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0034 TERN LANE
u' 41 Y Q f, 01' Town of Barnstable - Regulatory Services 111►LDi pp7- �' Thomas F.Geller,Direewr A_ Building Division Y 0I 2017 h Tom Perry,Building Commissioner ToW&l®P BAR tt 200 Main Street, Hyannis,MA 0260I �` ' Ez wwwAown.barmstable n&us , Office: 508-862-4038 Fag: 308-7 230 PERMIT#_ "f — o� FEE:$ . SHED REGISTRATION 200 square feet or less 3 ►��� L-a, C�� �r"'A e- Location of shed(address) Village 19 Property owner's name Telephone mbar 192 - p2,�;. Size of Shed Map/Parcel# S e Date Hyannis Maier Street Watsr&ont Historic District? Old Kmg's Highway Historic District Commission junsdicti=? If over 120 square feet,you must file with Old l ng's Highway Conservation Commissions ture r �� is eq uire d) � Sign off hours for Conservation 8:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF-THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. TMS FORM MUST BE ACCOMPANIED BY A PLOT PLAT Q-forms-shedreg REV:05201 OWNER OF RECORD THOMAS G&LEANNE FISHER LEGEND 10 OAK LEDGE DRIVE -O!1-. EX[SnNG CONTOUR BRAINTREE. MA 02184 48. FROM ANNUAL MEAN HIGH WATER EJ(IST.SPOT ELEV. 8.0' p 7.O' p 8.0' 8.0' 8.0' p 9.0, M. -- pp REFERENCES - PROPOSED CONTOUR -_ II II 011 III it OBS:,WATER._, -- DEED BOOK 25631 PAGE 64 198•+ A '- -34 I PROPOSED SPOT EL. --III n it 11-111 II - toes rHl �° -Ir--Irlr ur n 32 NOTE: HST HOLE 30 ` ) Wequaqu¢t Lak SLOPE NATURALI7AT10N: 2� SLom OF GROUND EXISTING ORNAMENTAL JUNIPER TO BE CUT AT BASE PROFILE AND REMOVED FROM SITE. fD unl.rn POLr a SLOPE TO BE SEEDED WITH ERNST NEW ENGLAND SCALE 1„=)0' WILDFLOWER AND GRASS MIX (OR EQUIVALENT) AND XL FIRE HYDRANT COVERED WITH 100%BIODEGRADABLE EROSION N01e Rm'+L m' RA7"P w t,fuwuro $ € CONTROL BLANKET. ANNUAL MOWING TO BE DONE BY MARCH 30 e $ LOCUS MAP SCALE 1"=2000't ASSESSORS MAP 192 PARCEL 25 FLORE192-23 WED. LAKE DATUM(NGVD29) .31.2n NCE L CASEY .32.0 31.54 PROPOSED 8'X10�;SHED PROPOSED 3'X5' RAM REPAIR IN KIN + .30- AS NECESSARY 286.51' i<"d fir, �39,46 3.27 3.aa ROPOSED "ALUMIDOCK" Wig& (OR EQUAL) CONSULT '1591 a! r�5,75 -4 33.a'. 0 2 MANUFACTURERS 60.82 28 ` �. LAwN I 2.13 31.0 > INSTRUCTIONS FOR - i 64.26 � n�/ I / m DETAILS/SPECS _ �..(:I i. .. \\ /f/.IFi \y` �:, j n.2+ 35 /36. SAND DFG( \ 1 ....l J] 0 9EACM 4a9' 4'8 4'Ma'.vo x8' 4'r8 4'K9' F •i8'-0- i �``11 ANDSCAPE TIE ,6_ T J 201 •UI.d"- ��l•9., \ 1\ /S1f.Ps w I2aL DECK / 16 \ I ,z r (m DE RF,1 LAL1:0) i''4 G y 64,75 +0.''!'I 35 0 MEAN ANNUAL HIGH u'^I ' •39.1 I Y WATER ELEV. 34.0' �64.74 SL PE 0 E Z 31.84 ST. ANRALI2 35. Z -6� DW 4\ }64.70 I DNELL .40.I �� Q •30.87 29.96 /"6.>---__-,.61\83 ` / 1 .5 / Fes` 40A3 / 3 7 2 N �,rn�G4.65 1. � / I A E 61.85 \Olt�lbV I TOP FNON. / 6 4.56 'u o�� AY i EL.65.5' / 3&97 h I�' 33.%9\ -(\\ .30.17 k64.15 1 y 30.93 }65.2 I/�'35 itrn \ G4.78 �65.07 1 5 57.77 ROPOSED SAND I .64:LAND E ST .2 ( .9� a, J,I, `---_N N`z p(i0P /m' NOURISHMENT F'(L�/// 211 Pt• 1 ---1665475 I PUMP Z&FlLL WTH nn m CLEAN SAND ElI15PNC 55POOL5 GARAGE yb �P\\\ � 4,5 � Q v S r \ / •b.62 HED 42.6J m SITE PLAN Z a 1 OF _ \ N 0 34 TERN LANE ZTO� �- CENTERVILLE 192-26 p PREPARED FOR MICHAEL G & CAROL N ? �ry5466789" HIRSH TRUST i s ,� M/M THOMAS FISHER i � *"• tS S t11 ,p (� Y to - SEPTEMBER 23, 2014 k. ,, �8escstW� I ru=5�06-3ez-4511 r flown cape engineering,inc. .-L.s-I-` `�.� `-�/ Scole:1"=20' civil engineers land surveyors DCE # 3-32I DATE DANIEL A. OJALA, P.L.S. 0 2( _ 939"c St eet(ere 61) 0 10 2(I 30 40 50 FEET YARMOU7NPORF w 02675 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X253471 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment G. Municipal Zoning Certificate Thomas Fisher Name of Applicant 34 Tern Lane Weguaguet Lake (Centerville)Barnstable Project street address Waterway CitylTown Description of use or change in use: Proposed seasonal dock 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." Printed Name of Municipal Official Date nature of Municipal Official Ti City own _ 'r „_0 ^� r I J . .. - _5 .) CH91App.doc•Rev.6106 Page 6 of i3 Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program x263471 Transmittal No.Chapter 91 Waterways License Application -310 CMR 9.00 Water-Dependent,Nonwater-Dependent,Amendment Important:When filling out forms A. Application information (Check one) on the computer,use only the tab NOTE: For Chapter 91 Simplified License application form and information see the Self Licensing key to move your Package for BRP W. W06. cursor-do not use the return Name(Complete Application Sections) Check One Fee Application# key. WATER-DEPENDENT- General(A-H) ® Residential with <4 units $175.00 BRP WW01a ❑ Other $270.00 BRP WW01b For assistance ❑ Extended Term $2730.00 BRP WW01c incompleting this ------------------------ - - - --- - - - _•-•---•--•-------•-•--------------•-----•--..-.._..-•---.-:.-..--•-••--•-------------------•------•--•-- application,please Amendment(A-H) ❑ Residential with <4 units $85.00 BRP WW03a see the — "Instructions". ❑ Other $105.00 BRP WW03b NONWATER-DEPENDENT- Full(A-H) ❑ Residential with <4 units $545.00 BRP WW15a ❑ Other $1635.00 BRP WW15b ❑ Extended Term $2730.00 BRP WW15c Partial (A-H) ❑ Residential with <4 units $545.00 BRP WW14a ❑ Other $1635.00 BRP WW14b ❑ Extended Term $2730.00 BRP WW14c -------------------------------------------------------------------------------------------------------------------------------------------------------------- Municipal Harbor Plan(A-H) ❑ Residential with <4 units $545.00 BRP WW16a Other $1635.00 BRP WW16b ❑ Extended Term $2730.00 BRP WW16c Joint MEPA/EIR(A-H) ❑ Residential with <4 units $545.00 BRP WW17a ❑ Other $1635.00 BRP WW17b ❑ Extended Term $2730.00 BRP WW17c Amendment(A-H) ❑ Residential with <4 units $435.00 BRP WW03c ❑ Other $815.00 BRP WW03d ❑ Extended Term $1090.00 BRP WW03e CH91App.doc•Rev.6/06 Page 1 of 13 Massachusetts Department of Environmental Protection Bureau of Resource Protection-Waterways~Regulation