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Town of Barnstable *Permit#
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aT +A�5P i ' Expires 6 mo from{ss e date e g
ry y Regulatory Services Fee -
tt BARNSTABLEMASS .
Richard V.Scali,Interim Director
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—._ Building Division
Tom Perry,CBO,Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.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 3t
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Property Address .3 `- U / -) 6.e L'L 6?_(," 2
(Residential Value of Work$ u l) Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address v(1.
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Contractor's Name 6, -' .11//� [�� f�av- Telephone Number SR IQ-y a
Home Improvement Contractor License#(if applicable)1 c 2A 3y Email:6461/t4r / .
Construction Supervisor's License#(if applicable) CS /0 PRESS �
orkman's Compensation Insurance
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Check one:
ElI am a sole.proprietor Qv a 11 2014
❑�am the Homeowner
L�f I have Worker's Compensation Insurance TOWN p� q • •
Insurance Company Name (e.,,,- 1�Qlyv/l / W OF BAR111�7 ABLE
Workman's Comp.Policy# 2 q ®?Y^4
Copy of Insurance Compliance Certificate must accompany each permit.
Permit R st(check box)
eqDRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to 0;92/. 2xs2—
❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof)
Er Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows
#of doors:
❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required.
Separate Electrical&Fire Permits required.
*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 Improvement Contractors License&Construction Supervisors License is
requi ed. �QQ`f'v ,
SIGNATURE: d
T:\KEVIN_D\Building Changes\EXPRESS PERMITIEXPRESS.doc
Revised 061313 S l l )
El1RT1Sr1'ABLS.
° .,�' Town of Barnstable
to Regulatory Services
Richard V.Scali,Interim 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, LA 17th -Ccit ,as Owner of the subject property
hereby authorize ? (tf,i ' L C*ftt . to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job) O3b
)06"8"tjL4CC 0 I 1 / / 4
Signa of Owner Date
kCLrii ,
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
T:\KEVIN D\Building ChangeslEXPRESS PERMITIEXPRESS.doc
Revised 061313