HomeMy WebLinkAbout0225 STRAIGHTWAY a�2�s 512,��maay
y_
�11KE Town of Barnstable * ermi clSf7
p� Expires 6 months from isshe date
Regulatory Services Fee
enartsrnBLE.
Mass.1639. $ Thomas F.Geiler,Director
�EDMP�a
Building Division ,
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY
,n Not Valid without Red X-Press Imprint
Map/parcelNumber� L� i
� \ A
Property Address 1 ��" �� I W`A-
i
esidential Value of Work Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address C.1� �� \�
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance
Check one- X-PRESS PERMIT
❑ I a sole proprietor
I am the Homeowner S F P 2 5 2009
❑ I have Worker's Compensation Insurance _
]nsurance Company Name TOWN OF BARNSTAB�L
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must accompany each permit.
Permit Request(check box)
❑ Re-roof(stripping old-shingles)All construction debris will be taken to
❑ Re-roof(not stripping. Going over existing layers of roof)
❑ Re-si e-•-
#of doors
" Replacement Windows/doors/sliders.U-Value (maximum.44)#of windows
*Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc..
***Note: P perty caner m Sftn7
ner Letter of Perm i sion.
copy the Ho atractors License&Construction Supervisors License is
require
SIGNATURE:
C:\Users\decollikWppData\Loca -soft\Windows\Tement.Outlook\4STGU5QO\EXPRESS.doc
Revised 090869
I I'
' 77re Commonwealth of Massachusetts :
Department of Industrial Accidents
Office of Investigation.s
k 600 Washington Street
Boston,:,U4 02111
witiv.niass.govldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information i Please Print Le-gibh
Name(BusinessiOrgauination€Inciichdual):
Address: 'l
City/state zip:_ �� \ LI'� . Phone 4, 1
Are you an employer?Check the appropriate bon: Type of project(required)-
ant a general d I contractor an
l.❑ I am a employer with 1_ ❑ I 6. ❑Neu=construction
employees(full and=or part-time).* have hued the sub-contractors
2.ElI am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling
ship and ha,.=e:no employees These sub-contractors have, S. Demolition
working for mein any capacity, employees and have workers' �
[No Ivor 'camp.insurance comp.insurance.
El But Addition
_pmq15redJ 5 ❑ the are a corporation and its 10.❑Electrical repairs or additions
3_ I ant a homeowner doing all work officers have exercised their 11.Q Plumbing repairs or additions
myself.[No workers'comp. right of exemption per N1GL 12.❑Roo repairs
insurance required.]_ c. 152,y 1(4),and we have no
1. they
employees.[No workers' 3.. v`)� '� �`-�t• �
comp.insurance required-]
`Auy applicant drat checks box#1 must also fill out the section below showing their workers'compensation policy information_
Homeowners who submit this affidavit indicating then are dome all work and then hire outside contractors must submit a new affidavit itdicating such-
-Contractors that check this boat must attached an addinoual sheet showing the uame of the sub-conttuctors and state whether or not those eunde>have
employees. If the sub-contractors have employees,they must provide their workers`comp.policy number.
I ant art e»eplarer that is proiiditig tt-orkers'.cotttpettsation ittsttrauce for nrs,eitiplay-ees. Beloit'is thepolicy and job site
inforniatiott.
Insurance Company Nance: .
Policy or Self-ins.Lic_ Expiration Date_
Job Site.Address- CityiState/Zip
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required.under Section 25A of l`a'1GL c. 152 can lead to the imposition of criminal penalties of a
fine tip to S1,500.00 an re-year,inipi`is...n . t,as well as cii it penalties in.the form of a STOP WORK{ORDER and a fine
of up to$250.00 a agar t the vi lator. Be iced that a opy of this statement maybe forwarded to the Office of
Investigations o e`D or insttra ce cavexa e v ification.
I'do liereby e t1 lull lie pant nd pens es o Pe 11u tlt t lie infortttation prodded above is true and correct.
