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HomeMy WebLinkAbout1136 CRAIGVILLE BEACH ROAD z .. 1���� rJ�e� ��`.L, P �:, �.�' ,, . r.. �.� �' ,, 1 � - ti 17 .. �,y ! , �: Town of Barnstable *Permit# o � ce ti Expir 6 months from issue date Regulatory Services BiIUR ' AB S PERMIT / v�A i639. ss�� gg 1 Thomas F. Geiler, Director TE� A�M � � 6� 2009 Building Division O � �/��(�S�-ABL�Tom Perry,CBO, Building Commissioner TWN200 Main Street,Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION. - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 10(o Property Address — []R sidential Value of Work t"C) Minimum fee of$25.00 for work under$6000.00 Owner's Name & Address 40\l ',�fD, �I ICI MA VA 1 3 CD cps}\90 t 0� BfAc� C Ce All Contractor's Name_ `VA1V11—/ — �Aeow15^L Telephone Number 'Yv-)0 Lno�( to I Ionic Improvement Contractor License#(if applicable) 0 a�)4 Construction Supervisor's License#(if applicable) y / y /t OWorkman's Compensation Insurance Check one: ❑ l-am a sole proprietor ❑ I am the Homeowner Q-11 have Worker's Compensation Insurance Insurance Company Name Vwx tA,\ Workman's Comp. Policy # ( Copy of Insurance Compliance Certificate must be on tile. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44) *Where required. Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Property Owner must ZmIr operty Ow er Letter of Permission. A copy f the ome em t ntractors License is required. I SIGNATURE: �G PFll.LSU 0lZMS\building permit forms\EXPRESS.doe Revised 100608 a" urVi r License Construction p CS 48546 License: Tr# 14362 Ivy , Expiration 112712010 0n } I Retion 1 - 0 r '? 1 HERBST MARK D Rp E 35 P,—' TOAD 3 / Commissioner I I 02632 I' CENTERVILLE,MA 1 pp ea/ ✓ '�` f"`d valid for individul use only istration �fie.C000�vrr�o�zui I before the expiration date. If found return to: j Board of Building Regulations and Standards '� License or reg' HOME IMPROVEMENT CON Regulations and Standards i TRACTOR ding Board of Buil Registration; 126480 One Ashburton Place Rm 1301 Exp irat�on 6t812010 Tr# 267766 I, Boston,Ma.02108 Individual ^i Typed! s ' MARK HERBST MARK HERBST 35 PEEP TOAD �l f� Not valid without signature ^, ` ..:, CENTERVILLE,MA 02632 Administrator k 04/18/09 13:34 FAX 617 267 7011 SHECHMOTHALPERINSAVAGE 4 001 APR-17-20013 05:13' FROM:MARK HERQGT+50N9 §oe4206216 TO!161'7�!677]11 P.1 MARK HERSST 35 PEEP TOAD ROAD CENTERVILLE MA 03632 50BA20-6216rR4-238-2930 www.ma*h_eftst PROPOSAL SUBMITTED TO: WORK PERFORMED AT: Gary sheatnen 1136 CtW19 Beat Road SAME Centervi8e MA OZ63Z We herby propose to furnish the materials sod peftrm tltef law naimsam for the completion c: At w Rboi; Remove 1 laver of e�risiino shinetes 1Mt811J1*-&xckr shield at vAto&in wNev_amas ln*#f5t,W eaner --- ►nstea 0eristnTeed 30yr:Am&bcWGR14fr y star.Waal ' Cut rldoo&install cabs vent e cg gu—mgm boats All dabrkcleaned de�jyt Replace tfsshka g sW wah stdnrrtes at tact cheek area PlfC9 inGYltdBs rttst9tf�febar&dgmm,�fees (�S& Kt5-ridU6- bNI P 'PbG All material is guaranteed to be as spedfi d. The abore work wltt be performed In socordance with the specifications submitted and camplated In a substantial workman-like manner for the sum of:Pour-Thousand Cwllam( $4000 OO with payments an Milows: full&gmurrt due upon armpreffon 'Any alterations from abovo proposal involving aoa costs will be.added under a separate written agreement and become an extra charge over and above said proposal. RESPECTFUL US TT 04/47toB Mark NerW ACCEPTANCE OF PROPOSAL The above price,specifications and conditions are s "afactory.I herby accept this proposal. You are authorized to do the work and payments will be as s ed above - SIGNATURE- al al may be withdrawn by said company if not accepted within 30 days. NOTICE NOTICE TO TO EMPLOYEES EMPLOYEES The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I(we)have provided for payment to our injured employees under the above mentioned chapter by insuring with: ASSOCIATED INDUSTRIES OF MASSACHUSETTS MUTUAL INSURANCE COMPANY NAME OF INSURANCE COMPANY 54 THIRD AVENUE,_P.O. BOX 4070, BURLINGTON, MA 01803-0970 ADDRESS OF INSURANCE COMPANY AWC 7016215012009 01/10/2009 - 01/10/2010 POLICY NUMEER EFFECTIVE DATES P O Box 494 Leonard Insurance Agency Inc Osterville, MA 02655 (508)428-6921 NAME OF INSURANCE AGENT . ADDRESS PHONE Mark Herbst 35 Peep Toad Road Centerville, MA 02632 EMPLOYER ADDRESS 12/23/2008 EMPLOYER-S WORKERS COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid.by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby noted that the insurer has arranged for such attention at the NEAREST AND BEST MEDICAL FACILITY NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ( Please Print LeLqblv Name(Business/Organization/Individual): V 1 P l� �7 Address �^A City/State/Zip: tt� yb'j Phone.#: ��o1 Are you an employer?Check the appropriate box: Type of project(required): 1.[ am a employer with .L_� ' 4. ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the stab-contractors 2:❑ I am a sole prpprietor or partner listed on the attached sheet 7. .0 Remodeling ship and have no employees These sub-contractors have g.'[]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'-comp.-insurance comp.insurance$ 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 11.0 Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12. oof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑Other employees. [No workers' comp.insurance required.] "Any applicant That checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ?Contractors 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�employecs,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.. n Insurance Company Name: Policy#or Self-ins.Lic.#: -1 �� 0`2 ��� c ���� Expiration Date: Job Site Address: l L 3 0 fi -• O'� � s# City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure fo secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a finq tip 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 co a e ve ' ation. I do hereby certify u r the ins-and enalt' s o Wry that the information provided above is true and correct Signature: Date: 07 �—B — Phone#: Official use only. Do not write in this area,to be completed by city or townofficiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health'2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. f Pursuant to this statute,an employee is defined as "...every person in.the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more —_ of the foregoing engag m atom enterprise inelu3mg the legal-represeh1!WWk—df-�dec�asezi-eropluy-er;mr the: receiver or tiustee of an individual,partnership,association or other legal entity,employing employees.-However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL.ebapter 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 vczth 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-eonti-actor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies•(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or UP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly..The Department has provided a space at the bottom of�y rGA a- C71 ♦L_ Q,-n4= iT ti..4� 0 1—M rnnMrt Arml rPoarA;na flee apnlir�lt, the,affil Wit LVL yvLL LU u i u Ll UUL LLL utk, vct L%a V vA r— 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 appiicarit should write"all•locations in - (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits'or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license of 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:Commonwealth of MamGhusetts Department of Industrial Accidents 4f ee of Investigations 600 Washington Street Boston,MA 02111 TO. # 617-727-4904 ext-406 or 1-877-MASSA.FE Revised 11-22-06 Fax#617-727-7749 www.mass_gov/dia © • i F Cr 1 ! j O Postage $ Ln /N, t7 O Certified Fee A j�•' �� O i t Postmark O O Return Receipt Fee / Here (Endorsement Required) = DEC- 12pD3 O Restricted Delivery Fee 1 , O (Endorsement Required) ,9 Total Postage&Fees (/ ru C3 Sent TWV41i5�-� _e/m p`i _---------------------- 17- Street �— V PO Box N-- -- City,State, I +4 I Certified Mail Provides: • A mailing receipt - o A unique identifier for your mailpiece o A signature upon delivery o A record of delivery kept by the Postal Service for two years Important Reminders: o Certified Mail may ONLY be combined with First-Class Mail or Priority Mail: o Certified Mail is not available for any class of international mail. o NO INSURANCE COVERAGE IS PROVIDED with Certified Mail. For valuables,please consider Insured or Registered Mail. o For an additional fee,a Return Receipt may be requested to provide proof of delivery.To obtain Return Receipt service,please complete and attach a Return Receipt,(PS Form 3811)to the article and add applicable postage to cover the fee.Endorse mailpiece `Return Receipt Requested".To receive a fee waiver for a duplicate return receipt,a USPS postmark on your Certified Mail receipt is required. o For an additional fee, delivery may be restricted to the addressee or addressee's authorized agent.Advise the clerk or mark the mailpiece with the endorsement"Restricted Delivery". o If a postmark on the Certified Mail receipt is desired,please present the arti- cle at the post office for postmarking. If a postmark on the Certified Mail receipt is not needed,detach and affix label with postage and mail. 6 IMPORTANT:Save this receipt and present it when making an inquiry. PS Form 3800,April 2002(Reverse) 102595-02-M-1133 TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION. Map Parcels e2ly Application : . Oo� Health•Division - Date Issued v Conservation.,Division Application Fee ' Planning Dept. Permit Fee �P Date Definitive Plari Approved by Planning Board Historic'- OKH Preservation/ Hyannis i, Project Street Address Village Owner Address Telephone Permit Requ st — x_ 0 Square feet: 1 st floor: existing proposed nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay f Project Valuation t Construction Type 1 ► ,y�o . Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ..a/' Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full kCrawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq. ) Number of Baths: Full: existing_ new Half: existing new Number of Bedrooms: existing �ke Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes Vl�o Fireplaces: Existing New b*isting wood/coal stove: ❑Yes W-No Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing Anew- size 1,': Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w $= Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 41 l6 If yes, site plan review# Current Use,�__ i __ Proposed Use: . _ APPLICANT INFORMATION ` (BUILDER OR HOMEOWNER) Name�� 1r=..w ,_tV— Telephone Number Address 1140 1A-)4E_ License # 6F b09,9 l � t �= 4 2, Home Improvement Contractor# r3.���� 7 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TQ- �I.L � c SIGNATURE - DATE FOR OFFICIAL USE ONLY APPLICATION# - r DATE ISSUEDIt ` MAP/PARCEL N0. ADDRESS VILLAGE ; s OWNER A' DATE OF INSPECTION: f FOUNDATION FRAME INSULATION ; ° FIREPLACE 1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL �} FINAL BUILDING Z05407 k} _ _r DATE CLOSED OUT ASSOCIATION PLAN NO. �1 I a a The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA OZIII www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual . � Il� /✓ City/State/Zip: l�(�19 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. ❑ ew construction. employees(hill and/or part-time).* have hired the stab-contractors 2. I am a'sole proprietor or partner- listed on the attached sheet 7. Remodeling ship and have no employees These sub-contractors have g, E]Demolition working for me in an capacity. employees and have workers' • Y aP tY• t 9. ❑Building addition [No workers' comp.insrrranr_C comp.insurance. roqed.] 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' comp. right 6f exemption per MGL 12.[]Roof repairs insurance require&]t c. 152, §1(4), and we have no employees. [No workers' 13.❑Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. . t Homeowners who submit this affidavit indicating they are doing ail work and then hire outside canttactors must subarit anew affidavit indicating such. :Contractors 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 providt their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the polity and job site information. Insurance Company Name: �tP�U/L ► Az-c_ — Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address:I m k/ 1.1,E �t f City/Statdzip: . 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 tip 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 aqunst the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investizations of the DW for insurance coverage verification. I do hereby certify undi. the pains-and penalties of perjury that the information provided above is true and correct Si attire: Date: _ Phone# e02-16— Officid use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. however the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that"every state or local licensing agency shall withhold the.issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )•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 numbers) along with their certificate(s)of insurance. Limited Liability Companies•(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members,or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit(license number which will be used as a reference number. In'addition, an applicant that must submit multiple permit/license applications in any given year,need only submit our,affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for fixture permits or licenses. A new affidavit,must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture o license or permit to bum leaves etc. said person is NOT required to complete this affidavit tie.a dog h , p ) P q� � . . The Office of Investigations would lice 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 C6mmonweaM of Massachusetts DTartmont of Industrial Accidents - - Qfte of Investigations 600 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 4•06 or 1-977-MASSAFE R Fax# 617-727-7749 evised 11-22-06 www.mass.gov/dia r .. � .��ie�omvina�zureal�a���aaac�iicaedta � f Board of Building Regulations and B':indat(is License or registration valid for individul use only, HOME IMPROVEMENT CONTRACTOR before tile expiration date. If found,return,fo - Registration 135897 Board of Building Regulations and Standards ;r Exp rat on 517/2008 One Ashburton Place m 1301 . . Type Individual Boston,Ma.02108 RICHARD ANDREW PRC_HLIK i" RICHARD PRCHLIK - 292 FULLER RD m, CENTERVILLE,MA 02632 isti ator Not slid without signature - _.� - - - E � :. ✓� L/IO�I77/lYG04ZG�Ep�L O�✓!�(.Q.d6l�Ell6P.�6 J { - ` i 1� oard of Building Regulations and Standards ' y • h 'k.,—Construction Supervisor License 1 t s 3 License CS _ 80591 Expi..... raxjon 6/28(2009 Tr# 1,4591 t q 8 I '� ___ ,Restriction �00 RICHARD A PRCHL1K '� ' .. PO BOX 346 /- CENTERVILLE,MA 02632, Commissioner ------------ ��z►+er° Town of Barnstable Regulatory Services SABN aA. Thomas F.Geiler,Director a6;9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma us Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A]Builder I;rrft4 C as 0%mer of the subject 7 property hereby authorize &tm�I-Av- to act en my behalf, La at,matters relative to work authorized by this building permit application for. G�I (.Address of job) tore er Date (. J Pint Name Q-TOIRM&OWNE"UMiS510N ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Applicant Narne: Site Address: T, o print T Town: Applicant Phone; - Applicant Signatur ! Date of Application: a NEW CONSTRUCTION: choose ONE of the following two options) 780 CMR TABLE 6107.1 , PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR NEW ONE- AND TWO-FAMILY BUILDINGS MAXIMUM' MINIMUM Ceiling or Basement Slab ❑.Option l: Fenestration exposed Wall Floor Perimeter U-factor floors. R-Value R-Value Wall R-Value AFUE HSPF SI�IR R-Value R-Value and Depth National Appliance Energy 3 S R-3 8 R-19 R-19 R-10 R-10, Conservation Act(NAECA)of q.ft. 1987 as amended,minimums or reater as applicable Note; This form is not required if you choose either of the two versions of R1;Scheek as.listed below. ❑ Option 2: �. REScheck Version 4.1.2 or later variant software analysis must-be completed (780 CMR 6107.3.2) _ REScheck—Web which can be accessed at http://www.energycodes,gov/reschecly ' :'AD)DITIO1vS<OX2 ALTERATIONS'TO"'EXISTING.BUI]LDI IGS:;OVER 5.YEA.RS OLD.* *Buildings under S years old must use option#1 or#2 in New Construction section above. Complete the following formula to determine the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a) / SF _ C/ 100 x 17,,� voo _� % of glazing (b) Glazing area equt l 2 SF b a If glazing is ;40% use.the chart below. If.glazih is >:40 %o proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling andT Wall Floor Basement Wall Slab Perimeter Fenestration Exposed floo R-Value U-factor R-Value -Value R-value' R-Value and De th 39 R-37 aR_13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling area(i;e,not compressed over exterior walls, and including any access o cnin s). SUNROOM—An addition or alteration to an existing building/dwelling unit where the total ❑ glazing area of said addition exceeds 40% of the combined gross wall and ceiling area of the addition, Note:. Owner to fill out ConsumerInformatzon Form (found in Appendix 120.P) 2WAf4- Id- Z- ,��� gr yooe . 