HomeMy WebLinkAbout0128 SANDY NECK 2
UPC 12543
No. 53LOR
a,x 1
'aC'}} TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
1;
Map Parcel pplication #
Health Division Date Issued Conservation Division �l� C3-sZ�� Application Feeklla�
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board v
Historic - OKH _ Preservation/ Hyannis
Project Street Address a O Y
Village ,,. 1`�
Owner _�� C�— � 1� Address (61= MC(Jr)
Telephone
Permit Request C�� q
0,_
a �
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
I
Project Valuation mm, --'- Construction Type IA/ori e
Lot Size Grandfathered: ❑Yes d2 No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)
Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No
Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other /V 01V6
Basement Finished Area(sq.ft.) ,4 Basement Unfinished Area (sq.ft) A111g
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: ni existing —new
Total Room Count (not including baths): existing new First Floor Room Count "/
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other �9
Central Air: ❑Yes ❑ 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 ❑ Q
I
Commercial ❑Yes ❑ No If yes, site plan review# �!
Current Use I/A ✓ Proposed Use « a
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APPLICANT INFORMATION :Z` can
`P a
(BUILDER OR HOMEOWNER)
NO rn
Name y�,-,_ %, Telephone Number
Address Poo T� o6;,-5 License #
� � ✓"lam Home Improvement Contractor#
Email Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
MA-2f70wf /Y1��U cJo 6W 6V4 fY.
SIGNATURE %/ DATE Z/
FOR OFFICIAL USE ONLY
t APPLICATION#
� DATE ISSUED`
MAP/PARCEL NO.
s
ADDRESS r VILLAGE
''. OWNER
DATE OF INSPECTION: 1
FOUNDATION
`Y FRAME
INSULATION
' FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
t
GAS: ROUGH FINAL `
w _
r'
FINAL BUILDING
DATE CLOSED OUT
• r
ASSOCIATION PLAN NO: __ r
r
F
I' �
1
ire Commonnwai#h of�Iassachmsefts
Ileparftnent of li luskzal Accidents
OjTwe of Imestigations
600 Washrsrgton reet
I3vstorl<,MA 02111
wtvm r1lassgoiVdia
` Workers' Compensation Insurance Affidavit:Builders/Contractors/FAectricians/Plumbers
Applicant Information Please Print:Lezibly
Name(Ih>siae�lOrgan�iion/tndivianal)=�..� � ���T�oe �
Address: crv(JV 6 7T
City/State/Zip: a - r -"L/4 oz6 a/ Phone� J- De ) 9 6 6.3 ZO
Are you an employer?Check the appropriate box: Type of project(red)_
a. rse contractor and I
I.�,I am a employes with 4 ❑ I a �cont 6_ ❑New comstrire#ioa
employees(fall andlorpartAime).* have hired the sub-contractoTs.
2._❑ I am a sore proprietor or partner-
listed on the attached sheet. 7- ❑Remodeling
ship and have no employees These sub-contractors have g. ❑Demolitioa
working for me many capacity employees and have workers' g_ ❑Building addition
[No workus' comp.-in =uce comp.rnsuranml
required] 5..❑ We are a corporation and its 10_0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I1..❑Plumbing repairs or additions
r myself [No workers•oontp right of exemption per MGL 12..❑hoof repairs
insurance required_]1 c-152, §1(4),andwe have no
employees-[No workers' 13-❑other
comp-insurance required-1;
v *Any spp that cbedcs boa 11 Est also fal out the section below storing their wodcers'compensation policy iUfo matian_
T Romevwners arbo submit this affidsv¢indacstin g they ue doing an Ranh and Hren hum outside contractors ID submit anew affidavit mehc$ii sorb
tContmctors that check this box meet gttached as additions!sheet shvcsiag the name of dms.cArconft3dva and state whether ornot Those Entities have
employees. Iftbe sub-cout�ctars have employees,dheg nmut provide ffi workers'comp.policy number
I am an employer that.is prmdd&W markers'compensation insurance for my emptnyem Below is thepaTiry and job srle
information. _
Insru-ance Company Name: J-E? /VJU4F D
Policy;#or Self-ins.UC #: Expiration Date:
Job Site Address: 12, �� �_4 /L/P C-k City/statelzip:
Attach a copy of the workers'compensation polio-declaration page(showing the policy number and expiration date).
Failure to secure coverage as requireduuder Section.25A of MGL c. 152 can head to the imposition ofcriminal penalties of a
fine up to S 1,500.00 and/or one-year unprssoument,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
Imrestigations of the DIA far+nmr ce,coverage verificatim
I da hereby certify under the pans and penalties of perjury that the infornzahon pratided abm�e iss hue and correct
Sienatore- Date-
Phone#- ee"
01kiad use only. Do not write in this area,to be completed by city:or town oficiaL
City or Town: PerrmtUcense it
Issuing Authority(tarcle one):
1.Board of Health 2.Building Department 3.City.frown Clerk 4.Electrical Inspector 5.Pltrmbiug Inspector
6.Other
Coatsct Person: Phone#:
6
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees.
Plursuantto 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 Iocal 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-contractors)name(s), address(es)and phone number(s)along with their cer-a-ficate(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 cant'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 'nie 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 permit/license 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 mi (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 homeowner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e.a dog license or permit 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 Gommonvmalth of Massachusetts
Department of Industrial Aocid.ents
QfC-zce of�avestig�tz�ns
600 Washington Street
Boston,MA 02111
Tel.A 617-727-49-00 ext4-06 or 1-977-MAS -E
Revised 4-24-07 Fax# 617-727-7749
w w mass,gov/dia
Town of Barnstable
0
Regulatory Services
BARNMASS. Thomas F.Geiler,Director
�''rEDMAIa`0 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
i
Property ORTner Must
Complete and Sign This Section
If Using A Builder
as Owner of the subject property
hereby authorize ��y�}-✓ L-4 U moo,✓ to act on my behalf,
in all matters relative to work authorized by this building permit
1-2e
(Address of Job)
**Pool fences and alarms are the responsibility of the applicant. Pools
are not to be filled or utilized before fence is installed and all final
inspections are performed and accepted.
