HomeMy WebLinkAbout0054 CRANBERRY LANE P' a e az-T__ /. /1),
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Town of Barnstable
*Permit#( o(r a q ICI.
If • . Regulatory Services > 6 a� S
its. Thomas F.Geller,Director
Building Division 112
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.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 01, `7`og° ��i 41 1±?
Property Address `)L/ (!Iriji A. , LwM.K., "'du'3,2
_t'�Residential Value of Wor ` (0. COO t " Minimum fee of$25.00 for work under$6000.00
rC�Owner's Name&Address ( t.l L4. l an i
(rgz1 -171 La/fa Oeriaditi �i� d 3� .
v('1✓` Jk "J1ld ' ird' l Telephone .
Contractor's Name �j Number ��� ��� "7�1 ��J
Home Improvement Contractor License#(if applicable) /L O !1/ X-P E S 'PERMIT
Construction Supervisor's License#(if applicable) /0 0 1 r/ /
J' - j 5 !111
4Workman's Compensation Insurance
Check one: TOWN OF BARNS TABLE
ABLE
❑ I am a sole proprietor
❑ I am the Homeowner
(i I have Worker's Compensation Insurance
Insurance Company Name Li)2/( i r/.
tlited
Workman's Comp.Policy# 14/()S_61 ✓ )1/.6 1 (J'
Copy of Insurance Compliance Certificate must be on file.
Pennit Request(check box)
iig Re-roof(stripping old shingles) All construction debris will be taken to Vista 0 Lc4,47iiWi
1 I
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)
*Where requited: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Ow er .st sign Property Owner Letter of Permission.
A co'y o i,e ,,e Impr 4 anent Contractors License is required.
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SIGNTATI3 Teilif/gqv keg „�r. -
C:\Users\decollik\APPD ata\Local\Microsofl M
tWiodows\Temporary Internet Files1Content.Outlook� Y7NB4IL\EXPRESS.doc
Revised 100608
BABN6rABLE, •
Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, wc1iA. ,as Owner of the subject property
hereby authorize 60/ (.4f hPY aj 2t 1 to act on my behalf,
in all matters relative to work authorized by this building permit application for:
64/ ( ! jyq lam ( thiv/&
(Address f Job)
Ali,aa-Vdj(24 7421il
Signature of Owner Date
A I
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
•
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\DDV87AAZ\EXPRESS.doc
Revised 072110
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