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0037 CAPTAIN BELLAMY LANE
,3 � CRP ' 63 �LLAMya LFlN� `S n f l S9 TO {{ i i n F ."Ir" CAPE SAVE 16D 552 Weatheriezation "!` b r 508-398 0398 December 14,2011 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main St. Hyannis,MA 02601 RE: Building Permits Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201101529, Status A, Parcel 230178 at 37 Captain Bellamy Lane, Centerville, Permit type: RADD, and issued on 3/29/2011 has been inspected by a certified Building Performance Institute (BPI) Inspector. R-18 Cellulose insulation was added to the attic.All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey j;D I�� 1/2 2Cape Save 7 Huntington Avenue Suite C, South Yarmouth,MA 02664 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ���" Application # Z I t d Health Division Date Issued 311,16 Conservation Division Application Feed Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - 0KH _ Preservation/Hyannis Project Street Address C4-t 6 Z z l ;R 4 A ;v C Village Gi- T v //G� f /y,9 ®.2 E 3,2 Owner Kra d k^o L/ Address 3C<<,,� z�G.' �e4k,A-$= _ r Telephone ("U 3 6 ,it 6 ,— Permit Request �i,4_i c� n AD o se-cl g p exe gP de e;0 0-�., Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3S DD Construction Type Lot Size C2. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family, Two Family ❑ Multi-Family (# units) Age of Existing Structure 6 Historic House: ❑Yes UdNo On Old King's Highway: ❑Yes Rt�No Basement Type: 'Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: �� existing —new Total Room Count (not including baths): existing -5- new First Floor Room Count Heat Type and Fuel: M Gas ❑ Oil ❑ Electric ❑ Other Central Air: W Yes ❑ No Fireplaces: Existing New / Existing wood/coal stove: ❑Yes 14 No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ 'n( Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Othe - CD Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ s k F Commercial ❑Yes 61 No If yes, site plan review# uYt� Current Use Proposed Use r. MA APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name GCI % n,' 5H A��d- a yv Telephone Number �� d' �46 6 - S Address Cat A tom:/L� License# ,v-Ee-A. Al"14 02 2 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY j S ti•APPLICATION# } � r DATE ISSUED . MAP/PARCEL NO. l� p it 1 ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION G "5�1��!t FRAME �1 �� )�( t `f INSULATION it FIREPLACE t F ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL I GAS ' — ROUGH <<<<'•, t 1. FINAL �� ;:� =FINAL•BUILDINGa F t E� DATE CLOSED OUT ASSOCIATION PLAN NO. .i a ' II „ The Comlmorcwealth of Massachusetts Department oflndustrial.Accidents Office of lnvestigafions 600 Washington Street t Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/organization/Individual): C ,t. 4e Address: 3 Gee d. ,t, ��Gc a� �.- �/�ti e- City/State/Zip: Ile . M� c�Z 6-5 L.Phone #: �� 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 6. ❑ New construction employees (full and/or part-time),* have'hired the sub-contractors.. . _ _ __.•_. . 2-❑ I am a sole proprietor.or partner- _ liste,d`on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workirr for mein an ca aci employees and have workers' g y P ty. 9. ❑ Building addition [No workers' comp. insurance comp: insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exerci g re hsed their l 1. Plumbing repairs`or additions 3.� lam a bomeowner doing all work ❑ p 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' I3.0:Other comp. insurance required.] *Any applicant that checks box f!l must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside conhactors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information Insurance Company Name: Policy# or Self-ins. Lic. #: W 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 and/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 a day against.the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalfies.ofp�erjury that the information provided above is trice and correct. Signature ! ` Phone#' v Official