/
phone#: j -7- 4j 6-�_ -041 aq Cell#
Email: 01'(2MDQ.(& A2GtCC/2OA1)1'�Lc� q6k),?
Agent/Contractor; /' 'S r
Address; J&Q�
CityfTown: h6 r State: MA Zip Code:
Phone#: Cell#
Email: C Cent(znmSY) nm
Panenn fnr riamnlicrsn
Description of structure to be demolished:
Please include with application:
• Color photographs of all sides of the structure being proposed for demolition
• Map showing location of property
• History of the building/property (if known)
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r)ffice Use Only
Penmii#
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Permit expires LBO days from
EXPRESS BUILDING PERMIT APPLICATION
TOWN OF Y,A.RMOUT14
Yarmouth Building Department
1146 Route 28
South Yarmoutb, MA 02664
(S08) 398-2231 Ext 1261
E C
F
PR
05 21;
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CONSTRUCTION ADDRESS: 1 2 &, ,-/ G /-/ X_ 13 a ��- -
ASSESSOR'S INF'ORMATTON:
Map. �,3Parcel:
OWNFR.: LC �Zj, •1-"7Z�Ylr�. K�iarxpa�d az�2.�ap��rx�
ear
lvArwtE -/ p u ,9 �lci nd r a iT' 20� -S .f.��r 79? -':1 tEl u o 8-95 mafl Address:
CONTRAC'T'OR: �71' f 5 � r a7Q(o x—
NAM1 IIIA G 1V]D355 S l—$58 - / io =-�. #0'1 Cen f� yy�fii':
Residers ' CarmoarcW list. Cost of Construction fi b
Home Improvement Contractor Lic. # a! --156 42 S Construction fiiiperviaor Lie. # d- S -Q fo q I R 6—
Workman's Compensation Insurance•
I am the bomeowner ` f am the (tole proprietor I have Worker's Compensation Insurance
Insurancc Company Namet Worker's Camp_ Policy#_ / !,
WORK TO BE PE' EM.RMED 149a
Tent Duration 0 616y,50Fire Retardant Certificate attached?) Wood Stove
Siding: # of Squares Replacement windows: #
Roofing: # of Squares ( ) Remove existing* (max. 2 Dyers)
Old Kings Highway/Historic Dist. ( ) Replacing like for like
CGIX)'t f -/'S -�b /SrU S Q l eo
• J"hc dchris will he dupnmd of at L12 C -M0
Location
Replacement doors: #
Insulation
I declare under peuttldm of per]nry that the statements herein contained are true and correct to the heat or ray knowledge anti belief. l nnderstand that any false annwer(s)
will he jv.vt cauac for denial <sr satin of y l'tconwe and fnr proseaution under M.G-1.. CL. 268. Sectlnra L.
Applicant's Signature �� _. _.._ _ l
Owners Signature (or attachment), --[1nte: 3 a
Approved 14y;
Date:
Building Official (or designer:)
Zoning District- __—
historical Mari= Yes No Mood Plain &ue: Yc9 No
Water Resource Protection District: Within IDD A. of Wetlands:
Yes No Yes No