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HomeMy WebLinkAbout0019 WARWICK WAY n. .tF T f c r ` i d! 0' I=y �, z p ,. >r•' .. .. w'" +}. yam,-� ��.r. C$iuG. �`o.de - w fib' n W1,'` . � n F a r j o 9 a r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION a Map Parcel Application # D O YO d.3 5— Health Division Date Issued N f Conservation Division Application Fee S Planning Dept. Permit Fee f Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village � �..•I�� Owner > ,Jk-,+- 1��rk Address S�►^�� Telephone k C'I Permit Request Square feet:. 1 st floor: existing proposed 2nd floor: existing proposed Total new .Zoning District Flood Plain Groundwater Overlay Project Valuation 19w Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family We" Two Family ❑ Multi-Family (# units) N o Age of Existing.Structure Historic House: ❑Yes ❑ No On Old Kings;Highway: 0 Yes❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other ' Ca 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 ❑ oCommercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Construction Telephone Number PO Box 52 Address West nennic, MA 02670 License # Cell (508) 280-6964 CS11- ,-58633 IC-169o,-3 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �. ll SIGNATURE DATE i FOR OFFICIAL USE ONLY ail x, APPLICATION# DATE ISSUED MAP/PARCEL NO. { °- ADDRESS VILLAGE OWNER r DATE OF INSPECTION: " €; FOUNDATION ' r• - FRAME j INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO. t The.Commonwealth of Massachusetts Department of IndustrialAccidents 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): Mike McCarthy Constructiur, Iro Box 52 Address: West Dennis, MA 02670 Cell (508) 280-6964 CSLP- 33 HIC-169393 Are you an employer?Check the appropriate bog: Type of project(required): . 1.2"fl am a with employer 4. ❑ I am a general contractor and I �— 6. ❑New,construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g; ❑Demolition workingfor me in an capacity. employees and have workers' Y com uran insce t 9. El Building addition [No workers comp. insurance P required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.�ther 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 hue outside contractors must submit a new affidavit indicating such. tContractors 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 for my employees. Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: W- L. 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 up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.06 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and th airs andpenalties ofperjury that the information provided t love is true and correct. Signature: Date: `( /I/y Phone#: Official use only. Do not write in this area,to be completed by city or town of 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,partnershi4.p,association or other legal entity, employing employees. However the owner of a dwelling house having not lore 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 liwlding appurtenant thereto shall not because of such employment be deemed to bean employer." t' 'r►-►tit#'.� ,; 10 -i 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-contractor(s)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 permitllicense 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 to any business or commercial venture (Le.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 lavestigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSAFB Revised 4-24-07 Fax#617-727-7749. WWW.M=.gov/dia Office of Consumer Affairs and Business Regulation . 