HomeMy WebLinkAbout0234 BUCKSKIN PATH 1
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T Town of Barnstable *Permit# &K 2
Expires 6 m the f�isrte d t
® CS Regulatory Services Fee �
SEp 2005 Thomas F.Geiler,Director
TOWN OF BARNSTA'BLE Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number
Property Address m`T 1_,t1 s 1 PoJ r 1 Qkf 4uv d t'-e—
�eesidential Value of Work -1 4,�� Minimum fee of$25.00 for work under$6000.00
ONvner's Name&Address -Q ),A
Contractor's Name Telephone Number Iq ®� 4ET�
Home Improvement Contractor License#(if applicable) I I
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
CY99 one:
I 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 Re (check box)
7Re-roof(stripping old shingles) All construction debris will betaken to
❑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.
H P7 Improvement Contractors License is required.
SIGNAT s
Q:Forms:expmtrg
Revise071405
le �omnw,uoea�/ a�,/�aaoac�i�raelld
Board of Building Regulations and Standards
HOME I License or registration valid for individul use only
VEMENT CONTRACTOR before the expiration date. If found return to:
Re istrafii`o'n 24310 Board of Building Regulations and Standards
�'vY2007 One Ashburton Place Rm 1301
lidual Boston,Ma.02108
James Curley "" °
James Curley -
287 Fuller Rd. �„ m
Centerville, MA 02632 �
_. ._
Administrator Not valid without signature
oF1 1 Town of Barnstable
Regulatory Services
1#L i
+ BARNSTABLE, #
MASS. $ Thomas F.Geiler,Director
tFD 39. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, - KAKArgYI NO�&n , as Owner of the subject property
hereby authorize l C�wtrz S to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
q jig 1()C
Signature of Owner Date
gKirM NIoLM
Print Name
QTORM&OWNERPERMISSION