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,: cs,,* ,..,,�* % Application fora Permit to Bu Id No. 1 '/
UPON FINAL APPROVAL $ fl / AP -s�� LOT b- 79
/ FEE MUST ACCOMPANY THLSrAP�PLICATION. DATE 1%' 1 90
90
The undersigned hereby applies for a permit to build �J
according to the following specifications -
/5/3/90
1. Name of property owner Arnold Chace Jr. Te1. 401-421-0254
Address 731 Hospital Trust Providence, R.I. 02903
2.Name ofArchitect(ifany) William Dennis Tel 617-232-7844
3. Name of builder Harry Garvey _Address Box 1098 Edgartown. Ma. 02539____
4. License No.; 013955 Tel, 508-627-3744
5. Name of Mason Scott Costakes -Address E. Dennis. Ma.
6. License No. Tel. 385-6370 (�,
zT
7. Construction address tar 7V- keei,r -rsJa. x `� v MC LRoss oss S ROAD
8. Date of subdivision Approval p
x//(87 plain zone C 4 B Zonteict R-87
a Private dwelling a Estimated Cost DO NOT WRITE IN THIS SPACE
j- /5-119 SF : Type of room No.
10. Multifamily El $250,000.
17 f /5-119eiNewahtes JAS.;11. Commercial ❑ "4-42:1—/atit 0- ' el - - ii 5- Kitchen 447-
12. Other ❑ tm act Ge7 Sr Dining Rm. '
�/S�
13. No. of stories 2 a Living Rm.
Bed Rm.
14.Foundation — Full 0 Half 0 Crawl Q Slab 0 Bath L
15. Materials — Wood 0 Cement)a Other ❑ t- —frDeck /
16.Type of heat — Oil 0 Gas a Electric 0 Other ❑ afore Closed porch
17. Garage — 1 ❑ 2 ElPfk• - ,yr Family Rm.
Sun room
18. Swimming pool - Size Garage
19. Storage shed — Size Shed
20. Stove —Wood 0 Coal 0 Alterations 7
21. Size of lot: No. of feet front ' 2 .5 S/te�of feet rear No. of feet deep
22. Size of building: No. of feet front % No.of feet side CC No. of feet rear 96
23. Distance from nearest building: Front 5?O7 Ft. side Caere"' Ft.side SOO/ Rear 521v t
24. Distance back from line or street 2 240 ' From rear lot line /{r/ Side line 7d '
LOT RELEASED BY Signature
PLANNING BOARD * 27A-7 Address `" 0"f / O !8
Date SEE 8.o. A . et Taun . 024-3'2
REGng.vEb PLAn1* 73 H RLGoRbED 516 188 C3 C.C.
2 / BUILDING PERMIT APPLICATION SIGN OFF
APPLICANT: �/2,JOtA C/l,ce /� BUILDING PERMIT #:
ADDRESS: L 7,74 IrUctJ �Sjeti cl' TELE. NO. : 6)/•-c'2/O2 ,5tATE FILED://G- y9a
*91 ()maioa R�j ROAD
BLDG. SITE LOCATION: (5t i-1 , tAct,GQ MAN: 4 LOT#: D 7/
THE FOLLOWING INFORMATION OUTLINES THE PROCEDURAL STEPS REQUIRED TO OBTAIN A PERMIT TO BUILD,
ALTER, OR ADD TO A STRUCTURE WITHIN THE TOWN OF YARMOUTH. THE BUILDING DEPARTMENT WILL DETER-
MINE COMPLIANCE TO THE FOLLOWING (A) ZONING REQUIREMENTS (B) HISTORICAL DISTRICTS (C) FLOOD
PLAINS ZONING. THE BUILDING DEPARTMENT WILL BE RESPONSIBLE FOR ASSISTING THE APPLICANT THOUGH
THE FOLLOWING DEPARTMENTS:
RESIDENTIAL AND/OR COMMERCIAL BUILDING
WATER DEPARTMENT: DETERMINES COMPLIANCE OF WATER AVAILABILITY.
ENGINEERING DEPARTMENT: DETERMINES COMPLIANCE FOR PARKING AND DRAINAGE.
CONSERVATION COMMISSION: DETERMINES COMPLIANCE TO WETLANDS ACTS, Z.E. : IF LOT(S) BORDER ANY
TYPE OF WETLANDS, STREAMS, PONDS, RIVERS, OCEANS, BOGS, BAYS, MARSH
LAND, ETC.