ZZ,
Signa e o caner Sign e of Ap licant
Print Name Print Name
Date
Q:FORMS:OWNERPERMISSIONPOOLS 62012
Parcel Locus
128 Sandy deck
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223/008
11/41
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Town of Barnstable
Old King's Highway Historic District Committee
200 Main Street, Hyannis, Massachusetts 02601
(508) 862-4787 Fax (508) 862-4784
CERTIFICATE OF EXEMPTION
Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter
470,Acts and Resolves of Massachusetts, 1973,as amended,for proposed work as described below and on plans,drawings,or photographs
accompanying this application:
Date Ja /O//q Address of Proposed work, Assessor's Map and lot#
r -
House# / Street ��� �� /�(�� k Village:
This application is for an exemption of the proposed construction on the grounds that work:
❑ Will not be visible from anyway or public place
❑ Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission
her
Description Description of Proposed Work:
`, 1
c ,ri l �(�i1 1 : 11.J C ..�-f - kr`\i1r1 nr1 CIA Cl` CC
Agent or contractor(please print): /y l- `y(, (C AC-,.r t"t(-t ;+'l Tel.no. `;�)( f�4.2 -c Y
Address �,�� 11 i d r}•f'r a'1 1 � , \\�L
Owner(please print): Tel no.
Owners mailing address: .
Signed,Owner/Contractor/Agent
For Committee Use Only This Certificate is hereby Approved/Denied Date:
Committee Members Signatures:
Any conditions of approval:-
E'CEJR�Nj?
1 TilVtrdf7l Marine&Ehvironm
Massachusetts Department of Environmental Protection Provided by MassDEP:
Ll
Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
WPA Form - ®rder of Conditions eDEP Transaction#:710207
City/I own:BARNSTABLE
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
1. Conservation Commission BARNSTABLE
2. Issuance a. r OOC b.C Amended OOC
3. Applicant Details
a.First Name b.Last Name
c.Organization TOWN OF BARNSTABLE-MARINE&ENVIRONMENTAL AFFAIRS
d.Mailing Address 1189 PHINNEYS LANE
e.City/Town CENTERVILLE f.State MA g.Zip Code 02632
4. Property Owner
a.First Name b.Last Name
c.Organization TOWN OF BARNSTABLE
d.Mailing Address 367 MAIN STREET
e.City/Town HYANNIS f.State MA g.Zip Code 02601
5. Project Location
a.Street Address 128 SANDY NECK,WEST BARNSTABLE
b.City/Town BARNSTABLE c.Zip Code 02668
d.Assessors Map/Plat#223 e.Parcel/Lot# 008
f.Latitude 41.73137N g.Longitude 70.34251 W
6. Property recorded at the Registry of Deed for:
a.County b.Certificate c.Book d.Page
BARNSTABLE 1171 261
7.Dates
a.Date NOI Filed: 11/28/2014 b.Date Public Hearing Closed: 12/16/2014 c.Date Of Issuance: 12/22/2014
8.Fi,nal Approved Plans and Other Documents
a.Plan Title: b.Plan Prep;tred by: c.Plan Signed/Stamped by: d.Revised Final Date: e.Scale:
SITE PLAN TOWN OF UNSTAMPED 11/24/2014
BARNSTABLE D.P.W.
SKETCH PLAN UNKNOWN UNSTAMPED 11/24/2014 NONE
B. Findings
Page 1 of 9 *ELECTRONIC COPY
Massachusetts Department of Environmental Protection Provided byMassDEP:
l� Bureau of Resource Protection- Wetlands MassDEP File#:003-5247
WPA Form 5 - Order of Conditions eDEP Transaction#:710207
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
City/Town:BARNSTABLE
1.Findings pursuant to the Massachusetts Wetlands Protection Act
Following the review of the the above-referenced Notice of Intent and based on the information provided in this application and
presented at the public hearing,this Commission finds that the areas in which work is proposed is significant to the following interests of
the Wetlands Protection Act.
Check all that apply:
a. r Public Water Supply b. ri Land Containing Shellfish c.r. Prevention of Pollution
d. r Private Water Supply e. n Fisheries f. f Protection of Wildlife Habitat
g. ri Ground Water Supply h. G Storm Damage Prevention i. f!—�, Flood Control
2.Commission hereby finds the project,as proposed,is:
Approved subject to:
a. r--�-The following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations.
This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above,the following
General Conditions,and any other special conditions attached to this Order.To the extent that the following conditions modify or
differ fi•om the plans,specifications,or other proposals submitted with the Notice of Intent,these conditions shall control.
Denied because:
b.F_I The proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations.Therefore,
work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are
adequate to protect interests of the Act,and a final Order of Conditions is issued.A description of the performance standards
which the proposed work cannot meet is attached to this Order.
c. F!!The information submitted by the applicant is not sufficient to describe the site,the work or the effect of the work on the interests
identified in the Wetlands Protection Act.Therefore,work on this project may not go forward unless and until a revised Notice of
Intent is submitted which provides sufficient information and includes measures which are adequate to protect the interests of the
Act,and a final Order of Conditions is issued.A description of the specific information which is lacking and why it is
necessary is attached to this Order as per 310 CMR 10.05(6)(c).