16 P-W �G� I 7�rs� . � . ;d 17,E tv WC ro ' 4d � G � I ` THE COMMONWEALTH OF MASSACHUSETTS Registration: 135897 Board of Building Regulations and Standards Home Improvement Contractor Registration Program Expiration: 5/17/2008 One Ashburton Place,Room 1301 0 Boston,MA 02108-1618 Received: Application for Renewal of Registration coo Home Improvement Contractor or Subcontractor MGL Chapter 142A,780 CMR R6 (PLEASE READ INSTRUCTIONS CAREFULLY) Business name can not change on renewal form! 1. RICHARD ANDREW PRCHLIK RICHARD A PRCHLIK yAi 2. PO BOX 895 3• BARNSTABLE, MA 02630 "'" °�� m�z. Please note changes to mailing address. 4. Street Addresss(if different): 292 FULLER RD CENTERVILLE MA 02632 �� a Please note charges to street address. 5.' Applicant type:11ndividual 6. Federal ID No: See Instructions to change Application type. 7. No.of Employees: F 01 No.Employees 9. Individual responsible for Home Improvement Contracts: RICHARD A PRCHLIK isa � R ins First Last 10. Title of Individual responsible for Home Improvement Contracts: s� Goa` OWNER Please note changes to title.V Phone No: (508)280-6295 II. Does the applicant or responsible person hold any other construction related,state,city,town licenses or registrations? Yes _J No Construction Supervisor License: 0591Expires: �o . Motor Vehicle Repair Shop: Expires: 12. List all partners,trustees,officers,directors and major owners(10%or greater of ownership)of an applicant partnership or corporation below. Use additional paper if necessary. Check here if you wish to receive an application for additional ID cards for key persons. Last "` First Mid. Title in Applicant Business %Owner Address 13. Is the applicant claiming exemption from the registration fee?(See the instructions) es �J No 14. Registration fee enclosed:S Guaranty Fund fee enclosed:S If necessary,in two separate certified checks or money orders-one marked"Registration Fee";one marked."Guaranty Fund".'See instructions for amount of fees.Make all certified checks or money orders payable to"Commonwealth of Massachusetts". NO PERSONAL OR BUSINESS CHECKS WILL BE ACCEPTED UNLESS"I9EY ARE CERTIFIED. Pur uant to Massachusetts General Laws Chapter 62C§49A,I certify under the penalties of perjury that I, to y best knowledge and belief have filed all state tax returns and paid all state taxes required under law. Signature of I' ant's representative Title held with applicant Date A false answer to any question in this application constitutes grounds for suspension or revocation of the applicant's registration. •Heavy Marine Construction •Pile Driving •Helix Mooring&Tieback •Sea Walls Installation •Dredging Marine Techln'� ••• Qr marinetech@comcast.net Jeff Vaughan h n 541 Buck Island Road (508)790-9149 W.Yarmouth,MA(Cape Cod)02673 Fax:(508)771-3116 BUILDER INFORMATION f Name Utl C-174 Up, C� 5� b Telephone Numbero r Address c fT' ,6S` License#` 6 J SS 3 - Home Improvement Contractor# (' Worker's Compensation# `.. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ` DATE �- TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map c�0(_o Parcel 685 Permit# Heal0Divis1on a-crj:p' —6 t-5, zo 5 t>-'&i6 Date Issu ".0 Co _ Conservation Division � Z OS � . 3- Y2ZZ- Fee DD �l� �,f°•�I /3 ZoaY /� Tax Collector Application Fe ; V 'V t Treasurer Planning Dept. Checked in By , V/� am' Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 1( �� Cirlku. Village otti-`4V-U V U' Owner -TU I��O a,t 4,1J J t - Address Ilv F VAIA L I -ter 1,-A C­e Telephone �-q 6g Permit Request mgk Square feet- 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes O No If yes, attach supporting documentation, Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) �7 Age of Existing Structure Historic House: ❑Yes Uq(lo On Old King's Hiway: ❑fe-t Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) " Number of Baths: Full: existing new Half: existing I 1 c--) Number of Bedrooms: existing new ,_, Total Room Count(not including baths): existing new First Floor Roorr& unt -e � u s Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other CD rn Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal slove: ❑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 C,lo If yes, site plan review# Current Use Proposed Use - BUILDER INFORMATION Name Telepho tuber T7�?`�-35 Address License# CS ("�0 -7ag-o `r M Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEB %ULTING FROM THIS PROJE CTLLCONS�TRUCTIONT WILL B r �, SIGNATURE DATE FOR OFFICIAL USE ONLY a ai t PPERMIT/NO.1 NO. DATE ISSUED MAP/PARCEL-NO. ADDRESS VILLAGE _ OWNER 1 r G DATE OF INSPECTION: Y - FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL { FINAL BUILDING Ck �I (?b a. DATE CLOSED OUT i f ±' ASSOCIATION PLAN NO. c s r wr 6 (j t BOARD OF BUILDING.REi; License; ONS U(ATI:pN:S TRUCTION SUP. ' Numbe FRVISOR �� 001553 I Re = Tr.no: 11658 ARTHUR z J STAA a`5 LAKE RD WiS o� W YAR'MOUTH, MA '" 4 Commissioner ', o 11/29/2005 09:47 19784434480 PAGE 01 11/xb/lbd5 9i :16 5887713116 MAPINETEOH NC PAGE 02 Town of Barnstable Replatory Services � TYo�S'.tirl4sr,�lsectvr . Building Divieion Tom Pan?, 3WHOn=C=mbdonsr 200 Main Suet, Ryands,MA 02601 wwwAmmbar ble.M160e Urine. 5W86Z-448 Fat: 508-790.6230 i PrQperiy 0rmet Must Complete and Sign This Sc If Tjdng A Builder, w Omer of subjectprop" h4ftb7 au XSiE V1:7 (J 1{1�1/iG. to act On all be" is eu aaatti to relative W work authorised b7 413 ba&q peed:s cation f0t:" GJi lLf- 419t i (Address of job) Aii AAA S' tun�f Owact atm Print Nape Department oflndUstrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211 u4m mass govldia Workers'Compensation Insurance Affidavit; Builders/Contractors/FIectricians/Plumbers A licant WQrmation Please Print LeElbi Name (Business/organization/Individual): �• ' Address: . City/State/Zip: • 6 2 Phone#: L�v ?� J . Are you an employer? Check the appropriate b I.❑ I am a-employer with 4. lam a general contractor and I Pe of project(required): employees(full"and/or p art time).* have hired the sub-contractors 6 ❑New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet # 7• Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. workers' comp.insurance. [No workers' co insurance 5. 9• E] Building addition comp. u We are a corporation and its required.] officers have exercised their 10.F—] Electrical repairs or.additions 3.❑ I am a homeowner doing an work right of exemption per MGL 1�1.0 plumbing repairs or additions myself.'[No workers' comp, c. 152,§1(4),and we have no 12• Roof r insurance required.)t employees. [No workers' repairs comp.insurance required.] 13•0 Other Any applicant that checks box#l must also fill out the section below sh Homeowners who sub owing their worker;'compensation policy i>formation . mit this affidavit indicating they are doing all work and then hire outside contractors must a new affidavit in submit dicating such contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers,comp,policy infornzation. am an employer that is`tfOYlnatlDn. providing workers'compensation insurance for my employees.•Below is the policy and job site nsurance Company Name: 1�C3 iAIN olicy#or Self-ins.Lic.#: At -s - (�, (� oo Expiration Dgte: )b Site Address:__ ity/State/Zip: e�L �r�lt.i �� vYt Mach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). allure to,secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcriminal penalties of a ne up to$.i,5oQ.40 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a.fine + Fop to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the lvestigations of the DIA for insurance coverage verification. .Office of do hereby certi der the pains and penalties of perjury that the information provided above is true and correct afore:. J Dat . / . lks lone - $ — 91 l Of,j`lcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority hori circle one t3'( ) 1.Board of Health 2..Building Department 3.City/Town Clerk 4..Mectrical Inspector s.Plumbing Inspector 6.Other Contact Person: Phone#: I ate: 12/1/2005 Time: 11:28 AM To: R 7,15087713116 Dowling & O'Neil . Page: 002-003 ® DATE(MMIO Client#: 20498 2MARINETE ACORD,-. CERTIFICATE OF LIABILITY INSURANCE 12101105D� ^ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 222 West Main St.PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Marine Tech, Inc. INSURER B: Safety Insurance Company 541 Buck Island Road INSURER C: West Yarmouth, MA 02673 INSURERD: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECTIVE POLICY EXPIRATION LTR INSRC TYPE OF INSURANCE POLICY NUMBER DATE MMIDDIM DATE IMMIDDIVYI LIMITS A GENERAL LIABILITY NPP972880 10/12/05 10112106 EACH OCCURRENCE_ $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $50 000 S n CLAIMS MADE ®OCCUR MED EXP(Any one person) $5 000 X BI1PD Ded:500 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE s2,000,600 GEN'L AGGREGATE LIMIT APPLIES PER: _ PRODUCTS-COMPIOP AGG S1,000,000 POLICY PROEl- JECT LCC B AUTOMOBILE LIABILITY 2433573 10127/05 10127/06 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS X SCHEDULED AUTOS B(Per person) $1 000 000 (Per person) : � X HIRED AUTOS BODILYINJURV S1,000,000 X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Pr accidad) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - - OTHER THAN EAACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ f—� I OCCUR u CLAIMS MADE AGGREGATE - $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WC STATU OTH- EMPLOYERS'LIABILTTY ' TLIMITS- ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT IS _ OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. Project: Proposed Pier CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Fulvio Fierimonte DATETHEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10_ DAYS WRITTEN, 1136 Cra igville Beach Road NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Centerville,MA 02632 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR T REPRESENTATIVES. AUTHOR17ED YPRESENTATFVE + 1 17 c, ate.'