HomeMy WebLinkAbout0128 RUDDER ROAD i
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�pFIME tOt,'b Town of Barnstable *Permit# -s/
P p� Expires 6 months from issue date
BARNSTABLE, : Regulatory Services FeeMASS ��—
v , ; ,tea Thomas F.Geiler,Director
�ATED M �
Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red%Press Imprint
Map/parcel Number �� /
-14
Property Address 1, ?�
G Gi
residential Value of Work
Owner's Name&Address
Contractor's Name—,, /�J�t , Y=�f�� �„� m Telephone
Home Improvement Contractor License#(if applicable) /1 2,7`'9
Construction Supervisor's License#(if applicable) .
❑Worthn's
Co pensation Insurance L
one:
I am a sole proprietor _
❑ I am the Homeowner co
❑ I have Worker's Compensation Insurance
Insurance Company Name
U7 co
Workman's Comp.Policy#
Permit Request(chec box) /
e-roof(stripping old shingles) All construction debris will be taken to /
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: P e Owner must sign P p ty er e r of Permission.
J
Signature
All
Q:Forms:expmtrg
Revised121901
F "
°FI►M r Town of Barnstable
Regulatory Services
* BARNSTABLE. •
v MASS. g Thomas F.Geiler,Director
$AlE1639. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
L I A S s as Owner of the subject
property
hereby authorize ,�Jfi�� ; �41,nz to act on my behalf,
in all matters relative to work authorized by this building permit application for: .
—� (Address of Job)
Signature of Owner Date
Print Name
Q:FORM&O W NERPERMIS S ION
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Board of B -]ding Regina ignsand Standards''.
, MVEIIAENT CFIT#tACTQR
4 WE If�P.
� �i�pigl�stra'�ion. 19983
. k{ pia�tio> ( 2003
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