Program X263471 Transmittal No: - Chapter 91 Watenivays License Application -310 CMR 9.00 Water-Dependent,Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: Thomas Fisher Name E-mail Address 10 Oak Ledge Drive Mailing Address Note:Please refer Braintree MA 02184 to the"Instructions" City/Town State Zip Code Telephone Number fax Number, 2. Authorized Agent(if any): Hamlyn Consulting (Lynne Whiting Hamlyn) Ihamlyn@capecodwetiands.com Name E-mail Address 690 Thousand Oaks Drive Mailing Address Brewster MA 02631 Cityrrown State Zip Code 508-258-3211 508-258-3211 Telephone Number Fax Number C. Proposed Project/Use Information 1: Property.Information (all information must be providedj: Same Owner Name(if different from applicant) Assessors Map 192, Parcel 25 41.6767444N 70.35007W Tax Assessor's Map and Parcel Numbers Latitude Longitude 34 Tern Lane, Centerville MA 02632 Street Address and City/Town State Zip Code: 2. Registered Land ®Yes ❑ No 3. Name of the water body where the project site is located: Weguaguet Lake 4. Description of the water body in which the project site is located (check all that apply): Type Nature Designation ❑ Nontidal river/stream Z Natural ❑Area of Critical Environmental Concern ❑ Flowed tidelands ElEnlarged/dammed ❑ Designated Port Area ❑ Filled tidelands' ❑ Uncertain ❑Ocean Sanctuary '® Great_Pond_ ❑ Uncertain ❑ Uncertain CH91App.doc-Rev.6106 Page 2 of 13 Massachusetts Department of.Environmental Protection. - Bureau of Resource Protection -Waterways Regulation Program• X263471 Transmittal No. Chapter 91 Waterways License Application 310 CMR.9.00 Water-Dependent, Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity description on pg.2 of the "Instructions" Proposed seasonal dock t 6. What is the estimated total cost of proposed work.(including materials& labor)? $20,000.00 7. List the name&complete mailing address of each abutter(attach a h ddition I heets,if necessary).ry) An abutter is defined as the owner of land that shares a common boundary with the project site, as well J as the owner of land.that lies within 50' across a waterbody from the project. Casey L. Florence - Name 26 Tern Lane, Centerville, MA 02632 Michael G &Carol N Hirsh Qual Pers Res Trust 30 Branch Avenue, Rochester, NY 14618 Name Address D. Project Plans - 1. . 1 have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan)' ❑ Appendix B(Permit plan) 2. Other State and Local Approvals/Certifications. ❑401 Water.Quality Certificate Date of Issuance ®'Wetlands SE 3-5229 File Number ❑Jurisdictional Determination JD File Number ❑ MEPA File Number ❑ EOEA Secretary Certificate Date ❑21 E Waste Site Cleanup RTN Number CHMpp.doc•Rev.6/06 Page 3 of 13 f " tea= Massachusetts Department of Environmental Protection Bureau of Resource Protection -Waterways Regulation Program X263471 Transmittal No. Chapter 91 Waterways License Applications-310 CMR 9.00 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. "I hereby make application for a permit or license to authorize the activities 1.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." "I hereby certify that the information submitted in this application is true and accurate to the best of my knowledge." r y Applicant's signbfure - Date Property Owner's signature(if different than applicant) Date f �o f Agent's ignature(if applicable). ate CH91App.doc•Rev.6/06 Page 4 of 13 B k 28470 P�269 XL49328 03 Massachusetts Department of Environmental Protection Provided byMassDEP: Bureau of Resource Protection-.Wetlands MassDEP File#:003-5229 WPA Form 5 - Order of Conditions eDEP Transaction#:696452 Massachusetts Wetlands Protection Act M.G.L.c. 131, §40 City/Town:BARNSTABLE A..General Information j 1.Conservation Commission BARNSTABLE 2.Issuance a. G OOC b.r Amended 00C ` ,.. r e� °s� a':+, s""�,�-z,,s"�`�,�^���4 ..r 4 � --'* *s,F` "'jy�ra�-<i�k✓" €<� i xt �6 3s'7v::k,C`y�'*'�r�. .r . "i:. �. a.First Name THOMAS b.Last Name FISHER c.Organization d.Mailing Address TEN OAK LEDGE DRIVE e.City/Town' BRAINTREE f.State MA g.Zip Code 02184 4 `Property Owner * z a.First Name THOMAS&LEANNE b.Last Name FISHER c.Organization d.Mailing Address TEN OAK LEDGE DRIVE e.City/Town BRAINTREE f.State MA g.Zip Code' 02184 5 Pro ect Locations � ,, a.Street Address 34 TERN LANE,CENTERVILLE b.City/Town BARNSTABLE c.Zip Code 02632 d.Assessors Map/Plat# 192 e.Parcel/Lot# 025 . f.Latitude' 41.67444N g.Longitude, 70.34997W a.County b.Certificate C.Book d.Page BARNSTABLE 25631 64 < <^ i '�` $ TF f .rgr,✓+ r t.+k+„ rt.C i �'ti z u$i wsi n £ - K 7 Dates ti V 4 L s a s t �2 g J7 �ii a t £ B- r` s 3 3 t a.Date NOI Filed: 9/29/2014 b.Date.Public Hearing Closed: 10/14/2014 C.Date Of Issuance: 10/24/2014 8 Final Approved`Plans and Oth&er Documeiits�� r i ; x is a.Plan Title: b.Plan Prepared by: c.Plan Signed/Stamped by d.Revised Final Date: e.Scale: DOWN CAPE SITE PLAN DANIEL A.OJALA,P.E. 9/23/2614 It,=20' ENGINEERING,INC. B..Findings t F n Fndmgspursuant to the�Massachusetts Wetlands Protection Act ;,�„ ' , '` _� y Page 1 of 9*ELECTRONIC COPY Massachusetts Department of.Environmental,Protection Provided by MassDEP. Bureau of Resource Protection-.Wetlands MassDEP File#:003-5229 LLI - dMTA Form 5 - Order of Conditions eDEP Transaction#:696452 Massachusetts Wetlands Protection Act M.G.L.c. I31,;§40City/Town:BARNSTABLE Following the review of the the above-referenced Notice ofhitent and based on the information provided in this application and presented at the public hearing,this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act:Check all that apply: a. F] Public Water Supply b. r Land Containing Shellfish c.rPrevention of Pollution d. r Private Water Supply e. [✓1 Fisheries f.'R Protection of Wildlife Habitat r Ground Water Supply h r Storm Damage Prevention i. r Flood Control Approved subject to: a.n The following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above,the following General Conditions,and any other special conditions attached to this Order.To the extent that the following conditions modify or differ from the plans,specifications,or other proposals submitted with the Notice of Intent,these conditions shallcontrol. Denied because: b.r The proposed work cannot beconditioned to meet the performance standards set forth in the wetland regulations.Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect interests of the Act,and a final Order of Conditions is issued.A description of the performance standards which the proposed work cannot meet is attached to this Order. c.rThe information submitted by theapplicant is not sufficient to describe the site,the work or the effect of the work on the interests identified in the Wetlands Protection Act.Therefore,work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the interests of the Act and a final Order of Conditions is issued.A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). 3.Cl Buffer Zone.Impacts:Shortest distance between limit of project.disturbance and the wetland resource area specified in 310CMR10.02(1)(a). a linearfeet Resource Area Proposed Permitted Proposed Permitted Alteration 'Alteration Replacement Replacement 1'i i7rtsear,ft'Zifeet Ic: d linear feet+5.f 1 Bordering Vegetated Wetland a.square feet b.square feet . c.square feet d.square feet 6 i�.Mdfidunder Waterbodmes and Waterways °2feet d squaref"B f c% Bred e{ .. y g Y g d o 7.ri Bordering Land Subject to Flooding . a.square feet` b.square feet c:square feet d,square feet Page 2 of 9*ELECTRONIC COPY Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection Wetlands MassDEP File#:003-$229 WPA Form 5 - Order of Conditions eDEP Transaction#:696452 Massachusetts Wetlands Protection Act M.G.L.c. 131, §40 City/Town:BARNSTABLE Cubic Feet Flood Storage e.cubic feet f.cubic feet g.cubic feet h.cubic feet ..x^,�• rtx..,p..��, n:z. ,z r ;>Ait ,� sk x' f s C �, r s r{,,.. 8 GtIsolated LandrSub ect to Floodm £f t" "' t ; +,' s 4a.�W 3pUVR iw r b, 1 fi r a scjuare feet n b square feet w i.:.z>w" ..,.si..arx,: s?:F.u,.;S,.t,-;..,? °� s ..,s.:uh.,s. ...e.k'..�c�.u.N.,.�..:ut., "`:•..�.r: _-. .°�,,,i.:,�..a s.�a•'a:..�.�.» ,».::.. :`?',.Ma,:.:w�T-4�'tS��a!�t 7'� ,-+ d "s w ""`a>S 'r3'n*'s'"" ;§ h'3`e t L °a ,�-y R'�' +•' `Fzv ''3` '€+ ?. ,� ``Et '• t`'»7F - Cubic Feet Flood Storage x Va - '� c"cubic feet { dracubic feet �'a cubic feet g� f cubic feet `y^,a Eu 3i 4n f T l ; ............:,,.`.�.•,,.;s. ; +::�k:.�tc..a"Hr�?,'1 .,,« .�....,..»..s...,_:�„ i.. a _.N._.�... ..a 9.f.-Riverfront Area a.total sq.feet b.total sq.feet Sq ft within 100 ft c.square feet d.square feet. e.square feet f.square feet Sg ft between 100-200 ft; g.square feet h.square feet i.square feet .' j..square feet ' .� #� 4-"n o-�+ v-� u:.s-'� �i„ ,�4 .�v`"a' e'•'Fc ;;,:`-�'� `z.. �x �. .� ,��`t�` � zc�x a�� ''w� '-�`s��`�„ �J. �: ��__ .� Coastal Resource Area4Impacts z u � M:k's�`:.'S�?-t v...�..:..f:.. `'s. xis t. .• z.Y.:�' � _: k=.Lr,-��' Resource Area 'Proposed Permitted Proposed Permitted l Alteration, Alteration Replacement Replacement - �" , �Ae,� �r v�.>K � > r Designated Port Areas In see under�Land Under the Ocean,below - ,,.,':Lx,ux .:i'..kY.kr, - 1 L 1-Land Under the Ocean a.square feet b.Square feet C.c/y dredged d.c/y dredgedqrz 12Y 1—Bamer Beaches' �� � _ zsz Indicate size uncle Coastal Beaches anrj/orCoastal Dunes below z"..:., _s._......, ,F.«...,�...:.�i., .._.....;s:;..:?�«� S:.<...�.:..r.»..:a.�.. :: ,.»,r.�•,..: s.....z.� r.:v..,�..�... .. ,�._.:.. ..t..rnz...�� .�.-t ...,: .,�..:..ti_x._s 13.a-.Coastal Beaches a.square feet b.square feet c.dy nourishment d.c/y nourishment " 14 I`Coastal Dunes: y x v � ? sc . x 4 square.feet"b square feet c c/y nounshment d c/y nouns11 _..,..�xn,e ,.,.,..,Ja,...,..sx*.G. .. ':._f.' r .k,..�..., .z ::u...it.,t',., ua's:.. ` :c,>zr4 •1s 7�"tsue'r .",-, - 1.5.C Coastal"Banks a.linear feet b.linear feet 16 r Rocky Intertidal Shores .„ �� 3 6�,s� � ��>_ ���t3 r x,. 3�r�d yE„g :�F :.: �s W�°ir,.�,,,,�g"n��. a �� x• `� t »r � - �' - 17.r Salt Marshes. a.square feet "b.square feet c.square feet . d.square feet a"a Land Under3Salt Ponds _ t' �' s �sr a square feet b square feet t�4 g 4 ; -rrz'..: �s L tl 'J3- �i•���: 5� � :,�F�'`J,y s. y✓,,. ,� �.:; K Fr�� •i.v:f Y ��� x `a, h� a aZ. � ... +� ,�� ��z� .�� �ei'�r.�b' � t,was �f�� �,�t +��zt e t �,N,�x�.ax"�a. �• €_�,� ^x a�,�'. ��:e �,/3o a4 � t� r '.': � ,�i �. ✓' �,.}.'c �'` f.:a� x �� 43�. tr�+lr.�i�a.'�:�4�5-.�•� o �•�.h 4>�:!�, 4u e�.�. g. �Z .� �s. a ice,. "5 `'z"u % . �"cTrr Y Y-3#* �� �nr' a �Est"• k �b Sy �,�x � � } �3 s �`k c c/y dXeclged c/y dredged ,x �4 4.3_�v'F .:xf�.x'�:a ��.i`�s,7.t.'��•..x e. _.�;3<.•s.3.3_f.. �:v.,».a�. _ .x".xi^s.,.zzm�J's.:ft:c...19.F Land Containing Shellfish a.square feet b.square feet c:square feet d.square feet . .._ J.:..:. Page 3-.of 9*ELECTRONIC COPY. Massachusetts Department of Environmental Protection'.... Provided by MassDEP: Bureau of Resource-Protection-Wetlands , MassDEP File#:003-5229 t WPA Form 5 Order of Conditions eDEP Transaction#:696452 - Massachusetts Wetlands Protectiori Act M.G.L.c. 131, §40 City/Town:BARNSTABLE '7"cY" o, g 2C•� �..'� r";., S^='+ cae,t-r !'4 o- K' z s Indicate s�ze$under Coastal Banks,uilandXBank,)✓and$Under the' , b 4 f`fkT Jet y, ,-ate . E „",.r� y „ - ,•� M�+,� 20 f Fish Runs, { a F r Ocean,and/or mland Land UnderWaterbodies and Waterways, S s��a �`� { � r�r � � x � »r' s U. { l pJs� L rK 'fq, � ;. +� 3 , c c/y dredged do/y dredged a ��� .: � 'ssoca...«,� `�., .±;�?•. ,a',a5i s_ `,,. 21.!-Land Subject to Coastal Storm Flowage i a.square feet b.square feet, - 'z'Z �V ��^�»x? ��*�-f'��q J'�.1�h3 _��Y. ��`r�s n•�'�"§k.`r� ' x�`,�;�"* �..�� .�, ~x:�'? � •„ �3`R4"h '�`?? ..,�s� fi�� j k'•�.>�+§1''r'� �E raz r Restoration/Enhancement:(For Approvals Only) If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.5:c&d or B.17.c&d above,please entered the additional amount here. a.square feet of BVW b.square feet of Salt Marsh . 