HomeMy WebLinkAbout0079 PINE AVENUE �� P//VG- _ve
1I-Cl-05
Town of Barnstable *Permit# �;
Expires 6 months from issue date
Regulatory Services ��PRE has ao
Thomas F.Geiler,Director
Building Division NOV 9 e 2005 D8
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601 TOWN OF BARNSTABLE
www.townbarnstable.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 k. 36!? 07�� C
Property Address r L YJ �- / �� � 0
p Pa i
®1sidential Value of Work r��® ' Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address > sfi �'z ��'`"Y 0, V
Contractor's Name jej��-i-- k��4P�/9-k'��C-4�� Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable) ) C 6-
❑Workman's Compensation Insurance
Chec ne:
Mlfam a sole proprietor
❑ I am the Homeowner
❑ I have Worker's Compensation Insurance
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box)
e-roof(stripping old shingles) All construction debris will be taken to -d'd! �
❑Re-roof(not stripping. Going over existing layers of roof)
M-Re-side
❑ Replacement Windows. U-Value (maximum.44)
*Where required: Issuance of this:permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Property Owner must sign Property Owner Letter of Permission.
me Improvement Contractors License is required.
SIGNATURE: :
Q:Forms:expmtrg
Revise071405
f
9
• - Town of Barnstable
Regulatory Services
Thomas F.Geiler,Director
9 �fo 39. �� Building Division
Tom Perry, Building Commissioner
200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403$ Fax: 508-790-623 0
Property Owner Must
Complete and Sign This Section
If Using A Builder
I, 4 as Owner of the subject propem
r
hereby authorize to act on my behalf
in all matters relative to work authorized by this building permit application for:
(Address of Job)
s
igna of r1 / Date
Print Name
QTORMS:OWNERMRMU SION