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rnstable *Permit# q
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ay Expires 6 mon to issue d
FEB 2 7 2014 Regulatory Services Fee
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M"S&1639. Richard V.Scali,Interim Director
WN OF BARNSTAOLMuilding Division
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
Map/parcel Number ,- . . I x
Property Address
Residential Value of Work di,�Q� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address V 0-1`1fzt
Contractor's Name -r#.L kgg�okA [( G Telephone Number Q0I"71"7`tyj 9
Home Improvement Contracto License#(if applicable) Email:
Construction Supervisor's License#(if applicable) 070077
a
�Workman's Compensation Insurance
I* Check one:
❑ I am a sole proprietor ,
❑ I am the Homeowner
I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side Replacement Windows/doors/sliders.U-Value Q30 (m-aximum.35)#of windoo
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Arre
er must sign Property Owner Letter of Permission. '
Home Improvement Contractors License&Construction Supervisors License is
SIGNATURE:
TAKEVIN D\Building C es\EXP OE TIEXPRESS.doc
Revised 061313
NAT-19276.7 Pre.RenovatiOn Form
this roan is used to =�.
Lead-eased paint Re document co►�pilance WM ti►e
Renovation,Repair,and Pal went Of ft Fe*W
Customer Addrees t Pmgmm>d}et April 2010.-
Job Number(s)
OCCUPANT C+aNFiR S
1NA-noN
Pamphlet Receipt
have received a copy of ft the Potential risk of the lead l�d hazard��Uon
Performed in My dwelling unit 1 I4 exposure &bm pm" t info��me of
ved this psmPhtetbefor� hY to bb
Herne Year guilt
the e _
y army home was built
iwhethertead®Safar euWo pre-f978,my hottre req�h�e6 .. .Work Practices are necessary per or t: lb,tle lno
N my liome Year Built is 1978 or after,.Lead-Sate}ly fs.
orir Practices are not required.
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Winter/Name P,.;r V
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�Bnatum of Owner ant .
$1QrrdtLire 0 arson Cn
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SEE STATE SPECIFIC FORMS ON REVERSE SIDE
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