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TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY INFORMATION
Address of Project: b) 61 46)1 in iimium • , , , ,
NUMBER STREET VILLAGE
Owner's Name: �-r-i 4 'te h Phone Number
Email Address: Cell Phone Number
Project cost$ ' o.' -0 0 Check one Residential Commercial
OWNER'S AUTHORIZATION .
As owner of the above property I hereby authorize TA 4 L Tact cfr i
to make application for a building permit in accordance with 780 CMR
Owner Signature%/' / ° -Cr-Date: i /1.`,/a 7
TYPE OF WORK
Er Siding 0 Windows (no header change)# 0 Insulation/Weatherization
El Doors (no header change)# I Commercial Doors require an inspector's review
ERoof(not applying more than 1 layer of shingles)
Construction Debris will be going to .0v,,r, O'4" kjefi°m vII
CONTRACTOR'S INFORMATION
Contractor's name 1-1,l LOL e 0y-111 VI r1
Home Improvement Contractors Registration(if applicable)# /e% ' i I (attach copy)
Construction Supervisor's License# P i I ✓0 El (attach copy)
Email of Contractor b "&J i,'),tv+&\/-9 a b 'din f�� , eI$° Phone number ( ) b �� � C
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ALL PROPERTIES THAT HAVE STRUCTURES 0 ER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN
A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED.
APPLICATION NUMBER
*For Tents Only*
•
Date Tent(s) will be erected Removed on number of tents total
Does the tent haves sides?Yes No ' (If yes please attach floor plan with exits marked)
Dimensions of each Tent X X , X
Additional tent dimensions can be attached on a separate piece of paper.
Purpose of Event
Check one: this event is a: for profit non-profit event
Check one: Food served Yes No
Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s)of each tent
Fuel source being used LP tank 20 lbs. or> Yes No ,if yes, a gas permit is required.
- Natural Gas Yes No , if yes, a gas permit is required.
If food is being served at your event please obtain a Health Department approval between the hours
of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval.
*WOOD/COAL/PELLET STOVES *
Manufacturer# Model/I.D.
Fuel Type Testing Lab
Offsets from combustibles: front back left side_ right side
HOMEOWNER'S LICENSE EXEMPTION
Homeowner's Name:
Telephone Number Cell or Work number
I understand my responsibilities under the rules and regulations for Licensed Construction
Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand
the construction inspection procedures,specific inspections and documentation required by 780
CMR and the Town of Barnstable.
Signature Date
APPLICANT'S SIGNATURE
17 i/u/a
Signature YCL 1 Date Li AO(
All permit applications are subject to a building official's approval prior to issuance.