3.rl Buffer Zone Impacts:Shortcst distance between limit of project disturbance and the wetland resource
area specified in 310CMR 10.02(1)(a). a.linear feet
Inland Resource Area Impacts:(Fur Approvals Only):
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
4. C,Bank
a.linear feet b.linear feet c.linear feet d.linear feet
5.1=1 Bordering Vegetated Wetland
a.square feet b.square feet c.square feet d.square feet
6. G Land under Waterbodies and Waterways _
a.square feet b.square feet c.square feet d.square feet
e.c/y dredged f.c/y dredged
Page 2 of 9 M ELECTRONIC COPY
Massachusetbi Department of Environmental Protection Provided byMassDEP:
Bureau of Re;:ource Protection-Wetlands MassDEP File#:003-5247
WPA Form S - Order of Conditions eDEP Transaction#:710207
�t Massachusetts Wetlands Protectionon Act M.G.L. c. 131, §40 City/Town:BARNSTABLE
7.r Bordering Land Subject to Flooding
a.square feet b.square feet c.square feet d.square feet
Cubic Feet Flood Storage
e.cubic feet ff,cubic feet g.cubic feet h.cubic feet
S.C Isolated Land Subject to Flooding,
a.square feet b.square feet
Cubic Feet Flood Storage
c.cubic feet d.cubic feet :e.cubic feet f.cubic feet
9.Ci Riverfi•ont Area
a.total sq.feet b.total sq.feet
Sq ft within 100 R
c.square feet d.square feet e.square feet f.square feet
Sq ft between 100-200 ft
g.square feet h.square feet i.square feet j.square feet
Coastal Resource Area Impacts:
Resource Area Proposed Permitted Proposed Permitted
Alteration Alteration Replacement Replacement
10.ri Designated Port Areas Indicate size under Land Under the Ocean;below
11.n Land Under the Ocean
a.square feet b.square feet
c.c/y dredged d.c/y dredged
12.r.Barrier Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below
13.f i Coastal Beaches _
a.square feet b.square feet c.c/y nourishment d.c/y nourishment
14.r'Coastal Dunes 122 122 0 _
a.square feet :b.square feet .c.c/y nourishment d.c/y nourishment
15.C1 Coastal Banks
a.linear feet b.linear feet
16.I—`Rocky Intertidal Shores
a.square feet b.square feet
17.1 11 Salt Marshes _
a.square feet b.square feet c.square feet d.square feet
18.G Land Under Salt Ponds
a.square feet b.square feet
.c.c/y dredged d.c/y dredged
19.C Land Containing Shellfish
Page 3 of 9 x ELECTRONIC COPY
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
WPA Form 5 - Order of Conditions eDEP Transaction#:710207
Massachusetts V/etlands Protection Act M.G.L.c. 131, §40 City/Iown:BARNSTABLE
a.square feet b.square feet c.square feet d.square feet
Indicate size under Coastal Banks,inland Bank,Land Under the
20.ri Fish Runs Ocean,and/or inland Land Under Waterbodies and Waterways,
above
c.c/y dredged d.c/y dredged
21.17 Land Subject to Coastal Storm.flowage
a.square feet b.square feet
22.
r Restoration/Enhancement(For Approvals Only)
If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been
entered in Section B.5.c&d or B.17.c&d above,please entered the additional amount here.
a.square feet of BVW b.square feet of Salt Marsh
23.
r-Streams Crossing(s)
If the project involves Stream Crossings,please enter the number of new stream crossings/number of replacement stream crossings.
a.number of new stream crossings b.number of replacement stream crossings
C. General Conditions Under Massachusetts Wetlands Protection Act
The following conditions are only applicable to Approved projects
1. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory measures,shall be deemed
cause to revoke or modify this Order.
2. The Order does not grant any property rights or any exclusive privileges;it does not authorize any injury to private property or
invasion of private rights.
3. This Order does not relieve the pe rmittee or any other person of the necessity of complying with all other applicable federal,
state,or local statutes,ordinances,bylaws,or regulations.
4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following
apply:
a.the work is a maintenance dredging project as provided for in the Act;or
b.the time for completion has been extended to a specified date more than three years,but less than five
years,from the date of issuance.If this Order is intended to be valid for more than three years,the
extension date and the special circumstances warranting the extended time period are set forth as a
special condition in this Order.
5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the
issuing authority at least 30 days prior to the expiration date of the Order.
6. If this Order constitutes an Amended Order of Conditions,this Amended Order of Conditions does not exceed the issuance
date of the original Final Order of Conditions.
7. Any fill used in connection with this project shall be clean fill.Any fill shall contain no trash,refuse,rubbish,or debris,including
but not limited to lumber,bricks,plaster,wire,lath,paper,cardboard,pipe,tires,ashes,refrigerators,motor vehicles,or parts of
any of the foregoing.
8. This Order is not final until all adtninist•ative appeal periods from this Order have elapsed,or if such an appeal has been taken,
until all proceedings before the Department have been completed.
Page 4 of 9 M ELECTRONIC COPY
Massachusetf;s Department of Environmental Protection Provided by MassDEP:
` Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
1\!1 eDEP Transaction#:710207
\� WPA Form - Order of Conditions Cityfrown:BARNSTABLE
l5
Massachusetts Yetlands Protection Act M.G.L.c. 131, §40
9. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or the Land
Covet for the district in which the land is located,within the chain of title of the affected property.In the case of recorded land,
the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the
proposed work is to be done.In the case of the registered land,the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done.The recording information shall be submitted
to the Conservation Commission on the form at the end of this Order,which form must be stamped by the Registry of Deeds,
prior to the commencement of work..
