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jKE T Town of Barnstable *Permit# 19 3
Expires 6months fronti date
anxx M
1 Regulatory Services Fee
.� MAAAM � Thomas F..Geller,Director
.19. 0. Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601 �-P®�� .a`a
Office: 508-862-4038 _ 1� E""
Fax: 508-790-6230 7 2004
EXPRESS PEPMT APPLICATION - RESIDENTIAL 0
Not Valid without Red X-Press Imprint TOWN OF BARNS -ABL
Map/parcel Numbera 033
Property Address O
Value of Work
(Residential Q
Owner's Name&Address A
11! GZr'eeA) it>Uwe S Dr u �nn� 5 �a CJo2C�?
ame Telephone Number 50�'-- ��S S
Contractor's N 7 3
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
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 be on file.
Permit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to t3 M 6J
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
Replacement Windows. U-Value (maximum.44)
*where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note,. Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
Signature
Q:Forms:expmtrg
Revise053003