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Town of Barnstable *Permit#
OF tl Tti Expires 6 months from issue date
• Regulatory Services Fee
BAMSTABLL
r� Mom• $ Thomas F.Geiler,Director
t639•
'°rEo►�a+' Building Division
Elbert C Ulshoeffer,Jr. Building Commissioner
367 Main Street, Hyannis,MA 02601w l�,qr
Office: 508-862-4038 �//� ZOQr
Fax: 508-790-6230 OFeq� S
EXPRESS PERMIT APPLICATION N T
Not Valid without Red X-Press Imprint t* r Ae��
Map/parcel Number __�','-/7 /,4 l �e 3
Property Address a c
J�:(Residential OR ❑Commercial Value of Work `' r
Owner's Name&Address
�� Telephone Number
Contractor's Names p
Home Improvement Contti cG?:`_ic_;€;::�sP;#(if 3ppl.ic able) o
Construction Supervisor's License#(if applicable)
• ❑Workman's Compensation Insurance
Chec one:
I am a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Permit Request(check box)
Re-roof(stripping old shingles)
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
❑ Other(specify)
*Where required: Issuance of this permit does not exempt compliance with other town department regulations.i.e.Historic,Conservation.etc.
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