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Permit#
Pormit cxpiEs I 80 days from
issua data
EXPRESS BUILDING PERMIT APPLICA
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(s08) 398-2231 Ext. 1261
CONSTRUCTTON ADDRESS:
ASSESSOR'S INFORMATION :
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Map: l.[1,17 Parcel:
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owNER, bQic'\(\rsrl to €\EDB(rcr< ?L o1?60
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By-UI
CEIVED
FEB 06202{
CONTRACTOR
NAME
Efi.esidential ECommercial
Homc Improyement Contrsctor Lic. #Losvso
Workman's Compensation lnsurance: (check one)
E I am thc homeowner fl I am thc solc proprietor
TEL. #
Est. Cost of Constuction $
Construction Su pervisor Lic.* Q3'o
E I hsve Workcr's Compcnsation lnsurance
Wood Stove
Replacement doors: #_
Insulstion
NAME PRESENT ADDRESS
MAILING ADDRESS
OO Ot
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hsurance Company Name: _Workcr's Comp. Policy+_
WORKTO BE PERFORMED
Tent Durstion_ (Fire Retardant C€rtifi cat€ rttached?)
Siding: # of Squares a Replacement wind ows: #1d-
Roofing: # of Squares- (!) Remove eristing* (max. 2 layers)
Old Kings Highway/Historic Dist. (f,-D Replecing like for like
.Thc dcbris will bc disposc{ ofat:
I declalr undcr prnaltirs of pcdury that lhe
Applicanl's SiSnature:
Own.r! Sig
Pool fenci
Loc.tion of Frcilit]
hcrcin contained arc fuc and conect to the bcst ofmy kno'rlcdgc and bclicf. I understand that ![ly false snswcr(s)
undcr M.G.L. Ch.26t, Scction I
Datei e /Aq-'7-TDrlt:
Date
etlrchor nmt
Approvcd By:
t+*,6.looo[1p.rr Ket 6 v*t;g-. dec
Building Ofticial (or dcsigncc)EMAIL ADDRESS
Zoning District
Historical District: Yes No Flood Plain Zone: Yes No
Water Rcsource Protection District:
Yes No
Within 100 n. of wetlands
.Ycs-No
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will bc jusl csusc for dcnial or
From: Rush, Eric - HCC Global erush@tmhcc.com
Subject: RE: Permit
Date: Jan "17,2024 at 9:31:54 AM
Tc: Thomas White TWWOODWORKER@verizon.net
Attention the Building Dept of Yarmouth Mass:
I herby give Thomas White permission to conduct work on my home at 80 Ellis
Circle in Yarmouth Port. Any questions please callat number below.
Thank You -
Eric Rush
80 Ellis Circle
Yarmouth Port
201-513-8774.
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