23 � r �"���'�`"sK »� 3 e.i°` �' ;'�s'+��s�`�{t�� �"* �� >� � 'r�i�s"��.:{:`�rna'""• ;'}, .:�. F^� iv txr� r�[ •; nx,�k„ 3s"� ,��# ' .. f <, . s ,;:z''.., .. '..<r,..{.,'�._a..a:sw ...I.:..an' .,,3 :.fie'-.. .,; .,_''a,. ,ia, ,..,�.tik!',`•Ft^ul'..,r, '�s w..,a..',o,.?R:or .��fi:'.�.' .xr�;.nc"k ..,A`, . .' . .,fit:._'�.- r Streams Crossing(s) If the project involves Stream Crossings,please enter the number of new stream crossings/number of replacement stream crossings. a number of new stream crossings b.number of replacement stream crossings C. General Conditions Under Massachusetts'Wetlands Protection Act The following conditions are only applicable to Approved projects 1 I. 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 pernuttee or any other person of the necessity of complying with all other applicable federal, state,or local statutes,ordinances,bylaws,or regulations. 4. The work authorized hereunder"shall be completed within three years from the date of this Order unless either of the following apply a.the work is a maintenance dredging project as provided for in the Act;or b.the time for completion has been extended to a specified date'more than three years,but less than five years,from the date of issuance.If this Order is intended to be valid for more than three years,the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be.extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order., 6. .If this Order constitutes an Amended Order of Conditions;this Amended Order of Conditions does not exceed the issuance date of the original Final Order of Conditions. 7. Any fill used in connection with this project shall be clean fill.Any fill shall contain no trash,refuse,rubbish,or debris,including but not limited to lumber,bricks,plaster,wire,lath,paper,cardboard,pipe,tires,ashes,refrigerators,motor vehicles,or parts of any of the foregoing. 8. This Order is not final until all.administrative appeal periods from this Order have elapsed,or if such an appeal has been taken P PP until all proceedings before the Department have been compieted. 9. No work shall be undertaken until,the Order has become final and then has been recorded in 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, Page 4 of 9*ELECTRONIC COPY Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection Wetlands MassDEP File#:003-5229 WPA Form 5-Order of Conditions eDEP Transaction#:696452 Massachusetts Wetlands Protection Act M.G,L:c. 131,§40 City/fown:BARNSTABLE the Final Order shall also be noted in the Registry s Grantor Index under the name of the owner of the land upon which the proposed work is to be done.In the case of the registered land,the Final.Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done.The recording information shall be submitted to the Conservation Commission on the form at the end of this Order;which form must be stamped by.the Registry of Deeds, " prior to the commencement of work.. u 10. A'sign shall be displayed at the site not less then two square"feet or.more than three square feet in size bearing the words; Massachusetts Department of Environmental Protection" [or'MassDEP"j File Number`."003-5229" 11. Where the Department of Environmental Protection is requested to issue a Superseding Order,,the Conservation Commission shall be a party to all agency proceedings and hearings before Mass DEP. 12. Upon completion of the work described herein,the applicant shall submit a Request for Certificate of Compliance(WPA Form 8A)to the Conservation Commission. 13. The work shall conform to the plans and special conditions referenced in this order. 14. Any change to the plans identified in Condition#13 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent. 15. -The Agent or members of the Conservation Commission and the Department of Environmental Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order,and may require the submittal of any data deemed necessary by.the Conservation Commission or Department for that evaluation. . 16. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 0. ,Prior to the start of work,and if the project involves work adjacent to a Bordering Vegetated Wetland,the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging..Once in place,the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 18. All sedimentation barriers shall 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: NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS 19. The work associated with this Order(the"Project")is(1) r is not(2)r.subject to the Massachusetts Stormwater Standards. If the work is subject to Stormwater Standards,then the project is subject to the following conditions; a). All work,including site preparation,land disturbance,construction and redevelopment,shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan and,if applicable,the Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Construction General Permit as required by Stormwater Standard 8.Construction period erosion,sedimentation and pollution control measures and best management practices(BMPs)shall remain in place until the site is fully stabilized. ` b) No stormwater runoff may be discharged to the post=construction stormwater BMPs unless and until a Registered Professional Engineer provides a Certification that:i.all construction period BMPs have been removed or will be removed by a date certain specified in the Certification.For any construction period BMPs intended to be converted to post.construction operation for stormwater attenuation,recharge,and/or treatment,the conversion is allowed by the MassDEP Stormwater Handbook BMP'specifications and that the BMP has been properly,cleaned or prepared for post construction operation, including removal of all construction period sediment trapped in inlet and outlet control strictures;i1i..as-built final construction BMP plans are included,signed