TOWN OF BARTIETT

OFFICE THESELECTMEN OF RR I BOX49 INITERVALE 03845 NH (603)3s629s0

T::T:i::"Y:Y g:i :y ::::i':: :::: :":

This form is to be usedfor notificationpuf,poses the Assessor's to Office of minor changes propertywhich to do not rcquirc a buiiding pe'nnitbut may changethe assessed value. Someexampleswould Ui a changein thetype of sidingon the house,replactnga roof, change tlpe of flooring, change type of hcatingryrt"* in in or changein insulatioa. Thereis no fee for filing this form.

DATE: 11/5/08

wu n;T.oCwInT sUBJEcT oF 5RT3}2/23LOO PROPERry

Edward Furlong III PROpERTy OWNERNA1,IE. P,O. N,{AILINGADDRESS, Box 447, Baftlett, NH 03812

PHONE NO. 374-9257

CONTRACTOR'S NAME: Property Owner

MATLING ADDRBSS.same

pHONE1qg. Same
*t*trt*tf tf***++**+***4*****fr*t*t'|. ,ra*****rt****rl****f'} *rt,tt **rtf'|. rrt'rat'l****rl++**rr't++***ir*:i't *!i

DESCRIPTION OF MINOR CHANGE (attachsketch if appropriatq):

wIrAT IT wAs BEF.RE:Cabin#3 on attached sketch

Cabin#3 on attached sketchwith new shingleson roof, WHAT WILLBEAFTER. IT paintedinteriorand exterior.
SIGNATURE OWNER*: ( OF

a --r'

*PLE,4.SE NOTE: Theoumer mustsignthis kim or obs-docilmerotation signed (e.g, contact)mustbe presented indicatingthattheownergivespe,rrrission thecontactorto performthiswork. to

TO\^N CF BARTLETT CFFICE THESELECTMEN OF R R I B C X4 9 INTERVALE, 03845 NII (603)3s629s0 NOTIFICATION FORM FOR MINOR CHANGES TO PROPERTY (MAINTENANCE OR COSMETIC CHANGES)
This form ls to be usedfor notificatronpurposes the Assessor'sOffice of minor changes propertywhich do not to to require a building permit but may changethe assessed value. Someexamples would be maintenance cosmetic or ttems such as a changein the fype of siding on the house,replacinga roof, changein type of flooring, change fype rn of heating system,or changein insulation. Thereis no fee for filine this form.

DATE:

MAP/BLOCK/LOT SIIBJECT OF PROPERTY

LOCATION OF PROPERTY

PROPERTY OWNERNAME:

MATLTNG ADDRESS: _

t.l <

K1z

3oe

PHONENO.774/'?Jg7
CONTRACTOR'SNAME:

MAILING ADDRESS,

ITAV

?7

PHONE NO. F MINOR attachsketch if

WHAT IT WAS BEFORE:

WHAT IT WILL BE AFTER:

SIGNATUREOF OWNE
*PLEASE NOTE: The
indicating that the owner gi this form or other documentation (e.g. signedcontract)must be presented Sionto the contractorto perform this work.

'

"

, l{ l
\/

w --------r-

\!

I
I

I
I

I
L_

''. / / / i I I t .
r

>:-*,./.l=}

/ @J
:.r srlq _:j!5rL].4 ._-.