EOEEA-CZM

THE COMMONWEALTH OF MASSACHUSETTS
BOARD OF UNDERWATER ARCHAEOLOGICAL RESOURCES
100 Cambridge Street, Suite 900, Boston, MA 02114

SPECIAL USE PERMIT APPLICATION

In accordance with 312 CMR 2, rules and regulations established by the Board of Underwater Archaeological Resources under MGL C. 91, s. 63, as amended, the undersigned herewith makes application for a permit to conduct archaeological research activities to identify and/or examine underwater archaeological resources located within the inland and coastal waters of the Commonwealth.

Permit Type(Required)

Initial Permit

Permit Renewal

Name(s):(Required)

(Enter first and last names of applicants.)

Organization:(Required)

(Applicant must be a qualified archaeologist or archaeological organization meeting the minimum qualifications under 312 CMR 2.09(4)(d); if multiple applicants, provide information for all parties and each must sign. If a corporation, include a copy of the certificate of incorporation with this application, and write both corporate name and contact information.)

Enter organization affilaition of applicants

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Number:(Required)

Email Address:(Required)

Project Name:(Required)

LOCATION OF PROPOSED ACTIVITY

Nearest City or Town:(Required)

Name of Water Body:(Required)

Depth of Water (in feet):(Required)

Total Acreage of the Project Area:(Required)

Longitude and Latitude of Proposed Project Area (Project area of potential effect):

NE:(Required)

NW:(Required)

SE:(Required)

SW:(Required)

Description of Proposed Permit Area (Narrative):(Required)

Please attach a copy of the section of the NOAA nautical chart(s) or USGS topographic map(s).
(Clearly indicate the exact location and extent of the requested permit area on an attached NOAA nautical chart or USGS topographic Map, specifying marker buoys, longitude and latitude, loran bearings and/or any other identifying features which define the requested Permit area. Use the space provided or attach additional sheets at end of this form, if necessary, to complete this section.)

Project Proponent (if not applicant):

Contact Name/Organization:(Required)

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Telephone Number:(Required)

Email Address:(Required)

Project Description, Which Includes the Purpose and Goals:(Required)

(Attach addtional sheets as needed or email to david.s.robinson@mass.gov. Attachment tool at end of this form.)

Description of an Known Underwater Archaeological Resources in the Project Area:(Required)

PLEASE INDICATE THE TYPE OF INVESTIGATION BEING UNDERTAKEN FOR THIS PROJECT (check one):(Required)

Reconnaissance Survey

Intensive Survey

Site Examination

Data Recovery

Please Attach a Copy of Your Research Design and Describe in as Much Detail as Possible What You Plan To Do, Including Documentary Research, Remote Sensing, On-Site Activities, Including Testing, Excavation, Resource Recovery, Conservation, Curation, etc.: (Attach additional sheets as needed at end of this form.)(Required)

(This work plan should include, but not be limited to, a description of: 1) the plans to document activities and finds; 2) the inventory and catalogue, which shall be maintained for all recovered artifacts; 3) the artifact conservation program; and 4) the artifact repository)

What is Your Proposed Work Schedule?:(Required)

(Attach additional sheets as needed at the end of this form.)

Professional Qualifications of Applicant: 1) on a Separate Sheet, Provide a Personnel or Organization Chart Indicating the Names, Duties, and Responsibilities of Key Personnel; 2) Include Copies of the Curricula Vitae/Resumes for the Project Director/Principal Investigator, Project Archaeologist,, and Other Key Staff, as Necessary.
(Attach additional items as needed at the end of this form.)

What are Your Public Benefit Plans, Such as Public Displays, Public Presentations, and/or Publication of the Results of Your Work?:(Required)

(Attach additional items as needed at the end of this form.)

You May Include any Other Information You Believe May Assist the Board in Assessing Your Application:(Required)

(Attach additional items as needed at the end of this form.)

Principal Investigator/Project Director:(Required)

First Last

Signature:(Required)

Type your name

Date:(Required)

Enter date of signature

Project Archaeologist:(Required)

First Last

Signature:(Required)

Type your name

Date:(Required)

Enter date of signature

Attach additional pages, photos, etc. here, if necessary: (The maximum total of all files uploaded to this form must be less than 20 MB.)

Drop files here or

Max. file size: 20 MB.