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' 'jkatftte eh"Aaa CONSER CATION ,adm All filings must be made on Town of Yarmouth forms found at www.yarmouth.ma.us/325/Conservation. The filing deadline is two weeks prior to the next scheduled Conservation Commission meeting. No new information may be accepted into the Commissioners' packets within the week before a meeting. Failure to follow this Checklist shall result in an Administrative Incomplete Application and will not be advertised for a Public Hearing. Refer to the meeting and fee schedule. Contact the Conservation Office if you need assistance. att �1 original application with original signatures (double sided). A detailed project narrative to include sufficient information to enable the Commission to determine whether the proposed work will alter an area subject to protection (in hardcopy form). BVW delineation sheet(s), coastal bank calculation and other relevant material (in hardcopy form). 1 hardcopy of a Yarmouth Assessor's locator map highlighting parcel(s) where work is proposed, including map and parcel numbers. Assessor's maps can be.found at www.yarmouth.ma.us/70/Assessor .1 original and 7 photocopies of the plan/sketch, folded separately, right side out with title visible. All plans shall reference NAVD1988 unless otherwise noted. Landscape plans shall be detailed to show proposed and existing conditions, native species, size and spacing. A pdf copy of the application, supporting information and plan/sketch emailed to kgrant(c-Dyarmouth.ma.us. Please put the property's street address in the pdf file name. Local filing fee —separate check payable to "Town of Yarmouth". i © Legal ad fee — separate check payable to "Town of Yarmouth". (Refer to Fee Schedule at https://www.yarmouth.ma.us/696/Filing-Forms) A pdf copy of the signed application and plan/sketch must be sent VIA EMAIL to DEP, Southeast Region at SERO NOI(a-)massyov with a subject line showing "YARMOUTH - RDA Street Address - Applicant Name" and copied to kgrant(cDyarmouth.ma.us. We must receive a copy of this email as proof that it has been sent to DEP. Submit a copy of any Certified Mail receipts (PS Form 3800) for others, such as Massachusetts Natural Heritage and Endangered Species Program, Massachusetts Division of Marine Fisheries, etc. Alternatively, you may visit their websites for electronic filing information. If filed electronically, please copy kgrant yarmouth.ma.us. If the applicant is not the property owner: Please submit a signed Site Access Authorization Form; AND The owner must be sent a copy of the application via Certified Mail on the same day it is filed with this office. Please submit a copy of the Certified Mail receipt with application. Yarmouth Conservation Commission - 1146 Route 28 - South Yarmouth, MA 026644492 Tel. (508)-398-2231 Ext. 1288 - Fax (508)-398-0836 - TTD# (508) 398-2231 - kgrant@yarmouth.ma.us Rev. 9/2021 Initial Construction Control Document = To be submitted with the building permit application by a ro ' Registered Design Professional for work per the ninth edition of the 5Y v� Massachusetts State Building Code, 780 CMR, Section 107 Project Title: A Date: t 7-22 Property Address: q ,lA 1 A¢i> P0. 5. mA Project: Check (x) one or both as applicable: New construction Existing Construction Project description: �� rS V. S&-T44 �306? I A MA Registration Number: Expiration date: , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': "chitectural structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information, and belief such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I (or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/ comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the Enter in the space to the right a "wet" or electronic signature and seal: .Fly Phone number: d b7�YWEmail: J f� 1KrS 0SOF% I-T* Building Official Use Only Building Official Name: Permit No.: Date: item 3.) together with pertinent Control Document'. ASS. tJrT Note 1. Indicate with an'a' project design plans, computations and specifications that you prepared or directly supervised. If 'other' is chosen, provide a description. Version 01 01 2018 Important: When filling out forms on the computer, use only the tab key to move your cursor - do not use the return key. raim Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands City/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 A. General Information 1. Applicant: 111 C Name E- ail Address City/Town Phone Number 2. Representative (if any): Firm 'M4, 0(�63 State Zip Code Fax Number (if applicable) Q<o-;;`c ) c ti Mails ress Mdq�l' City/Town / State Zip Code ��� Phone NtimbeC Fax Number (if applicable) B. Determinations I request the Ya,- A 0 U -tk - make the following determination(s). Check any that apply: Conservation Commission ❑ a. whether the area depicted on plan(s) and/or map(s) referenced below is an area subject to jurisdiction of the Wetlands Protection Act. ❑ b. whether the boundaries of resource area(s) depicted on plan(s) and/or map(s) referenced below are accurately delineated. c. whether the work depicted on plan(s) referenced below is subject to the Wetlands Protection Act. d. whether the area and/or work depicted on plan(s) referenced below is subject to the jurisdiction of any municipal wetlands ordinance oi� bylaw of: r11 Name ❑ e. whether the following scope of alternatives is adequate for work in the Riverfront Area as depicted on