HomeMy WebLinkAbout0283 PINE STREET (HY }
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X-PRESS PERMIT .
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NOV 2 1 2005 Town of Barnstable *Permit# S, Z
TOWN OF BARNSTABLE ]Expires 6 m the from issue date
Regulatory Services Fee - 00
Thomas F.Geiler,Director
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.townbamstable.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 . 2 8 3 P,w� S I C-'e-�-.[I/ C VIA ✓---
(,Residential Value of Work 5 y Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address 4 V1 V1 E S q 2.e t
S1-
Contractor's Name_ �dAjpg,:cn)j Ax G�1.'—cw Q-r i S t, Telephone Number ra Q t8 +V t_
Home Improvement Contractor License#(if applicable) 3 3
Construction Supervisor's License#(if applicable)
MWorkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
M_I have Worker's Compensation Insurance
Insurance Company Names
Workman's Comp.Policy# c1 �`�s A- 0 3 3 0
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
EL Re-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)
*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.
Home Improvement Contractors License is required.
SIGNATURE: -�
Q:Forms:expmtrg
Revise071405
9
Town of Barnstable
Regulatory Services
• a $ • ' Thomas F.Geiler,Director
�fz.6 0. � � Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862.403 8 Fax: 508-790-623 0
Property Ov%mer Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize - C'LP f 6 c-& U L to act on my behalf,
in all matters relative to work authorized by this building permit application for:
2-93
(Address of Job)
Signature of Owner Date
Print Name
Q:FORMS:0WNERFERMiS SIGN