Si tore: Date-
Phone s
Official use ottty. Do not write itt this area,to be completed bl,city or totvtt official
or Town: Permit/License t;__
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.Citp1rown Clerk 4.Electrical Inspector 55.Plumbing Inspector
G.Other
Contact Person: Phone#:
Town of Barnstable
Regulatory Services
` SS. Thomas F.Geiler,Director
�F%639. a 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
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
umber i f\ street village
..HOMEOWNER": �C,1 tam ' l �Ll f�� �v�b
name home phone#' work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow
homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor.'
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-
family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one
home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form
acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section
109.1.1)
The undersigned"homeown "assumes responsibility for compliance with the State Building Code and other applicable codes,
bylaws and r gulatio
Th andosignedmeoe 'certif s that he/she understands the Town ofBarnstable Building Department minimum inspection
p, eme is d Mthae/she will comply with said procedures and requirements.
Signature of Hom owner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the.State Building Code
Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section
109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as
supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for
Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems;:particularly when the homeowner hires unlicensed persons.
In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately
responsible:
To ensure that the homeowner is fully aware of his/her responsibilities,_many communities require;as part of the permit application,that the homeowner
certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns: You may care t amend and
adopt such a form/certification for use in your community.
C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\4STGU5QO\EXPRESS.doc
Revised 090809
1
;1
Town of Barnstable *Permit# n?
OExpires 6 months from-i me
r r
Regulatory Services Fee
+ HARN6TABLE, r -
v amass'
1639• Thomas F.Geiler,Director
♦�
�fD MAC�
Building Division
Tom Perry,CBO, Building Commissioner
200 Main Street,Hyannis,MA 02601
www.town.bamstable.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 '
Property Address � �� � t�
24
esidential Value of Work LJ Minimum fee of$25.00 for work under$6000.00
Owner's Name&Address
Contractor's Name Telephone Number
Home Improvement Contractor License#(if applicable)
Construction Supervisor's License#(if applicable)
❑Workman's Compensation Insurance -PRESS PERMIT
Check one:
❑ I sole proprietor
I am the Homeowner MAY �DOQ
❑ I have Worker's Compensation Insurance 1-®W(v OF BARNSTABL
Insurance Company Name
Workman's Comp.Policy#
Copy of Insurance Compliance Certificate must be on file.
Permit Request(check box) ll"Sb �D 4_A .
Re-roof(stripping old shingles) All construction debris will be taken to
❑Re-roof(not stripping. Going over existing layers of roof)
❑ Re-side
❑ Replacement Windows/doors/sliders.U-Value (maximum.44)
*Where required ance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc.
***Note: Prope Owne ust sign Property Owner Letter of Permission.
A cop of the a Im ovement Contractors License is required.
SIGNATURE:
C:\Users\decollik\AppData\Local MIv osoft\ indows\Tem rary ft rnet Files\Content.Outlook\MY7NB4IL\EXPRESS.doc
Revised 100608
a �
-\ The Commonwealth of Massachusetts
- Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LeLyibly
Name (Business/Organization/Individual):
Address:
City/State/Zip: Phone #: 7
Are you an employer?Check the appropriate box: Type of project(required):
1.❑ I am a employer with 4. ❑ I am a general contractor and I
employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
working for me in any capacity. employees and have workers' 9 ❑ Building addition
[No wor s' comp. insurance comp. insurance.$
re 'red.] 5. [] We are a corporation and its 10.0 Electrical repairs or additions
3. am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions
myself. [No workers' comp.- right of exemption per MGL 12.❑ Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.0 Other
comp. insurance required.]
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners.who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp,policy number.
i
I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site
information
Insurance Company Name:
Policy#or Self-ins.Lic.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 day agai st the violator. a advised that a copy of this statement may be forwarded to the Office of
Investigations f the D or ins ance co age ve ' tcation.
I do hereby c un the p s and n ties o erjury that the information provided above is true and correct
Signature: Date: ems`
Phone#:
Official use only. Do not write in this area,to be completed by city or town official,
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire,
express or implied,oral or written."