HEALTH DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REGULATIONS, I.E. : REQUIRE-
MENTS FOR SEPTAGE DISPOSAL AND OTHER PUBLIC HEALTH ACTIVITIES.
FIRE DEPARTMENT: DETERMINES COMPLIANCE TO STATE AND TOWN REQUIREMENTS FOR PERSONAL
SAFETY, PROPERTY PROTECTION, I.E. , SMOKE DETECTORS, SPRINKLER SYSTEMS
ETC.
THE FOLLOWING DEPARTMENTS MUST SIGN OFF, IN THE RESPECTIVE ORDER, PRIOR TO BUILDING INSPECTOR
ISSUING THE REQUIRED BUILDING PERMIT:
REVIEWED BY:
1. WATER DEPARTMENT i DATE: N/A:
2. ENGINEERING DEPARTMENT. p, 4„, 4, DATE: I fiEll . , N/A: sec SVLoW
3. CONSERVATION: 4 / /Mr DATE: //AMC N/A:
ff�. HFlTTH DEPAR'J7jF % A DATE: i ieilla� N/A:
// / .2796 t.. 111,11 _
I ,IND STR • AND/OR COMMERCIAL PERMITS
5. WIRING INSPECTOR: DATE: N/A:
6. PLUMBING INSPECTOR: DATE: N/A:
7. FIRE DEPARTMENT: DATE: N/A:
PLEASE NOTE
ALL STUMPS AND/OR BRUSH MUST BE DISPOSED OF AT AN APPROVED SITE. A SIGNED RECEIPT FROM THE
DISPOSAL SITE MUST BE SUBMITTED TO THE BUILDING DEPARTMENT PRIOR TO ISSUANCE OF THE BUILDING
PERMIT.
COMMENTS: 2„ WEEDS PRoFESSIOILA.L LAUt, SOttJEYORS STAMP oN S1TE PLArJ.
-f1,1Ylj"H : W>ft YIiii ew0 CLEV lALc)ic to SEq -j± U Wk- .
:yr Cvi MIA (-MOW"
—Tb lat5C0 1 Y� d
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a $cass Caut�i �e UNOErL Exruuo2 &orron( osc� PL/YTJE
Fit/ r C,'197vz SPsgc • RPD itCC(5.�
V'V ADD 6U//MbOtA's 7Z /151u fpvi'L 4L/)41L.
BLM/89
///7/9e)\-.)74--
l ;- Form 5 DEP Fk No. SE 83-1090
a,a••• (To to orwoea q DEP)
=-•r Commonwealth city"Town
YARMOUTH
• - i✓'kms f, of Massachusetts
y ` 'Applicant Fields Deel-
ocent
' Partnership'
'4 '_�` r
Order of Conditions
Massachusetts Wetlands Protection Act '. • . ' .
• G.L. c. 131 , §40 •• _ , • .
• " and the Town of Yarmouth Wetland Bylaw ,
From TOWN OF YARMOUTH CONSERVATION COMMISSION
' • Arnold B. Chace, Jr. & Malcolm G. Chace, III
• To • Fields Point Limited Partnership Trustees of Great Island Realty Tntct
(Name of Applicant) ` (Name of property owner)
Addre 's O."Box 1530, Mashpee rrxr r,rt M.ehpe@mc •
ddres$ Sarno
.' "This Order is issued and delivered as follows:
❑ by hand delivery to applicant or representative on • (date) ,
,- . •fi by certified mail, return receipt requested on November 5, 1990 (date) ,
This project is located at Lots 73 & 74. Uncle Roberts Road Great Island, West varnn„th
• The property is recorded at the Registry ' BARNSTABLE '
s ,
Boo), Page .
•
Certificate (if registered) 118975
The Notice of Intent for this project was filed on September 18 1990 • (date)
The public hearing was closed on October 18, 1990 (date) •
•
Findings
The Town of Yarmouth Conservation Commission has reviewed :he atove-references Notice of
Intent arc clans arc has `e!d a public hearing on the project. Eased on the information available to the
COMMISSION at this time. the COMMISSION has determined !hat
the area on wnicr me:rcp:sea work is to oe cone is significant to the fc:icwing interests in a6.._•baur..e wan
the Presurt::tans of Signdtcar:e set tdnn in me regulations tor each Area Suo:ec:to Frc:eat::n Uncer me
Ac:(check as ac:rc:r:ate,:
E Pu:i:c water su:::v G/F!ood control Ln: containing snellfisn
Private water su:::y �C•orm carnage prevention rFisnenes
• L" Ground water suety C`� rt***-reventicn of pollution �Prcto=wn ct wildlife hap:rat
Tc:al Fling "---ca Su_:-,rec 110.00 S:ate Snare n so
C::w i cwn Share - 67.50 (t^ fee in excess :t .__)
Total Fetunc .Cue S C::vittown Pc.•.:n S State P_...cn
(V: :c:a;1 ('.•: ::t_t)
C.