10. A sign shall be displayed at the site not less then two square feet or more than three square feet in size bearing the words,
"Massachusetts Department of Environmental Protection"
(or'MassDEP"]
File Number:"003-5247"
11. Where the Department of Environmental Protection is requested to issue a Superseding Order,the Conservation Commission
shall be a party to all agency proceedings and hearings before Mass DER
12. Upon completion of the work described herein,the applicant shall submit a Request for Certificate of Compliance(WPA Form
8A)to the Conservation Commission.
13. The work shall conform to the pl;3ns and special conditions referenced in this order.
14. Any change to the plans identified in Condition#13 above shall require the applicant to inquire of the Conservation Commission
in writing whether the change is significant enough to require the filing of a new Notice of Intent.
15. The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to
enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this
Order,and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that
evaluation.
16. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and
to any contractor or other person performing work conditioned by this Order.
17. Prior to the start of work,and if the project involves work adjacent to a Bordering Vegetated Wetland,the boundary of the
wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging.Once in place,the wetland
boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission.
18. All sedimentation barriers shall bo maintained in good repair until all disturbed areas have been fully stabilized with vegetation or
other means.At no time shall sediments be deposited in a wetland or water body.During construction,the applicant or his/her
designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed.The applicant
shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission,which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary.
Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order.
NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS
19. The work associated with this Order(the"Project")is(1) ❑ is not(2)R subject to the Massachusetts Stormwater Standards.
If the work is subject to Stormwater Standards,then the project is subject to the following conditions;
a) All work,including site preparation,land disturbance,construction and redevelopment,shall be implemented in accordance
with the construction period pollution prevention and erosion and sedimentation control plan and,if applicable,the
Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Construction General
Permit as required by Stormwater Standard 8.Construction period erosion,sedimentation and pollution control measures and
best management practices(BIVIPS)shall remain in place until the site is fully stabilized.
b) No stormwater runoff may be discharged to the post-construction stormwater BMPs unless and until a Registered
Professional Engineer provides a Certification that:i.all construction period BMPs have been removed or will be removed by
a date certain specified in the Certification.For any construction period BMPs intended to be converted to post construction
operation for stormwater attenuation,recharge,and/or treatment,the conversion is allowed by the MassDEP Stormwater
Handbook BMP specifications and that the BMP has been properly cleaned or prepared for post construction operation,
including removal of all construction period sediment trapped in inlet and outlet control structures;ii..as-built final construction
Page 5 of 9 *ELECTRONIC COPY
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection -Wetlands MassDEP File#:003-5247
WPA Form S - Order of Conditions eDEP Transaction#:710207
Massachusetts A etlands Protection Act M,G.L. c. 131, §40
City/Town:BARNSTABLE
BMP plans are included,signed and stamped by a Registered Professional Engineer,certifying the site is fully stabilized;iii.
any illicit discharges to the stormwater management system have been removed,as per the requirements of Stormwater
Standard 10;iv. all post-constriction stormwater BMPs are installed in accordance with the plans(including all planting
plans)approved by the issuing authority,and have been inspected to ensure that they are not damaged and that they are in
proper working condition;v. any vegetation associated with post-conshuction BMPs is suitably established to withstand
erosion.
c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another party has legally assumed
responsibility for BMP maintenance.Prior to requesting a Certificate of Compliance,or Partial Certificate of Compliance,the
responsible party(defined in General Condition 19(e))shall execute and submit to the issuing authority an Operation and
Maintenance Compliance State:rnent("O&M Statement")for the Stormwater 13MPs identifying the party responsible for
implementing the stormwater F;MP Operation and Maintenance Plan("O&M Plan")and certifying the following:i.)the O&M
Plan is complete and will be implemented upon receipt of the Certificate of Compliance,and ii.)the future responsible parties
shall be notified in writing of their ongoing legal responsibility to operate and maintain the stormwater management BMPs and
implement the Stormwater Pollution Prevention Plan.
d) Post-construction pollution prevention and source control shall be implemented in accordance with the long-term pollution
prevention plan section of the approved Stormwater Report and,if applicable,the Stormwater Pollution Prevention Plan
required by the National Pollutant Discharge Elimination System Multi-Sector General Permit.
e) Unless and until another party accepts responsibility,the landowner,or owner of any drainage easement,assumes
responsibility for maintaining each BMP.To overcome this presumption,the landowner of the property must submit to the
issuing authority a legally binding agreement of record,acceptable to the issuing authority,evidencing that another entity has
accepted responsibility for maintaining the BMP,and that the proposed responsible party shall be treated as a permittee for
purposes of implementing the r,quirements of Conditions 19(f through 19(k)with respect to that BMP.Any failure of the
proposed responsible party to implement the requirements of Conditions 19(o through 19(k)with respect to that BMP shall
be a violation of the Order of Conditions or Certificate of Compliance.In the case of stormwater BMPs that are serving more
than one lot,the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs.A plan and
easement deed that grants the msponsible party access to perform the required operation and maintenance must be submitted
along with the legally binding agreement.