An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the
receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the
dwelling house of another who employs,persons to do maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of _
insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the
members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy,please call the Department at the number listed below. Self-insured companies.should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant
that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current
policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or
town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permm to bum leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel.# 617-7274900 ext 406.or 1-877-MASSAFE
Revised 4-24-07 Fax# 617-727-7749
www.mass.gov/dia
Town of Barnstable
-
„�. Regulatory Services
BARNsr,ELF- Thomas F. Geiler,Director
riJ►ss
� 3¢ ..0g Building Division En i6
Tom Perry,Building Commissioner
200 Main Street,_ Hyannis,MA_02601
www.town.barnstable.ma.us
Office: 508-862-403 8 Fax: 508-790-6230
HONIEOVNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION: 11:5 l W
bcr n 1 street village
"HOMEOWNER": CG,�J� ` �l s�S .r` a
name —y home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as
supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to
be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A
person who constrgcts more than one home in a two-year period shall not be considered a bomeoRmer, Such
"homeowner'shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
reseOnsible for all such work performed under the building permit. (Section 109.1.1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applica des, b laws,nil s and regulations.
e un signed' omeown 'certifi that.he/she understands the Town of Barnstable Building Department
um inspcc ' proced and r irements and that he/she-will comply with said procedures and
em ts.
Signature of Hom owner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with'the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that "Any homeowner performing work for which a building pcmrit is required shall be exempt from the provisions
of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such
work,that such Homeowner shall act as supervisor."
)4.any homeowners who use this exemption are unaware that they are-assuming the responsibilities of a supervisor(see Appendix Q,
Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly
when the homeowner hires unlicensed persons. In this case,.our Board cannot proceed against the unlicensed person as it would with a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,
that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by
several towns. You may care t amend and adopt such a form/certifrcation for use in your community,
Q:forms:homcexcmpt
zTti Town of Barnstable
Regulatory Services
MABS. E Thomas F. Geiler,Director
16 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
as Owner of the subject.property
hereby authorize to act on my behalf,
in all matters relative to work authorized by this building permit application for:
(Address of Job)
Signature of Owner Date 6
Print Name
If Property Owner is applying for permit please complete.the
Homeowners License Exemption Form on the reverse side.
Q:FORMS:O WNERPERMISS]ON
I
167 Straightway
Hyannis,MA 02601
November 27,2006
Mr. John C.Klimm,Town Manager Ms.Robin Giangregorio,Zoning Enforcement
Town Offices Town Offices
367 Main Street 367 Main Street
Hyannis,MA 62601 Hyannis,MA 02601
Dear Mr.Klimm and Ms.Giangregorio:
I write to express my dismay over what has recently been happening on our street, Straightway. I try to be
charitable and look the other way,particularly at this time of the year,but I am afraid that,if I do remain
quiet,things on Straightway will only get worse.
First,I am a very good neighbor,and I try to maintain good relationships with those who live near me.
However,I cannot say the same for residents who have recently moved onto the street and near my
property,which I have lovingly maintained for the past 20 or so years. Let me explain.
First,I believe that residents,including those of us on Straightway,are only allowed ONE unregistered car
on their property AND absolutely NO heavy trucks or construction equipment of any kind. Straightway is
not zoned commercial. One unregistered car,as everyone knows,is bad enough. Unfortunately,new
people have moved in at 225 Straightway,and with them,they now have a huge flat-bed tow truck in the '
yard,sometimes running,sometimes with a wrecked vehicle on its bed,and at least two unregisterd cars on
the property. I should not have to listen to the running truck,nor smell its exhaust,nor look at the
unregistered cars every time I go for a walk in the neighborhood.
Down4t,the=othertend of the street at 55 Straightway,the resident there has just brought his huge flat-bed
tow truck BACK into the neighborhood—probably since he saw that the people at 225 Straightway were
allowed to keep theirs at their property. He,too,leaves it with wrecked vehicles on its bed,and to make it
a darige-rous situation,he regularly parts it on the narrow street. I am surprised that no one has rammed into
the back of it at night,since there is no room for it and it juts out into the road. The bottom line is that it
shouldn't be on the street to begin with.
Across the street from me,at 166 Straightway,the new residents there now have painting vans and
landscaping equipment being housed in the driveway. Need I say that during the course of the day and
night,there is more traffic coming and going from that driveway than there is on West Main Street?
Some taxpayers like to maintain their r 'property and do abide by the town s zoning enforcement. That
would be me. Other people think that they can do whatever they want because no one will complain. Well,
I am really sorry to have to complain,but it is NOT FAIR that good neighbors such as myself get stomped
on by newer inconsiderate residents.