t<se 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#: - -1 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensalion for their employees. Pursuant to this statute, an emplo),ee 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, corporalion or other legal entity, or any two or mord of the foregoing engaged in a joint enterprise, and including the legal representatives of i deceased employer, or the receiver or trustee of a❑ individual, partnership, association or other legal entity, employing employees, Ho.,yever 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, constniction or repair Work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be decmed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or any renewal of a license or.perrnit to operate a business or to construct buildings in the commonwealth for applicant who has not produced acceptable evidence of compliance with the insurance.coverage re g sion " Additionally,MGL chapter 152, §25C(7) stales "Neither the commonwealth nor any of its political subdivivisions shall enter'into any contract for theperforrnance 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-contractors) name(s), addresses)and phone number(s)along with their certificate(s) of insurance, Limited Liability Compariies (LLC)or Limited Liability Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' compensation i n LLC or LLP does have nsurance. If a employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation ofinsurance coverage. Also be sure to sign and date th-e 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 Accidmis. 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 belcm.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 permiUlicense,number which will be used as a.reference number. In addition,an applicant that must submit multiple permit/license appli,caLions in any given year, need only submit one affidavit indicating current policy information(if necessary)amd under"Job Site Address" the applicant should write"all ]fat'ons in _(city or town),"A copy of the affidavit that has been officially stamped or marked by the city or town may be provid e d to the applicant as proof that a valid affidavit is on file for Future permits or licenses. A new affidavi lmust be filled t,ti t each year. Where a home owner or citizen is obtaining a license or permit not related to any businessorcommercial venture (i,e, a dog license of permit to burn leaves etc) said person is NOT required to complete this a$fdavil. The Office of Investigatjons wou�likeTo lh�nkryob�n a�va �e for our nnrratinn and should youlhaye 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 02 11 1 Tel. 4 617-727-4900 ext 406 or 1-877-MASSAFF Fax 9 617-727-7749 Revised 4-24-07 www.mass.gov/dia Town .of Barnstable ti Regulatory_ Services su Ns-rABrx. : Thomas F. Geiler,Director toss, I65p• ��� Building Division Tom Perry,Building Commissioner 200 Maiti.Street, Hyannis, MA.02601 www.town.barristable-ma.us Office: 508-862-4038 Fax:f 508-790-'6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: CQ,a a r 'V . j6 LL.LiA 1kX lag N e- A. T eye U/ Ile number street village '"HOMEOWNER": Gae;,J _SH&daoU -0; p 36T y 6;,t2S— name home phone# work phone# CURRENT MAILING ADDRESS: Jd� .e 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"OR BOMEOWNER , 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"homeowner"assumes responsibility for compliance with the State Building Code and other v applicable codes, bylaws,rules and regulations. , The undersigned "homeowner"certifies that,he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and . requirements.. