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oe Town of Barnstable *Permit 06 0- 6,9 7-
Regulatory Services F ff Bh issue dare
ee
• ' Thomas F.Geiler,Director
'$e)aud* Building Division
Tom Perry,CBO, Building Commissioner•
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office:, 508-862-4038
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Fax: 508-790-6230
Not Valid without Red X-Press Imprint
Map/parcel Number 0 2 3
Pr petty Address 2 aJ M /1 I IV 5 . BR NI S i5 LE.. , N1 Ac 02 0
ELi Residential Value of Work ("1" Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address CH RI 5 614 A
a' M F )nl •�,T PARr\I57A LG, MA Oz(o9q
Contractor's Name T. . H 1 T C CoC IC. Co 1J314? /C-1-► t7 Ai VC.—Tni C.. Telephone Number 550% -7 7.S'-1 763
Home Improvement Contractor License#(if applicable) I �j o
ErWorlcman's Compensation InsuranceX-PRESSPERMIT
Check one:
❑ I am a sole proprietor MAY 20 2008R I am the Homeowner
I have Worker's Compensation InsuranceT OWN OF BA NS TA L
E
Insurance Company Name Tile (a R.(�/J I i e tTFrT E a-m no c ✓u C E Co
Workman's Comp.Policy# - 1 < 3'`) C)
Copy of Insurance Compliance Certificate must be on file.
Permit Reques heck box)
Re-roof(stripping old shingles)� ) All construction debris will be taken to 5 k _j
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)
"`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 is required.
SIGNATURE:
Q:Forms:buildingpennits/express
Revised 123107
►:i5„
a Town of Barnstable
,,mid '' Regulatory Services
Thomas F.Geiler,Director
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
Property Owner Must
Complete and Sign This Section
If Using A Builder
- SLR) -
,as Owner of the subject property
hereby authorize 7,Z., Nth-40_,6649,
'4) to act on my behalf,
in all matters relative to work authorized by this building permit application for:
235 9 SY. Z CtA114444,6. I . tr2(0 v
(Address of Job)5< 11Ar 02‘/de ---,4
Signature of er
Date
(N1 ',s o leg G. 51h4m/
Print Name
s
•
Q.Forms:expmtrg
Revise071405