HomeMy Public PortalAboutWork Notice/Owner Affirmation of Responsibility For Work
Owner affirmation of responsibility for work and
5-day request for site Inspection/notice of work for
Order of Conditions
To:
Brewster Conservation Commission
2198 Main Street
BREWSTER, MA, 02631
_______________
(Date of Request for Site Inspection)
Order of Conditions (SE 9-_______) - Order of Conditions recorded at the Registry of Deeds or
Land Court, Barnstable County on _________________________.
Location of project - Street _______________________ Assessor's Map _____ Parcel_____
I, ____________________________(Contractor), wish to schedule a site visit with an agent of the
Conservation Commission to inspect the siltation barrier for this project. I would like the inspection to take
place at the following date and time: .
The Order was recorded at the Registry of Deeds or Land Court, Barnstable, and proof of recording was
submitted to the Conservation Department for the project file. I understand that work shall commence only
with approval of the Conservation Agent, and that any work activities which have commenced prior to an
inspection and approval by the Conservation Commission may result in a "cease and desist" order and fine of
up to $300.00 per day.
The type of work is __________________________________________.
(dwelling construction, sewage disposal installation, landscape work, etc.)
Included with this request is a series of photos of the existing wetland edge and the installed erosion control
barriers. A copy of the Order of Conditions and the approved site plan are available on the site. This form
shall serve as proof that I have read and understand the terms of this Order of Conditions.
Telephone Number of Contractor _______________________
Signature of Contractor __________________________________
Signature of Owner _____________________________________ This form shall serve as proof that I, the
owner of the above referenced property, have read and understand the terms of this Order of Conditions, and
am responsible for any violation which occurs on this property.
Signature/Initial of Conservation Agent The required erosion controls were installed
according to the plans approved by the Conservation Commission.
Work notification and affirmation of responsibility/site visit/ forms 10/15/07