The responsible party shall operate and maintain all stormwater BMPs in accordance with the design plans,the O&M Plan,
and the requirements of the Massachusetts Stormwater Handbook.
g) The responsible party shall:
1.Maintain an operation and maintenance log for the last three(3)consecutive calendar years of inspections,repairs,
maintenance and/or replacement of the stormwater management system or any part thereof,and disposal(for disposal the
log shall indicate the type of material and the disposal location);
2.Make the maintenance log available to MassDEP and the Conservation Commission("Commission")upon request;and
3.Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure
that the responsible party is in compliance with the requirements for each BMP established in the O&M Plan approved by
the issuing authority.
h) All sediment or other contamimints removed from stormwater BMPs shall be disposed of in accordance with all applicable
federal,state,and local laws and regulations.
r) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04 are prohibited.
j) The stormwater management system approved in the Order of Conditions shall not be changed without the prior written
approval of the issuing authority.
k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site Design Credit(as defined in the
MassDEP Stormwater Handbook,Volume 3,Chapter 1,Low Impact Development Site Design Credits)shall not be altered
without the prior written approval of the issuing authority.
1) Access for maintenance,repair,and/or replacement of BMPs shall not be withheld.Any fencing constructed around
stormwater 13MPs shall include access gates and shall be at least six inches above grade to allow for wildlife passage.
Page 6 of 9 *ELECTRONIC COPY
i
Massachuseti::Department of Environmental Protection Provided by MassDEP:
4`
Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
, WPA Form S - Order of Conditions eDEP Transaction#:710207
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Cityfrown:B ARNTSTAB LE
Special Conditions:
D. ]Findings Under Municipal Wetlands Bylaw or Ordinance
1. Is a municipal wetlands bylaw or ordinance applicable?Ed Yes r No
2. The Conservation Commission hereby(check one that applies):
a. r DENIES the proposed work which cannot be conditioned to
meet the standards set forth in a municipal ordinance or bylaw
specifically:
1.Municipal Ordinance or Bylaw 2.Citation
Therefore,work on this project rnay not go forward unless and until a revised Notice of Intent is submitted which provides
measures which are adequate to meet these standards,and a final Order or Conditions is issued.Which are necessary to
comply with a municipal ordinance or bylaw:
b.
r, APPROVES the proposed work,subject to the following
additional conditions.
1.Municipal Ordinance or Bylaw TOWN OF 2.Citation S.237-1 - 237-14
BARNSTABLE
3. The Commission orders that all work shall be performed in accordance with the following conditions and with the Notice of
Intent referenced above.To the extent that the following conditions modify or differ from the plans,specifications,or other
proposals submitted with the Notice of Intent,the conditions shall control.
The special conditions relating to municipal ordinance or bylaw are as follows:
SEE PAGES 7.1 AND 7.2
Page 7 of 9 * ELECTRONIC COPY
SE3-5247
Name: Town of BarnstablehM.E.A.
Approved Plan = November 24,2014 Site Plan by Barnstable D.P.W., and
Noven.iber 24, 2014 Sketch plan with elevation views
Special Conditions of Approval
I. Preface
Caution: Failure to comply with all Conditions of this Order of Conditions may have serious consequences.
The consequence may include: issuance of a Stop Work Order; fines; requirement to remove un-permitted
structures; requirement to re-landscape to original condition; inability to obtain a Certificate of Compliance,
and more.
The General Conditions of this Order begin on Page 5 and continue through Page 8. The Special Conditions
contained herein and all Conditions require your compliance.
II. Prior to the start of work,the following conditions shall be satisfied:
1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work
approved herein,General Condition Number 9 (recording requirement) shall be complied with.
2. It is the responsibility of the applicant, the owner and/or successor(s) and the project contractors to ensure
that all conditions of this Order are complied with.
3. General Condition Number 10(sign requirement) shall be complied with.
4. The Conservation Comnvssion shall receive written notice one(1)week in advance of the start of work.
III. The following additional Conditions shall govern the project once work begins:
5. General Conditions,Nurriuers 14 and 15 (changes in plan)shall be complied with.
6. Unless extended, this perrut is valid for three years from the date of issuance.
7. All work shall conform with the approved plans.
IV. After all work is completed, the following condition must be promptly met:
8. At the completion of work:, or by the expiration of this Order,the applicant shall request in writing a
Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C
shall be completed and returned, along with the request for a Certificate of Compliance and appropriate fee.
I
Where a project has been,;ompleted in accordance with plans stamped by a registered professional
7.1
engineer, architect, landscape architect or land surveyor,a written statement by such a professional shall be
submitted, certifying sub;,tantial compliance with the plans, setting forth what deviation(s),if any, exists
with the record plans approved in the Order. This statement shall accompany the request for a Certificate of
Compliance and fee, along with an updated sequence of color photographs of the undisturbed buffer zone
7.2
I
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection - Wetlands StE3-_,Z*1Z
I WPA Foi('m m Order of Conditions MassDEP File#
Ll
Massachusells Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction#
Barnstable
City/Town
E. Signatures
Important: This Order is valid for three years, unless otherwise specified as a special I)EC 2 2. 2014
When filling out condition pursuant to General Conditions#4,from the date of issuance. 1. Date of Issuance
forms on the
computer,use Please indicate the, number of members who will sign this form. Si—
to
only the tab key This Order must be signed by a majority of the Conservation Commission. 2. Number of Signers
move your
cursor-do not The Order must be mailed by certified mail (return receipt requested) or hand delivered to
use the return the applicant. A copy must be mailed, hand delivered or filed ele tronically at the same
key. (� time with the appropriate MassDEP Regional Office.
Signatures:
❑ by hand r:lelivery on ® by certified mail, return receipt
requested, on DEC 22 2014
Date Date
F. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting
the land subject to this Order, or any ten residents of the city or town in which such land is
located, are herel:)y notified of their right to request the appropriate MassDEP Regional
Office to issue a `3uperseding Order of Conditions. The request must be made by certified
mail or hand delivery to the Department, with the appropriate filing fee and a completed
Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7)
within ten business days from the date of issuance of this Order. A copy of the request
shall at the same time be sent by certified mail or hand delivery to the Conservation
Commission and to the applicant, if he/she is not the appellant.