and stamped by a Registered Professional Engineer,certifying the site is fully stabilized;tii. any illicit discharges to the stormwater management system have been removed,as per the requirements of Stormwater' Page 5 of 9*ELECTRONIC COPY X, * Y iZ .t y�,yYfi'ktyfYbsk "# k, Massachusetts Department of Environmental Protection: Provided by MassDEP: Bureau of Resource Protection Wetlands MassDEP File#:003-5229 r WPA Form 5 Order of Conditions i eDEP Transaction#:696452 Massachusetts Wetlands Protection Act M.G.L."c. 131, §40 City/Town:BARNSTABLE Standard 10;iv.all post-construction stormwaier BMPs are installedin accordance with the plans(including all planting Plans)approved ed by th. e issuing authoritY>and have been inspected to ensure that they are not damaged and that they are in proper working condition; - • P kin P g c,o dition;v any vegetation associated with post construction BMPs is suitably established to withstand , erosion. c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another party has legally assumed responsibility for BMP maintenance.Prior to requesting a Certificate of Compliance or Partial Certificate of Compliance,the . P responsible party(defined.in General Condition 19(e))shall execute and submit to the issuing authority an Operation and "Maintenance Compliance Statement O&M Statement for the Stormwater BMPs identifying the responsible for P. ( ) �g Party P implementing the stormwater BMP Operation and Maintenance Plan O&M Plan and certifying the following:i. the O&M � ) mpg g ) Plan is complete and will be implemented upon receipt of the Certificate of Compliance,and ii.)the future responsible parties shall be notified in writing of their ongoing legal responsibility to operate and maintain the stormwater management BMPs and implement the Stormwater Pollution Prevention Plan d) Post-construction pollution prevention and source control shall be implemented in accordance with the long-term pollution prevention plan section of the approved Stormwater Report and,if applicable;the Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Multi-Sector General Permit. e) Unless and until another party accepts responsibility,the landowner,or owner of any drainage easement,assumes responsibility for maintaining each BMP.To overcome this presumption,the landowner of the property must submit to the issuing authority a legally binding agreement of record,acceptable to the issuing authority,evidencing that another entity has accepted responsibility for maintaining the BMP,and that the proposed'responsible party shall be treated as a pemvttee for purposes of implementing the requirements of Conditions 19(f)through 19(k)with respect to that BMP.Any failure of the proposed responsible party to implement the requirements of Conditions 19(f)through 19(k)with respect to that BMP shall be a violation of the Order of Conditions or Certificate of Compliance.In the case of stormwater BMPs that are serving more than one lot,the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs.A plan and easement deed that grants the responsible party access to perform'the required operation and maintenance must be submitted along with the legally binding agreement fl The responsible party" shall operate and maintain all stormwater BMPs in accordance with the design plans,the O&M Plan, and the requirements of the Massachusetts Stormwater Handbook. g) The responsible party shall: 1:Maintain an operation and maintenance log for the last three(3)consecutive calendar years of inspections,repairs, maintenance and/or replacement of the stormwater management system or any part thereof,and disposal(for disposal the r log shall indicate the type of material and the disposal location); 2.Make the maintenance log available to MmsDEP and the Conservation Commission("Commission")upon request;and 3.Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure that the responsible party is in compliance with the requirements for each BMP established in the O&M Plan approved by the issuing authority. h) All sediment or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal,state,and local laws and regulations. i) Illicit discharges to the stormwater management system as defined in 310 CMR 10.04 are prohibited. j) The stormwater management system approved in the Order of Conditions shall not be changed without the prior written approval of the issuing authority. k) Areas designated as qualifying pervious areas for the purpose of the Low Impact Site Design Credit(as defined in the MassDEP Stormwater Handbook,Volume 3,Chapter_1,how Impact Development.Site Design Credits)shall not be altered without the prior written approval of the issuing authority. 1) Access for maintenance,repair,and/or replacement of BMPs shall not be withheld.Any fencing constructed around stormwater BMPs shall include access gates and shall be at feast six inches above grade to allow for wildlife passage. Special Conditions: Page 6 of 9*ELECTRONIC COPY < -Pr v o ided b M M assDEP ass ach artment of usetts De Envir nmental'Pr P 0 otection . y Bureau of Resource Protection Wetlands. MassDEP File#:003-5229 MTA Form 5 - Order of Conditions: eDEP Transaction#:696452 ' Massachusetts Wetlands Protection Act M.G.L.c. 131, §40 CitylIown:BARNSTABLE' D. Findings Under.Municipal Wetlands Bylaw or,Ordinance: .' L Is a municipal wetlands bylaw or ordinance applicable?rFl Yes Eli:No 2. The Conservation Commission hereby(check one that ajiplies): x ` a r DENIES the proposed work which cannot be conditioned to. meet the standards set forth in amumcipal ordinance-or bylaw specifically. I.Municipal Ordinance or Bylaw 2.Citation : Therefore,work on this project may not go forward unless and until a revised Notice of Intentis submitted which povides: measures which are adequate to meet these standards,and a final Order or Conditions is issued;;Which are necessary to comply with a municipal ordinance or