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�Of1NE 1pw� Town of Barnstable *Permit# CDC �8�s
P Expires 6 months-from issue date
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= Regulatory Services Fee
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9:� Thomas F.Geiler,Director pIFD K a Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 -
Fax: 508-790-6230
EXPRESS PERNIIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint
Map/parcel Number ^j �" in fi-
Property Address O(FPv (��T�1 (� Q `2_
esidential Value of Work ��, 5'D , a e)
Owner's Name&Address 1J_p r E
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Contractor's Name_ 1�d vvt 7!�S r :z w,+\r-Le (C Telephone Number 1�,-o
" Home Improvement Contractor License#(if applicable) C9 0 3
Construction Supervisor's License#(if applicable) D
❑Workman's Compensation Insurance
Check one:
❑.I am a sole proprietor 10? 1�01
I am the Homeowner 1
❑ I have Worker's Compensation Insurance
• OF BPR
Insurance Company Name .•n�IN
Workman's Comp.Policy#
Permit Request(check box)
❑ Re-roof(stripping old shingles) F21 construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature.o G444"aa-a
Q:Forms:expmtrg
Ravised121901