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,006 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 homcownc performing work for which a building permit is required shall be excmpt from the provisions of this scction_(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 arc unaware that they are assurrring the responsibilities of a supervisor(see Appendix Q,` Rules&Regulations for Licensing Construction Supervisors,Section 2.15) Ibis lack of awarcness.bftcn 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 homcowncr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitics,many corhmunities require,as part of the permit application., that the homeowner certify that heAhe understands the rtsponnbilities 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./ccriification for use in your community, Q:forrns:homccxcmpt 4` Town of Barnstable Regulator Services t ILL"STAB - f y v uAa� g Thomas F. Geiler,Director P6 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign.This Section If Using A Builder as Owner of the Subject.pr operty hereby authorize to act on my behalf, is all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0WNERPERMISS]0N 82LL,gm Y LANE MO H TG A'G E IIVSPEC TI01V PLA1V APPLfOANT: SHKODROVE & HAMBLIN TOWN: CENTERVILLE 9�4 � 1ti � II LOT 6. i LOT 7 '0 A//„ — .......... . ' N of I ' LOT 5 LOT 10 oa. 0 6i 0 �o o 95,21' 0 LOT 9 j o LOT e � k 0,jII,,AAAA A OF r �� STEPHEN ® DOYLt N Y � FLOOD PANEL: 250001 0005 C FLOOD ZONE: "C" DATE MAP . REVISED: 08/19/1985 I HEREBY CERTIFY THAT THIS MORTGA E INSPECTION PLAN HAS BEEN PREPARED FOR: DATE: 08/29/07 SCALE: 1" = 40' BANK OF AMERICA DEED REF: 13773-171 PLAN REF: 395-90 THE LOCATION OF THE DWELLING SHOWN DOES NOTFALL.WITHIN A SPECIAL FLOOD HAZARD ZONE. .. .. PER TAPED INSPECTION THE DWELLING APPEARS TO CONFORM TO THE LOCAL ZONING BYLAWS IN EFFECT THE STRUCTURES SHOWN ON THIS MORTGAGE INSPECTION PLAN ARE LOCATED BY TAPE SURVEY AT THE TIME OF CONSTRUCTION WITTI RESPECT TO£4CR17ONTAL DIMENSIONAL SETBACK REQUIREMENTS ONLY. NO-INSTRUMENT SURVEY WAS PERFORMED AND LOCATIONS 9'10VM ARE APPROXIMATE. OR IS EXEMPT FROM VIOlLAMN ENFORCEMENT ACTION UNDER MA GENERAL LAWS CHAPTER 40A AN INSTRUMENT.SURVEY IS NECCESARY FOR PRECISE DETERMINATION OF BUILDING LOCATIONS SECTION 7, REFERENCE DEED SUBJECT TO AND WITH THE BENEFIT OF ALL RIGHT% RIGHTS OF WAY, AND ENCROACHMENTS, IF ANY EXIST", EITHER WAY ACROSS PROPERTY LINES, YANKEE LAND' EAS£PAENIs, RESERVATIONS AND RESTRICTIONS OF RECORD, IF ANY THERE SHALL BE, AND INSOFAR SURVEY COMPANY INC. SHA;l NOT BE HELD LIABLE FOR DAMAGES RESULTING FROM ANY USE AS THE SAME. ARE OF LEGAL FORCE AND EFFECT, IPF THIS PLAN FOR PURPOSES OT?.?ER TITAN'MORTGACE INSPECTION, TELEPHONE: 508-428-0055 YANKEE LAND SURVEY.. COMPANY, INC FAX: 508-420-5553 40 Industry Road, Marstons Mills, MA 02648 yankeesurvey®com cost.net www.yankeesurvey.c&n 39233 SH ® v.TERdL VPLIFI axaxv.•rum uue�a EXISTING Na..eraenn +�Pue 0 o TTP IXa/IXq ;� PDYIIDATgNW4LL3• LL LNR.6RDa. EXISTING 'o. •o� REAR ELEVATION EXISTING ra• R IV - } I�•coNc �I TYP,ANCHOR BOLT SPACING 0j o DIIeT�'a§ /C �9 g7 I� Tir+.IXenx N� 8! i°V NEW WALLS ; D ;.... 0<15TING WALLS M 'A=Z"DR LEFT ELEVATION ere ae.uRIGHT ELEVATION i e•-e• e•-e• NEW BLOCK UI;d.LLB .e. .......... ..................... 0 ExIeTIN"° -- ••�• EXISTING t NEW e.neeneNr EXf�YING GOIJG.-IUiSL1'S Ex19TIN6 mxea �arl� } FOUNDATION PLAN D CECK �---------'"-.-. DECK EXI8TM6 7 CF EXIBTM6 ♦aB4 n4ea LOWBi DECK Q+ 1 BEvaoon + 75 rxer. ® + BATHNEW DWK E%I+T - -•[_-me.�eu�w Ex10TR10 ®oernu eaTN ��'+•m eEDRoon KRCNENIDINM6 ExI8T1N6 lei' aevaoon TM e �•.a exlernvc a®T. naernr. ,yv Y eEDRaDM eaTN eEDROOYI SF/' IXIBrINb ex16TNG pa LMN6 jI BmROOM Ny'YII .......................eaow..........-.. ..-BE_L.. .... ................................ eweimc, _ ®(IBTRI6 7/1 EXISTING t NEW eEaan EXISTING t NEW FIRST FLOOR PLAN SECOND FLOOR PLAN EXISTING FIRST FLOOR PLAN EXISTING SECOND FLOOR PLAN aul�DeR .Ice.eDDaEse MD.. /•� //�M� 'Ii�L SI� aG®� DAE REV610N yRayNer wme ✓B //�OiB/(.r/I/0 BKODROV RESIDENCE EXTEND EXISTING BEDROOM 02-20-11 • JB •�vv3 v♦'a'c• �/ 31 CAPTAIN BELLAMY LN. CENTERVILLE MA. $I�1°`•` ,.,�, .® ��" )n/ ]n/ ]/��—�//{//J /{J(�`��J�(((��� ///(//n//)l//n /5/(���� //(///nJ/(//////////n /////(�,�\\\\'/(///l///)//�r/�//l/' ///l/(��\\\\'/(////f/5/(���/ AWC fillmE TO WOOD GONBI W)OTION M NIGH WINO AREAS Ib HPII WPID rONB // //O ��U U (�J����l/V (� WIND V(� ZONE (ram ' MASSAGNIISMS CHECKLIST FOR COMPLIANCE 0SO GMR BSOL2.I.II �� e U U O EXPOSURE O 1.1 SCOPE umn eP®rsem.Duen.._......._.