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 b �, t Home Improvement Contractor Registration O 0D Registration: 169393 Type: Individual t l uX, r c o c°'i. ` r , zSi Expiration: 6/16/2015 Trl# 238121 m = MICHAEL.MCCARTHY - �i MICHAEL MCCARTHY n m �• - � a 'k9 5 o o 2 P.O. BOX 52 1,6 C o WEST DENNIS, MA 02670 cn ca4 d ✓;3. ' Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card rr '" SCA 1 is 20M-05/11 — — a U/separrnraaracaeaCCl o-��lc��ocrc/zuaeCGr or License registration valid for individul use only cn a• Office of Consumer Affairs&Busibess Regulation m W F. CONTRACTOR • before the expiration date. If found return to: a OME IMPROVEMENT O ° Y a cn egistration: 169393 Type: Office of Consumer Affairs and Business Regulation a xpiration >6/16/2015 Individual 10 Park Plaza-Suite 5170 o w r Boston,MA 02116 MICHAEL MCCARTHY ; z'` t = MICHAEL MCCARTHY,\ ' 6 RANGLEY LN SOUTH DENNIS, MA 02660 Undersecretary Not valid without signature - u� DATE(MMIDO/YYYY) AC CERTIFICATE OF LIABILITY INSURANCE DATE(MW DN 013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): !PRODUCER 01962-001 '. - !CONTACT NAMBryden&Sullivan Ins Agcy of Dennis Inc `•PHONN.EXt1_-(508)398-6060 -- — — FAX_No__ (508)394-2267 PO BOX 1497 ( EMAIL - ---------- So Dennis,MA 02660 1 ADDRESS: ---"__._—_--_,—INSURERL$)AFFORDING COVERAGE_ NAIC# I INSURER A A.LM_Mutual Insurance Company _— _ _ — _ 33758 INSURED 'INSURER B_----— ..:------- -------Michael McCarthy Construction Inc —--- — --- -- — ---—- I INSURER C: WOox 52 t Dennis,MA 02670 i INSURER D __-- --------' --- _ __-- _ I INSURER E L---- ----'- ----'—--------— ------ i i INSURER F, i COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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 CONDITICNS OF SUCH PCL!CIES.LIMITS SHOWN MAY HAVE BEEN'REDUCED BY PAID CLAWS. L S INSR IADDUBR T POLICY EFF POLICY EXP LTR'_ TYPE OF INSURANCE INSR I WVD I POLICY NUMBER LIMITS )(MM/DD/YYYY MM/DDIYYYY)GENERAL LIABILITY I I -�- I EACH OCCURRENCE -!$ -- _ --- DAMAGE TO RENTED $ COMMERCIAL GENERAL LIABILITY PREMISES LEg occurrence I CLAIMS-MADE I OCCUR ; j j MED EXP(Any one person) $ .1------- PERSONAL&ADV INJURY j$ —--------- .._._._.. I I GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: ; PRODUCTS-COMP/OP AGG '$ j POLICY PRO-JE LOC — — : AUTOMOBILE LIABILITY I - - i I 1 COMBINED SINGLE LIMIT ANY AUTO _ i i _ i, j I I BODILY INJURY(Per person) L$ - -- i ALL OWNED SCHEDULED -- _-!AUTOS AUTOS ! I BO INJURY ;DILY J RY(Per accident) $ HIRED AUTOS ; NON-OWNED (PROPERTY DA MAGE -— - ---i iAUTOS j I (Per accidentL i$ UMBRELLA LIAB OCCUR. ' 1 I _ TEACH OCCURRENCE F$ j_EXCESS LIAB i CLAIMS MADE I AGGREGATE 1$ DED i RETENTION $ { !$ 1 W I _ _ L—AppD S TLAT— OTH- RYIMS. LIABILI EREMPLOYERS ' !ANY PROPRI��TTOR/PARTNER/EXECUTIVE Y!N I E.L.EACH ACCIDENT I$ 500,000.00 A OFFICER/MEMBER EXCLUDED? I J(NIA! VWC-100 6017656-2013A 17/17/2013 7/17/2014 r -- -- --- —'--`-- — (PJandator,In NH) t I I I E.L.DISEASE-FA EMPLOYEEI$ 500,000.00 If Yes desc ibe under DltiSCRIPT(ON OF OPERATIONS below i I I F F:L.DISEASE-POLICY LIMIT $ 500,000.00 i i i 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION I TOWN OF SANDWICH Attention:BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ,_ ©1988-2010 ACORD CORPORATION.All rights reserved. • R ` (Owner's Name) M t owner of the property located at (Property address) s , (Pr0p6rty Address)' hzreby authorize (:t (Subcontractor).-. an authorized subcontractor for RISE Engineering, to act on my behalf,to obtain`a building, . p3rmif and to perform work on'my property, ' er's- Signature ®ate t 1 TOWN OF BARNSTABLE Permit No. 23205 Building Inspector saaPrrw Cash -------_—__-- 1639 M b'` Bond _' ' 4 OCCUPANCY PERMIT ---------------K---------- Issued to/ Coolidge Homes � . Address lot #38 119 Warwid Way, Centerville Wiring Inspector r Inspection date Plumbing Inspector Inspection date Gas Inspector � �,�� Inspection date-7"9 A&G 189- v Engineering Department"'.-"" ! Inspection date �BOard of Health ,� Inspection date THIS PERMIT WILL NOT E VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. .... a......:� 19......