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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map 207 Parcel_ O��6d � � .Permit#
Health Division n C� Sc c- S �'°� '"a'' Date Issued
�f�ZwJ
Conservation Division /-,Se 1'aOo 50.3 ` Fee 6- v
Tax Collector
r
Ar
Treasurer '
• F 4 t~
Planning Dept. e
Date Definitive Plan Approved by Planning Board
1
Historic-OKH Preservation/Hyannis
Project Street Address 2(077
Village CEUTZ ayiL_L�
Owner KATL W+IOUL!�Y Address �'► --
Telephone 5-06`1 7,5' -
Permit Request AAA M c6++94o. :E4e %t ay46A - b eV lL4i n!4 _A-1'M AA �oUSe-
Square feet: 1 st floor:existing '190 proposed 51 . 2nd floor: existing _ proposed _ Total new s1q
Estimated Project Cost js, Zoning District Flood Plain Groundwater Overlay
Construction Type 4A=d-
Lot Size ��'� "u- Grandfathered: ❑Yes ❑No If yes,'attach supporting documentation.
• a a '
Dwelling Type: Single Family JU Two Family ❑ Multi-Family(#units)
Age of Existing StructureJJ& Historic House: ❑Yes WNo On Old King's Highway: ❑Yes No
Basement Type: O Full JJ Crawl ❑Walkout ❑Other Gmus! In YN��i to0 b)i r-)mo',ed
- Basement Finished Area(sq.ft.)• Basement Unfinished Area(sq.ft) 3M
Number of Baths: Full: existing ( new l Half: existing new
Number of Bedrooms: existing new
Total Room Count(not including baths):existing 3 new s First Floor Room Count
J
Heat Type anVuel: Jt4 Gas ❑Oil ❑ Electric ❑Other
4 Central Air: ❑Yes, 0 No Fireplaces: Existing ( New '. Existing wood/coal stove: ❑Yes 0 No
Detached.garage:O existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size
Attached garage:❑existing ❑new size Shed:I existing ❑new size X Id Other:
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Cornmercial ❑Yes 16 No If yes, site plan review#
Current Use K,51 6C¢/r1 a, Proposed Use IBC Si !2
BUILDER INFORMATION
Name ���� P2/��k� Telephone Number snA ?2p 9Yw
Address 2S w�,sAzw�u, r�-� License# �:S 0 7a-3 6i
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Home Improvement Contractor# 2
Worker's Compensation#
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATUREJ' �- %� DATE _ l//p/0a
' FOR OFFICIAL USE ONLY
PERMIT NO.*
. DATE ISSUED
MAP/PARCEL
'ADDRESS VILLAGE
4 OWNER `
® f J S I I
DATE OF INSPECTION:...
�jAaO -
FOUNDATION r- 2
FRAME _
INSULATION C3 ��'�
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
GAS: r ROUGH FINAL
FINAL BUILDING
DATE CLOSED OUT
ASSOCIATION PLAN NO.
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- - 1�A /! /MPALD M 1111 14
00
` WALL
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FaaT416 S }
B�Ghcf�l�l� �
ble �LEE,
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The own of Barn
sta Fc'r '�crr�
c.,Fa.., an(i Environmental Services
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263 South Main St.
