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Town of Barnstable *Permit# 19 Ri/
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Ex� is ue
�'L , 3, Regulatory Services Fee rres 6 moom
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Richard V.Scali,Director
Q Buildinggot a
G \t Paul Roma,Building Commissioner
C1o������ t, `�� 200 Main Street,Hyannis,MA 02601
www.town.bamstable.ma.us (ifj8.44104)
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
� j4of Valid without Red X-Press Imprint
Map/parcel Number `7 0'7 oS
Property Address IRO �e-ce7 P=i C2--134 IJ74- S i NI f{- ,
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Residential Value of Work$ , 1 _O0 Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address P' toll.) l"'r
G*-yr - Arw &IQ
Contractor's Name Ccv 1 Telephone Number -2
Home Improvement Contractor License#(if applicable) aqo 74-/ Emai1:C044 C ram. tve.f
Construction Supervisor's License#(if applicable) (.j — j 9 86 7
❑Workman's Compensation Insurance
Check one:
.0,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 accompany each permit.
Permit Request(check box)
❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
❑ Re-side r,
R. Replacement Windows/doors/sliders.U-Value e 30 (maximum.32)#of windows J
#of doors:
*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.
A copy of the Home Improveme t Contractors License&Construction Supervisors License is
r aired.
SIGNATURE: ' �7�
Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc •
01/25/17
Town Brnble
Regulatoryofa
Services
•
Richard V.Scull,Director
1659.Iasi.. • Building Division. •
Paul Roma,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 •
#)P1121A-n) it4214ricet • ,as Owner of the subject property
hereby authorize to act on my behalf,
in all matters relative to work authoiizedly this-balding permit application fon
• �r Yo rm&e
rqe Address of Job) 2.10
**Pool fences and alarms are the responsibility of the applicant Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
(1. /7/7-
Signature of e'of Applicant
Print Name Print Name
•
/2/Z7hr
Date '
•
•
Q FORMS OWNERPERMISSIONPOOIS
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