HomeMy WebLinkAboutBLDX-26-545 application 4, yq Office Use Only
° RECEIVED
y' J U L 08 2026 Amount__
-MA TACMUSE
Sq^
CORPORATES°
BUILDING DEPARTMENT
By'
EXPRESS BUILDIN IT APPLICATION
TOWN OF YARMOUTH
Yarmouth Building Department
1146 Route 28
South Yarmouth, MA 02664
(5008)) 398-2231 Ext. 1261
CONSTRUCTION ADDRESS: 22 ba-1v ` 15 (
OWNER:
NAME PRESENT ADDRESS TEL. 4
CONTRACTOR:
NAME MAILING ADDRESS TEL.#
EMAIL:
❑Residential ❑Commercial Est.Cost of Construction$
Homeowner is Applicant? Yes No
Home Improvement Contractor Lic.# Construction Supervisor Lic.#
` WORK TO BE PERFORMED
Tent `� DurationlO(k � �w (Fire Retardant Certificate required) Wood Stove
V
Siding: #of Squares _ Replacement windoils: # Replacement doors: #
Roofing: #of Squares Insulation Temporary Mobile Home
Temporary Construction Trailer Demolition— Interior only Demolition Raze Structure
Solar System ESS System Chimney Fence
*Please submit utility disconnect letters for electric& gas—structures over 75 years old require historical review
*The debris will be disposed of at:
Location of Facility
I declare under penalties of perjury that the statements herein contained are true and correct to the best of my knowledge and belief. I understand that any false answer(s)
will be just cause for denial or revocation of my license and for prosecution under M.G.L.Ch.268,Section I.
Applicant's Signature: Date: (�
Owners Signature(or attachment) / %/� Date: 15 y�
Approved By: Date:
Building Official(or designee)
Rev 6/24