HomeMy WebLinkAbout0147 AUGUSTA NATIONAL DRIVE I '
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Town of Barnstable *Permit t A.9
Expires 6 months from issue date
Regulatory Services Fee /5Z, Y
x- -1'= SS IT Thomas F.Geiler,Director
MAY 3 U 2007 Building Division
m Perry,CBO, Building Commissioner
TOWN OF BARNSTABLE 200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 ax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
Not Valid without Red X-Press Imprint ® , /I
(1)
Map/parcel Number ;5( 0 ) 6
Property Address_ "f 1 / v"U'V" " 4/ Ott l"//`
6:'Residential Value of Work/ ?3 c, 90o. 07 Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address L C oiv o-v-ot. 720
C✓rt4 vvii4'6Lv;b
/y7 ,i/Gt'Sfg /frit-Vow/f t. D,2ty
Contractor's Name 41,L C 19.li44 vim- F/01OY P'?Se S CUTelephone Number•C.3DD,) tf Z d- 993 q
Home Improvement Contractor License#(if applicable) 1 3 LI q i-1 3
Construction Supervisor's License#(if applicable)
XWorkraan's
Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
t2 I have Worker's Compensation Insurance
Insurance Company Name L i 4/- l"l'✓41/A,I 1� ��U� 0
Workman's Comp.Policy# C 2 — 3 J.3 -3q')S yZ - D! to
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
Re-side
Replacement Wjaiat sIdoors/Akdt U-Value /v 4 (maximum.44)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
copy of o rovement Contractors License is required.
SIGNATURE: -
•
Q:Forms:expmtrg
Revise061306
Town of Barnstable .
or o Regulatory Services
COM
wsu . Sliz; Thomas F.Geller,Director
14)0 g$s� Building Division
�� Tom Terry, Building Commissioner
. 200 Main Street, Hyannis,MA 02601 . .
- varrr.town.barnstable.ma.us --
Fax: 508-790-6230
Office: 508-862-4038
::Y. ._._. .. - _ . Property Owner Must
- -Cormplete and Sign This Section •
If Using ABuilder •
. •
I, _ b S g is.
_ -. ,as OFrn.er of the subject property
'A �_CJ���� •.to act on mybeha k
behalf;
herby authorize 4 . .
in all matters relative to work authorized by-this building permit application for: -•
(A s of Job)
' ®6
ate ... __ .;�--
aattue of Owner -
Paint Name