Any appellants seeking to appeal the Department's Superseding Order associated with this
appeal will be required to demonstrate prior participation in the review of this project. Previous
participation in the permit proceeding means the submission of written information to the
Conservation Commission prior to the close of the public hearing, requesting a
Superseding Order, or providing written information to the Department prior to issuance of
a Superseding Order.
The request shall state clearly and concisely the objections to the Order which is being
appealed and hove the Order does not contribute to the protection of the interests identified
in the Massachusetts Wetlands Protection Act(M.G.L. c. 131, § 40), and is inconsistent
with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a
municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or
regulations, the Department has no appellate jurisdiction.
wpa5sigs.doc- rev.0 212 5/2 0 1 0
Page O of
i
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
LIZ
eDEP Transaction#:710207
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Ibwn:BARNSTABLE
E. Signatures
This Order is valid for three years from the date of issuance,unless otherwise specified
pursuant to General Condition#4.If this is an Amended Order of Conditions,the Amended 12/22/2014
Order expires on the same date as the original Order of Conditions. 1.Date of Original Order
Please indicate the number of members who will sign this form.This Order must be signed by 5
a majority of the Conservation Commission. 2.Number of Signers
The Order must be mailed by certified mail(return receipt requested)or hand delivered to the applicant.A copy also must be mailed
or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office,if not filing
electronically,and the property owner,if different fi-om applicant.
_...........
---...._._.---._.__.....____..
Signatures: LAURENCE MORIN
DENNIS R.HOULE LOUISE R.FOSTER
FAT PIU LEE
PETER SAMPOU
n by hand delivery on 17 by certified mail,return receipt requested, on
Date Date
F. Appeals
The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land subject to this Order,or any ten
residents of the city or town in which such land is located,are hereby notified of their right to request the appropriate MassDEP
Regional Office to issue a Superseding Order of Conditions.The request must be made by certified mail or hand delivery to the
Department,with the appropriate filing tee and a completed Request for Departmental Action Fee Transmittal Form,as provided in
310 CMR 10.03(7)within ten business days from the date of issuance of this Order.A copy of the request shall at the same time be
sent by certified mail or hand delivery to the Conservation Commission and to the applicant,if he/she is not the appellant.
Any appellants seeking to appeal the D(partment's Superseding Order associated with this appeal will be required to demonstrate prior
participation in the review of this project.Previous participation in the permit proceeding means the submission of written information to
the Conservation Commission prior to the close of the public hearing,requesting a Superseding Order,or providing written information
to the Department prior to issuance of a Superseding Order.
The request shall state clearly and conci 3ely the objections to the Order which is being appealed and how the Order does not
contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act(M.G.L.c. 131,§40),and is
inconsistent with the wetlands regulations(310 CMR 10.00).To the extent that the Order is based on a municipal ordinance or bylaw,
and not on the Massachusetts Wetlands Protection Act or regulations,the Department has no appellate jurisdiction.
Page 8 of 9 *ELECTRONIC COPY
i
Massachusetts Department of Environmental Protection Provided by MassDEP:
Bureau of Resource Protection-Wetlands MassDEP File#:003-5247
WPA Form: 5 - Order of Conditions eDEP Transaction#:710207
�.� Massachusetts Wetlands Protection Act M,G.L.c. 131, §40 City/Town:BARNSTABLE
G. Recording Information
This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located,
within the chain of title of the affected property.In the case of recorded land,the Final Order shall also be noted in the Registry's
Grantor Index under the name of the owner of the land subject to the Order.In the case of registered land,this Order shall also be
noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information on
this page shall be submitted to the Conservation Commission listed below.
BARNSTABLE
Conservation Commission
Detach on dotted line,have stamped by the Registry of Deeds and submit to the Conservation Commission.
To:. ........................................................................................................................................................................................................
BARNSTABLE
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
128 SANDY NECK,WEST BARN-STABLE 003-5247
Project Location MassDEP umber
Has been recorded at the Registry of Deeds of:
County Book Page
for:
Property Owner
and has been noted in the chain of title of the affected property in:
Book
Page
In accordance with the Order of Condit ions issued on:
Date
If recorded land,the instrument number identifying this transaction is:
Instrument Number
If registered land,the document number identifying this transaction is:
Document Number
Signature of Applicant Rm 4w2010
Page 9 of 9 * ELECTRONIC COPY
Commonwealth of Massachusetts
Division of
Fisheries & Wildlife
MassWi/d/ife
Wayne F.MacCallum,Director
December 23,2014
Nina Coleman
Town of Barnstable
1189 Phinneys Lane
Centerville MA 02632
Barnstable Conservation Commission
200 Main Street
Barnstable MA 02601
RE: Applicant: Town of Barnstable Marine and Environmental Affairs
Project Location: 128 Sandy Neck
Project Description: Tenting Platform
DEP Wetlands File No.: 003-5247
NHESP File No.: 14-33943
Dear Commissioners&Applicant:
The Natural Heritage&Endangered Species Program of the Massachusetts Division of Fisheries&
Wildlife(the"Division")received a Notice of Intent with site plans(dated November 14,2014)in
compliance with the rare wildlife species section of the Massachusetts Wetlands Protection Act
Regulations(310 CMR 10.37). The Division also received the MESA Review Checklist and supporting
documentation for review pursuant to the MA Endangered Species Act Regulations(321 CMR 10.18).