I wrote once before about a similar problem on the street. At that time,police beefed up their patrols,the
construction equipment and dump truck disappeared,and the street was a cleaner,quieter place. I am
hoping you will act once again on behalf of myself and my family and enforce the laws on Straightway.
Thank you.
• Siiicerely,s,, ��7e,a .,..r�;4; ;4� ,, ... . �, _„:r,. p, czc l°�"-. .,.s�rr ,..
Q.^ , .
3
Maureen McLaughlin 01 ° 3�:x tins_,. x:„.t r.� c zsG"!s,.. '1�•J; ,,-i, sE- €ci
r
l4i1<_� ._Maureen McLaughlin � �"�„�,,,„.�'��•� �«�'
i 167 Straightway':=: CAPE COD ,9'�,ry A 0, 25-026
£ Hyannis,MP1S 02601-3617
fl
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yin is A �at�al
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Town of Barnstable
CF THE Tp�
Regulatory Services
Thomas F.Geiler,Director
• - Building Division
wexsrABM i
9� MASS. `�g Tom Perry,Building Commissioner
RFD 39. A 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Approved:
Fee: � e2
Permit#:
HOME OCCUPATION REGISTRATION
Date:
Name: .� l5s If !ZPY Phone#: 14'e.
Address: 2 2 S S 1�'��6/VAy�� Village:_�9�y�nyl �S
Name of Business: /s &y F6'5/1)-f/11/& CL U1.3
Type of Business: 7 6-C eC rl&V Map/Lot:
INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation
within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the
activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual
alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal
residential volumes;and no increase in air or groundwater pollution.
After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the
following conditions:
• The activity is carried on by the permanent resident of a single family residential dwelling unit,located
within that dwelling unit.
• Such use occupies no more than 400 square feet of space.
• There are no external alterations to the dwelling which are not customary in residential buildings,and there
is no outside evidence of such use.
• No traffic will be generated in excess of normal residential volumes.
• The use does not involve the production of offensive noise,vibration,smoke,dust or other particular
matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects.
• There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess
of normal household quantities.
• Any need for parking generated by such use shall be met on the same lot containing the Customary Home
Occupation,and not within the required front yard.
• There is no exterior storage or display of materials or equipment.
• There is no commercial vehicles related to the Customary Home Occupation,other than one van or one
pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to
exceed 4 tires,parked on the same lot containing the Customary Home Occupation.
• No sign shall be displayed indicating the Customary Home Occupation.
• If the Customary Home Occupation is listed or advertised as a business,the street address shall not be
included.
• No person shall be employed in the Customary Home Occupation who is not a permanent resident of the
dwelling unit.
I,the unde
VH pplicant: � �,, �
Date:
omeoc.doc Rev.5/30/03
TO AL NEWrSINESS OWNERS
DATE: - •J
Fill in please:
x
APPLICANT'S
arr YOUR.NAME: � LZ,a
BUSINESS rr YOUR HOME ADDRESS S'
TELEPHONE � ` � ����� .
_ Tele hone Number Home 1!
NAME OF NEW BUSINESS U2�?.. EAZJA� LL v TYPE OF BUSINESS 0 US
IS THIS A HOME OCCUPATION? YES NO
Have you been given approval from the building division? YES NO
ADDRESS OF BUSINESS 2Z.SST"IG� 2✓g /t�al0�' MAP/PARCEL NUMBER .
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed
below,you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town.Hall). You MUST go to the following office to make sure
have all the required permits and licenses.. you
GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) and you will find the following offices:
I. BUILDING COMMISSIONER'S OFFICE
This individual has n informe o any permit requirements that pertain to this type of business.
tit orized Signa rre*
COMMENTS: CC a
2. BOARDbF HEALTH
This individual has been informed o the permit requirements that pertain to this type of business.
Authorized Signature** 3
COMMENTS: `
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing.requirements that pertain to this type of business.
Authorized Signature**
COMMENTS:
Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you.must do by M.G.L.
-it does not give you permission to operate-you must get that through completion of the processes from the various departments involved.
**S/G/V/F/ES APPROVAL FOR BUS/NESS CERT/F/CATEO/VL Y.