_ (/ Building inspector 4x 4- Assessor's map and lot number ............................. .. THE .. ... •. �w Pic _ F Sewage Permit number .................................... !C SYST.... ... � ' #`Ut S'NS6 ALLY'® IN Co �L��ly, • B9SH9TAH E, i'Z L House number. ..........................................................:.............. T � '�Ide IT L 5 .1639,�\0m� TITLE�ENTAL CODE � �MPr TOWN, OF BARNS ASMojq ,m - BUILDING .. IISPECTOR APPLICATION FOR PERMIT TO . ... 'v 1A,' lei .. D. . '..I1 ' TYPE OF.CONSTRUCTION ...........:.. P... ........... �...................................................................................... fA 2 Vh T.. ........ ... .............1993 7 TO THE INSPECTOR OF BUILDINGS: The undersi ed ereby ap I'es fora according to the following information:.( jermit � (k �idt�l���L cation ...................................1.�..................................:........................................... .......................................,.. Proposed Use .......?r P � ...... ..... WG'l(/2 ..................................................... .. ...... ........ � � p' Zoning District .... -?t V� C�� ...................Fire District ..� ... ...4/, r�- .l.�.F-�. �S. ...... s Name of Owner © 1. rg ��..................Address l 4..........................................................�eS(.�-4�.. ' ...�.I.�Ca . V '... �....... Name of Builder .......:...... ...�. �. ..........................Address ........ . S I / 'c1� � .... w/01 /r�G► . .......... ..... ..... Nameof Architect ..................................................................Address ;........................................... 1 l � ........................... le........................ Number of Rooms / , :,oundation oIn. k�ilP ` ��®'O` FIR�fing .. .....� .ACL,...�:... �A � ..Exterior ......... ......................... . .. .. ..... J ..................... ' Floors /•!.. ....................Cr.....p� .. t�0 .......................Interior .../�..I.. .. `!I. ......... ....................... Y . Heati t ....... .................................................Plumbing .... D .. .......................... ....................... Fireplace .... IC.. ....1.(.11.I Q Approximate Cost .....:�.'j.`��.��.............. .......................... Definitive Plan Approved by Planning Board -------------------_-----------19--------. Area Q .,..... .......... 1 Diagram of Lot and Building with •Dimensions: Fee ............................................. /1O ... ^T... ........................ ......... .... SUBJECT TO APPROVAL OF BOARD Of HEALTH i I U ��. OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the To of Barnstable regarding the above construction. f Name ..........`........... Uh'............... I. ........................... . la Construction Supervisor's License .. .. .. . ...................... OOLIDGE HOMES . 1 25205 1 One Story + ................. Permit,'for .................................... - - Single Family Dwelling ' ...-.......•...... ... . ...... ... ck Wa,� Location .....Lot.............38...,...........19...Warwi......................... _ Centerville " _ ............................................................................... LOwner ......Coolidge...Homes....................... •- '• - �•. _..>> , a.m..e �� �: r � •jam �� .--�•,-�- -� y� Type of Construction ....Fr.. ............................... s5 _ ,.-�-• % =:- Plot ...................... Lot ................................ i June 17, 83 Permit Granted ..................... ... 19 . /� �* Date`of Inspection .......Z... . - �- 19 tDate Completed ....... . LJ'v f a• .`fir � �., .,.} _.e.�� f •� iw. ti. _.. ��i y J�, Imo♦ . 1M i y I; �� •s s [mow ` H.L n o(,� a'b/�4 Jim I wimp Y -vo /v/cL4 z7,-Y.c .yo sMrf-7-,,447 \ �'�• �d�� -!�/'Y/rYo� �/'/..0 of l�Y7orJ/'►�O� .%��'�� 1� 1b/tr�1 Q/Yd rYb��s�N /1+MG4�/.s !C6/ Q/'►'�0��✓' � s7/'r1 /YO C3�16r��7 �/ /�'b�7d 1C//•f� /'YO /'�'�li�i'Y� i I f?Gi210 q I N �a "1 : ate 1 SS 2d 05 '1d (r i r+tMot-is_ �G �, :alga � ,�—: �'rt�►�� I I ip 99 I L .r I 1 I I AA I 'I� Assessor's map and lot number ....