bylaw: b APPROVES the proposed work,subject to the following r additional conditions. TOWN OP", ' t I.Municipal Ordinance or Bylaw 2.Citation+ S 237-1'7 237-14 BARNSTABLE 3. The Commission orders that all work shall be performed in accordance with the'following conditions and with the Notice of Intent referenced above.To the extent that the following conditions modify or differ fromthe plans,specifications,orother proposals submitted with the,Notiice of Intent,the conditions,shall control. The:special conditions relating to municipal.ordinance or bylaw are as follows: SEE PAGES 7.1 AND 7.2 , p° t a r ' d Page 7 of 9'*ELECTRONIC COPY 4. Gj n t•� a T S."3i.',hx y'p ,r{,' }hz 4 ! a SE3-5229 Name: Thomas Fisher , Approved Plan= September 23,2014 Site Plan by Daniel A.Ojala,P.E. . Special Conditions of Approval I. Preface t Caution: Failure to comply with all Conditions of this Order of Conditions may result in serious consequences. Such consequences may include issuance of a Stop Work Order,fine(s),the requirement to remove unpermitted structures,requirement to re=landscape to original condition,the inability to obtain a Certificate of Compliance,and more. The General Conditions`of this Order begin on Page 4 and continue on Pages 5 through 6. The Special Conditions,if necessary,are contained on Pages 7.1,7.2 and 7.3 All Conditions contained herein require strict compliance. H. Prior to the start of work,the following conditions shall be satisfied: 1. Within one month of receipt of this Order of Conditions,and prior to the commencement of any work. approved herein,General Condition Number 9(recording requirement)on Page 4 shall be complied with. 2. It is the responsibility of the applicant,the owner and/or successor(s),and the project contractor,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 No. 10 on Page 5'(sign requirement)shall be complied with. 4. The Conservation Commission shall receive written notice one(1)week in advance of the start of work. M. The following additional conditions shall govern the project once work begins: 5. General Conditions Nos. 13 and l4(changes in plan).on Page shall be complied with. 6. Sediment controls shall.be deployed,as needed.y c 7. The Conservation Commission,its employees,and its agents shall.have a right of entry to inspect for compliance with the provisions of this Order o..f Conditions: 8. Unless extended,this permit is valid for three years from the date of issuance. Page 7:1 9. All areas disturbed during construction shall be revegetated immediately following completion of work at the site. No disturbed areas shall:be leftunvegetated or unmulched for more than.thirty(3.0)days. Mulching shall not serve as.a substitute:for the requirement to revegetate disturbed areas at.the conclusion ' of work. 10. The seasonal pier shall bey stored'at a suitable,upland site: Sections shall not be stored on the pondshore or wetlands. 11. Proposed nourishment sand shall be.clean and coarse. x 12. All mitigation planting shall becarved out"Advance consultation with the Conservation Agent required for species and densities.Once-done;.the planting shalfbe retained.Replacement shall be provided for specimens failing to thrive.Temporary irrigation maybe provided. The mitigation area shall be permanently monumented,in consultation.with the Conservation Agent. 13. The proposed meadow shall be'mowed onlyonce per year,in the fall. Woody invaders(e.g.,vines,shrubs, etc.)may be removed by hand at anytime necessary. . 14. All shrubs cut from the slope shall be removed and appropriately disposed of. IV. After all work is completed,the following condition shall be promptly met:, 15. At the completion of work;or by the expiration of this.Order,the applicant shall request in writing 'a r 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 shall be submitted,certifying 'substantial compliance with the plans.,setting forth what'deviation(s),if any,exists with the approved plans. This statement,along with Form C, shall accompany the request for a`Certificate of Compliance. Page 7.2. ' ; Fes' , Massachusetts Department of Environmental Protection Provided by MassDEP:� Bureau of Resource`Protection -Wetlands SE3-5229 MassDEP File# WPA Form 5 - Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131,:§40 eDEP Transaction# Barnstable -' t ' City/Town E. Signatures Important: This Order is valid for three years, unless otherwise specified as a special OC�?.014 When filling out. condition.pursuant to General Conditions#4,'from'the date of issuance. 1.Date of Issuance forms on the r computer,use ' Please indicate the'number of members who will sign this form. , only the tab key This Order must be signed by a majority of the Conservation Commission. , 2.Numb r of Signers to move your, cursor-do not , .The Order must:be mailed by certified mail (return IL ipt requested)or hand delivered to use the return : the applicant..A copy must be mailed, hand delive d o filed electronically at the same key. time with the a -t-e ' MassDEP Regional Offic . Signat s �❑ by hand deliver on ® by certified mail, return receipt y , a requested,on OCT 2A 2014 Date 'Date F: Appeals." , i F The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to INS Order,or any residents of the city or town in which such land is located, are hereby notified of their right to request the appropriate MassDEP Regional 'Office to issue:a Superseding Order of'Conditions. The request must be made by certified -mail or hand delivery to the Department,with the appropriate filing fee and a completed Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within ten business days from the date of issuance of this Order.A copy of the request shall at the same time be sent by certified mail or hand delivery;to the Conservation Commission and to the applicant, if he/she is not the.appellant.' Any appellants seeking,tol appeal the Department's Superseding Orderassociated with this, appeal will be required,to demonstrate prior participation in the review of this project. Previous participation:in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the' public hearing, requesting a r :Superseding Order, or providing written information to the Department prior to issuance of a Superseding Order.. , , „ The request shall state clearly,and concisely the objectionsto 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 th&extent that the Order is based on a -.