•
Therefore. the COMMISSION hereby finds that the following conditions are
necessary, in accordance with the Performance Standards set forth in the regulations, to protect those inter-
ests checked above.The COMMISSIONorders that all work shall be performed
in accordance with said conditions and with the Notice of Intent referenced above. To the extent that the fol- ' •
lowing conditions modify or differ from the plans.specifications or other proposals submitted with the Notice
of Intent,the conditions shall control. ,
General Conditions
1. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory meas-
ures,shall be deemed cause to revoke or modify this Order. ,
2. This 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,
4, The work authorized hereunder shall be completed within three years from the date of this Order unless -,..
_ either of the following apply: • . :Y : .. a ..
(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 and both that date and the special circumstances warranting -
,' the extended time period are set fo• rth in this Order, r
. - . . 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,containing no trash,refuse,rubbish or de-
bris, 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. No work shall be undertaken until all administrative appeal periods from this Order have elapsed or. if
such an appeal has been filed,until all proceedings before the Department have been completed.
8. No work shall be undertaken until the Final Order has been recorded in the Registry of Deeds or the Land
Court for the distnct in which the land is located,within the chain of title of the affected property. In the
case of recorded land, the Final Order shall also be noted in the Registry's Grantor Index under the name
•
of the owner of the land upon which the proposed work is to be done. In the case of registered land, the
Final Orcer snail also be noted on the Land Court Certificate of Title of the owner of the land upon which
the propcsea work is to be dcre.The recorcing information shall be submitted to the COMMISSION
on the form at the end of this Order prior to commencement of the work.
9. A sign shall be displayed at the site not less than two scuare feet or more than three scuare feet in size
bearing the wares. 'Massachusetts Department of Environmental Protection,
File Numger SE 83-1090
10. Where the Department of Environmental Protection is requested to make a determination and to issue
a Supersecing Orcer, the Conservation Commission shall be a party to all agency proceedings and
hearings oefore the Department.
11. Upon cora:et:on of the work cescribed herein, the applicant shall forthwith recuest in wnting that a
Certifica:e of Comp:iance pe issued stating mat the work has been satisfactorily ccmpietec.
12.The work snail ccntcrm to the following pians and special conditions:
5.2
•
Flans:
Title Dated • Signed and Stamped by: On File with:
Revised
Proposed Sewage Dis- • 10/25/90 .1Arn.s Richard Pelkey Con. Com. officc
Posal System ,
•
Special Conditions (use additional paper if necessary)
•
13. The applicant shall be held responsible to advise-the contractor of al
: ; these orders of conditions.
14. The Conservation Officer shall be notified at least 48 hours prior to
fhecommencement of.the proposed work . Tel.#398-2231 Ext. 284.
_- ;15: These orders of conditions shall apply to any successor in interest or ;
successor control. '`
16. The driveway shall be constructed of stone or gravel.
-
-;17. A hay bale dike shall be 'staked in place as shown on the ;
._ plan, before any work begins on the project.
18. This dike shall constitute a work limit line. No work of
. any kind will be permitted on the wetland side of this line. "
19. Gutters and downspouts directed into drywells shall be
installed to provide for roof runoff.
20. Any area proposed for removal of vegetation for a period
of more than 7 days, shall be mulched or otherwise treated
to prevent erosion
21. The cesspool is to be pumped dry, the connection broken,
and filled with clean sand.
22. The applicant shall be responsible for having a copy of the
Orders of Conditions on the site at all times. Failure to
do so could possibly result in a revocation of the Order,
or a fine, or both.
23. Upon completion of the project a Certificate of Compliance -
shall be requested. This Order shall be considered
incomplete until the Certificate of Compliance is recorded.
Issued By TOW O YARMOUTH Conservation Commission
• S!gnatti e(s) itiasJes "i• •
� e.
is Order must be signed by a majority of the/C�oonservation Commission.
