HomeMy WebLinkAbout0056 WILTON DRIVE .--� 6); 146
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�W Town of Barnstable *Permit#
FApires 6 months from issue date
Regulatory Services Fee
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�1639. Richard V.Scali,Director
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Building Division
Tom Perry,CBO,Building CommMio r, Is
200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us OCT 25 ZOIt)
Office: 508-862-4038 TOINAI nv ,,� 4, Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENT' V 10,,�� bYc
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Not Valid without Red X--Press Imprint
Map/parcel Number
Property Address 56 Wilton Dr Centerville, MA 02632
R Residential Value of Work$ 10,000.00 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address Hazel Warren
56 Wilton Dr Centerville, MA 02632
Contractor's Name Anatoli Sivitski Telephone Number 617-710-1001
Home Improvement Contractor License#(if applicable) 168043 Email: capecodinc@gmaii.com
Construction Supervisor's License#(if applicable) CSSL.-106040
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name AmGuard
Workman's Comp.Policy# R2WC649737
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
® Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to S&J Exco
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
'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.
A copy of the Home Improvement Contractors License&Construction Supervisors License is
required. J
SIGNATURE:
C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOIDHR\EXPRESS.doc
Revised 040215
oFTME ,
• 1ARNYMBLE, •
g- Town of Barnstable
Regulatory Services
Richard V.Scali,Director
Building Division
Thomas Perry,CBO
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
1, Hazel Warren ,as Owner of the subject property
hereby authorize Anatoli Sivitski to act on my behalf,
in all matters relative to work authorized by this building permit application for:
56 Wilton Dr Centerville, MA 02632
(Address of Job)`
Yr.A Gt')a4 10/25/2016
SignatuVe of Owner Date .
Hazel Warren
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
4
C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc
Revised 040215