HomeMy WebLinkAbout0150 CONNERS ROAD .. � . .. ..
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Town of Barnstable *Permit# ,
Expires 6 moos from a date
p ' w Regulatory Services Fee ' C�
JAN 6 Thomas F.Geiler,Director
Poft OF 2006 Building Division
BAN,97ABLL Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not.Valid without Red X-Press Imprint
M?q/parcel Number / 3
R~ erty Address U (f0/kj/L)61>)5 12
U1.
jkesid�enal Value of Work A G C: Minimum fee,of$25.00 for work under$6000.00
Owner's Name&Address
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Contractor's Name t el-J. /lJr Telephone Number9_�,1��cc-0 776 P-i 3 3 Gg
Home Improvement Contractor License#(if applicable) /oZ J 9 �
(-nnctr„rtian . upervisor's License#(if applicable) �� S
❑Workman's Compensation Insurance
Check
am a sole proprietor
❑ I am the Homeowner ,
❑ I have Worker's Compensation Insurance
Insurance Company Name /Vl P/ZC°� till fZ
Workman's Comp.Policy# -AJ d /a-
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 G�17.JS IITAJ(P
❑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 Improvement C tractors License is required.
SIGNATURE:
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Q:Forms:expmtrg
Revise071405
• 1-4 Town of.Barnstable
regulatory Services
' Thomas F.Geiler,Director
Bufldfng Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
- Fax: 508-790-6230
Office: 508-862-403 8
Property Owner Must
Complete and Sign This .Section
If Using A Builder
E �
as Owner of the subject property
I
hereby authorize ✓��'�'"� ���� "� Ne-<< to act•on my behalf,
in all msdE rs relative to work authorized by this building permit application for:
(Address of Job)
5
UL 5 G�
Signature of Owner. ate ,� f
Print Name
Q:FORMS:OY,rI�RPERMI3SI0N s
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Reg. No. Applicants Street City State Zip Name Title Expiration
1487
123941 Martin W. OLD MARSTONSI MA 02648i O'Donnell, Owner 4/2N2007 i
O'Donnell POST Martin
j RD.
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