' ' . On this • • /?a' �a of ' ( (Pr-.v u • 19 To before me
personally appeared ' , to me known to be the •
person described in and whoexeduted the foregoing instrument and acknowledged that he/she executed
the sameashii�s/her free act and deed.• " -
- . A i"/�/ (-j - Ibfkrmnyin E>mGU Ko�hs.41430
NotaryPublic . . Mycommission expires.. p•
.
.
The anoueant.Me owner.any person aggneved by this Oroer.any owner of land abutting Ine land upon which the or000sea work is to De ,
• cone.or any ten resiaents or the city or town in which such lana is located,are nereoy notified of their ngnt to request the Department of
Environmental Protection to issue a Superseding Order,providing the request is made by certified mail or hand delivery to the Department, . I:
with the approonate filing fee and Fee Transmittal Farm as prowled in 310 CMR 10.03(7).within ten Bays from the Gate of issuance of this
• Determination.A copy of the request snail at the same time De sent by certified mad or hand Gelivery to the Conservation Commission . • • -,.
and the applicant . .. ,� . - ..
•
•
Detach on dotted line and submit to the CONSERVATION ION COMMISSION prior to commencement of work.
—
To TOWN OF YARMOUTH . CONSERVATION COMMISSION tsswngAumcnty
Please oe acvtsea:oat the Crcer of C.ncrticns far me orciect at
Fie Numcer has been reccrcea at the Registry ct BA R N S TA B E ono
has teen natea in me chain of tn!e of the ailectea crocerty in accprcance with General Canc:tion 8 an , t g_
If reco:cea land. the instrument numcer which Ramifies this transac.`:en is
If reg•sterec lana. the=CCtment numcer wnicn identifies Inas transact.cn,s
Signature =C:.!Cant
, „
t.YY'-f..t•. �S% .i m` ^yi' -"a't•.t"L,hC�,'*A'' '' � .1 yx'• ✓.�.y�,g}Se .p It-s,sl b 4...- p t.4.y A, e ♦ ,
''py rs. '• :4i:� ,l„ eYu. aX ,"f,' k: .rrt' ?,r .�,;" Nst'`'t� r'}::•' ..'.•,.;"" 'PArt .,-.4, -;,.%.6 `t -t1 4 v,: >n•_:•f>..... 'Itrk;4 5.•414 c:
y.�,r. �e�=. .�[ < . ;'A¢.p 1Y;+3', 'S-•£�4 '-.tv. ��� ;� ,'�;.!". r. l A'. €^-,• r:tiyi]s�'.". :..a
..s. f , ! �-F �� q ss ,`: rF ..r l'N•. 7'.. e��c ��`A�T s'w?:t'.. r.
�`..> CEIT.ING':AS5EMHL �
• TOY SURFACEII= g .D3 WINDOWS:
9" FIBERGLASS
INSULATION
• R=38 ,
rpnn I/711MAnMnnnnp!
DOORS
�_SHEETROCR'
I R= 0.45 442..
� —BOTTOM SURFACE'
R= 0.61 .
LI2"PLYWOOD_. O INSIDE SURFACEWALL ASSEMBLYREAR
l REAR'ELEVATION
Rs 0.62 r R= 0.68 TOTAL R= /3 '79 G.W.A. /60 ?
WOOD ' _}" SHEETROCR . II= ", a 9
SHINGLES R= 0.45
R= 0.87 WINDOWS:
2./ O
OUTSIDE ,r-=-g; FIBERGLASS
SURFACE U ATION "
R= 0.17 r ' R=11
=SURFACE RESISTANCE
R= 0.61
1 FLOOR ASSEMBLY
1' •— FINISH FLOOR TOTAL R= 2-/.75 ,I DOORS: Z
R= 0.91 U= . O Y-/// -7 „X � } BOO
i RIGHT SIDE ELEVATION
, SUFIR
A 17
R= 0.62 Ii G.W.A.- l° 8
OUTBID ) 1 -5' ; , , i Ii
SURFACE 11 .7 ✓ J L� V (JV L�lf. �t��
R= 0.17 I WINDOWS: 'L
' II —6}" FIBERGLASS 'S�B
/ \ •. INSULATION FOUNDATION
CONCRETE' R= 19 WALL ASSEMBLY
FOUNDATION (may be used instead DOORS: /
WALL SURFACE RESISTANCE 2
\ 1 R= 0.61 of floor insulation)
R= TOTAL R=
LEFT SIDE ELEVATION
U=
!_ i G.W.A. / Q P8
/—INSIDE SURFACE
i R= 0.68
I 3/8" SHEETROCK WINDOWS: /.�L
R= 0.32
. " STYROFOAM
pi , /! DOORS:
NOTES: '//o4A /E v: ./ ,i
PERMANENTLY INSTALLED STORM v - 6.392X.0? t 7 6(IX .5- 71-/24X . z y
WINDOWS TO BE USED
GROSS WALL AREA= 5392 - 377 t 387. t 3u
WINDOW AREA= 7a 9- 5 3'72.
