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11/10/2003 11:90 500775 WYNN HYANNIS PAGE 11 <br /> yr <br /> nn <br /> • <br /> n The Commonwealth of Matleachuaetta Town of Co�tvh <br /> State Board of Building Regulatlons and SUuWw a Buildlag DeW <br /> Masssch Seth State Building Code 16 Great Neck <br /> 780 CMR <br /> • APPLICATION TO CONSTRUCT,REPAIR,RENOVATE OR DEMOLISH-A-ONE OR TWO PAMILY DWELLING <br /> This Section For Official Use Only <br /> Building umLln I Date Issued: <br /> Signature: j-- <br /> Building Cmmmirrim•fi of siMudinp Dam <br /> SECTION 1.-SITE INFORMATION <br /> L I Property Address: 1.2 Assessor-Map&Parcel Number. L O "`G 3 <br /> $ T rel)2tls a(2T <br /> Y um - r <br /> yNume -- 6=1 Numb" <br /> 1.3 Zoning Information: 1.4 Property Dimensions: Lot Coverage%: <br /> SOD f <br /> 7omra traaicr NTnsd um - {ot Mope Fronga fN <br /> 1.6 Building Setbacks(A) <br /> Front Yard Side Yards Rear Yard <br /> Required Provided Required Provided Required Providod <br /> 1.7 Water Supply(M.G.L.c.40.134) 1.5 Flood Zone Map 1.9 Sewage Disposal System: <br /> Public 0 Private O Zone Ouuide Flood Zone O Municipal O On site disposuil system O <br /> SECTION 2.—PROPERTY OWNERSHIP/AUTHORIZED AGENT <br /> 2.1 Owner of Record: <br /> 170—%%rlm zz n2 <br /> N (Mml ww Aedrwr <br /> —i <br /> hbp6orm <br /> Audlorized Agent: <br /> aw 4141m) Aeemn <br /> llpamn Tlspame . <br /> SECTION 3.—CONSTRUCTION SERVICES <br /> 3.1 Licensed Construction Supervisor: Not Applicable O <br /> Uuiue4 Camweuon 7upennar llcmn Numbm !� <br /> Aadnm e.q' rWen am— <br /> 9 <br /> 3.2 Registered Home Improvement Contractor. Not Applicable O <br /> �wnr Car <br /> Nine <br /> A� r fs�/res¢ <br />