HomeMy WebLinkAbout0014 DOLPHIN LANE 4
pFVE Town of Barnstable *Permit# k1l 7 9
Expires o k fro issue date
:PAMSTABLE' . -.:Regulatory Services ... . Fe
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;_..Thomas:F.Geller,Director.e A�0
Building Division
- Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 PIER
Office: 508-862-4038 1
Fax: 508-790-6230 : ,,._,.....:. . :...._:.- 200
EXPRESS.PER1i�IIT APPLICATION
Not Valid without RedX--Press Imprint OARNSTASLe
Map/parcel Number � � � UY9
Property Address D u ,rn �✓ 14 rn ' ° "t �- U
Residential Value of Work 16 , 000 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address h 1 K C 1 U �� C
Contractor's N Telephone
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
[�I am the Homeowner
(� I have Worker's Compensation-Insurance
i
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate'must be on file.
Permit Request(check box) l
Re-roof(stripping old shingles) All construction debris will be taken to p S T''r `+ C y ,"►�f'�
❑Re-roof(not stripping. Going over existing layers of roof)
ER Re-side 1
n -f/SJA
( 'Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
ome Improvement Contractors License is required.
Signature
Q:Forms:expmtrg
Revise063004 '