HomeMy WebLinkAboutImage_003.pdf - BLDX-24-88 35920,., * e{at1-!-1 7
e^ou* I Od.00
Permit cxpires 180 days ftom
issue dale
EXPRESS BUILDING PERMIT APPLICA
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Roure 28
South Yarmouth, MA 02664
(508) 398-2231 Ext. 1261
{/,r'irz lae
N
CONSTRUCTION ADDRESS
ASSESSOR'S INFORN'1.{TION
,**, ftr/l ./"L/t 1:z-2,1 t *: t:ts l4A 9ot-X-73es
JAN 85 202{
UILOtNG DEpARTtr4
REC EIVED
B
R ENTv.-...-.-_.-
Parcel
NAIVE
coNr*ecrop.:&.r., /l rC-J ,/o 4@-vr.ou Al*/*.729 -74-H/
PRESEN_T ADDRESS TEL. #
NA.\,IE ilLAILNG ADDRESS TEL. #
Est. costof Coostuc tioa g 9d6A . AO Residential E Commercial
Home Improvement Contracto r tic. S ,12151y'Constructioo Supervisor Lic. # CS'A5-77/o
Workman's Compensation lnsurance: (check one): I am the homeowner t I am the sole proprietor I I have Worker,s Compensation lnsurance
Insurance Company Name
..7-5 Z-4 Worker's Comp. Policy#_
Roofing: # of Squares_ ( ) Remove existing* (mar. 2 layers)
_ OId Kings Highway/Historic Dist. ( ) Replacing like for like
'The debos will be disoosed ofat:b,
Tent _ Duratiotr
Siding: # ofSquares
Applicant s Slgnaturel
Owoers Signature (or anrchment)
(Fire Reta rdant Certificate attached?)
Replacement windows: #_Replacement doors # /
Insulation
Pool fercing
s
Loc r of Fecilitv
I declate under penalties ofperjury- that the statements h.rein conrained are tnre and conect to the best ofmy knowledse and belief I undarstard that any false answer(s)wrll bejust cause for dedial or of ml and for prosccution under lvl.G L. Ch. 268. Section Ilr
Date: /
Drle
Approved By DateBuilding Ofriciai (or designce)E}LA,IL ADDRESS
Zoning District:
Hisrorical Districr: I Yes : No
Water Resource Protection District:i Yes lNo
Flood Plain Zone: I Yes lNo
within 100 ft. of Wedands
- Yes _ No
lns/ruc*rr'-fiot;(w-
9//Za//. rrl,-_
\\.ORK TO BE PERIOR}IED
Wood Stove
Map: