HomeMy WebLinkAboutFinal cost affidavit/owners affidavitTOW\ OF YAR-N,IOUTH
I146 Route 28,South Yarrno
ext. 1261 Fax
uth N{A 02664
508-398-2231 508-398-083
Office of the Building Commissioner
FINAL COST AFFIDVIT FOR WORK IN FEMA FLOOD ZONE
To the Building Commissioner,
In accordance with 780 CMR Section 109 of the Massachusetts State Buil ding Code, the total estimated co$ of
construction, including all related costs* ofthe building at b.
permit no b
?
and constructed- reconstructed. altered- reDaired- or extended under buil
amounts to s 1te .o$ ' ao 1o
S being referred to as the owner/agent identified below, do solemnly
swear that the statemen made herein are strictly true, correct and made in good faith
*Related construction costs include all work done with or concurrently with the work contemplated bythe building
permit including construction, reconstruction, repairs, demolition, HVAC work, etc. Fumishings and portable
equipment are not part of the total coDstruction costs.
u)
lgrature of owner/agent
.T
J{l 0tr )Dq
tary Public Signature My Commission Expires
,t
I,
v
S
N
rAN26; I,ao,"c oeoen ar6fr,
RECE IVED
BUI
Notary Seal:
@*,mf"mi.;xl;-,
t
TOWN OF YARMOUTH
BUILDING DEPARTMENT
1146 Route 28, South Yarmouth. MA 02
Telephone 508-398-2231 ext. 1261 Fax 508-3
Owne/s Affidavit: Substantial lmprovement or Repair of Sub
Property Address:il
Parcel lD Number:
c5
t(L
E6CEI\.rEDI
L
JAN 2 6 202{IlBUILDINGOtPnRTrUettr
Owner's Name:C Q"..-lt C(',\)1
Owne/s Address/Phone: Y
Contractor:
Contractorr's License Number:o4,, g't/)
Date of contracto/s Estimate:
I hereby attest that the description included in the permit application for work on the existing building all
improvements, rehabilitation, remodeling, repairs, additions, and other forms of improvement. lfurther
attest that I requested the above-identified contractor to prepare a cost estimate for all of the work, including
the contractor's overhead and profit. I acknowledge that if, during the course of construction, I decided to add
more work or to modify the work described, that the Town of Yarmouth will re-evaluate its comparison of the
cost of work to the m arket value of the building to determ ine if the work is su bstantial improvement. Such re-
evaluation may require revision ofthe permit and may subject the property to additional requirements.
I also understand that I am subject to enforcement action and/or fines if inspection of the property reveals
that I have or authorized repairs or improvements that were not included in the description of work, and the
cost estimate for that work that were basis for issuance of a permit.\
Owne/s Signature:
Date: 0 t/a,-/t .i
,@Notarized:-/+
C-zc>-
GEPHSONEUfl*?,ffi*m1llffif*,