DOOR AREA= ! Z G
> vile U = e'• /414
.--•1:M \,rST" 71 ON- / o/ -----------
PLOT PLAN
FOR LOT # 71
Indicate location of garage or accessory building
Additions with dashed lines
Sewerage disposal (cesspool)
Well 0
yI I
(lot ft. rear) I
0
Abuttor's I Abuttor's
Name I Name
Lot # 73 I Lot # 75 -
REAR YARD
If this is a ria/4
VC-. If this is
corner lot, .... .. ..ft. corner lo
write in name
� write in
of street. / 0
I name of
P " I a other
61/6S 0 o street.
•
•
4
SIDE YARD SIDE YARD
0 2/0 FT. HOUSE ` __7D _ EF T>�I 0
•
I
I .
SET BACK
g
I
0
(Iot ft. frontage)
\ / Uvc/E ,®doers 7Z
\ /
/ - (NAME OF STREET)
/ Information
/ \ \ Supplied by #41,e4-7 17141,,,-7
MARK NORTH POINT
•
TOWN OF YARMOUTH
BUILDING DEPARTMENT
CONSTRUCTION SUPERVISOR FORM
PLEASE PRINT:
JOB LOCATION: Ler 7V Ozett ars/a4
NUMBER STREET VILLAGE
OWNER OF PROPERTY: Arnold Chace Jr. pp 5555
CONSTRUCTION SUPERVISOR: Harry Garvey Box 1098 Edgartown, ma3902539 627-3744
NAME LICENSE NO. PHONE NO.
ADDRESS:
LICENSED DESIGNEE:
(IF OTHER THAN SUPERVISOR) NAME LICENSE NO.
2.15 RESPONSIBILITY OF EACH LICENSE HOLDER:
2.15.1 THE LICENSE HOLDER SHALL BE FULLY AND COMPLETELY RESPONSIBLE FOR ALL WORK FOR WHICH HE
IS SUPERVISING. HE SHALL BE RESPONSIBLE FOR SEEING THAT ALL WORK IS DONE PURSUANT TO THE STATE
BUILDING CODE AND THE DRAWINGS AS APPROVED BY THE BUILDING OFFICIAL
2.15.2 THE LICENSE HOLDER SHALL BE RESPONSIBLE TO SUPERVISE THE CONSTRUCTION, RECONSTRUCTION,
ALTERATION, REPAIR, REMOVAL OR DEMOLITION INVOLVING THE STRUCTURAL ELEMENTS OF BUILDING
AND STRUCTURES ONLY PURSUANT TO THE STATE BUILDING CODE AND ALL OTHER APPLICABLE LAWS OF THE
COMMONWEALTH, EVEN THOUGH HE, THE LICENSE HOLDER, IS NOT THE PERMIT HOLDER BUT ONLY A SUB—
CONTRACTOR OR CONTRACTOR TO THE PERMIT HOLDER.
2.15.3 THE LICENSE HOLDER SHALL IMMEDIATELY NOTIFY THE BUILDING OFFICIAL IN WRITING OF THE
DISCOVERY OF ANY VIOLATIONS WHICH ARE COVERED BY THE BUILDING PERMIT.
2.15.4 ANY LICENSEE WHO SHALL WILLFULLY VIOLATE SUBSECTIONS 2.15.1, 2.15.2 OR 2.15.3 OR ANY
OTHER SECTION OF THESE RULES AND REGULATIONS AND ANY PROCEDURES, AS AMENDED, SHALL BE SUBJECT
TO REVOCATION OR SUSPENSION OF LICENSE BY THE BOARD.