* ACORD 25(2001108)1 of 2 #40782 NS2 © ACORD CORPORATION 1988 SENDER: . COMPLETE,■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. ❑Agent ■ Print your name and address on the reverse X ❑Addressee so that we Can return the Card to you. B. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, or on the front if space permits. D. Is delivery address different from item 1? ❑Yes 1. Article Addressed to:`f If YES,enter delivery address below: ❑ No u""oo m 4� 7 _ 3. Service Type f �G �S 0-Certified Mail ❑ Express Mail CJ ❑ Registered ®-Return Receipt for Merchandise ❑ Insured Mail ❑C.O.D. 4. Restricted Delivery?(Extra Fee) ❑Yes 2. Article Number 7002 1000 0005 0781 7549(Transfer from service label) PS Form 3811, Domestic Return Rece' 102595-02-M-1540 UNITED STATES POSTAL SERVICE First-Class Mail Postage&Fees Paid LISPS Permit No. G-10 • Sender: Please print your name, address, and ZIP+4 in this box • TOWN OF BARNSTABLE BUILDING DIVISION 200 MAIN ST. HYANNIS,MA 02601 I i I I Town of Barnstable gesPosr Regulatory Services 5� 9C 0 F 22dMain Stree t et J PITNEY BOWES Hyannis, MA 02601 -' I 02 1A $ 04.420 7002 1000 0005 0781 7549y 9_1 # 0004606238 DEC01 2005 MAILED FROM ZIPCODE 02601 RETURN R t UIPT __--- -� ilillilllliu �� flEQQ.E3-ran �.�J0 0 ' Conte � + 0 vR OT O ����R {errrace zRy6 SETFIL 02458 IBC FOR�"�'aD OR5E� ,�® �®Fc�1�RD UI�T7�LR TC� E13�E�: RETURN J �� � �- C - ,�_LL�- ,� �, /�; � r �� �� ,� � � C� . �' _ M � r` � _ ____ ___ - � , ay \ , / � ¢ �r \ - pUTHE roy, Town of Barnstable tip Regulatory Services • BMWSTABLE, ' Thomas F. Geiler,Director Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building code Violation and Order to Cease, Desist and Abate: ~ �Fuivio'&-Juan Fiermonte and-all persons"having notice``oftliis=order:` As owner/occupant of the premises/structure located at 1136 CRAIGVILLE BEACH R.D. Map 206 Parcel 088, you are hereby notified that you are in violation of the Massachusetts State building code 780 CMR Article(s) 110.0, Section(s) 110.1, and are ORDERED this date November 30,2005. 1. CEASE AND DESIST IMMEDIATELY, all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: 780 CMR Article 110.0 Section 110.1.Build dock without a permit. Permit Application. 2. COMMENCE immediately, action to abate this violation. SUMMARY OF ACTION TO ABATE: File a written application for a building permit for work that has been done, or return area to original State. And, if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by filing an appeal with the State Building Code Appeals Board(as specified in Article 1, Section 122 of 780 CMR State Building Code)within forty-five(45) days after the service of this notice. By order, -Jack Fitzgerald J Local Inspector A�1�\� �'�� ��� ����� ��� � � �'C� � � �v� ��� �� �\ J Total Apprai ASSf'.SSt3d V Extra Featur 179001002 Out Building 0076 Land Buildings " E I MAP DISCLAIMER Total Assess 008 Town of Barnstable,MA All rights reserved.Send questions or comm( BarnstableMA v1.2.3357 [ProdUCUOn] p.aspx?propertyID=156056 3/11/2009 �FTME lqy, Town of Barnstable Regulatory Services + MASS. E Thomas F. Geiler,Director Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building code Violation and Order to Cease, Desist and Abate: Fulvio&Joan Fiermonte and all persons having notice of this order: As owner/occupant of the premises/structure located at 1136 CRAIGVILLE BEACH RD.Map 206 Parcel 088, you are hereby notified that you are in violation of the Massachusetts State building code 780 CMR Article(s) 110.0, Section(s) 110.1,and are ORDERED this date November 30,2005. 1. CEASE AND DESIST IMMEDIATELY,all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: 780 CMR Article 110.0 Section 110.1.Build dock without a permit. Permit Application. 2. COMMENCE immediately, action to abate this violation. SUMMARY OF ACTION TO ABATE: File a written application for a building permit for work that has been done,or return area to original State. And, if aggrieved by this notice and order,to show cause as to why you should not be required to do so,by filing an appeal with the State Building Code Appeals Board(as specified in Article 1, Section 122 of 780 CMR State Building Code)within forty-five(45)days after the service of this notice. By order, Tack Fitzgerald Local Inspector �SSed 5kum cc . 5�1� ev1 Massachusetts Department of Environmental Protection o29�s Bureau of Resource Protection -Waterways Regulation Program Transmittal No. Chapter 91 Waterways License Application -310 CMR 9.00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment G. Municipal Zoning Certificate FULVIO FIERIMONTE Name of Applicant 1136 CRAIGVILLE BEACH ROAD CENTERVILLE RIVER CENTERVILLE Project street address Waterway Cityrrown Description of use or change in use. TO LICENSE, BUILD & MAINTAIN A DOCK WITH APPURTENANCES ON CENTERVILLE RIVER FOR NON-COMMERCIAL, RECREATIONAL USE BY THE RESIDENTS OF A SINGLE FAMILY DWELLING — To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws.' Tom Perry Printed of Municip vial Dat 6cAt� rJ �u r�SJ/t? '� 0 Signature of Municipal Official SIT a �— Ci own d,CJC S �- rA A-o "`5 `n 4+\e- a4 4c L�,e-d SkunnP ed. s,I4- A dlre sS e d e,nue_�o� CH91APP.doc•Rev. 10102 Page 6 of 17 M Enter Your Transmittal Number W 029484 fl Your unique Transmittal Number can be accessed through DEP's web site or by calling the DEP InfoLine as listed on the last � page of this document T Massachusetts Department of Environmental Protection Transmittal Form for Permit Application and Payment Ins-tu A Apr . r1 :�t1011 .: DEP Permit Code(the 7 or 8 character code from first page of permit application instructions): 1. Please type or print. nWATER-DEP;=NnFNT A separate Transmittal Category: Form must be PIER LICENSE completed for each or Activity: permit application. CK N D B ATI CCE T NAVI ABLE WAT R 2. Your check should ippl ean`.t InformaU., 0 (117 or Indl�ri�fuai� be made payable to Name of Firm: the Commonwealth of ' Massachusetts. Or,if party needinq this approval is clearly an individual: Please mail your check Individual's Last Name: First Name MI along with a copy of FULVIO this form to:DEP,P.O. FIERIMONTE Box 4062,Boston,MA 02211. Street Address 16 ARUNDEL TERRACE 3. Three(3)copies of City/Town State Zip Code Telephone Number this form will be NEWTON MA 02458 1-617-964-8837 needed. Contact: e-mail address (optional) Copy 1 (the original) SAME must accompany your permit application. :Ite or lnd��ldualequr�ng ApprDyal Copy 2 must Name of Facility,Site or Individual DEP Facility Number(if Known) accompany your fee FULVIO FIERIMONTE SE3-4222 payment. Street Address e-mail address: (optional) Copy 3 should be retained for your 1136 CRAIGVILLE BEACH ROAD records City/Town State Zip Code Telephone Number CENTERVILLE MA 02632 1-617-964-8837 4. Both fee-paying and exempt applicants D..': App11Ca#.iott Prepaecl f ,/ (ifi different fromSectiorr B) must mail a copy of Name of Individual or Firm: this transmittal form to CRAIG R. SHORT, P.E. DEP,P.O.Box 4062, Address Boston,MA 02211 P. O. BOX 1044 For DEP Use Only city own State Zip Code Telephone Number Permit No. SOUTH DENNIS MA 02660 508-398-8311 Rec'd Date Contact: LSP Number(21 E only) Reviewer CRAIG R. SHORT E P&Mit ro,ect Coortllnatlo'n Is this project subject to MEPA review? ❑yes X no If yes, indicate the project's EOEA file number(assigned when an Environmental Notification Form is submitted to the MEPA unit) EOEA# Is an Environmental Impact Report Required?0 yes❑ no Is this application part of a larger project for which two or more DEP permits are being or will be sought? ❑yes X no List any other DEP permits that apply to this project. °! Permtt:Cat egory Date of Submission{tentative or actual) Transmrttal Number(if application already submitted), ►M O. Due Special Provisions: ❑ Fee Exempt'(city,town or municipal housing authority)(state agency if fee is$100 or less) ❑ Hardship Request(payment extensions according to 310 CMR 4.04(3)(9)] _ ❑ Alternative Schedule Project(according to 310 CMR 4.05 and 4,10) There are no fee exemptions for 21 E,regardless of applicant status Check#: 4248 Dollar Amount: .