__............................................................m F►N u.Dm BooelFm uTmoln.................................................................................e 1.2 APPLICABILITY NurBFw w eTOF¢D a weOF WNGI 0C✓gi'e e M tl eLwE eNLLt ee eornme®a aiwl+') �mm D��T� ,u,ow w �w J—aTam<e gigD®�L rerinw sox NAee Nee Maeen nBAN Imw ee....................................MO L._...................................,�Fr f N'�L ROOF RPAMeJ6 WILDING YmR,W-----------------------------------nleG.................................. 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AROUND WALL OPENINGS pIINDER JOB ADOREBB DEBK.N SKODROV RESIDENCE j N4 N _®� DA REV�N DRALLM BY PAGE 8C� �� ^�S/ MS EXTEND EXISTING BEDROOM L� // 02-28-II • JB 3pF� w•'o v g1' 31 CAPTAIN BELLAMY I.N. CENTERVILLE MA. I N,,'°D,,,°'"DMe v rEON 4Baes9•t YOU WISH TO OPEN A BUSINESS? Fear Your Information. ......gUJIn�J`� :I�r•t:ificates (cost.$3a.0❑for 4 ears .—.-.__....._�.�.._.._..,..____.�.... ...._.___..._..__--- ..-:_. .,�._ _ __ you must do by M.G.L. - it'does'not ive OU er mis y � A business certificate ONLY REGISTERS YOUR NAME in town [whist y F' , Ion lei operate.] Business Certificates are available at the Town.Clerk's Office, I' FL., :36 Main Street:, Hyannis, MA 02GO1 (T6wn Hall) WNW,'a+w aHUiL MWN Fill ill Pierian! i APPLIGAN.I"S Y01JR:RIAME:_ 13 o1 I�I GZ ti tip. U V i t L1C.0�- h� a OUrINI- C YOUR HOME ADDRESS: ,�'.��.,��zc3 `fit�'�� - �`j •'a _ TEt.E_�PONL JI Har°nc l- lophone Numbcr -� ►-.h(L I p, P Aa?`Az 5 L L C NAME OF NEW Bui'b)I11E58 ~^ _ 7'Y�� O� IS THIS A-HOME 0C CUPATION?J YLS -11t0 _ _ C�,? C _°►R _ _� Have yiau bann givers :appra►��,f frUm t hc: btiild'ng—divi8lun^ Y S' NCB i 1lc� SLt1Arl it; �yuc ,ts ! 4A ADDRESS'OF BUSINESS 37 CI�rP-r_; Q w� L1.e, ,� ,airy MA►P/PARCEL NUMBER _ __ When starting a new business thews, area several things you must: d6 in order.to be in c,ornpliancae: with the rules and rt,,qulations'of the Town of Barnstable. This forrn is intended t o assist you in obtaining>he information you [nay need., You MUST GO TO 200 Main St;. - (corner of Yarmout Rd. & Main Street), to rtiake sure you have the appropriate hermits and 1iQensesrequirPd to legally operate your business in this town. 1. BUILDING'COMMISSIONER'S OFFICE This individual has been informed-,of any permit requirements that pertain tq this type of business. Aut.l prized Signature—" ( COMMENTS: 2. HOARD OF HEALTH This individual has be c infr7rmcc�th r t require er s thIt:nprt;ain to this type of busiriGs s. uthnrized SignrrturG� COMMENTS: 3: CONSUMER AFFAIRS (LICENSING AUTHORI This individual haft�, infor d Uf the lir int. e ent:s that pemain to this type of business. Authorized Signature:,* ' COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address amp, i-an6 ✓Jt�.(`'�(� Village Ce)-1-er-V Owner I (`�Q� Urn bl�11 Address S ,D0 Telephoned Permit Request ��o��,n j ���c,�o 5e Q,n - Cd���eCe � r.�P -�'Yie� Z'a±i6r) 1�-30 ( Y\ a-k�ir 12 —15 w0ts Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �6A00 Construction Type _J a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family M Two Family ❑ Multi-Family (# units) Age of Existing Structure 19 F5 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes=540 No Basement Type: 0 Full ❑ Crawl ❑Walkout ❑ Other ) _ Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing — new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ;d Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes W No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review,# Cirent Use Proposed Use °t r APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name w i! cam 1'I c s k. /C-fe ove Telephone Number Address _]C 4 d ni,,ttnn 'Ll License # � -� �Y-9-j Z , r� tl a.��� Home Improvement Contractor# Worker's Compensation # 9 9 b 51 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO YC.r ,d j-'I SIGNATURE \\\, DATE FOR OFFICIAL USE ONLY -4N APPLICATION# DATE ISSUED J MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL `r . t GAS: ROUGH FINAL FINAL BUILDING Y. DATE CLOSED OUT ASSOCIATION PLAN NO. '' kw H SI(C- ,Hyannis, .A4-A 02x,01•-,*369QS - r h ENERGY & HOME RE`"A _ T {5U8) 77I-5400 F (5081 90 2:2-57 CO OR``L-H. I �,.