HomeMy WebLinkAbout0176 GREENWOOD AVENUE 176 Cye�,u,�� �,/ yE
f,
;6iFt loy� Town of Barnstable *Permit# 'es,
Expires 6 n s fro ue date
Y
1AMSTABLE, : Regulatory Services Fee • C7
y MASS.
c� i639, Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 -P
Office: 508-862-4038 {
rr z
Fax: 508-790-6230 N 0V 42005 .
EXPRESS PERMIT APPLICATION - RESIDENTI LY .
Not Valid without Red X-Press Imprint
Map/parcel Number V' 9 S� L�
Property Address
'Residential Value of Work Minimum fee of$25.00 for work under$6000.00
04�mer's Name&Address
11U 6ywi-nond ftte,. . j�mvu_.
Contractor's Namej—U—M-9 Telephone Number
Home Improvement Contractor License#(if app icable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Ch k one:
VI am a sole proprietor
❑ I am the Homeowner
❑. I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp. Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
(/Re-roof(stripping old shingles) All construction debris will be taken to AA114 DtgC54 I du� �`k,F,
❑Re-roof(not stripping. Going over existing layers of roof) `�
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
ome Im rovement Contractors License is required.
Signature
Q:Forms:expmtrg '
Revise063004
- - vuge°ply
• too°vava�to°�agta�aa�as .t
oY teg�st<t�°�as�at�oo5
—o eotetbeBv
ce
da�ds Boa<a S
�Y a�astop poe A tea.
Re�atat�O°ON,�Rp,C�Oa
Gf{,e tao� G, to
oa�a°t$o" o v�MEN t
B � 2� o�
320� � otvava�;tb '
Re
��' � mn�st atO •
,O
es
G '
p oeSaUe p2632
Z ',ev4"\e.N`P
' vn-o .Barnsta]ble
Rego lAtory Services
Muss.
:.:.Bitcling Division
s6 9•
-TomPerry; Building Conunissioner ;
200 Main Street, ]jyannis,.MA 02601
vy
w.town.barnstable;mama
Fax: 508-790-6230
Office: 508-862-403 S
Property Owner Must
Complete and Sign This Section
If Using ABuilder
as Owner of the subject property
hereby authonze
to act on Fnybealf,
in all matte relative to work authorized by this building permit application for;
Ave-,
(Addres s of rob)
Signa a of Owner : Date
• Print I'�ame
,