$175.00 Date: 09/15/04 I Please make check payable,to the Commonwealth of Massachusetts and mail check and one copy of this form to DEN, F.O. Box 4062, Boston; MA 02211 rev:OX211W Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program Tr o2s4s4' i ransrnittal No. Chapter 91 Waterways License Application , 310 cnnR 9.00 Simplified, Water-Dependent, Nonwater-Dependent, Amendment Important: A. Application Information (Check ones When filling out forms on the computer,use Name (Complete Application Sections) Check One Fee Application # oniy the tab key to move your SIMPLIFIED - cursor-do not use the return Water-dependent and key. Nonwater--dependent(A-E} ❑ Residential with-4 units $55.00 8RP "JJ06a . n Other .. $55 fin BRP\nnnl061:i Ij WATER-DEPENDENT - E 175.D0 BRP WW01a units General {A-H} X Residential with < 4— $ For assistance ❑ Other $250.00 BRP VWV01h in completing this application,please see the ❑ Extended Term $2500.00. BRP WW01 c "Instructions". Amendment(A-H) ❑ Residential with <4 units $60.00 BRP WW03a ❑ Other $100.00 BRP WW03b NONWATER-DEPEN DENT - Full (A-H) ❑ Residential with<4 units $500.00 BRP WW15a ❑ Other $1500.00 BRP WW15b ❑ Extended Term $2500.00 BRP WW15c Partial (A-H) ❑ Residential with < 4 units $500.00 BRP WW14a ❑ Other $1500.00 BRP WW14b ❑ Extended Term $2500.00 BRP WW14c' Municipal Harbor Plan (A-H) .❑ Residential with < 4 units $500.00 BRP WW16a ❑ Other $1500.00 BRP WW16b ❑ Extended Term $2500.00 BRP WW16c Joint MEPA/EIR (A=H) ❑ Residential with < 4 units $500.00 BRP WW17a ❑ Other $1500.00 BRP WW17b ❑ Extended Term $2500.00 BRP WVV17c Amendment'(A-HI h` ❑ Residential with <4 units $310.00 BRP VW ❑ Other $750.00 BRP WW'03d ❑ Extended Term $i 000.00 BRP WW03e t CH9 i 4pp.doc•Rev. 10r02 Page 1 o!17 i Massachusetts Department of Environmental.Protection _ Bureau of Resource Protection Waterways Regulation Program 9 Transmittal, W 029484' _ - No. Chapter 91 Waterways License Application - 310 CMF2 9:00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment B. Applicant Information proposed Project/Use Information 1. Applicant: I 'C1LSl1Q FtERI(tltQfuTE _ -- Name E-mail Address `I��.,;1•�R>JMt}E,L_TERF(ACE; -- ------ ------------------- ----------------. Mailing Address Note:Please refer NIFT ?N MJ 02458 to the"Instructions" — ---- - -_—City/Town State Zip Code Telephone Number Fax Number 2. Authorized Agent(if any): Name E-mail Address �ttt�� Mailing Address } 1 TIDE II IS:. M An _ Cityrrown State Zip Code 508-398-8311 5 "; Telephone Number Fax Number C. Proposed Project/Use Information 1. Property Information (all information must be provided): 1ERQQ1 4atJ .4N F� F1tV( Jl Owner Name(if different from applicant) K AN Tax Assessor's Map and Parcel Numbers Latitude Longitude ��tf6fill�lzEt��N Ri�AQ,I�ENTEE �XI'i LE hill ' u (� 2 - Street Address and City/Town• State Zip Code 2. Registered Land X Yes No " 3. Name of the water body where+the project site is located: 4. Description of the water'body in which the project site is located (check all that apply): ' Type Nature Designation { t ❑ Nontidal river/stream Natural ❑Area of Critical Environmental Concern X Flowed tidelands ❑ Enlarged/dammed _ ❑ Designated Port Area ❑ Filled tidelands ❑ Uncertain ❑ Ocean Sanctuary Great Pond' Uncertain ❑ Uncertain y CH91 App.doc•Rev. 10/02 Page 2 of 17 i Massachusetts Department of Environmental,Protection �29484 ___- Bureau of Resource Protection - Waterways ;11+Regulation Program Transmittal - Chapter 91 Waterways License Application -310 CMR 9.00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type T abie 5. Proposed Use Activity description on pg.2 of the "Instructions" TO LICENSE, BUILD &MAINTAIN A DOCK WITH APPURTENANCES ON CENTERVILLE RIVER FOR NON-COMMERCIAL, RECREATIONAL USE BY THE RESIDENTS OF A SINGLE FAMILY DWELLING. 6. Is the project a pre-1984 existing structure AND less than 600 square feet? ❑ Yes No 7. Is the project a post-1984 existing or new structure, less than 300 square feet AND water dependent? Yes ❑ No 8. What is the estimated total cost of proposed work(including materials& labor)? $6,000 9. List the name & complete mailing address of each abutter(attach additional sheets, if necessary). An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50' across a waterbody from the project. SEE ATTACHED LIST Name Address Name Address Name Address --- — ----------- --..------ D. Project Plans 1. 1 have attached plans for my project in accordance with the instructions contained in (check one): X Appendix A(License plan) ❑ Appendix B (Simplified License plan) ❑ Appendix C(Permit plan) 2. Other State and Local Approvals/Certifications ❑ 401 Water Quality Certificate Date of Issuance X Wetlands SE3-4222 File Number Jurisdictional Determination JD File Number ❑ MEPA ---- --- ----------..... File Number, `` ❑ EOEA Secretary Certificates _ Date -- ---- - _-_-- - 21 E 0.1a s t e Site Cleanup f RTN Number CH9?App.doc.Rev. 10/02 Page 3 of 17 ABUTTERS OF: Fierimonte Richard M. Blackwell X4206148 Steplien E. W'ocrel AIv1206/106 1136 Craigville Beach Road Diane BlackN%cli Jane F.Woefel Centerville AM 206f88 5 Frederick Circle 117 Walpole Street ' File#1-864 Dock NOi Woburn,MA 01801 Norwood,MA 02062 Fulvio Fierimonte AM206/88 Dorothy P. Br son Atii'_06/49 Frances Baumgartner AM206/126 Joann Fierimonte 1 1 Acorn Drive 1096 Craig ille Beach Road 16 Arundel Terrace Auburndale,MA 02166 Centerville,MA 02632 Newton,MA 02458 Celestine A- DiGiovanni AM206/25 Thomas H.M. Hamilton AM206/50 David G.,Drake AN1206/136 Anne Theresa DiGiovanni P.O- Box 106 Catherine G. Drake 66 Crystal Ridge Road .P 0. Box 6 Centerville,MA 02632 Cotuit_ MA 02635 Cotuit,MA 0263- � Catherine G. Roncone AM206/26 Anthony J.Balsamo AM206/85-1 Mary Balsamo 206/87 21 Norfolk Drive 1204 Craigville Beach Road 206/90 Leominster,MA 01453 Centerville,MA 02632 Town of Barnstable AM.206/86 Michael S.Sullivan AM206/42 Conservation Commission 333 Quaker Meetinghouse Road 200 Main Street East Sandwich, MA 02537 Hyannis,MA 02601 Anne H. Healy AM206/43 Barnstable AM206/89 M 194 Grove Street Conservation Foundation P. Boa 224 Wellesley,MA 02482 o Cotuit,MA 02635 Frederick W. Tonsberg AM206/44 Barry Tobins AM206/91 Roberta J.Tonsberg Saundra Tobins 1939 Ocean Street 1110 Craigville Beach Road Marshfield,MA 02050 Centerville,MA 02632 Philip C.Bateman Tr. AM206/45 Robert W:Greene AM206192 Short Beach Estate Trust Elizabeth A.Greene 25 Short Beach Road 16 Laurel Avenue Centerville,MA 02632 Shrewsbury,MA 01545 Margaret A. Hine Tr. A 06/46 Donald F. Richter AM206/97 2 M Joan W- Richter 12 Claudette Circle •, 3ZWaterside Drive . Framingham,MA O 1701 , Centerville.MA 02632 R. Brian Ladner Trs AM206/47 John Peck AM206/99 Ronald F. Ladner Trs Karen Peck 29 Juniper Lane 415 Thompson Street Holden,MA 01520 Halifax,MA 02338 I - Massachusetts Department of Environmental Protection W 0294s4 Bureau of Resource Protection - Waterways Regulation Program Transmittal No. --- Chapter 91 Waterways License Application - 310 CMR 9.00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment E. Certification All applicants, property owners and authorized agents must sign this page. All future application correspondence may be signed by the authorized agent alone. 1 hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the premises of the project site at reasonable times for the purpose of inspection." 1 hereby certify that the information submitted in this application is true and accurate to the best of my knowledge." -- ------ .... --------------- — Applicants signature FULVIO FIERIMONTE Date . Property Owner's signature(if different than applicant) JOANNA FIERIMONTE Date Agent's signat (if applicable) CRAIG R.SHORT,P.E. Date APPLICANTS FILING A SIMPLIFIED APPLICATION STOP HERE kA .. CH91App.doc•Rev. 10/02 Page4.of 17 f Massachusetts Department of Environmental Protection ' Bureau of Resource Protection - Waterways Regulation Program !IV 029484 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Simplified,Water-Dependent, Nonwater-Dependent,Amendment F. Waterways Dredging Addendum NIA 1. Provide a description of the dredging project ❑ Maintenance Dredging (include last dredge date&permit no.) ❑ Improvement Dredging Purpose o f Dredging 2. What is the volume (cubic yards) of material to be dredged? 3. What method will be used to dredge? ❑ Hydraulic ❑ Mechanical ❑ Other 4. Describe disposal method and provide disposal location(include separate disposal site location map) 5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes, the Department recommends that the'dredged material be used as beach nourishment for public beaches. Note: In the event beach nourishment is proposed for private property, pursuant to 310 CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by applicant and submitted to the Department. u ; j - • Ili • CHPApp.doc•Rev. 10102 a Page 5 of 17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program W 029484 ____ Transmittal No. Chapter 91 Waterways License Application -310 CMR 9.00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment G. Municipal Zoning Certificate FULVIO FIERIMONTE Name of Applicant 1136 CRAIGVILLE BEACH ROAD CENTERVILLE RIVER CENTERVILLE Project street address Waterway Cityrrown Description of use or change in use: TO LICENSE, BUILD & MAINTAIN A DOCK WITH APPURTENANCES ON CENTERVILLE RIVER FOR NON-COMMERCIAL, RECREATIONAL USE BY THE RESIDENTS OF A SINGLE FAMILY DWELLING To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws." Tom Perry Printed Name of Municipal Official Date, Signature of Municipal Official Title City/Town CH91 App.doc•Rev. 10/02 Page 6 of 17 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program Tr o294sa _ Transmittal No. Chapter 91 Waterways License Application -310 CMR 9.00 Simplified,Water-Dependent, Nonwater-Dependent, Amendment H. Municipal Planning Board Notification P Notice to FULVIO FIERIMONTE _— Applicant: Name of Applicant - - - -- - - Section H should 1136 CRAIGVILLE BEACH ROAD_ ' _ CENTERVILLE RIVER CENTERVILLE be completed and Project street address Waterway City/Town submitted along with the original Description of use or change in use: " application material. TO LICENSE, BUILD & MAINTAIN A DOCK WITH APPURTENANCES ON CENTERVILLE RIVER FOR NON-COMMERCIAL, RECREATIONAL USE BY THE RESIDENTS OF A SINGLE FAMILY DWELLING To be completed by municipal clerk or"appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans have been submitted by the applicant to the municipal planning board." Jackie Epstein -J p _ Printed Name of Municipal Official Date Signature of Municipal Official Title City/Town Note:Any comments,'including but not limited to written comments, by the general public, applicant, municipality, and/or an interested party submitted after the close of the public comment period pertaining to this Application shall not be considered, and shall not constitute a basis for standing in any further appeal pursuant to 310 CMR 9.13(4) and/or 310 CMR 9.17. r . CH91 App.doc•Rev. 10102 - 'Page 7 of 17 I yokIWE i Massachusetts Department of Environmental Protection " ' DEP File Number: o� Bureau of Resource Protection - Wetlands • BARNSTABLE. WPA Form 5 Order of Conditions, SE3-4222 M Provided DEP 9Q3A 1639 � Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 o ded by fFD MAC and Town of Barnstable Ordinances Article XXVII A. General Information Important: When filling From: out forms on Barnstable the computer, Conservation Commission ; use only the tab key to This issuance if for (check one): move your cursor- do ® Order of Conditions not use the return key. ❑ Amended Order of Conditions r� To: Applicant: Property Owner (if different from applicant): Fulvio Fierimonte Name Name 16 Arundel Terrace Mailing Address Mailing Address Newton MA 02458 City/Town State Zip Code City/Town State Zip Code 1. Project Location: 1136 Craigville Beach Road Centerville Street Address City/Town 206 088 Assessors Map/Plat Number Parcel/Lot Number 2. Property recorded at the Registry of Deeds for: Barnstable County Book Page C138791 �L P/G�t �`jcj2 � l.Ct f �'3 Certificate(if registered land) 3. Dates: December 12, 2003 April 13, 2004 .t:f-;41 Date Notice of Intent Filed Date Public Hearing Closed, Date of Issuance 4. Final Approved Plans and Other Documents (attach additional plan references as needed): Revised Site Plan April 13, 2004 Title Date Title Date Title Date 5. Final Plans and Documents'Signed and Stamped by: Craig Short, PE Name }h 6. Total Fee: 496.00 (from Appendix B:Wetland Fee Transmittal Form) Wpaform5.doc•rev.5/6/04 Page 1 of.7- i Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands ABL = WPA Form 5 - Order of Conditions, SE3 4222 y nus Provided by DEP �p 079• Massachusetts Wetlands Protection Act M.G.L. c. 131 , §40 lfD MPS a and Town of Barnstable Ordinances Article XXVII B. Findings Findings pursuant to the Massachusetts Wetlands Protection Act: Following the review of 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: ❑ Public Water Supply ® Land Containing Shellfish ® Prevention of Pollution ❑ Private Water Supply ® Fisheries ® Protection of Wildlife Habitat ❑ Groundwater Supply ® Storm Damage Prevention ® Flood Control Furthermore,this Commission hereby finds the project, as proposed, is: (check one of the following boxes) Approved subject to: ® the following conditions which are necessary, in accordance with the performance standards set forth in the wetlands regulations, to protect those interests checked above. 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 from the plans specifications,'or other proposals submitted with the Notice of Intent, these conditions shall control. Denied because: ❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations to protect those interests checked above. 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 these interests, and a final Order of Conditions is issued. ` ❑ 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 Act's interests, 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). a General Conditions (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 permittee or any other person of the necessity of'complying with all r other applicable federal, state, or local statutes, ordinances, bylaws,�or regulations. Wpaiorm5.doc•rev.5/6/04 Page 2 of 7 Massachusetts Department of Environmental Protection DEP File Number: "o Bureau of Resource Protection - Wetlands BA BLE, = WPA Form 5 - Order of Conditions sE3-4222 Provided by DEP �A i639. Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 TEo r,�y a and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) 4. The work authorized hereunder shaiibe compieted.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. 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. 7. This Order is not final until all administrative appeal periods from this Order have elapsed, or if such an appeal has been taken, until all proceedings before the Department have been completed. 8. No work shall be undertaken until the Order has become final and then has been 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 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 this 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. 9. 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, "MA DEP"] "File Number SE3-4222 . " 10. 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 DEP. 11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of Compliance (WPA Form 8A) to the Conservation Commission. 12. The work shall conform to the plans and special conditions referenced in this order. 13. Any change to the plans identified in Condition #12 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. 14. 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. Wpaform5.doc•rev.5/6/04 .. Page 3 of 7 Massachusetts Department of Environmental Protection DEP File Number: do Bureau of Resource Protection - Wetlands BARNSrABLE. WPA Form 5 - Order of Conditions sE3-4222 y nmss Provided by DEP �A i631. Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 len Ma+" and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) i 5. This Order of Conditions shaii 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. 16. 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. 17. All sedimentation barriers shall be 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. see attached I Findings as to municipal bylaw or ordinance Furthermore, the Barnstable hereby finds (check one that applies): Conservation Commission ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: Municipal Ordinance or Bylaw Citation Therefore, work on this project may 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 of Conditions is issued. ® that the following additional conditions are necessary to comply with,a municipal ordinance or bylaw, specifically: Article 27 of Town Ordinances Municipal Ordinance or Bylaw Citation The Commission orders that all work shall be performed in accordance with the said additional 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: R Wpaform5.doc•rev.5/6/04 - Page 4 of 7 t SE3-4222 Fierimonte Approved Plan = April 13, 2004 Revised Site Plan by.Craig Short, PE Special Conditions of Approval [. Preface Caution: Failure to comply with all Conditions of this Order of Conditions can have serious consequences. The consequence may include issuance of a stop work order,fines, requirement to remove unpermitted 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 2 and continue on pages 3 and 4. The Special Conditions are contained on pages 4.1,4.2 and 4.3 if necessary.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 8 (recording requirement)on page 3 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. The applicant shall provide copies of the Order of'. Conditions and approved plans(and any approved revisions thereof) to project contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the Commission prior to the start of work. 3. General Condition 9 on page 3 (sign requirement) shall be complied with. 4. The Conservation Commission shall receive written notice 1 week in advance of the start of work. 5. The Natural Resources Dept..shall be notified at least 21 working days prior to the start of work at the site, to inspect the areas for shellfish. If deemed necessary by the Shellfish Constable,shellfish shall be removed from the work area to a suitable site and/or replanted at the locus following construction. The foregoing ' measures for shellfish protection shall ensue at the expense of the applicant.' 6. . The applicant shall obtain a building-permit for the proposed pier from the Town Building Commissioner. Page 4.1 III. The following additional conditions shall govern the project once work begins. 7. General conditions No. 12 and No. 13 (changes in plan)on page 3 shall be complied with. 8. The Conservation Commission, its employees, and its agents shall have a right of entry to inspect for compliance with the provisions of this Order of Conditions. 9. This permit is valid for 3 years from the date of issuance, unless extended by the Commission at the request of the applicant.Caution: a future Amended Order does not change the expiraiion date. 10. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer is used,only slow-release low-nitrogen fertilizer shall be applied. Over-fertilizing - shall be avoided. 11. There shall be no disturbance of the existing salt marsh. 12. No creosote-treated or CCA-treated materials shall be used. 13. Deck plank spacing shall be at least one half inch. 14. Work shall occur during the off-season only: October 15 through May 1. 15. No dredging(including but not limited to effects of propeller wash) is permitted herein. Deepening the berth by propeller scouring is strictly prohibited under this Order. 16. The seasonal storage of floats shall be at a suitable upland site. Floats shall not be stored on banks,marshes or dunes. 17. Float stops shall be used to prevent the grounding of the float on the substrate. The following special conditions in italics shall govern boat use at the approved pier. These conditions shall continue over time.,-Note: For purposes of this Order of Conditions,the term"pier" shall refer not only to the linear pile-supported structure, but also to any of its components or s , appendages such as the float(s),ell,tee, ramp,outhaul piling,etc. 18. Due to shallow depth at the float,motor craft use shall be limited to one•11 ft. (or snzaller)•inflatable with no more than a 9.9 horsepower motor. 19...For the allowed nnotor cnift, when a clearance of I foot between the propeller and the bay bottom cannot be maintained, the engine shall be shut down, raised up, and the craft shall be rowed or poled to and from the float. Y. Page 4.2 R 20. Boats berthed at the pier shall not ground at any low tide. 21. Boats shall only be berthed at the float. ` 22. Oars and oarlocks shall be present at all times when underway 23. A small sign shall be posted at the float with the following: SE3-4222 limitations: 11 ft. inflatable 9.9 h.p. limit Props 12"above bottom, all tinges Seasonal only 1. The pier shall be only seasonally deployed: out by Nov. I",not in before April I". 2. Any desired pier lighting shall receive,prior approval of the Conservation Commission or Department.; 3. Work on the pier shall ensue mid-tide rising to mid-tide falling or as otherwise necessary to prevent the grounding of the work barge on the substrate. IV. After all work is completed,the following condition shall be promptly met: 1. 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 with the request for a Certificate of Compliance. Where a project has been completed in accordance with plans stamped by a registered professional engineer,architect,landscape architect or land surveyor, a written statement by such a professional person certifying substantial compliance with the plans and setting forth what deviation, if any,exists with the record plans approved in the Order shall accompany the request for a Certificate of Compliance. At the time of the request for a Certificate of Compliance an updated sequence of color photographs of the undisturbed buffer zone shall be also submitted. ' Page 4.3 ... r Massachusetts Department of Environmental Protection �oFTt�Tory DEP File Number: Bureau of Resource Protection - Wetlands- AB WPA Form 5 - Order of Conditions SE3-4222 v Mass �* Provided by DEP �A 1639. Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 ren na+a and Town of Barnstable Ordinances Article XXVII B. Findings (cont.) Additional conditions relating to municipal ordinance or bylaw:. see attached This Order is valid for three years, unless otherwise specified as a special condition pursuant to General Conditions 44, from the date of issuance. s Date This Order must be signed by a majority of the Conservation Commission. 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 (see Appendix A) and the property owner(if different from applicant). Signatures: 11 P On Of Day Month and Year before me personally appeared --=� �J �- ►�, C_ to me known to be the person described in and who executed the foregoing instrument and ackno d.that h he exec ted t e ame as hiS/hpr free act and deed. Notary Public ZIV. My Commission Expires This Order is issued to the applicant as follows: 0 by hand delivery on p " ® by certified mail, return receipt requested,on 2004 Date Date Wpaform5.doc•rev.1/27/04- Page 5 of 7 �t r Massachusetts Department of Environmental Protection DEP File Number: ' moo Bureau of Resource Protection - Wetlands KARNSTABLE. = WPA Form 5 - Order of Conditions ' SE3-4222 i639- Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP Aj fp�,f a and Town of Barnstable Ordinances Article XXVII C. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of iiand 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 DEP 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 fee and a completed Appendix E: 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. The request shall state clearly and concisely 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. D. 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 Page 7 of Form 5 shall be submitted to the Conservation Commission listed below. Barnstable a Conservation Commission Wpaform5.doc•rev.5/6/04 - - • '� - Page 6 of 7 oFtr+�r Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection r. Wetlands Ae� : WPA Form 5 ® Order of Conditions SE3-4222 Mnss Provided by DEP Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Teo rnr+' and Town of Barnstable Ordinances Article XXVII D. Recording Information (cont.) 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: 1136 Craigville Beach Road Centerville SE3-4222 Project Location DEP File Number Has been recorded at the Registry of Deeds of: , Rrrr`,r E County Book Page_ r 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 Conditions 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 RNU KY Woaform5.doc•rev.6/6iO4 - •' •., - Page 7 of 7 o - � Q 5 a R1 IZABEIN SNQZ �pG O m OCUS O z N/F C�o FREDERICK W. TONSBERG CEN TER VILLE HARBOR N/F ROBERTA J. TONSBERG DORTHYP. BRYSON 1939 OCEAN STREET _LOCUS MAP 11 ACORN DRIVE MARSHFIELD, MA 02050 AUBURNDALE, MA 02166 REl�7i1'1E/VT CRA/GI/LLE BE,gCH ROgO S/DEWAL� CRA/Gl/j NIF 60' W/DE WA y _ E BEACH RD. BARSTABLE 100.0'f �'i�__=___ = B R/OGE CONSERVA T/ON FOUNDA 77ON P.O. BOX 224 /•% � � � COMIT, MA 02635 J/ WELL/NG 0 / , / PROPOSED - ,� o / PIER f ' _'\\ 5.0`± SANDBARNIF THERESE M. MULRENIN 7RS 77-IIRD CAPE REALITY 7RUST P.O. BOX 696 /� / N/F CENIERI/ILLE, MA 02632 OF ANTHONY J, BALSAMO VO �� / OGE RSA MA 04YCRAIGWLLE BEACH RD. ��� SPLT MP CEN TER WLLE.,MA 02632 IN � tip E SITE PLAN : 50 O 25 50 Jn{d aT � U F, i" � SCALE 1 INCH = 50 FEET PLAN ACCOMPANYING PETITION OF FUL WO FJERIMONTF TO BUILD, LICENSE AND MAINTAIN A STAIRWA Y, PIER, RAMP, & FLOA TING DOCK IN CEN TER VILLE RIVER BARNSTABLE (CRAIGVILLE) BARNSTABLE COUNTY, MASSACHUSETTS CRAIG R. SHORT, P.E. P.O. BOX 1044 SOU TH DENNIS, MA 02660 DATE 0911512004 508 398-8311 SHEET 1 OF 4 Cl'?A IC VIZ Z SOSWA A 60 " . ROAD - WID F WAY 1 00.0,t POSTED SIGN (�ji i ....... 