Centerville
Foundation Plan
new 8' poured
new 4' poured concrete
' foundation foundation
new 4' concrete
block foundation new 8' poured
concrete
foundation
0 o--- SM
<— Entry
new 4' poured
foundation
8
existing 4' concrete
m block foundation
mC
U10,
C Ci
010
10,
C
new 4' poured
foundation
new 4' concrete
access to block foundation
crawlspa e
existing 4' concrete
block foundation
chimney
263 South Main St.
Centerville
Floor Plan
writing studio
relocated
existing step
cottage
9 i down
bedroom s • i'- guest
bedroom
_ bath
I W
existing 3
kitchen
r.— — 0
existing L•— — — O
bathroom a
O
CL
o a-- SH (existing)
existing
Living room
. TaWe.lSub� with rangFaeia
t'rssetip:tre Psa3cs�fo r das sad Tws-Faotilt►Residmdsl Baitdta�Bested
lYt�1I0H[1M
MAXIMUM � Wail Floor 8aseme>oe
Glaz�aS � &vet R►vdaes Ws11 Aas:a� F3
5701 todw Hnrfa;Orate BMW Noz>si
31 13 19 t0 6
B 1Z:S 1 Q3Z 1 30 19 19 10 6 N°
S 12% ( QSO 31 Is 19 t0 6 iS AFUE
T 15% 1 Q36 31 � 25 WA WA No::asi
u 15%. 1 U6 131 ) f 19 19 10 6 Nortaai
13 w mot =S AF{JE
V 127b 1 dud+ 1 N LS AFZJE
W 13% I am 1 30 I 19 19 10 • 6
0 13 2S WA WA Nozasat
x 11Y. am � Nasal
Y 11Y. ( 0.42 31 19 25 WA WA
13 19 10 6 90 AFUE
Z 1EY. 1 0.42 I 32 40AFUE
AA 1E7. ( OJO 30 19 19 t0 6
1. ADDRESS OF r'ROPERTY. 261 SOUT-( MAl rU sr
Z, SQUARE FOOTAGE OF ALL FOR S WALLS-
3. Q SQUARE FOOTAGE OF ALL GLAZING: °a
4. %GLAZING AREA(#3 DIVIDED BY#2):
AA-See chart above):
S. SELECT PAC:;AGE(Q — -
NOTE: OTHER MORE INVOLVED METHODS OF DEi ' MINING ENERGY REQUIRE1ri 'I'S
ARE AVAILABLE. ASK US FOR THIS INFORMATION.
BUILDING INSPECTOR APPROVAL:
YES: NO:
of THE A
The Town of Barnstable
• snRNSTAet.e. -
9�A �0� Department of Health Safety and Environmental Services
39.�Eo Building Division
367 Main Street,Hyannis MA 02601
Office: 508-862-4038 Ralph Crossen
Fax: 508-790-6230 Building Commissioner
Permit no.
Date
AFFIDAVIT
HOME IMPROVEMENT CONTRACTOR LAW
SUPPLEMENT.TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion,
improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied
building containing at least one but not more than four dwelling units or to structures which are adjacent to
such residence or building be done by registered contractors,with certain exceptions,along with other
requirements.
Type of Work: . Re MOD,1 Estimated Cost
Address of Work: a 3 So n'I,w,, Sr
Owner's Name: o�/ev
Date of Application: Z)
I hereby certify that:
Registration is not required for the following reason(s):
[]Work excluded by law
[]Job Under$1,000
❑Building not owner-occupied
®Owner pulling own permit
Notice is hereby given that:
OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED
CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE
ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A.
SIGNED UNDER PENALTIES OF PERJURY
I hereby apply for a permit as the agent of the owner:
Date Contractor Name Registration No.
OR
Date Owner's Name
q:forms:Affidav
ESTIMATED PROJECT COST WORKSHEET
Value
LIVING SPACE q1— square feet X$55/sq. foot= d(a
GARAGE (UNFINISHED) square feet X$25/sq. foot=
PORCH square feet X$20/sq. foot
DECK square feet X$15/sq. foot= a hg 0
OTHER �e y Z square feet X Se/sq. foot d
Total Estimated Project Cost I Sj az�
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g990915b i
600 Washington Street
Boston,Mass. 02111
Workers' Compensation Insurance Affidavit
name J6`In 6�IP/L�Atit��� -
location: (0 3 So
city ��P y l ert[�i//P IV4 Da F, 3,2 phone# 7 7S -S03
❑ I am a homeowner performing all work mysdL
Q I am a sol rietor and have no one working in anv capamtY
��//%�� � /%/O%%O%%�%/%i
I am an employer providing workers compensation for my employees working on this job.::: :.:..::::: ;;;:;;>: :;:;;;> y:;:;:
. .........
cam anv name: :.::.....;:.:.::::•::.::.:;; ::::.:: .: ;::.>::-::.;.....: :.;:::. .:...:.:.::..,:,..::,.
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address :::::»:.- •;::':>;:<::>::::: :::::::<:�::::>:<:�> ��:::::�:';�>s�«:`>?�?:;:?::::�:>�:�>:�::::::':::=�»::<:>::��'::s�>:�:<::::= .: •> {:>:;:>;>•>:.:>
han
....:::.::.:.::.:........:.
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insurance co:
❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who
have
the following workers' compensation polices:
comranvniiiie.
address. :: •:.>;:::;;:.: ;;;:;;:;:,.,;::,:::::::..:,.;.:::::..;::';:::..,:,;........:.:...,,:::.:{:.:......... ........
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ccnanv name:•::..,:;::»::::::>:;>:;::>;>:;{<{{,.;{{.::{:.;:.;;;:.:{.;:::::.
addressad
ne
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Failure to secure coverage as m4 raider Seetiaa 25A o[MGL 152 can lead to the imposittoa of criminal penalties of a One up to 51�00.00 and/or
one yem,imprisomuent as weII as dvII peaaltles in the foam of a STOP WORE ORDER and a 8ne of 3100.00 a day against me. I understand that a
copy of this statement may be lerincattoa
I do hereby certify under the pars and penalties of perjury that the information provided above is&u:and correct
Signature Date __ � S) co
Print name
CO:chrc
do not write in this area to be completed by city or town otHcist
permitNca se# ❑BEe,
dnent
❑L
ediate response h regnired ❑Sce❑Hent phone#; ❑
Uavued 9/95 PIA)
372.
HOME IMPROVEMENT CONTRACTOR
Registration 127087
Type - INDIVIDUALS...=�
Expiration . 0y/02/00
JOHN OBERLANDER
JOHI� E. 08ERLANDER
7f WASHINGTON AVE
ADMINISTRATOR W. YARMOUTH MA 02601
- .J17� 1�J67Y1i7720i2CIJP.lLLL12 4���<'/,[iJJCLC�2l[JB�S .
DEPARTMENT OF PUBLIC SAFETY
CONSTRUCTION SUPERVISOR LICENSE
Nu�ber � €xpiresc > Birthdate.
CS ;- 01236 ,.05I20I 02 05/20/1969
IOBER,LAHDER
35 WASHINGTON AVE
W. YARMOUTH) MA 02673
` . Date issued— April 5, 2000
d+ k
Massachusetts Department of Environmental Protection. DEP File NumbL.
Bureau of Resource Protection - Wetlands SE3-3632
WPA Form 5 - Order of Conditions Pravider9byD�
Massachusetts Wetlands Protection Act M.G.L. c. 131,.§40 of HE 0 -
o~- `♦r
.e,
TOWN .
A. General Information err ?
Important: E)K 12!3.2.- PGO06 20 59-i
When filling From: 04-05-2000 1? 1 1 a 41
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
To: Applicant: Property Owner(if different from applicardy
Kate Whouley
Name Name
263 South Main 'Street
Mailing Address Mailing Address r
Centerville, MA 02632
City/Town State Zip Code'! 1 City/rown State Zip Cabe
1., Project Location: x
y 263. South Main _Street, ,Centerville
Street Address Cityrrown
_. 207 ;. 097-00'1
Assessors Mip/Plat Number, Parcel/Lot.Number
2.'• Property rec"orded at;the Registry of Deeds for: .
.. Barnstable 5695 274 --
County - Book Page
Certificate(if registered land)
3. Dates: .
February 9, 2000 MArrh 28, 7000'
Date Notice of Intent Filed Date Public Hearing Closed. s Date of Issuance
4. Final Approved Plans and Other Documents (attach additional plan references as needed):
Site Plan": .:. .. January 13, 2000
Title Date
I 5. Final Plans and Documents Signed and Stamped by:
David Thulin, RPE
Name
f 6. Total Fee:
$55.00 _
(from Appendix B:Wetland Fee Transmittal Form)
VVPA For,5 gage t 7
Rev 02/00
i
BK 12929 t GO8 r 20SS r
DEP File Number:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands SE3-3632
WPA Form 5 - Order of Conditions Provided by DEP
` Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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 0 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 thatall
work shall.be performed:in,accordance.;with the.Notice of Intent referenced above, the.following,=
•, ;_.,4. '_„ General Conditions,-and'any.other,specia1.conditions attached.to this Order:To the.extent that the
: .following conditions modify-or.differ.;from:the plans; specifications, or other proposals submittedwlth+-:
the:,Notice-of Intent, these conditions shall control.
Denied because:
❑ the proposed,work cannot be conditionedi,fo'meetthe 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.
R ❑ 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).
