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rq Town of Barnstable *Fernut#SL/77 3
p* Expires 6 months from issue date
79TABLE. Regulatory Services Fee 37?0
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E posh Building
Thomas F.Geiler,Director 7/2 5/®/
Building Division XaPRESS PER
Elbert C IJlshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601w J U L 2 3 2001
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Office: 508-862-4038
Fax: 508-790-6230 ,TOWN OF BARNSiABL_
EXPRESS PERMIT APPLICATION
k (/ Not Valid without Red X-Press Imprint
Map/parcel Number " 0% 9
Property Address c2, O a2/9/) S]' `Cc)AJ S ( ) •
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Residential. OR ❑Commercial -� Value of Work
Owner's Name&Address $6-eI 4 //1 dxYl Sc'3T)
Contractor's Name 7)f# -•� l/?a9�r�t Telephone Number fV Ff Y
Home Improvement Contractor License#(if applicable) //QS 3 6
Construction Supervisor's License#(if applicable)
®Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I am the Homeowner
EZ I have Worker's Compensation Insurance
Insurance Company Name CQ,elcA Gen fA oC,l' c4/4,1 - 41UCe CO
Workman's Comp.Policy# cS L(./G / 70 / V 0040
Permit Request(check box)
a Re-roof(stripping old shingles) S" !►4-e Cam, 0 C k c-.A
❑Re-roof(not stripping. Going over existing layers of roof)
[ll. Re-side fS%9-t'litC C.d-edZ PVC) C'/'t4+�.C�.P /
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with othertown department regulations,i.e.Historic,Conservation,etc.
Signature
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