-,municipal ordinance or bylaw, and not on Massachusetts Wetlands Protection Act or - regulations, the Department has no appellate jurisdiction.. wpa5sigs.doc- rev.02/25/2010 i Page_of BARNSTASLE REGISTRY OF DEEDS v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v Parcel Application # -COd� f (I A '�/* Health Division Date Issued 5 Conservation Division Application Fee Planning Dept. Permit Fee ;�5 Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address + t�" �� , �a N -�✓,�L- Village CEng Owner �`_P- `ice " ce �f-0 iNN �Address Oiso d,2 I L C iA&4 S'I CA�C , Telephone j 5 O51 110 &2cC.) 51 H it Permit Request ajo-f✓i fJ 1'Daw "A o2Ja s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District F�loQ' d Plain Groundwater Overlay Project Valuation l,(J& Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ 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 ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameL C�G1 F- ��� i�`ff - -- Telephone NumberL� 7 � Address �1-ubnl5 ccf?l _, 1 C License # Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �� DATE I? 2-0-it `l}lfe&wG� FOR OFFICIAL USE ONLY ,APPLICATION# t r DATE ISSUED s' MAP/PARCEL NO. ADDRESS VILLAGE OWNER S DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL } GAS: ROUGH FINAL FINAL BUILDING 1'� �• « � S DATE CLOSED OUT- - ASSOCIATION PLAN NO. s 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 Legibly Name(Business/Organization/Individual): L �o Ix�. �'l� 'll�G ? �t� �V'�l�r'� s C/ `J Address: ,,�'r�/1 �rI)� Zu SOMA"b e31 1 ` Lic?r>�it/� . .® 26 d City/State/Zip: Phone.#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I .. employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am.a sole proprietor 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 Q Building addition [No workers'comp.insurance comp.insurance.# required.] 5. 0.We are a corporation and its 10.0 Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their' 1'1.0 Plumbing repairs or additions Nmyself. [No workers'comp. right of exemption per MGL liEl Roof repairs insurance required.] t c. 152, §1(4),and we have no, �" employees. [No workers' 13.[3 Other ''Get)f 0 comp.insurance required] t 1 vYl'rr *Any applicant-that checks box#1 must also fill out the section below showing their workers'compensation policy infomretion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new-affidavit indicating such. xContractors 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 provide their workers'comp.policy number: I am an employer that is providing workers'compensation insurance formy employees. Below is the policy,;and job site information Insurance Company Name: ------------ Policy#or Self-ins.Lic.#:. . Expiration Date: Job Site Address: City/State/Zip: 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 against the violator. Be advised that copy of this statement maybe forwarded to the'Office of Investigations of the DIA for insurance coverage verification I do hereby certify under the pains and penalties of perjury that'the information provided above is true and correct o _ Signature G Date: a. Phone#: j C1 Official 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 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 chapter 152,.§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their 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 one 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 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 fo any business or commercial venture (i.e. a dog license or permit to burn 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 Massachusetts Department of Industrial Accidents Office of fai ts gatlons 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-72777749 i Revised 11-22-06 www.mass.gov/dia aF Vr:r� Town of Barnstable ti Regul'atory Services H� 0 Thomas F. Geiler,Director- Building Division PrED a Tom Perry,Building Commissioner 200 Mairi.Street,_Hyannis,MA.02601 www.town-barnstable-ma.us Office: 509-962-4038 Fax: 508-790-6230 HOT\' OWNER LICENSE EXEMPTION Please Print DATE: 8) 16 I 2-0 i JOB LocnnoN: number street village -HOMEOWNER GUL i�' A7, name / home phone# work phone# CURRENT MAILING ADDRESS: `�ZD J(:2tiztt .5—m-t--f,% 5z-�'etj ec)L- ., PC A-Izi t 2_�' r i 'ty/town states zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who'does not possess a li'cense,'provided that the owner acts as supervisor. DEFINITION OFEOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, an which there is, or is intended to' be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constr-ticts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minirrium inspection procedures and requirements and that he/she will comply with said procedures and rernrirements. AtQ' �o� e� � i/�n'UJ, C=>CCC'(J70/ Signature of Homeowner _ Approval of Building Official Notc: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code staters that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section,(Scctio'n 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regu on lations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly *hcn the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsrbilities,many communities require,as part of the permit application, that the hDmeDWner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fornr/certification for use in your community. Q:forrns:homccxcmpt , �T r - Town of Barn-stable r_ . ` Regulatory Services • L�RTI$TABL.E, i i, KAM& Thomas F. Geiler,Director i639- �E1659- 16 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Office: 509-862-403$ . Fax: 508-790-6230 Property Owner Must Complete and Sign This Section , If Using A Builder I _ , I as Owner of the subject subjproperty J hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of Owner Date Pnnt Name If Properly Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0RM5:0VrNERPERMIS3)0N Aug 02 2011 12: 48PM HP LRSERJET FAX. P- 1 GERARD P. WILLIAMS Certified Public Accountant*Certified Valuation Analyst Executor of The Estate of Bruce Phinney 110 Breeds Hill Rd., Ste 4 Hyannis,MA 02601 Telephone: 508-775-0518 ewilliamscpa(FEhotmail.com Fax, 50 790-8542 August 2, 2011 Building Commissioner Thomas Perry,CBO 200 Main St. Hyannis,MA 02601 e Dear Mr. Perry, I am the executor of The Estate of Bruce Phinney. The property located at 1,4 71'ern Lane is an asset of the estate sin need of restoration. Please accept this letter authorizing Attorney Laura Boucher to act on beh,:1 E of The Estate of Bruce Phinney in all matter legal and binding thereof,including securing : wilding permit to restore the property to a single family home. Thank you for your attention to this matter. Smc y, Gerard P. Williams 34 TERN LANE, CENTERVILLE X , in 1 N � 'Deck T �. 16 s 12' r, Dining Room G X Bedroom KJtchen °+ Uving Room v 1 z i Bath M Deck Laundry X Foyer v `wwwww�ww•t Al 31 f� - 79 , f' H :-� Bedroom A Front of Dwelling N G MAIN FLOOR E 16' � 3.4 TERN LANE, CENTERVILLE E 31' 16' Bedroom G Unlit I00m'� Uvin9 Room . - Closet- Bath M t ar 31' 0 counter cupboards-sink ;., Front of Dwelling ° "Kitchen" N GROUND FLOOR.. 16' �v 19CAD n C 0 ca t0 C rn Cd 3. m v i a co 31• o m c o 70 o z M � � -zL- ©�S MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town:, � lln�" �-'6• MA. Date: tI !Permit# Building Location„ ' ,, Owners Name: Type of Occupancy: Commercial Educational Industrial 0 Institutional L] Residential ✓� New: D Alteration: Renovation: Replacement: Plans Submitted: Yes 0 No 0 FIXTURES �t z y 0 r � U ! � i W Z � J S Imo- / W a: U) W Q 'N J z a w z F- z rn z a ¢ N z �I O m w o. ui m rn z co O O3 aj X a ILLcn a z O p W uj N z W re re L, w U H = a 00 w � c) > LL> 0 0 0 z z W � _ 1 a a y y a o o = -5 a R a a a � \ a to to 0 0 u- c� = Y ca (n I— SUB BSMT. BASEMENT / —isT FLOOR 2 N u FLOOR 3 u FLOOR 4 FLOOR - 5 FLOOR 6 FLOOR 7 FLOOR 8 Tr FLOOR Check One Only Certiff tpte# Installing Company Name: �,C r•� aCorporAddress: ? 17 b City/Town She R� JState: MA Business Tel: -�1u•e�7 7 Fax: o 0 Partnership Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: I have a current IlabilitV insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes NoEI . If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. A liability insurance policy j Other type of indemnity Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Signature of Owner or Owners Agent Owner L] Agent L] I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chap 142 of the General Laws. ByF— _-- -_ — Type bf License: Title� S re of Licensed Plumber L Plumber CitylTowni Master APPROVED OFFICE USE ONL Journeyman { License Number: ` g OWNER OF RECORD LEGEND THOMAS G & LEANNE FISHER 10 OAK LEDGE DRIVE 99- EXISTING CONTOUR 1 .00 48.0' BRAINTREE, MA 02184 FROM ANNUAL MEAN HIGH WATER X 99•' EXIST. SPOT ELEV. , , 8.0 8.0 8.0 8.0 8.0 9.0, REFERENCES 99 PROPOSED CONTOUR ~� DEED BOOK 25631 PAGE 64 [98.4 OBS. WATER PROPOSED SPOT EL 34 Locus TH 1 - 32 NOTE. � TEST HOLE 30 YY Wequaquet SLOPE NATURALIZATION: SLOPE OF GROUND Qo Lake EXISTING ORNAMENTAL JUNIPER TO BE CUT AT BASE PROFILE AND REMOVED FROM SITE. UTILITY POLE „ , �oke��Qf SLOPE TO BE SEEDED WITH ERNST NEW ENGLAND SCALE 1 =10 0 i \ WILDFLOWER AND GRASS MIX (OR EQUIVALENT) AND tiY FIRE HYDRANT o o COVERED WITH 100% BIODEGRADABLE EROSION NOTE: NOT ALL SYMBOLS MAY APPEAR IN DRAWING CONTROL BLANKET. o ANNUAL MOWING TO BE DONE BY MARCH 30 LOCUS MAP SCALE 1"=2000'f ASSESSORS MAP 192 PARCEL 25 192-23 x 31.20 WEQ. LAKE DATUM (NGVD29) FLORENCE L CASEY x 32 0 x 31.54 PROPOSED 8'X10' SHE PROPOSED 3'X5' RAM x 5. 2 REPAIR IN KIN x 30.44 AS NECESSARY 286.51' 139.46 �' x 32.0o x 31.27 --x 9.85 33.82 �4 � �1 � \ 3 48 ,.-PROPOSED "ALUMIDOCK" 5 X 1.12 7 5T 4-68\/ (OR EQUAL) CONSULT N -'�-3 .4 MANUFACTURERS _ _ 6-4�2 64.26 \\ R41.59 I �e-35�75 33.89x x 2.13 31.03 0 2 INSTRUCTIONS FOR 60.82 _ �27 - - - - - - - �SONE� p /x x 42.28 x 40.3� LAWN / 00 DETAILS/SPECS x 64.28 63-51 x'!' A 9 I as.o' 6 \ 41.42 x 41.35 1 /36.6 SAND o x Z7.98 4'x8' 4' 8' 4'x8' x8' 4'x8' _ 02 DECK 37 o BEACH 4'x9' - 6776 - _ _ - 'QU�4QUET LAKE LANDSCAPE TIE N �0 92 64.63 �� � // x 9. = x 3201 P � x 61 1 \ DECK I 6.2 (�0 BE REPLACED)RAIL 3 .53 � 30.9- >1 w -, 61.46 f 64.75 5.89 = 29.86 (A GREAT POND) z I 35. 9 MEAN ANNUAL HIGH x 40.59 1` 64.74 65.53 y 40.94 x 39 I= Wp WATER ELEV. 34.0' \ SLOPE TO BE 62.43 I I EXIST. m NATURALIZED \ I 35. Z x 31.84 64.70 DWELL. / 86 Q ?-6 . �- - - - - -x.61.83 \ �' � / I 40.93 x 40. 1 LAWN W x 30.87 29.96 --x/64.65 I x 57.81 mo / 3 7 A N 61.85 \ ,Olt TOP FNDN. / r 6 09 4 .56 (A \A wq Y I EL. 65.5' n ch 33.79 31.95 -x.64.15 I Z / 38.97 65. 2 30.99 x 30.17 'x\64.78 5.8 p. M OD 5.86 x 34.39 65.07 I 57.77 d•McncJKnPP�•� �•P 'P (� O � ��N�OtOOD�°'`r n' ROPOSED SAND LANDS P ` .02 P / x 64. TIES 2 I 9 \ 8 0` d 1 20 � NP�URP� PRE m NOURISHMENT I 0.21 - -- 665 45 1 PUMP & FILL WITH T x 44 cP� \ CLEAN SAND 58 d6 I 6 8 EXISTING CESSPOOLS z s GARAGE 6Ac 6,d+�C;�O`� 4 .5 v' r � 0 \\ / x 63.62 SHED 42.63 j z 68.21 SITE PLAN OF I, 34 TERN LANE 2�°oO CENTERVILLE :o 192-26 PREPARED FOR MICHAEL G & CAROL N HIRSH TRUST M/M THOMAS FISHER J\ _ SEPTEMBER 23, 2014 Vil 111 1 t 1 off 508-362-45Y1 fox 508-362-9880 downcope.com down cope e�gineering, ia�. oI_I-:s -1�` ' Scale: 1"= 20' civil engineers land surveyors DATE 939 Main Street ( Rte 6A) DANIEL A. OJALA, P.L.S. 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675 DCE # 13-327