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Town of Barnstable *Permit#
p� Expires 6 mont/is front issue date
STAB , + Regulatory Services Fee �5—.60
v� MASS. � Thomas F.Geiler,Director
AlED11°`� 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 X-Press Imprint
Map/parcel Number 'Z I O/q 3
Property Address
Residential Value of Work S'7.P'�a
Owner's Name&Address V.
'2 6 G e�n't•�.it ll C /"l ri
,Contractor's Name Telephone Number jGa' 7 7 S r �/9 6 Z
Home Improvement Contractor License#(if applicable) a
Construction Supervisor's License#(if applicable)
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❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
Z I am the Homeowner
❑ I have Worker's Compensation Insurance A-PRES s pE
Insurance Company Name _ IT
- 200Z ,,
MAY
Workman's Comp.Policy# f
Permit Request(check box) "IV UF
B'4RNSTABLE
® Re-roof(stripping old shingles)
❑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.
Signature JYiy���-rn
Q:Forms:expmtrg
Revised121901 I