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pFIKE rpm Town of Barnstable *Permit# "7 119 I
tips Expires 6 months frons issuCdate
WtNST„eM : Regulatory Services Fee
MASS. Thomas F.Geiler,Director
Building Division _
Tom Perry, Building Commissioner PRESS PE �T
200 Main Street, Hyannis,MA 02601 JUN 7 20�4
Office: 508-862-4038
Fax: 508-790-6230 TOWN OF BARNSTABLE
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
J�} Not Valid without Red X-Press Imprint
Map/parcel Number /_1 / ®O
Property Address 6 W*L4IM�C� r 7
®,Residential Value of Work /1 16?Il9
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement.Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance v,
Check one:
❑��am a sole proprietor y
Ltd 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)
Re-roof(stripping old shingles).All construction debris will be taken to UM U'
❑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 Impr Neme Contractors License is required.
Signature
Q:Forms:expintrg
Revise053003
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