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
other applicable federal, state, or local statutes, ordinances, bylaws, or regulations. j
i
• it
WPA Forth 5
Rev.02/00 Page 2 of 7
I
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9K 12929 PGOGP• 205!9 r
DEP File Number:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands cF11_3A
Y WPA Form 5 — Order of Conditions Provided byDEP
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
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. 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.a dm inistrative;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 orthe.Land Court for the district in which the land is located;within the chain of title
n of the affected'.property.,ln:the case`of:recorded land, the Final Order shall alsobe noted,in the:, ;
Registry's:Grantor,lnderunder,the name of the owner of the land upon-which the proposed work is to
be:done..tn-the:case of the.registered,land;.the Final Order shall also,be noted on the„Land Court
Certificateof Title of the owner of.the land upon which the proposed work is done. The recording
7 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, WA DEP]
"File Number SE3-3632 "
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.
WPA Form 5 Page 3 of 7
Rev 02/00
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DEP File Number:
_= Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands sE3-3632
WPA Form 5 - Order of Conditions Provided byDEr
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings (cont.)
15. 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.
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.
Special Conditions (use additional paper, if necessary):
see attached-
Findings as to municipal bylaw or ordinance
Furthermore, the Barnstable hereby finds (check one that applies):
Conservation Commission
E that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
Name Municipal Ordinance or Bylaw
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
Name Municipal Ordinance or Bylaw
i
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.
WPA Fo m S Pape 4 of 7
Rev 02100 I
r
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r
i
BK 12929 F">C090 20S9 t
SE3-3632 Whouley
Approved Plan= January 13, 2000 Site Plan by David Thulin,RPE
Special Conditions of Approval
I
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 (preceding page) shall be
complied with.
2. This permit is valid for 3 years from the date of issuance, unless extended at the request
of the applicant.
3. The work limit shown on the approved plan shall be strictly observed.
4. The work limit line shown on the approved plan shall be staked in the field by the project
surveyor/engineer prior to the start of work.
5. Prior to the start of work, staked strawbales backed by trenched-in siltation fencing shall
be set along the approved work limit line. Effective sediment controls shall remain until
the site is stabilized with vegetation.
6. There shall ,be no disturbance -.of the site, including cutting of:vegetations beyond the
_.-..work limit. This restriction shall continue over time.
7. The Conservation:Commission-shall receive 1 week advance notice of the start of work
(our phone number is 508-862-4093)
8. All areas, disturbed.'during construction shall be revegetated immediately following i-
completion of work at the site.-' No areas shall be left unvegetated or unmulched for
more than 30 days.
9. Drywells or gravelled trenches along the drip lines shall be installed to accommodate
roof runoff.
10. 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.
11. 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. '
12. At the completion of work, or by the expiration of the present permit, the applicant shall
request in writing a Certificate of Compliance for the work herein permitted. Where a
project has been completed in accordance with plans stamped by a registered 1
professional engineer, architect, landscape architect or land surveyor, a written statement J
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.
I
DEP File Number:
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - .Order of Conditions Provided by DEP
:Q-
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
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#4, from the date of issuance.
April 5, 2000
Date
This Order must be signed by 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 (seeAppendix.A nd the property owner(if differentfrom applicant).
Si 7�ures
r
On Of ;� C'�3fJ
Day Month and Year
before me personally appeared
to me known to be the person described in and who executed the foregoing instrument and ,
acknowledged that he/she executed the same as his/her free act and deed.
Ak--A
Notary Public My Commission Expires r
This Order is issued to the applicant as follows:
by hand delivery on ❑ by certified mail, return receipt requested;of i
I
.Date Date
I
WPA Form 5 Page 5 or 7
Rev.02100 I!
i ;
i
I
1
i
SK 12929 P0092 210ISS
'Llmass rDep ...s..- DEP File Number:
%< rviwaaaC�'1USettS vcNa��n�2ilt Of �nVlrOtin'ierii.a� Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 Order of Conditions Provided by DEP
m Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. 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 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 1.0.03(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
Conservation Commission
BARNSTABLE COUNTY
REGISTRY OF DEEDS
A TRUE COPY,ATTEST
JOHN F.MEADE,REGISTER
J
WPA Firm 5 BARNSTABLE REGISTRY OF DEEDS
Pape 6 of 7
Rev 02/00
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