WETLANDS PROTECTION ACT MA)
Based on a review of the information that was provided and the information that is currently contained in
our database,the Division has determined that this project,as currently proposed,will not adversely
affect the actual Resource Area Habitat of state-protected rare wildlife species. Therefore,it is our
opinion that this project meets the state-listed species performance standard for the issuance of an Order
of Conditions.
Please note that this determination addresses only the matter of rare wildlife habitat and does not pertain
to other wildlife habitat issues that may be pertinent to the proposed project.
MASSACHUSETTS ENDANGERED SPECIES ACT(MESA)
Based on a review of the information that was provided and the information that is currently contained in
our database,the Division has determined that this project,as currently proposed,will not result in a
prohibited"take"of state-listed rare species. This determination is a final decision of the Division of
Fisheries and Wildlife pursuant to 321 CMR 10.18. Any changes to the proposed project or any additional
work beyond that shown on the site plans may require an additional filing with the Division pursuant to
the MESA. This project may be subject to further review if no physical work is commenced within five
years from the date of issuance of this determination,or if there is a change to the project.
www.mass.Qov/nhesp
Division of Fisheries and Wildlife
Field Headquarters,One Rabbit Hill Road,Westborough,MA 01581 (508)389-6300 Fax(508)389-7890
An Agency of the Department of Fish and Game
NHESP No. 14-33943,page 2 of 2
Please note that this determination addresses only the matter of state-listed species and their habitats.If
you have any questions regarding this letter please contact Emily Holt,Endangered Species Review
Assistant,at(508)389-6385. `
Sincerely,
o 'F O'Otw*
Thomas W.French,Ph.D.
Assistant Director
cc: MA DEP Southeast Region
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e Town of Barnstable
Old King's Highway Historic District Committee
200 Main Street,Hyannis,Massachusetts 02661
►�'' (508) 862-4787 Fax(508) 8624784
i
CERTIFICATE OF EXEMPTION
Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Exemption under Section 6 and 7 of Chapter
470,Acts and Resolves of Massachusetts,1973,as amended,for proposed work as described below and on plans,drawings,or photographs
accompanying this application:
Date IQZI0119 Address of Proposed work, Assessor's Map and lot#
House# a Street Village: S
This application is for an exemption of the proposed construction on the gro Ids that work:
❑ Will not be visible from any way or public place
❑l Is within a category declared exempt by the Old Kings Highway Regional Historic District Commission
0--"Other
Desc�tion of Proposed Work: -F�1� �DT6 �Cc� t nl 7C�11105 �o�S�C���1
a a- 9 �4, z- ' - or w
LA li5 i ;n
� --)
Agent or contractor(please print): N I VA ( >`P_VnC4,r it I Tel.no. —83(f X�
Address _ 11 89 26 r\!Lve ..
Owner(please print): Tel no.
Owners mailing address:
Signed,Owner/Contractor/Agent
I
For Committee Use Onto This Certificate is here Approve enied Date: I I I
P Committee Members Signatures:
fk?
JAN 14 2�15 wl oil �o A --V
of Barnstable
Town. s Highway
old K' mi►tee
i
I
Any conditions of approval:
I
C:V)ocumenu and SettingsldecolliKowl SettingslTemporwyIniernet Files10LK110KHExempfon Form ORdoc
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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map dR3 Parcel 0 U Application VFeel�g
Health Division Date IssuedConservation Division Application EY19
Planning Dept. Permit Fee
Date Definitive Plan Approved by PlannjnncgBppoard
Historic - OKH / 13>P /rvation/ Hyannis
Project Street Address
Village
Owner Ipon � � A Address
Telephone �� (�500
Permit Request MO C
c 4
I
Square feet: 1 st floor: existing 660proposed 2nd floor: existing proposed Total new
Zoning District Flood Plain Groundwater Overlay
Project Valuation 4f 0(3 Construction Type
Lot Size 0•02 S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family Two Family ❑ Multi-Family (# units)
Age of Existing Structure I J Historic House: &Yes ❑ No On Old King's Highway: Iles ❑ 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: i existing _new
Total Room Count (not including baths): existing % new First Floor Room Count
Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes C 446d _
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 If yes, site plan review #
Current Use �(�� Proposed Use
I
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name "3RYA�✓ ZA v Za N Telephone Number sop lAp 9-- //u_9
Address G: License #
a�•,,,,b/ 026 o/ Home Improvement Contractor#
Worker's Compensation #
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE DATE �� 3
FOR OFFICIAL USE ONLY
APPLICATION#
'rs DATE ISSUED
o
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
r •
DATE OF INSPECTION:
;F,OU.NDATI.ONai � �
FRAME -- — — -- — —
{INSULATION:.
FIREPLACE
ELECTRICAL;, ,,ROUGH FINAL —
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL .
FINAL BUILDING'
_DATE CLOSED OUT
ASSOCIATION PLAN NO.
f
The Commonweakh of Massachusetts
Department of Industrial Accidents
- Office of Investigations
600 Washington Street
Boston,MA 02111
fvn*w.massgov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectriciansMumbers
Applicant Information Please Print Ugibly
Name seness!Organizationdudividnal): in
(Ba
Address: Or ur
City/State//7ip: rleo4tf tzi ��y�•,�`� Phone# �+
Are you an employer?Check the appropriate boa: T o j r 7
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- listed on the attached sheet 7. ❑
ship and have no employees These sub-contractors have 8 e tion
working forme in any capacity. �lA�and have workers' 9. ❑Building addition
insurance[No workers' comp.insurance comp.insurance.I
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions
myself[No workers'camp. right of exemption per MGL 12❑Roof repairs
insurance required.]i c. 152,§1(4),and we have no
employees.[No workers' l3.❑Other
comp.insurance required.]
