HomeMy WebLinkAboutForm A-B SignedRev 07-17-2023
Office: 508-862-4093 conservation@town.barnstable.ma.us
For SE3-________
ALL PARTIES INVOLVED WITH THIS PROJECT MUST SIGN THIS STATEMENT
The undersigned confirm that they have read and understand the Notice of Intent, Order of Conditions, and
approved plans for the project. The undersigned also understand that subsequent plan revisions shall require
advance approval by the Conservation Commission. Please SIGN and PRINT name.
_____________________________ ________________________
Property Owner Phone number
______________________________ __________________________ __________
Signature E-mail address Date
_____________________________ ________________________
Applicant (if different from owner) Phone number
______________________________ __________________________ __________
Signature E-mail address Date
_____________________________ ________________________ ______________ ______________
Project Supervisor Business Name Cell phone no. Bus. Phone no.
______________________________ __________________________ __________
Signature E-mail address Date
_____________________________ ________________________ ______________ _______________
Alternate Project Supervisor Business Name Cell phone no. Bus. Phone no.
______________________________ __________________________ __________
Signature E-mail address Date
Please return this form to: Barnstable Conservation Division or e-mail as a .pdf attachment to:
230 South Street conservation@town.barnstable.ma.us
Hyannis, MA 02601
Town of Barnstable
Conservation Commission
230 South Street
Hyannis Massachusetts 02601
Form A B
Tullio Pereira 774-268-6675
03/19/2025imaginebuildingsolutions@gmail.comTullio Pereira