29-215 (4) ! d A
Date Filed., DN'10F gUlLplflG fN5PEGT10NS File No C)U
OA 01060
REGISTRATION OF HOME OFFICE/OCCUPATION (§10. 2 & 11. 11)
With the Building Inspector
1. Name of Applicant: t-t�.,,,I q t 4T _R
Address: A�n'er;,e�.,.1 /7i �v�� , .��, ,a , Telephone:
2 . Owner of Property: S �-
Address : Telephone:
3 . Status of Applicant:/Owner Contract Purchaser Lessee
Other (explain: )
4 . Parcel Identification: Map # _�cj_, Parcel # ,
Zoning District (s) (include overlays)
Street Address
5 . Narrative Description of Proposed Home office: (Use additional sheets
if necessary) ScHysf7i'w pp gamin'riis 5 c,)irW 5>i
6. Is this a legal residential building? NO
7 . Will there be an employee who does not live in the home? YES (XV
8 . Will you ever see clients or customers at your site? YES
How often
For what purposes
9 . Will there be any signs for the Home Office? YES dM
10 . Will there be, any goods sold from the premises or any sale of
goods stored on premises, either retail or wholesale, or any
display of goods on premises? YES qqb
11. Will there be any outdoor storage of materials? YES
12 . Will your use be totally within a building and not cause any
outward manifestation (including traffic generation, parking
congestion, noise, air pollution, and materials storage) ? YMS NO
If No explain:
13 . Attach Plans .(if applicable)
14 . Certification: I hereby certify that the information contained herein
is true and accurate. I understand that if any information is incorrect,
my permit is null and void and I may be liable for non-criminal fines and
criminal and civil actions.
Date: t2�� Applicant's Signature: ,C?� ,
- - - - - - - - - - -- - - - - - - - - - - - - - -- - - - - - - - - - - - -
• THIS SECTION FOR OFFICIAL USE ONLY:
Approved as presented/based on information presented
APPROVAL EXPIRES ON DECEMBER 31 OF THIS YEAR AND MUST THEN BE RENEWED
e i d as esented---Reason:
ignatu --of-- Buil g Inspector Date
NOTE: Issuance of a permit does not relieve an applicant's burden to comply with all zoning requirements and obtain all required permits
from the Board of Health, Conservation Commission, Department of Public Works and other applicable permit granting authorities.