HomeMy WebLinkAbout0009 KELLEY ROAD w �` g;..; � .,�,�, ;x �� �:ti ���`� ��4�P�lh'1i��dW� ,i���'hi��d���►7 . 7��E' � w� ��? r;�s��ar,�+��vv�rar�v
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F Town of Barnstable *Peru#t$`71S9� qd
EvLrw 6 m'ond a from Issue date
Regulatory Services F
U%63 ,$l�
�� Thomas F.Gellert Director o
QED Ni°�� Building Division
Tom Perry, Building Commissioner
200 Main Street,.Hyannis,MA 0260.1 iN $'
office: 508-862-4038 OP.e Z OoS
Fax: 508-790-6230
EXPRESS PERWr APPLICATION - RESED ENTUL ONLY
Not Valid without Red X Press Imprint
Map/parcelNumber 07,-2—
3 /
Property Address
M Residential Value ofwork ei 0 D d Minimum fee of•$25.00 for work tinder$6000.00
AAOwner's Name&Address kaH T &S j,
Contractor_s_N J Telephone Number
Home Improvement Contractor License#(if applicable) i —(e 03
Construction Supervisor's-License#(if applicable)
®Workman's Compensation Insurance
Check one:
❑ I am a sole proprietor
❑ I an the Homeowner
I have Worker's Compensation Insurance
Insurance.Company Name 2�1S• 6 , 0.7�
Workman's Crimp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
J �Re-�f(stripping shingles) All constru�debris will be taker!to,_,j Q,[k {�"&4egcytt
l Yl �Sv o viu C,PrL�
❑Re-roof.(not stripping. Going over existing layers of roof)
❑ Re-side
Replacement Windows. U Value (maximum.44)-
*Where required: Issuance of this perrmt 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. ,
Signature
QFarms:expmtrg
Revisc063004
oFF ra,, Town of Barnstable
Regulatory Services
RAMri ABU& ' Thomas F. Geiler,Director
z69. ,��
A�F. 39 Building Division
Tom Perry, 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
I, LIU
,as Owner of the subject property
hereby authorize IMcAr1L AV ��� to act on my behalf,
in all matters relative to work authorized by this building permit application for:
C-e 11
(Addre s of Job)
Signature of weer Date
t-1 U Vl (T�sS 1 Yl
Print Name
Q:FORMS:OWNERPEF MISSION
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