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Town of Barnstable 4 *Permit#
Expires 6 months from issue date
. ,4JUM„BIX . Regulatory Services Fee
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1659. �� Thomas F.Geiler,Director
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Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601w
Office: 508-862-4038 �Gji� 191.9 � e
Fax: 508-790-6230 OP �40y
EXPRESS PERMIT APPLICATION RNS�
Not Valid without Red X-Press Imprint ,9e
Map/parcel Number 0 /) (.A
Property Address_ to(l c3(n e--V p���I,I to
esidential OR ❑Commercial Value of Work o�, 9 -77. UV
Owner's Name&Address (301'GLn
Contractor's Name �( (hP p ) tY�D�Telephone Number
Home Improvement Contractor License#(if applicable) UO 7,qQ
Construction Supervisor's License#(if applicable) C_S 7a Al
UW"o"rkam's Compensation Insurance
r Check one:
❑ I am a sole proprietor
�# ❑ I am the Homeowner
Ej,k6ve Worker's Compensation Insurance
Insurance Company Name 7-k-) A-m-pertce n
Workman's Comp.Policy# W C 3 / of`1 r 96 —6z)
Permit Request(check box)
❑ Re-roof(stripping old shingles)
❑Re-roof(not stripping. Going over existing layers of r000
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
r KKther(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature � .� (_ c V ' r
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