HomeMy WebLinkAbout0081 CRAWFORD ROAD� gi ow��a Ra
of Town of Barnstable *Permit# See 2 9 7
O� F.Vires 6 an'onths from issue date
MASS. Regulatory Services Fee .
Thomas F.Geiiler,Director
�EDN1P`� Building Division
Tom Perry, Building Commissioner
200 Main Stree; Hyannis,MA 02601 PRESS . .`'�`I
Office: 508-862-4038 OCT 2 5 2004
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDQWa&N§ NSTAELE
Not Valid without Red X-Press Imprint
4ap/parcel Number 013 rn 2 zP C—
'roperty Address
desidential Vahie of wd S 6 00 -,9 a Minimum fee of•$25.00 for work under$6000.00
)wner's Name&Address_C� /�rlX
'ontractor's Name r l{LI�O� Telephone Number.(5a9-) Z,?r-9: a9
come Improvement Contractor License#(if applicable) , �—
,onstruction Supervisor's License#(if applicable) gldey i t::57Z'a6 5S
- Workman's Compensation Insurance
Check one:
0 I am a sole proprietor
the Homeowner
0 have
ave Worker's Compensation Insurance
asurance Company Name O f L cDrl/Y!/tC
7Vorkman's Comp.Policy#
�opy of Insurance Compliance Certificate must be on file.
?ermit Request(check box)
ff l"of(stripping old shingles) All construction debris will be taken to CAD
❑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 sip Property Owner Letter of Permission.
Home Improvartractors License is required.
3ignature
Z:Forms:expmtrg
temc063004
w: � M
Town of Barnstable
Regulatory Services
"B Thomas F.Geller,Director
mess.
Building Division
�p fD MA a g .
Tom Perry; 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
n /Yt, �,�'— _,as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
��C'2te✓�j 2o�D �rL,11T 4.3s-'
(Address of Job)
Signature of Owner Date
Print Name
QTORM&O SSION
and ofBWAU Remotions and Standard - µ
HOME IMPyEMENT CONTRACTOR License or registration valid for individul use o
Registi�o i 126252 before the expiration date Hfound return
my
_ r1006 Board of Building Regulatioms and Standards
�pT otf
�. One Ashburton Place Rm 1301
M.A.SLIWq HOME Boston,Ma,02108
�—g-� 'l
MICHAEL SLLIW,eAfiEEEMEI�T
i .._.` ,
94 REDBROOK RD?
MASHPEE,MA 02649� %=
Administrator
Not valid wit out signature