�'v� TT`. iDk of i lik'1.E'.s i_w€w.h,,x zn_-aPeC0''P.0,, HOME OWNER WEATHERIZATION WORK PERMIT& FUEL RELEASE: PLEASE FILL OUT AND SIGN THIS FORM IF YOU ARE THE APPLICANT HOME OWNER. hereby consent to and agree that weatherization work maybe done by the Weatherization Program of Housing Assistance Corporation ( herein after referred as "Agency") on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather-stripping & caulking of windows and doors,insulation of attics, sidewalls &basements, attic and other ventilation measures and possibly replacement of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the "Agency" its agents and employees to travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. Z. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement as listed and freely give my consent. Home Owner: (Signature) l�6!>''°��'f �� Date: e) 3 Agent: (signature) Date: _ LI ` HAC approved Weatherization Company : el ✓ Caliber Building&Remodeling Cape Cod Insulation (:C�, pe ave Creswell Construction Frontier Energy Solutions Lohr& Sons Peter Smith Resolution Energy Rock Solid Construction All Cape Insulation sik_a_' ;rn:.-.perm_t_C! di c.d . Office of Consumer Affai s and Business Regulation tF 1.0 Park Plaza.- Suite 5170 Boston, Massachusetts 02115 Home Improvement Contractor Registration Registration: 164432 Type: Supplement Card CAPE SAVE Expiration: 10/6/2011 WILLIAM MUCCLUSLEY 8201 S. HOURD CT CHAPEL HILL, NC 27596 Update Address and return card.Mark reason for change. Address 3 #renewal Employment i Lost Card ;,. .:/sti; �!'G•)Tl.L;•;:-fa7us��� ty.,- r• <SX'!�tsd:}dt�c'�5 - : Office of Consumer Affairs&Business Regulation License or registrar#onr valid for individul use only <- before the expiration date. If found return tw. -HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 164432 Type: 10 Park.Plaza-Suite 5170 Expiration:..10/612011 Supplement Card Boston,MA 02116 CAPE SAVE WILLIAM MUCCLUSLE.Y. .7C HUNTING AVE.. � - --S.YARMOUTH,MA 02664 Undersecretary '`• Not valid witnout signature �- - . 11;t,.ati fttt�i•it, - lli'liatrtmrtrt tf.1'ttiili� �ai�:t`4 ' #3c:trt1 +it # tliltiin�12r��tl;ttiun. :ttttit.tt�cl:ttil, • �. ,..... :i�:....:��';:�wi>f,t:�;�J'..i} �'�'3:�f'i::3 s' ......-.iffy>; - ;canse: CS SL 102776 Restricted to. IC : WILLIAM 'MC CLUSKY t 37 NAUSET ROAD WEST YARMOUTH, MA 02673 �--G-- -� Eg)tr.;tiow 6128/2013 T'= 102776 The Commonwealth of Massachusetts :- Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dig Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Auulicant Information Please Print Legibly Name(Business/Organization/Individual): (/1 a �_ e o IS 14 I, CME, S Address: _-C, &rJ m niGw-, t,—Aac. City/State/Zip:S YAP,%aq t,� Ai 62-(o'�one#: - 3�.&- a Are you an employer?Check the appropriate box: Type of project(required): 1.Iff I am a employer with 4• ❑ 1 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 $, ❑.Demolition working.for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' conip. insurance comp.insurance.- required.] 5: ❑ We are a corporation and its 10.0 Electrical repairs or.additions .3.0 1 am a homeowner doing all work officers.have exercised their 11.0 Plumbing repairs or additions. myself. No workers' comp. right of exemption per MGL Y [ + p c. I52,ti 1 4 12.0 Roof repairs insurance required.] b O,and we have no 99 employees. [No workers' 13.� Other n S o I aIlpi) 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 axe 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. lfthe sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer d:at is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: �' `T( S LA l C; Policy#or Self-ins.Lic.#: Cif C: �2 1;3- �` Expiration Dater Z (. Lane ty p - �'16 6 b3 Job Site Address: 37 C�.G-�l � f1�1� �.