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Town of Barnstable *Permit# ?
Expires 6 months from issue dote
„ , : Regulatory Services FeeMAW
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�'g Thomas F.Geiler,Director
Building Division
Tom Perry, Building Commissioner ®PRESS PERMIT
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 S E P 2 2 2004
Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIALT&Y,tOF BARNSTABLE
Not Valid without Red X-Press Imprint
�p/parcel Number r2 9j —0,�
)pertyAddress aF—y .`h`RZA(SES AVAy NYANAZI S _ MA, el a Go
,Residential Value of Work Minimum fee of$25.00 for work under$6000.00
vner's Name&Address ,III YSS 7-RaS7- 3F
C-" 3 9 826 QiC A NAI cn17 2?W v r� into o a C
nntrabtor's Name_6`FQ I?CC �/. Y—A L 1VF- T n /1'), Telephone Number P 77 S y�7,&-
ime Improvement Contractor License#(if applicable)
instruction Supervisor's License#(if applicable)
lWorkman's Compensation Insurance
Check one:
�I am a sole proprietor
I am the Homeowner
❑ I have Worker's Compensation Insurance
urance Company Name
arkman's Comp.Policy#
ipy of Insurance Compliance Certificate'must be on file.
rmit Request(check box)
Re-roof(stripping old shingles) All construction debris will be taken to 2�qf?Al_' Lr CAA11 F/LL
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-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.
***Note: Property Owner must sign Property Owner Letter of Permission.
Home Improvement Contractors License is required.
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