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S, To,,ti Town of Barnstable *Permit# '792jI
Expires 6 months from jssue ate
, ,► , : Regulatory Services Fee60
039. ,0� Thomas F.Geiler,Director
� Building Division
Tom Perry, Building Commissioner IT
200 Main Street, Hyannis,MA 02601 SEP 3
Office: 508-862-4038 2004 '
Fax: 508-790-6230 TOWN
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY BARNSTASLE
Not Valid without Red X-Press Imprint
Vlap/parcel Number jggJ 5 4v .3
Property Address SA T Y��L� t - D ?�
Residential Value of Wo '*7 Minimum fee of$25.00 for work under$6000.00
Dwner's Name&Address TK C, Nb_ 99_ ,4 t/ ,o LZ
/J/Us w l4 eewwx / t
Contractor's Name WM "tbQ L e Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one:
❑ Iam a sole proprietor
�am the Homeowner
❑ I have Worker's Compensation Insurance
[mnmce Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate'must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
I ❑ 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 rovgnynt Contractors License is required.
Signature