�Y Ci /State/Zi : r, p'<d e 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 and/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 a day against the violator. Be advised that a copy of this statement may be forwarded to.the Office of, —Investigations of the DIA for insurance coverage verification. I do hereby certify under:the pains nd penalties o erjury.that the information provided above is true and correct. Signature: ! Date: a. Z d Phone.#: Official use only. Do not wrife 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#: Ate® CERTIFICATE OF LIABILITY INSURANCE °A'�i��"' "Y' ' 11/1%2010- r� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING iNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION 1S WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER l NAME CT Shannon Sperrazza Risk Strategies Company PHONE , (781)986-4400 FAX No:(701)963-4420A__.__. 15 Pacella Park Drive ADDRESS:ssperrazza@risk-strategies.com _ Suite 240 PRODUCER i)0018476 Randolph VIA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A.Seneca Specialty Insurance Co INSURER aAeating Group Ins Services .Michael McCluskey, DBA: Cape Save INSURERC:Chartis Insurance 7 C Huntington Ave INSURER D INSURER E: South Yarmouth MA 02644 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1011132675 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE A PouCY EFF POLICY EXP i POLICY NUMBER MM/ D i MM/DDIYYYY I LIMITS j GENERAL LIABILITY i f f EACH OCCURRENCE ;-$ 1,000,000 X;COMMERCIAL GENERAL LIABILITYDAMAGE TO RE PREMISES aoocurrance $ 50,ODO A _ CLAIMS-MADE I X OCCUR ;9AG1002608 10/16/2010'10/16/2011 MEO EXP An one rson is 10,000 i -r----�_—.—' _ j j PERSONAL&ADV INJURY i$ 1,000,000 GENERAL AGGREGATE is 1,000,000 EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG j$ 1,000,000 X ;POLICY PRO- LOC. -- j JECT AUTOIl1081lE LIABILITY i COMBINED SINGLE LIMIT $ 1,000,000 (6208200 11/6/2010 71/6/2011 (Ea accident) ANY AUTO I----- ----- - ALL OWNED AUTOS i j BODILY INJURY(Per person) $ BODILY INJURY(Peraccidentl $ i X SCHEDULED AUTOS { -- I 1 PROPERTY DAMAGE X HIRED AUTOS i i(Per accident) ;$ X ; NON-OWNED AUTOS ! i I $ X ;UMBRELLA LiAe f ' EXCESS UAB OCCUR i ! EACH OCCURRENCE � $ 1,000,000 CLAIMS MADE, i AGGREGATE is 1,000,000 DEDUCTIBLE B 1 RETENTION $ ; I023578601 3.0/16/2010 10/16/2011I -�is C i WORKERSCOMPENSATION Michael McCluskey __'TORY LIMITS: iOTH.I AND EMPLOYERS'LIABILITY y/N ' ANY PROPRIETORlPARTNERIEXECUTIVE ' is excluded from coverage E.L.EACH ACCIDENT s 1(Mandatory OFFICER/MEMBER inN)EXCLUDED? I N I A i l9930951 10/21/201010/21/2011 500,000 If yes,describe under , ( E.L.DISEASE-EA EMPLOYEE$ 500�000 DESCRIPTION OF OPERATIONS belowDISEASE•POLICY LIMIT $ 500,000 1 f DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Issued as evidence of insurance. Contractors-Executive Supervisors or Executive Superintendents. CERTIFICATE HOLDER CANCELLATION (508)790-2425 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Housing Assistance Corp ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Ruth 460 West Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601-3698 r Michael Christian/SMS ACORD 25(2009/09) 01988-2009 ACORD CORPORATION. All rights reserved. INS026(2oome) The ACORD narne and logo are registered marks of ACORD 00/25/2010 09:23 9193212955 PAGE 01i01 CAPEPI SAR .. 1 . Weatherization 508-398-0398 - r . August 2.2, 2010 To Whom It May Concern: William J. McGluskey is an employee,of-Cape.,Save., He is authorized to negotiate contracts and building permits for our,company. h Michael McCluskey Cape Save—Owner 919-593-5939 cell a X Huntington.Avenue.,South Yarmouth, MA 02664- . r r S .. u , (2q -' O 3.3 r, w w� 9 01. q'00 Z ti f c 2C , 340 or 4u CERTV71ED PLOY P_L�A�N "r RGBERT /p�u races�.•/®N P Ems. �p r s ✓ T 7 CA,�T'; �B�LG.f /�t Y L p N a v B. ELDREDGE No. 19367 0 . a�Fs' '�fv�STER�Q qy�` 16u U -41 1 SCALE= �� DATE , � z7/$S AGE ENMMING Co.l�V '���/"aRiE2 I CERTIFY THAT THE I: LENOINEER TER REGISTE1RIrD CLIIEPIT„_,_„___,. SHOWN ON THIS PLAN 13 LOCATED " VIL LAND" . Joe 140, 8309/ ON THE GROUND AS INDICATED AWD CONFORMS T SURVEY®R DR.®Y+ 0 THE ZOIdIIda LAWS OF ..®ARNSTAS E , MASS 712 MAIN S T R E.E.T 0M•®Y! HYANRIS, MASS,A SHUTLOFL_ p TE m REG. LAND SURVEYOR Assessor's map and lot riumber ......11..'