6.9 EX/ PROPOSED /PVC ST. STAIRS 5 /.,% j x OWELL/iVG —1.6 ,#1136 CRA/GbILLE BEACH /gyp / C - - - 'T p F / /,,Y PROPOSED 12' FIXED PIER, EL. = 6.94'M.L w �= 6.24 NGVD // /r' 0 x-1:7 x PROPOSED -1.6 OLD 'XI I' RAMP EXIS77NG PILES SMALL STONE REVETMENT PROPOSED 6 X12' ,!Q 9 ,_ r x \ FL OA 77NG DOCK WITH (4 0J)_ ... - I / f-o 1.7 FLOA T STOPS A T ELEV -0.5 3.0 �8� � •� -1.0 1.2 x i �.• - \ i /,.•x x - 0 .. x' / 0 / .l •0.7 x -1.4 / \ -0.1 55.04 / v SANDBAR SITE PLAN �. y(/�/ 20 0 10 20 / ' Y 0 i/ SCALE 1 INCH = 20 FEET / 4!4 PLAN ACCOMPANYING PETITION OF EL. 10 FUL WO FIERIMONTE TO BUILD, LICENSE AND MAINTAIN MHw EL. 5, MHW MHW A STAIRWA Y, PIER, RAMP, & FL OA 77NG DOCK L. A41 ill IN CENTER WLLE RI VER z , , BARNSTABLE (CRAIGV/LLE) , EL. -5 BARNSTABLE COUNTY, MASSACHUSETTS ' 22' CRAIG R. SHORT, P.E. 3o 40 50 60 70 • 80 90. . 100 P.O. BOX 1044 PROFILE 20 0 10 20 SOU TH DENNIS, ,MA 02660 DATE 0911512004 508 398-8311 SHEET 2 OF 4 SCALE I INCH = 20 FEET • 2X6 TOP RAIL 3 ROWS OF 2 X 4 H" MAFIBERGLASS PILECAP SIDE RAILS 2"X6" OR DECK EL. = 6 ML W 514" X 6" DECKING (/E. 5' ABOVE EL. 0.0) W1 TH J14" GA P SPA CING 4 X 4 POST MID-SPAN r. 3X10 JOIST (IF -3) 518 DIA. GAL V, BOL T, 5 X 8 BEAM EA CH NUT & WASHERS SIDE OF PILE 3 X 6 CROSS BRACE--ld . MHW = 2 8 20d GAL V. NAILS MLW = 0. 0 EXISTING GRADE iii\\Ziii PILE EMSEDMEN T TO REFUSAL 16' MINIMUM TYPICAL PIER BENT .(12' O.C. )' CROSS SEC TION. CONSTRUCTION NO TES N. T s , _. 1. ELEVA 77ONS SHOWN REFER TO ML W DA TUM. SEE BENCHMARK ON THE PLAN. 2. ALL DISTURBED AREAS RESUL 77NG FROM CONSTRUCTION SHALL BE VEGETATED PER THE CONSTRUCTION SPECIFICA TIONS A TTACHED WITH ORDER OF CONO/77ONS 3. PIER CONSTRUCTION TO BE NONLEACHING PRESSURE TREA TED TIMBER OR I IS EQUIVALENT. NO CREOSOTE OR CCA TREATED MATERIALS 4. ALL HARDWARE SHALL BE STEEL, HOT DIP GAL VANIZED. 5. ALL CONSTRUCTION DEBRIS SHALL BE REMOVED FROM THE RESOURCE AREA EACH DAY 6. ALL CONSTRUCTION.MA TERIAL, SHALL BE STORED ABOVE THE PROPOSED PIER. 7. CONSTRUCTION ACCESS SHALL BE AS SHOWN ON THE PLAN OR AS NOTED IN THE ORDER OF CONDI TIONS. 8. THE CONTRACTOR PERFORMING THE INS TALLA TION SERVICES IS TO (HA VE) BE PRO WDED WI TH A COP Y OF THE ORDER'OF CONDI 77ONS ISSUED FOR THIS PROJECT PRIOR TO THE START OF CONSTRUCTION 9. PIER IS FOR USE AS.A DINGY DOCK.AND IS TO BE SO STA TED ON POSTED SIGN AS SHOWN PLAN ACCOMPANYING PETITION OF FUL WO FIERIMONTE TO BUILD, LICENSE AND MAINTAIN A STAIRWAY, PIER, RAMP, & FLOA TING DOCK _ IN CENTERWLLE RIVER `.ja."�62 BARNSTABLE (CRAIGVILLE) Yke BARNSTABLE COUNTY, MASSACHUSETTS CRAIG R. SHORT, P.E. ' P.O. BOX 1044 = ......;v. ` SOUTH 'DENNIS, MA 02660 M 09/15/2004 508 398-8311 SHEET 3 OF 4 • k 6, (TYP.) o BL OCK CONC.--° 8"XS"X16" 1J � O a SALT O , MARSH 3' X 11 ' RAMPpm N FIXED PIER O 16" 0.C. SAL T 1 X 3 CLEA TS MARSH BENEA TH WHEELS NO GAP IN DECK o PLAN VIEW 50--4222 Z/Y/TA770#5 N. T S 11 FT. INFLATABLE •9.9 H.P. LIMIT -PROPS 12" ABOVE x .w BOTTOM, ALL TIMES •SEASONAL ONLY • s . 2" DIA. GAL V. p PIPE` FL OA T DOCK EL. 0.5 POSTED SIGN SALT N. T S MARS EL. - 1.5f -1.8f PLAN ACCOMPANYING PETITION OF 2- BXBX16 FUL WO FIERIMONTE CHAIN IN RUBBER.BRACKET CONCRETE TO BUILD, LICENSE AND MAINTAIN' II BLOCKS AS A STAIRWA Y, PIER, RAMP, & FLOA TING DOCK FLOA T STOPS IN CENTERVILLE RIVER PROFILE DETAIL ANCHORED BARNSTABLE (CRAIGVILLE) BARNSTABLE COUNTY, MASSACHUSETTS N. T.S. BY 2" DIA. CRAIG R. SHORT, P.E. GAL.V PIPE P.O: BOX 1044 SOUTH DENNIS, MA .02660 DATE 09/15/2004 508 398-8311 SHEET 4 OF 4 l CER TIFY THA T THIS PLAN CONFORMS TO THE 1976 RULES AND RIEGVLAMOMS OF THE REGISTERS OF DEEDS !//43 DA TE PRD E55/TONAL ENGINEER i\` c 7' 'r }yam f x � � �-- "CEN DER 1,%IrL�LE HA�RB�OR I�. • Z N/F L OCUS MAP FRED•ERICK W. TONSBERG r N/F ROBERTA J. T0NS6ERG i DORTHY P. BRYSON 1939 OCEAN STREET r _ 11 ACORN DRIVE MARSHFIELD MA 02050 AUBURNDALE, MA 02166 , �'EVETuovT CR,q • D(� '•,;,-+U ..-• .tw^� -._y='" �'" =tom. .i Lr� � ,� ?Re' BARSTABLE V\ a �, P.O. BOX 224 ju hh COTUIT, MA 026,3 S" y /{/ / \ x iVj � '' D ED SANDBAR N/F THERESE M. MULRENIN FRS THIRD CAPE REA.UTY TRUST P.D BOX 696 v. //i N/F CENTER'OLLE, MA 02632 �v 09�� . v �/ �F ANTHONY ✓, BALSAMO �1 �� MARY ✓. BALSAMO T �v EO MPR 1204 .CRAIG14LLE BEACH RD. CENTFRMLE, MA 02632 OF �� sP CRNG Jtlf L SHORT Sl TE PL A N CIVIL ' 5 0 25 No,27483 SCALE 1 INCH 50 FEET ' PLAN A CCOMPAN YlNG PETITION OF } FUL V10 nmR.177WW7LF ..� TO BUILD, VCEM� AND MAINTAIN UC- SE PLAN Pam._/DI_ A STAlRWAY, PER, RAMP & FLOA 77NG DOCK /N CEW�ER VX E RMER - -- -'' BARNST69tE (LRAIGI/,ILLE) of MamadumnApr OU/ lY, M,A SSA.CHUSETTS r BARNSTABLE C Z ��OS OATS Cy? HY� , T PRE --- 0--45/2004 P.O. BOX 104°4 rs G REIN SOUTH OENIN/5 A�1�A 0266fD -- .. Ol/21/2005 (W ) 3°8 8311 SHEET 1 OF 4. 1 a l ti, •l CER TIFY THA T THIS PLAN CONFORMS TO THE 1976 RULES AND REGULA TIONS OF.,. THE REGISTERS OF DEEDS _ t �. DA T E PROFESSIONAL ENGINEER x WA - 00 ..V % Ot r �7•0y n F (6 • POSTED S/GN 5' WE PUBLIC - 6.9 AROUND PIER �,b; jP —1.6 Ill° . , ', • #1136 CRAfGa�'1LLE r� w '0Sf79 12' FIXED PIER CH R„p I F 'G / kr'' C TO F. EL. BEA � ' 624 �yL.W • _ ✓��� fir, /r �, ' 1n OLD PIER EX4S7tt ING PILES Srl9:4LL STONE REI/E�"ENT—� �s �' ' ;o" ='r FLeOA�n°G DY^CK WITH i x1.7 FLOAT 5370P5 AT — —(2.0)—� —0.9/ x 1.8 vx d, r x / obi: tiv \ 404011 SA, 20 D 10 20 " F lET �;0 � S,A�t E s I/AYefe'H7T2�7 ' E t� . ,•.,,„ _ ;� r 4 j 1 l rr Y "" � " Hofrnii ;Prot1 , ---14't-12--r-a—t-s'-i EL 5 PLAN AMCCO° PAMY {G PETITION Ol= TD BUI D, Ll ,E l AYND MArIN:TAI A STA;R"rW` & fLOA TINE DOCK i R I if'L•. 5 i �+ i !lN tC� TER IiCLE RI'I/ER B.rg1 e�5 l IL ,(Cl?A;V I/IlLLE) r 30 4'0 50 60 7®' 80 90 100;' BA�RNSt�TBL ArSSApCH`US TTS PR'OFIL,E DAyTE C NAGAR � A��T P.E ! 09'15/2004 P O B®X 1194 20 0 10 — 20 REV., SOUTH DIEM`lES MA 026601. j 01 21/2005 (5D8) 398-8311 sh T 2 OF 4 SCAE 1 %INCH 20 FEET ` 'I x. a 4 l CER TIFY THAT THIS PLAN CONFORMS'', 7- - THE 1976, RULES AND REGULATIONS OF.,,THE REGISTERS, OF DEEDS. - f; i/ f PROFESSIONAL ENGINEER I , • , DARE 1.1 - -2.X6 TOP RAIL 3 ROWS OF 2 X 4 3' �' MAX FIBERGLASS PILECAP SIDE RAILS i 3' • DECK EL. _�6 ML W 514 �X 6" DECKING (/.E 5 ABO VE EL. 0.0) Wl TH 3/4,, GAP SPACING 4 X 4,POST /�1lD-SPAN ` 3X10 JOIST f ( ' =3) 518" DIA. GAL V BOL T, ' i WASHERS NUT do _ 3 , 8BEAMEA'CH SIDE OF PILE j X 6� CROSS BRACE HIV = 2.8 �I - 0.0, 20d GAL V NA=ILS ML - - rpE PlCE EA INEDl 1/EN T TO_REFvSAL a - - .• '' .k. cr r?. a.. ` -.T i T YPICA=L PIER BIEN T .(12' 0.C..) r •, :A� . CROSS SEC TIOJN • Y. . _ N. T S. ` COIV Q ucTION NO TES �y �/ i 1 ELEt /.'Q/VTS SHOO l�l REFER TO L f'V RYA 7Z/M.r�Y STR�B�T IN SN 1rL� 8E GET TED 2 ALL DlS RFB!:D AREAS RESd/L T/NG FRIOM C ^,� ;% XsS ATTACHED W/7N QRflER OF CO °11®/T/fOIVS. PER THE C0-"S 'l!/CT/UN SP�EC/F/ � n GON1.STRrUCTION TO B``E NEON'EArCHI/MG PRE,a`'� EaEA TED llw1�BER OR l TS ' J. PNER ,i , �' Eq(j V ENT NO CREOSOTE OWN' CGA *A TED .A�1rA TERI✓A°LS. . . ' :r=3 /,+Ar 3AOT �'JI/P GA�LVABrEB r 4. ALL HAf�IA�RE SHALL STEEL, 5 ALL CO'la�l �RUjCTlO BFzel5 s-mamLL BE R� iV1�0�1%ED' FR flt1 Tah!E RESOlJRCE'A=RHEA '- •3 EAV�:! 10YAY T� O A�BrOVE �>E �cSE© PER. 6 ApLL COISTf 770/�l M1tA+ �RdIA�L Sal,rLL BE STOJE. YN A�G'cESS �rEl BE AS S06K,"I ON TflE PLAkN OR AS M'OTED 7 CO �S'rN `nl® lN TH/E 0�41 'JR OF C r'I�IT nC®' S THE C'®I �TRA"CTOR ,PERFORAMI G TH/E 1,`STAOF GON°-I TlON5WN �S5dJEDT FORHATHES BE PRO� IOD t!/�'7N A COPY OFE OVER PR0�IECT P';TOR TO THE START OF°COMSTRaUC' ©' • . ?; ems,~. USE AS A DaIMGY DOW AN/D IS TO BE SO STATED ON POSTED SIGN a g. RISER lS FOR -- ,r, ., PLAbIV A�CC'�� �P�l?�l3Yl A rG PE�ON � 2 200: E } UL \ �LICEM E A "fD MA/NTA,IN sr , TOEB1/ D; J /P & f L(7A TING DOCK =+ A 57ArIRtWlc�; P/ERr .RAC q F t r J E RIVER ;r �l/LL4� T LE �GR�A�IGiI!lilLrE) p p 'BD�C 10�4 V. t�9/15�r2004 , --C '- , SOUTH ®�ENlz�lilS, MA 02�660 e.' 1/21/2005 (508) 39�&-8y 1 SHEET 3 OF 4 I y E �.0 l CERTIFY THA T THIS PLAIN CONFORMS - TO THE 1976 RULES AND REGULA TONS , OF THE. REGISTERS OF DEEDS. A DA TE PROFESSIONAL;ENGINEER NO FLOAT THlS � Y 0 °° 2x1 D ; i ; 3X8 ODD Si UP BOL TED r0 PIPE rYROFOAM KITH 112 DIA. BOLT. R0A, T SET TOP OF PUP o o 1'W' RU.'SER AT ER f05 D r:PER STOP Q !I ! 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