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HomeMy WebLinkAbout40 Crosby St Ext Express Building PermitPei[expires 18o days from JAWOL= issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route, 28 South Yarmouth, MA 02664 C (508) 398-2231 Ext. 1261 )NSTRUCTION ADDRESS: 4 `- ram' S S 1%e e i k 7 i ECEIVED %J ?011 YARMOUTH 'SESSOR'S INFORMATION: Map: i Parcel: WNER. CL nr+ L_::i%e w Ltr; c�ui 11-t S�Ilk -7-2 y-�3L -C7Cc lc r ©. nr, �(1 l�l� rrAME FRESEi T ADDRESS TEL n E m ail Address : ti'--+ ]NTRACTOR NAME M-i=G ADDRESS Residential Commercial Est Cost of Construction 3me Improvement Contractor Lie. # Constructiou Supervisor Lie. Mlaw�i d=an's Compensation Lmurance: (check one) I am the homeowner I am the sole proprietor I have Worker's Compensation Ins trance surance Company Name: Worlrer's Camp. Falicyrt WORK TO BE PERFORNIED 'ent Duration (Fire Retardant Certificate attached?) Wood Stove iding: # of Squares Replacement windows: # Replacement doors: 1 roofing: # of Squares ( } Remove exisfing* (max. 2 layers) Insulation Old Kings Highway/Ostoric Dist. ( } Replacing like for like `The debris wHI be disposed of at Location of Facility Email Address: leclare tinder penalties of perjury that the statements herein contained are trite and correct to the best of my !=fledge and belief I understand that any fa:se answer(s) ill be just cause for denial or revocation of my License and for proRNutiou under IvLG.L Ch. 262, Section L. i pplicanfs Signattme.: _ 0- ti ls�h_�L ( i Date: I Lt t 1-7 wners Signature (or : 9.rLih- pproved By: Date: Building Official (or designee) Zoning District RS FEstorical District: Yes Flood Plain Zane: Yes No 4j� r ProPer4-1 — `-teS Water Resource Protection Distdct Within 100 ft of Wetlands: Yes No Yes No E VE s l i SEP 2017