�. ...................... .... ...... THE Sewage Permit number .,.. .....r.` J.............. .�.f? ..... ... B>HBSTSDLE, i House number r ~ » amoa T WN OF BARNSTABLE BUILDING INSPECTOR n 1� o I � �1/►� APPLICATION FOR PERMIT TO .....IVY............�...........��'.......................... . TYPE OF CONSTRUCTION .......... `'..aA.r�.....`..f! . ...................................................................................... 44 ............. 903 TO THE INSPECTOR OF BUILDINGS: The undersi ned hereby applies -for a permit according to the following information: Location ... . .. .. ..... v .... .... (kl�tG�G iNAY ...................... ....... ........................; . Proposed Use ...... �.�.. ..C ....... ! �!�.!...U......�!Uo�1(l/ .�j....................................................... ... .. 00 Zoning District J,U��Nx .", ­ .............. .....Fire District ..!✓. !✓.!.��� �� /..'. !ri�'.�1,`. ..... u ®lrl S .Addres 11. �esu. � G ..le4-4m v+N..S Name of Owner ... .. ..... 4. s .. . Name of Builder .......... k J ?E%i ............. ............Address .P. ... -c; S( I m �/ KFI :..... f r t \ i, a v l'a-, ( t' r Nameof Architect ........ . ................. .. , ......:..........Address ......... ..................................................... Number of Rooms .......... .........:....:.......................... .... .... Foundation ... , U. �....:. ............. Exteriortl �1i��J I {}�t..W�p� 7r!!�1ong ..... ..RS f �((tr � �,Ef� 3 .. .. ...................... t� ... ..... ... ".... . � i.. .. Lj p Floors . !..........�...�... .p...:'D",�.+�.lt/bD.........1'..................Interior ...��...... PP.. ..!-'��'`....:`. .......................... 4.7....... Heating nu.S. ... .. :.Plumbi+ng ..... . � .. ..,: t. . �k... ...... . ...... Fireplace ��... .... p >�. ... ...... ... ........Approximate Cost .. 3 �C E� Definitive Plan Approved by Planning Board _______________________________19________. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD`OF HEALTH �• rr; r i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ." .. ....... ............................................ ' Construction Supervisor's License ......l .ad�........ COOLIDGE HOMES A=148-67 No .,25205 permit for .One Story ................... Single Family Dwelling .............. .......... Location ...Lot...3 a......1.9... Wa�W�,CkI..T�13y. Centerville ............................................................................... Owner .....Coolidge Homes........................ Type of Construction ....Frame ........................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ..... June 17.:.............19 83 Date of Inspection ....................................19 i Date Completed ......................................19 l (4 1 THE Town of Barnstable X RE. SIT > .. Po Regulatory Services - ,�,�y� ; Thomas F:Geiler,Director E 1 �.� Building Division JTOW .0 N A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PERMIT# 5 (9 FEE: 45 SHED REGISTRATION 120 square feet or less cr Af �Qcation of shed(address) Village 71'f Jeai-� /_ �Q c.�r/ ��� t 7 'roperty owner's name �� v / Telephone number /O/c/cz 7 4 G -3 K t n e of Shed Map/Parcel# tore /O Date —+ c, Main Street Waterfront Historic District? CD ' n - Kings Highway Historic District Commission jurisdiction? ® > nervation Commission(signature required) NO 0106 co �. r PLEASE NOTE: IF YOU ARE WITHIN TEE JURISDICTION OF ANY OF THE,�ovE `� rn COM1ViISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE, PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPA11rIIF-D By A PLOT PLAN L� 34? 1 7 IZ7. 55 I tj n, ao`t . . 3 4 L p-f f 53 . IN pow ,43 r,WOry v o.v rN>st ,c+*.c ,�1•�✓ L o � T T �4t e ,�s�3vva As sr,r�o w!V s++.�,eec�,v F ,vr n� � � �C��vs�'OG'A•4 r 0 s G .5ty''�L.ia .c,'&-.v ccz v�r.�c�c r�n. , s �( . r /ric. ' s