.`4.��:.: 30. .. SEPTIC SYSTEM MAST BE THE o t-A C , ' INSTALLED IN COMPLIANC °` TOE Sewage Permit number r :�...:...........�:...... """""' """" WITH TITLE 5 s° ENVIRONMENTAL COD a$as E, House number E A E M Ta L p!¢t TOWN REGULATIONS '°°,,i�owpYa`e TOWN . OF �BARNSTABLE B.UI'LDING- INSPECTOR APPLICATION .FOR 'PERMIT TO ... /.�..,((. ......................................... TYPE OF CONSTRUCTION ...... ....... ......../'..f ... ...................................................................... ................ yl .............19..t TO THE INSPECTOR OF BUILDINGS: The undersigned ere y applies for a permit, according tg t� followin information: Location ...o..........°° z.r ............ ...... ...rr/....N=. ..�'...���......... ... .•......................................................................... ProposedUse ...:... /. lry .............................................. ....................................................... Zoning District ...... . .�.. .... / ................................. District ./%J ... . . ...... .. Name of Owner .... f7 i.. ... ,..Address ........J...C. .........�..... 0..... � .... Nameof Builder ............ ./ ." ...................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of( R� m ....... ......,,.pp.... ...........ms.......e.....................Foundation ........... Exlerior ... .. yc- 7z - ........Roofng ..... ... .......................... Flo ....................Interior .....� <f!...................................... Heating ...�....S.N........ ...... .... ...... S.S................Plumbing ......0 X... .. .. ................................................. Fireplace .o9ae7...c............................................Approximate. Cost ......... 4.tad...� ............................. r p / Definitive Plan Approved by Planning Board ------------- ---------19_ S, Area ......O....l... .................... !�G y`t✓ ._ Diagram of Lot and Building with Dimensions Feeo;............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH r I�b OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . .. ........ Construction Supervisor's License .......... REENBRIER CORP. I `28509 12, Stor No Permit for .................................... f Single Family Dwelling ' ...............................'............................................... Lot 7 37 Capt. Bellamy Lane Location ... .................. . ................. .......... Centerville ............ f Greenbrier Corp. � •� '"� �� ` Owner { < ..........:........ ...Frame.. ................. � , .� Type of Construction .............................. . -.......... ,7 ,.�' Plot ............................ Lot ..... ................ Permit Granted ..October..9, ! 19 85 " J Date of .Inspection ..... �. ri 9 ` Date Completed jIle � , .,J • s TOWN OF BARNSTABLE Permit'-No. ---28509 Building Inspector Cash - ----------- —_ Ewa OCCUPANCY PERMIT 'Bond ___ _/ a4____ Issued to Greenbrier Corp. Address Lot 7, 37 Capt. Bellamy Lane, Centerville Wiring Inspector Inspection date Plumbing Inspectors -Inspection date Gas Inspector Inspection date r XEngineering Department` Inspection date Board of Health �3 �-- �� '� `� :Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE;WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSET76 STATE BUILDING CODE. .......... .._,......» :... Buildi g Inspector t TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 BAEass TOWN OFFICE BUILDING '9r t6 9• �� HYANNIS, MASS. 02601 E MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued.for theluilding authorized by; ._. ?�--1�.»»' 1» . ......................................... .....................»....»... . ..........»................. Building Permit. # issuedto ............... � } Lt� ... ......... »...»»........» ......».»».... » 7 Please release the performance bond: /Ub"�- p17T 7 S� �i7CGS.T7r'G G✓L2 c . 0 prl S /. yo �� a iPc � / �r5 � w / LvT 7 2 3cr Tv C�.ULl O o o 6/ 4'• h raw 4 00 r A cR e z;S'w i D Tt/ v ..I QT ..' 