*'Any appticsffi that checks boa#1 mast also fill our the section below showing their woakere compensation policy infflimation_
1 Homeowners who submit this affidavit indicating they are doing all we*and then hire outside con=tors mast submit a new affidavit indicating such_
fCCoatsactors that check this boa must attached an additional sheet showing the name of the sab-counactmrs and state whether is not those entities have
employees. Ifthe subcontractors have employees,they must provide their workers'comp.policy number.
I am an employer that is providing nwrkers'compensation insurance for my employees. Below is the policy and job site
information. 7613 � � ��) -CD —
Insurance Company Name: )
Policy#or Self-ins.Lic.#: ��.LF -7-,/xu Ran Expiration Date:�/A
Job Site Address: Au -,V9W0 5 A(,,-4, City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(shoeing 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 painsandpenatties ofperjury that the information provided above is true and correct
Sigmture . �i-- Date �1/.�
Phone#: �t5�_�.P 9 — //J�p
Qfcial use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/I,icense#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
6
Massachusetts -Department of Public Safety
Board of Building-Regulations and Standards
Construction Supervisor
License: CS-065007
BRYAN E LAUZOJrY
18 LAKEVIEW ST PO �
S CARVER MA 0236 I
OECommissioner
f
'ME Town of Barnstable Barnstable
OF
•t, Department of Public Works
Q► Administration&Technical Support Division All,ftpdcaCl(y
• 800 Pitcher's Way,Hyannis,MA 02601 1 I
ELAMSTABLE,
w.
MASS, wwtown.barnstable.ma.us
1639.
`0�
�ArF�MA't A
2007
John W.Juros,AIA
Rebecca Nickerson 508.790.6316 Town Architect
Mark Marinaccio 508.790.6323 Voice 508.790.6324
NancyLee Cormier 508.790.6320 Fax 508.790.6344
MEMO
Date: August 22, 2013
To: Thomas Perry, Building Inspector
n From: John Juros, AIA, Town Architect
Re: 128 Sandy Neck,Winders Cottage#BVG228
C: Daniel Santos, PE, DPW Director
Rob Steen, PE, Assistant DPW Director
Nina Coleman, SNBP Ranger
Steve Sundelin, S+G Supervisor
On August 21, 2013, Nina Coleman and I inspected the Winder's Cottage at Sandy Neck. As Town
Architect, I report herein formally the former cottage has been abandoned for years. It is in a state of
demolition by neglect. There are no services to the site, including electrical power, water, sewer, gas,
phone and cable, nor are there any services on the road which accesses the site. I believe the fuel
source for cooking or heating, years ago, was probably by propane which has since been long
removed.
I report to you that their are no services to the structure today and as such a demolition permit can be
issued. All that remains is exposed wood studs, rafters, joists and unpainted wood shingles and
pieces of roofing felt, no old piping and wiring or any.finishes. This can be seen in the photo sent to
you this day by email.
The remains are a hazard to visiting persons and a blight to the wooded dune are and is an inviting
debris pile awaiting someone's match. I recommend this be removed as soon 'as possible and a
demolition permit be issued as requested by Nina.
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C:\cache\Temporary Internet Files\0LK1AWIemo-Winders Cottage 082213.doc
c a
Town of Barnstable
Old King's Highway Historic District Committee
? 200 Main Street,Hyannis,Massachusetts 02601
KAMM
(508)862-4787 Fax(508) 862-4784
APPLICATION,CERTIFICATE OF APPROPRIATENESS FOR
DEMOLITION OR RELOCATION OF A BUILDING OR STRUCTURE
(including partial demolitions of buildings,structures;outbuildings,stonewalls,etc.)
Application is hereby made,with four(4)complete sets,for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470,
Acts and Resolves of Massachusetts,1973,for proposed work as described below and on plans,drawings,or photographs accompanying this
application: 22 p
Date: 7/ cR Address of Proposed work: Assessors Map and lot# /� 1�J 00O
House# 0 Street �5AI1/D y &CC&4- Village: }�/4-/Z/tCs17f'fjC
Demolitionof: ❑house ❑partofhouse ❑Garage ❑ bam ❑stable ❑commercial ❑stonewall bother
Description of Proposed Work: .1 u/V rr
Please complete the following information:
Square footage of footprint of building(s)to be demolished: Building 1: C660 2:
Square footage of total floor area of building(s)to be demolished: Building 1: 2:
Owner(please print): C-- �FC-01��`4Z Tel#: z(o " 2 '—C ad
Owner's mailing address: 5
Signature of Owner : -r
Note: All applications must be C signed by the ner,or evidence of authority to act for the owner submitted
Agent/Contractor(please print): /\ f/�/i4 - �Q(�/1�.�}/�/ Tel#:
Address: 9 P /V JZ()! (,
Signature of Contractor/Agent: we "/C m�v�
If application is for removal to a different location,state where:
Note. A separate Certificate of Appropriateness is required for a relocation of a building or structure within the Barnstable
Old Kings Highway Historic District.
Check list
Application for Certificate of Appropriateness for Demolition or Removal,4 copies
_ Site plan,4 copies, ls '
Photographs of all elevations of building(s),outbuilding(s)or stone walls being demolished.
_ Fee according to schedule.
List of abutters,see staff
For Committee Use Only This Certificate is hereby rove Date: el
Committ e M bers ' atures:
RECEIVED
2 7 2013
left(IIA—
Conditions of Approval,if any
+OWT*H A� AG'E 4-1
C:IDocwnents and SettingsldecolliklLocal SetungslTemporary Internet FilesIOLK110Kll Demolition 07.doc AUG 14 2013
Town of Barnstable
Old i ms Highway
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