HomeMy WebLinkAboutCorrected PAGE 1 WPA Formwpaform3.doc • rev.12/4/2023 Page 1 of 9
4
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 3 – Notice of Intent
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
Provided by MassDEP:
MassDEP File Number
Document Transaction Number
Barnstable (Centerville)
City/Town
Important:
When filling out
forms on the
computer, use
only the tab key
to move your
cursor - do not
use the return
key.
Note:
Before
completing this
form consult
your local
Conservation
Commission
regarding any
municipal bylaw
or ordinance.
A. General Information
1. Project Location (Note:electronic filers will click on button to locate project site):
749 South Main Street
a. Street Address
Barnstable (Centerville)
b. City/Town
02632
c. Zip Code
Latitude and Longitude:41.635990
d. Latitude
-70.354350
e. Longitude
185
f. Assessors Map/Plat Number
012 001
g. Parcel /Lot Number
2. Applicant:
a. First Name b. Last Name
Sandcastle Family Holdings, LLC
c. Organization
1332 Stewart Street
d. Street Address
Winter Park
e. City/Town
FL
f. State
32789
g. Zip Code
h. Phone Number i. Fax Number j. Email Address
3. Property owner (required if different from applicant):Check if more than one owner
a. First Name b. Last Name
c. Organization
d. Street Address
e. City/Town f. State g. Zip Code
h. Phone Number i. Fax Number j. Email address
4. Representative (if any):
John
a. First Name
O'Dea
b. Last Name
Sullivan Engineering & Consulting, Inc.
c. Company
711 Main Street, P.O. Box 659
d. Street Address
Osterville
e. City/Town
MA
f. State
02655
g. Zip Code
h. Phone Number i. Fax Number j. Email address
5. Total WPA Fee Paid (from NOI Wetland Fee Transmittal Form):
$2253.00 + town fees of
$1070.00 = $3,323.00
$1114.00
b. State Fee Paid
$2209.00
c. City/Town Fee Paid