referenced plan(s). wpaforml.doc • rev. 7/27/2020 WPA Form 1— Request for Determination of Applicability • Page 1 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands City/Town ° WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description 1. a. Project Location (use maps and plans to identify the location of the area subject to this request): Street Addrefs CitylT n Assessors Map/Plat Number Parcel/Lot Number b. Area Description (use additional paper, if necessary): S:k J1\ s,,A,Rc� w �j1 ,- FE+�'R Fiovct 2 /� E l 0 0 o-t L"O- r wed + 0 L'd P'-c sou V c via c. Plan and/or Map Reference(s): Tit L� �'�� c} �� �-_-�-, — ������ - - _— 1 l Title Date Title Date 2. a. Work Description (use additional paper and/or provide plan(s) of work, if necessary): wpaformt_doc • rev. 7/27/2020 WPA Form 1 — Request for Determination of Applicabdfly • Page 2 of 4 Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands L'i WPA Form 1- Request for Determination of Applicability City/Town Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 C. Project Description (cont.) b. Identify provisions of the Wetlands Protection Act or regulations which may exempt the applicant from having to file a Notice of Intent. for all or part of the described work (use additional paper, if necessary). 3. a. If this application is a Request for Determination of Scope of Alternatives for work in the Riverfront Area, indicate the one classification below that best describes the project. ❑ Single family house on a lot recorded on or before 8/1/96 ❑ Single family house on a lot recorded after 8/1/96 ❑ Expansion of an existing structure on a lot recorded after 8/1/96 ❑ Project, other than a single-family house or public project, where the applicant owned the lot before 8/7/96 ❑ New agriculture or aquaculture project ❑ Public project where funds were appropriated prior to 8/7/96 ❑ Project on a lot shown on an approved, definitive subdivision plan where there is a recorded deed restriction limiting total alteration of the Riverfront Area for the entire subdivision ❑ Residential subdivision; institutional, industrial, or commercial project ❑ Municipal project ❑ District, county, state, or federal government project ❑ Project required to evaluate off -site alternatives in more than one municipality in an Environmental Impact Report under MEPA or in an alternatives analysis pursuant to an application for a 404 permit from the U.S. Army Corps of Engineers or 401 Water Quality Certification from the Department of Environmental Protection. b. Provide evidence (e.g., record of date subdivision lot was recorded) supporting the classification above (use additional paper and/or attach appropriate documents, if necessary.) wpaforml.doc • rev. 7/27/2020 WPA Form 1— Request for Determination of Applicability • Page 3 of 4 Massachusetts Department of Environmental Protection -- Bureau of Resource Protection - Wetlands City/Town WPA Form 1- Request for Determination of Applicability Massachusetts Wetlands Protection Act. M.G.L. c. 131, §40 D. Signatures and Submittal Requirements I hereby certify under the penalties of perjury that the foregoing Request for Determination of Applicability and accompanying plans, documents, and supporting data are true and complete to the best of my knowledge. I further certify that the property owner, if different from the applicant, and the appropriate DEP Regional Office were sent a complete copy of this Request (including all appropriate documentation) simultaneously with the submittal of this Request to the Conservation Commission. Failure by the applicant to send copies in a timely manner may result in dismissal of the Request for Determination of Applicability. Name and address of the property owner: Dom_ Name I` City/Town — ' MR . 0a 3 State Zip Code Signatures: I also understand that notification of this Request will be placed in a local newspaper at my expense in accordanq@ with Section 10.05(3)(b)(1) of the Wetlands Protection Act regulations. QP -0 ap-�� ; - a—) — Signature licant Date t< (fttf Signature epresentative if any) Date wpaforml.doc - rev. 7/27/2020 WPA Form 1— Request for Determination of Applicability - Page 4 of 4 OF •Z'A� Conservation Once (O , y Town of Yarmouth kgrant{a_yarmouth.ma.us ` NAT1AC" CS Conservation Commission ' M°yanAt[o'�' Building Permit Sign -off Application TOBEFILLED OUT BY BUILDING PERMIT APPLICANT: Building Site Location: Map # 3 q Lot(s) # 2 7' Property Owner: Dti s) Date filed: 1 - .2 *Applicant: Applicant Address: _� Email: Telephone: Proposed Project Description: / q , L"� ( Is Site Plan Title/Date: 6i) Z C- I .. TO BE FILLED OUT BY CONSERVATION ADMINISTRATOR: Does the proposed project require a permit? Refer to: SE83- or DOA permit Comments from Conservation Commission: Approved Conditionally Approved Rejected Conservation Commission Sign -off Signature: Date: *TO APPLICANT: All work -related debris shall be taken offsite or disposed in a legal upland location. At the end of each day, the area shall be clean and no debris shall be in the Resource Area. If work is permitted under an Order of Conditions, please arrange a pre -construction site visit with the Conservation Administrator. At the time of site visit, the MassDEP File Number sign must be installed, along with the erosion control/work-limit line. A copy of the Order of Conditions must remain on -site during construction. Please refer to the Order of Conditions for further details.