4SS UM EF L.vT 7 vWA, ALBERT ` Roar,,R i s\ . . A- r l - R - iA Lt DR": GC rU 6, :, �r icy ' LEGEND ��/ `' ,r P.XISTIN® SPOT ELEVATION 010 CERTIFIED PLOT ;;EXISTING CONTOUR --- 0 -- LAN FINISHED SPOT ELEVATION " L(J T / Av: p'lNISMEO CONTOUR 0 !�� ''?: �1 : fi ! _.N TH r t/ z Z E The;•location 'of any existing underground sewerage — I� 1',0111,`;ox other utilities shown on this plan is approx- an7�y as determined from records..and/or verbal ion. The= contractor isspo.psible for `the J ©�•:tl?e g 1pcaximns �n.Ahe field. "CALF= / 4or 'DATE 6�2.� 8s ENGINEERING CLIENT I CERTIFY THAT THE PROPOSED x MISTERE REGISTERED JOB NO. 09 BUILDING SHOWN ON THIS PLAN ,. CIVIL LAND DR. y`'1 CONFORMS TO THE ZONING LAWS . ENGINEER SURVEYOR . OF BARNSTABLE , MASS. 712 MAIN STREET CH. BY: IZ• 1' .E /`'///`�'y HYANN I S, MASS. Z - SHEET— OF ATE _ EG LAND SURVEYOR 1 - I �rUB) der- 3613(-- Assessors map and lot number .......... ..... <l i3 C Q� v Sewage Permit number ........ ............ `!.......................... d w Z HARNSTADLE, i House number 1 Ak� 0 G& . .�,�.!.j............................... 9� 16 a TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ..:....... . ....... ......z.r..,,.r.; TYPE OF CONSTRUCTION ...... .Gk /i�...., ..................................... .................... ...............*� .�.: ".�............19.xjts v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies form permits according tvhe following information: Location ...`.."..� .. .. �..� ....':: <.'...f..... //"t :.................................. ....... ProposedUse - -�.!:�'��.....:...................�..,.�.....................................................,. PZoning District ........�.........H..........�f..........................:...............Fire District ...... Name of Owner ... ....... 20.... .... U! f ..;0/� . Nameof Builder ...........:5 rl.�'r?.'E'..................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation C.....:..................................................... ........... Exterior ...... ..... ............................_........ 1�:5........Roofing ..< .......... ..: .. ... .... ............................ Floors ���...!�..:�1....... �..... Interior ? � C" �JC �C ..................................................................................... s" Heating ...Z.....�.C .;�.. .................Plumbing ......., ..mac 1 Fireplace ..................................................................................fApproximate. Cost .......:'... :...,.....:..... 5' rat . Definitive Plan Approved by Planning Board __ ________________19_ Area Diagram of Lot and Building with Dimensions f Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH f / J OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the,Town of Barnstable regarding the above construction. Name Construction Supervisor's License .:'''fat'-Z •%'. 1 GREENBRIER CORP. A=230-119 a t a3 »P` , �......���o� rmit for ......No ....28f•09 . � 1. ...StorY............. Single Family Dwelling .......... ......... .................. Location .,,Lot 7, 37 Cast. Bellamy Lane Centerville ............................................................................... Owner ...Greenbrier Cork........... Type of Construction ,Frame ................................ ................................................................................ Plot ............................ Lot ................................ Permit Granted ..O:c.tober...9.................19 85 Date of Inspection ....................................19 Date Completed ......................................19 l 8/93 The Town of Barnstable Department of Health, Safety and Environmental Services . Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230. _ Building Commissioner Home Occupation Registration Date: //_7 V Name: �.r�l �( � Q c,. S ate, Phone#: Address: -3 Village: Name of Business: G .e o-e- Type of Business: Map/Lot: .2., ° (90 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 undersigned, have read and agree with the above restrictions for my home occupation I am registering. Applicant: Date: U C Homeoc.doc