2.16. ALL BUILDING PERMIT APPLICATIONS SHALL CONTAIN THE NAME, SIGNATURE AND LICENSE NUMBER 0
THE CONSTRUCTION SUPERVISOR WHO IS TO SUPERVISE THOSE PERSONS ENGAGED IN CONSTRUCTION, RECON—
STRUCTION, ALTERATION, REPAIR, REMOVAL OF DEMOLITION AS REGULATED BY SECTION 109.1.1 OF THE
CODE AND THESE RULES AND REGULATIONS. IN THE EVENT THAT SUCH LICENSEE IS NO LONGER SUPERVISI
SAID PERSONS, THE WORK SHALL IMMEDIATELY CEASE UNTIL A SUCCESSOR LICENSE HOLDER IS SUBSTITUTE
ON THE RECORDS OF THE BUILDING DEPARTMENT.
I HAVE READ AND UNDERSTAND MY RESPONSIBILITIES UNDER THE RULES AND REGULATIONS FOR LICENSING
STRUCTION SUPERVISORS IN ACCORDANCE WITH SECTION 109.1.1 OF THE STATE BUILDING CODE. I UNDERS
THE CONSTRUCTION INSPECTION PROCEDURES AND THE SPECIFIC INSPECTION AS CALLED FOR BY THE BUILD
OFFICIAL.
SIGNATURE: 4111Pr
BUILDING OFFI I r ' AL:
TOWN OF YARMOUTH
BOARD OF HEALTH •
ADVISOfY LETTER #25-A
TO: COMMERCIAL/RESIDENTIAL BUILDERS
DISPOSAL WORKS INSTALLERS
FROM: BRUCE MURPHY, HEALTH AGENT
FORREST E. WHITE, BUILDING INSPECTOR
DATE: MARCH 5, 1987
REF: DISPOSAL OF STUMPS & BRUSH FROM BUILDING SITES
NOTE: THIS ADVISORY LETTER SUPERSEDES ADVISORY LETTER #25, DATED AUGUST 23, 1985
ON NOVEMBER 18, 1986 THE BOARD OF SELECTMEN VOTED TO PROHIBIT ALL STUMPS AND BRUSHES
LOADED BY MACHINE FROM BEING PUT INTO THE LANDFILL, EFFECTIVE JANUARY 1, 1987
PLEASE BE ADVISED THAT, AS OF THIS DATE, WHEN APPLYING FOR A BUILDING PERMIT THE
APPLICANT MUST PRESENT AN AUTHORIZED STUMP/BRUSH DISPOSAL RECEIPT INDICATING WHEN
ALL STUMPS AND BRUSH, CLEARED FROM THE LOT(S) , HAVE BEEN DISPOSED OF, AS IT IS NOT •
REQUIRED THAT ALL SUCH MATERIALS MUST BE DISPOSED OF IN ACCORDANCE TO REQUIREMENTS
OF THE DEPARTMENT OF ENVIRONMENTAL QUALITY ENGINEERING (DEQE) , UNDER THE MASSACHUSETTS
GENERAL LAWS: CHAPTER 111 - SECTION 150A.
WITH REGARD TO DISPOSAL SITES, ALL SIGNED DISPOSAL RECEIPTS WILL BE FORWARDED TO THE
HEALTH AGENTS OF EACH RESPECTIVE TOWN, AFTER THE ISSUANCE OF THE BUILDING PERMIT.
AFTER ISSUANCE OF A FOUNDATION PERMIT, AND PRIOR TO OBTAINING A BUILDING PERMIT, THE
SIGNED STUMP/BRUSH DISPOSAL RECEIPT, WHICH INDICATES THE SITE OF DISPOSAL, MUST BE
SUBMITTED TO THE BUILDING INSPECTOR. IF THE APPLICANT DOES NOT HAVE A SIGNED RECEIPT
INDICATING LOCATION OF DISPOSAL, NO BUILDING PERMIT WILL BE ISSUED.
ANY QUESTIONS, RELATIVE TO THE AFOREMENTIONED, MAY BE DIRECTED TO EITHER THE BUILDING
INSPECTOR OR THE HEALTH AGENT.
MAP: PARCEL: 'MI LOADS: . DISPOSAL DAtE(S) : /l' // — /1-30 -1°
CONSTRUCTION SITE:
PRIVATE DWELLING : MULTI-FAMILY: COMMERCIAL: OTHER: '/
” ✓
OWNER OF PROPERTY: roll evAle,'C 4f TELE: /-qq2/-crz.s
NAME OF CONTRACTOR 4At. -C
CLEARING SITE: / / ( TELE: 627-S75454
DISPOSAL SITE FOR STUMPS/BRUSH: fi/,g' -- ,nisc Zilll/Alal(r dg4,Li,<
SIGNATURE OF GATE ATTENDANT AT DISPOSAL SITE • DATE: