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X-PRESS PERMIT Town of Barnstable *Permit# 9)108 •
Expires 6 months from issue date
APR 1 ,0 2006 -- ,6 Regulatory Services Fee' 5 , 06
Thomas F.Geiler,Director
TOWN OF BARNSTABLE Building Division .
•
Tom Perry,CEO, 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 3 l 7 I j 8-
Property Address S C— CAS P Let. 6 C b 1 s 144,i ii_
e]Residential Value of Work g# `e' . Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address ,g$,H e",c £a,(6 - f,q
4-"15 4c'tdti ,yam.4-
Contractor's Name 4 , ii C l^ '5 I U`PL, Telephone Number t ?7 l 2 V1 r
Home Improvement Contractor License#(if applicable) /GA-GCi 2.3
Construction Supervisor's License#(if applicable) 0 ('f t i Z
❑Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor •
❑ I am the Homeowner
ave Worker's Compensation Insurance
Insurance Company Name t l T h to Nr‘otAc
Workman's Comp.Policy# 7O( 3611 i 0-( 2 r
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
f I'a-roof(stripping old shingles) All construction debris will be taken to 6G'041 6 L/t, t"v`"+Ja
❑Re-roof(not stripping. Going over existing layers of roof)
ale--side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
7/44
***Note: Property Owne st sign Property Owner Letter of Permission.
liome Impr• - ent •- . ors icense is required. .
SIGNATURE:
Q:Forms:expmtrg
Revise071405 ,
w •"
•
aFi NEToy • Town of Barnstable
•,,1, Regulatory Services
Thomas F.Geiler,Director
rtirst,...J,
pE tos_ Building Division.
Tom Perry, 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, ‘C''. strA'N\ S D i\-L ,as Owner of the subject property
hereby authorize iS i t J C rbt 411. to act on my behalf,
in all matters relative to work authorized by this building permit application for.
' 5 Lc t 6-il 64-4 S 44
(Address of Job)
V'21/01°
Signa e of Owner Date
cYP1Thf-C C_ Decr)-1
Print Name
Q:FORMS:OWNERPERMISSION