HomeMy WebLinkAbout0066 SUMMERBELL AVENUE of Town of Barnstable *Permit# Sbs�
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»� Regulatory Services Fee _
Thomas F.Geilert Director
Building Division v S
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Tom Perry, Building Commissioner ��O IV
Office: 508-862-4038 200 Main Street, Hyannis,MA 02601 9 bOQl QJ. f
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Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY `
Not Valid without Red X Press Imprint
Map/parcel Number 2` (D p o a) l
Property Address U42 ✓� `� L AA V
ET-Residential Value of Work Dom. '— Minimum fee of.$25.00 for work under$6000.00
Owner's Name&Address �O t-E� yL-o t S / uk���
Contractor's Name ��''''� � Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance -
Check one:
0 I 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 Request(check box)
afi�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 fiance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner sip perry Owner Letter of Permission.
Inc IM00V t Con ctors License is required.
Signature
Q:Fonns:expm
Revisc063004
oFTME,�,. Town of Barnstable
ti
regulatory Services
s ra"on,U, Thomas F.Geiler,Director
nsnss. •
1639• p`e� Building Division
'0�'fD MA'S
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
wwvv.town•barnstablepa.us
office: 508-862-4038
Fax: 508-790-6230
Property Owner Must
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Complete and Sign This Section
If Using ABuilder
� �t Owner of the subject property
I
as Own J P Perty
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for;
,to U
(Address of Job) .
Sig a of ' e Date
Print Name
Q..FORMS;OWNWERMISSION