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0,THETpk Town of Barnstable *permitl#
sj,
�O Expires G months f om issue date
Regulatory Services Fee
HARNSTABLE,
•• m � Thomas F. Geller,Director
P1?----
iv,,,0).46,9.,,....b ,
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 c61(C 0(.9 ..
i 1.°110
Property Address � (p �' t+J �(�frgN\ k.. ,Fl`(` n S 's'° .
alk—esidential Value of Work 3 ( 5O r Ora Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address 2&,\,,9e`�4— 8 e bC-11
OU
Contractor's Name ‘..N).1:I V- ►" ,*, L. Telephone Number
Home Improvement Contractor License#(if applicable) 1 Z `Q l Bb
� � <� 6 TConstruction Supervisor's License#(if applicable) L� V�t-(
ElVVorkman's Compensation Insurance APR 7 Q z o 1
Check one:
❑ I am a sole proprietor . TOWN OF BARNSTABLE
❑ I am the Homeowner
(E"1 have Worker's Compensation Insurance
•
Insurance Company Name ' J \in +)'y) t) V Eft-
Workman's Comp. Policy# n 1 (o a 5 C \ ‘a. 0
Copy of Insurance Compliance Certificate must accompany each permit. •
Permit Request(check box) -
El—re--roof roof(stripping old shingles) All construction debris will be taken to V n t\,-Q A`J1,
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
#of doors
❑ Replacement Windows/doors/sliders.U-Value (maximum .44)#of windows •
*Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: ' Property Ow er mu sign Pr perty Owner Letter of Permission.
A copy of a Ho e I r ement Contractors License & Construction Supervisors License is
e uire
SIGNATURE: A .
Q:\WPFILESIFORMS\building permit forrnslEXPRESS.doc .