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HomeMy WebLinkAbout0465 SHOOTFLYING HILL RD �3 s�o-,--�y,�G �h ie� _ - -- � - --- - - - e oFIME, Town of Barnstable *Permit# �.t. Expires 6 months from issue date tszABt E : Regulatory Services Fee v� MAML Thomas F.Geiler,Director . 039. Building Division Elbert C Ulshoeffer,Jr. Building Commissioner X-PRESS PERMIT 367 Main Street, Hyannis,MA 02601w Office: 508-862-4038 MAY 1 5 2001 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION TOWN OF BARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number a 13 oo M 001 �-. Property Address _ - X Residential OR ❑Commercial Value of Work ` Owner's Name&Address YV. �,r-V- Telephone Number��0S0 Contractor's Name C Contractor License# if applicable)_ Home Improvement Con ( ` Construction Supervisor's License#(if applicable) C 7 5 d r ed TZ ❑Workman's Compensation Insurance Check one: ® I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name T04 AC VAC.• Workman's Comp.Policy# Permit Request(check box) ❑ Re-roof(stripping old shingles) ❑Re-roof(not stripping. Going over existing layers of roof) Re-side /CReplacement Windows. U-Value •�y (maximum.44) ❑ Other(specify) *Where required: suance of this permit doe exempt compliance with other town department regulations.i.e.Historic.Conservation.etc. Signature expmtrg 4kl, THE COMMO i55A�n� l'3 -� Board of Building Regulations and Standards Transaction No. One Ashburton Place-Room 1301 Boston, Massachusetts 02108 Registration No. — Application for Registration as a Effective Date Home Improvement Contractor or Subcontractor wy MGL Chapter 142A, CMR 780.6 Expiration Date FOR OFFICE USE ONLY _ Date 7=f —U 1. Name 1(7 MSS Print the na of the individual or busin pplying for the registration(not both) �37'— 5�(7 4 CZ 2. Mailing Address O Area Code&Telephone Number 3. City A A rl l State Tip L11)aZ(o D I 4. Street Address(if different) �--^ t State tip Print street and Number(P.O.Beat not acceptable) City S. Applicant type: ® Individual ❑ DBA ❑ Partnership ❑Trust ❑ Private Corporation ❑ Public Corporation ( we instructions 7. Number of Employees responsible for Home Improvement Contracts 8. Individual respo Pam L Firu by 9. Title of individual responsible for Home Improvement Contracts S� �vQyw So r' 10. Does the applicant or responsible individual hold any other construction related state,city;,,towa licenses or registrations? ❑ 14 U yes.complete the table below. Use additional paper if necessary. Yes No i Type license or registration Issued By License or ,Jx0ration Name of License Holder registration number Date 11. List all partners, trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary.(See instructions on back) Check here if you wish to receive an application for additional M cards for key persons.[:] Last First, Middle initial Title in Applicant Business %Owns Adder 1z is the applicant claiming exemption from the registration fee?_(See the instructions on the bade) ❑ ®- If yes,include a copy of a current Construction Supervisor license or motor vehicle repair shop lie or registration. Yes No 13. Registration fee enclosed:$ 409 Guaranty Fund fee enclosed:S ©d Include two separate certified checks or money orders-one marked"Registration Fee%one marked'Guaranty Fund". ALL APPLICANTS MUST INCLUDE A GUARANTY FUND FEE EVEN IF EXEMPT FROM THE REGISTRATION FEE See instructions on back for amount of fees. Make all certified checks or money orders payable to"Commonwealth of Massachusetts! ursuant to Massachusetts General Laws Chapter 62C section 49A I certify under the penalties of perjury that 1, b my best knowled and lief;have filed all state tax returns and paid all state taxes required under law. t r� 's 0 r-- Signature of applicant or applicant's representative Title held with applicant A false answer to any question in this appliealio ristilutes grounds for suspension or revocation of the applicant's registrallom r V .. •�_,•' fe41 V/!.G �� 7KI/Gf.iK/4 �I.YU.f i BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS 078657 :.} Expires: 12/1212004 Tr.no: 78657 Restricted To: 00 THOMAS A PERRY JR PO BOX 145 �. ; HYANNIS, MA 02601 Administrator