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��FSHE Tod, Town of Barnstable *Permit# 6 L/0 0 /0 /
Empires 6 n+onths jron,issue date
• Regulatory Services Fee 4 . _o
B"NSMBLE. g orY=
v s. 10 Thomas F.Geiler,Director
39.�ArfDNtD'`A Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyamus,MA 02601 Nobler-
Office: 508-862-4038
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid►vitkout Red X-Press Imprint
Map/parcel Number lo / 0?� —
Property Address V a
[residential Value of Work je::2 dry,
Owner's Name&Address
C3ame
Contractor's Name�r n>> �������Q_nT Telephone Number 7 02 0 ' 9cj 0
Home Improvement Contractor License#(if applicable) /60 7,110
Construction Supervisor's License#(if applicable) CL5 05703.)
orkman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I the Homeowner
have Worker's Compensation Insurance
Insurance Company Name /l Ul kV,I an.� ���LJCC[,0 NO, G,(.Q c�D
Workman's Comp.Policy# C l4 we JL500 Z.c 7
Permit Request(check box)
Re-roof(stripping old shingles) v� T �� m PRESS PERMIT
❑ Re-roof(not stripping. Going over existing layers of roof) SEP 0 9 2002
AS,' e-side
TOWN OF BARNSTABLE
g', — [ Replacement Windows. U-Value . 317 (maximum.44)
t n-
JLs• EKOther(specify)
wtUWL �Akm Croy
*Where required: Issuance of this permit does not exempt compliance with other t6wn department regulations,i.e.Historic,Conservation,etc.
1
Signature
Q:Forms:expmtrg
Revised121901