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" An
J
of lati Town of Barnstable *Permit#� ���Cof
Expires 6 months from issue date
BAR STABLE, = Regulatory Services Fee
SS.
MA
g rY
0 9. $ Thomas F.Geiler,Director
A
ArED 11°r Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 X PRESS-PERMIT
Office: 508-862-4038 .S E P 0 4 2002
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL7MM OF BARNSTABLE .
Not Valid without Red X-Press Imprint
Map/parcel Number
4
Property Address ,S' ! AV/m�; l
Residential Value of WorkJ-a
Owner's Name&Address
Contractor's Name p I elephone Number �� l
Home Improvement Contractor License#(if applicable)_ / e
Construction Supervisor's License#(if applicable)_
❑Workman's Compensation Insurance
Check one:
❑ I am a le proprietor
❑ the Homeowner
I have Worker's Compensa 'on Insurance
Insurance Company Name �/?�'//Zl✓fi
Workman's Comp.Policy# e-2,
Permit Request(check box)
❑ Re-roof(stripping old shingles) _
❑Re-r of(not stripping. Going over existing layers of roof)
4-0 Replacement Windows. U-Value 4 (maximum.44)
❑ Other(specify)
*Where required: Issuance of this p 't does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
Signature
Q:Fomis:expm C7
-
Revised121901