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Home My WebLink AboutSMOLAK, MARTIN (2) Massachusetts Department of Environmental Protection Bureau of Resource Protection - Wetlands DEP File Number: WPA Form 7 — Extension Permit for Orders of Conditions 242-1114 ' Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. General Information Important: When filling out 1. Applicant: forms on the Meetinghouse Commons, LLC computer, use Name only the tab key to move 121 Carter Field Road your cursor- Mailing Address do not use the North Andover MA. 01845 return key. City/Town State Zip Code t� 2. Property Owner(if different): Martin Smolak Revocable Trust, H. Michael Smolak and Helen R. Smolak Name 315 South Bradford Street Mailing Address North Andover MA. 01845 City/Town State Zip Code B. Finding Information The Order of Conditions(or Extension Permit) issued to the applicant or property owner listed above on: 3/2_8/02 Date for work at: Dale Street/South Bradford Street Map 104C 28 &31 Street Address Assessor's Map/Plat Number Parcel/Lot Number recorded at the Registry of Deeds for: Essex North Instrument# 17053 County Book Page Certificate(if registered land) is hereby extended until: 3/28/07 Date This date can be no more than 3 years from the expiration date of the Order of Conditions or the latest extension. Only unexpired Orders of Conditions or Extension may be extended. Date the Order was last extended (if applicable): 3/28/06 Date Issued by: North Andover Conservation Commission wpaform7.doc•rev.7/14/04 - Page 1 of 3 Massachusetts Department of Environmental Protection DEP File Number: Bureau of Resource Protection - Wetlands AWPA Form 7 — Extension Permit for Orders of Conditions 242-1114 \, Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Finding Information (cont.) This Order of Conditions Extension must be signed by a majority of the Conservation Commission and a copy sent to the applicant and the appropriate DEP Regional Office. Signature ��,,.---- F !t-/ 4 Notary Acknowledgement Commonwealth of Massachusetts County of Essex North -,JA _ X40 On this Day of fie— Day Year Before me, the undersigned Notary Public, personally appeared � �C,+i IMC,5.S Name of Signer proved to me through satisfactory evidence of identification, which was/were Massachusetts License Description of evidence of identification to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he/she signed it voluntarily for its stated purpose. As member of North Andover Conservation Commission City/Town DONNA M.WEDGE NOTARY PUBUC Signature of Notary Public w 101 i t c ,10 i'rcALTH OF MASSACHUSETTS > Expires Aug.7'2009 ��/�/']fi d,� L�`C:�(T, .._ Printed Name of Notary Public Place notary seal and/or any stamp above My Com ssio xpires(Date) wpaform7 doc•rev.7114/04 Page 2 of 3 Massachusetts Department of Environmental Protection DEP File Number: -- Bureau of Resource Protection - Wetlands WPA Form 7 — Extension Permit for Orders of Conditions 242-1114 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP C. Recording Confirmation The applicant shall record this document in accordance with General Condition 8 of the Order of Conditions (see below), complete the form attached to this Extension Permit, have it stamped by the Registry of Deeds, and return it to the Conservation Commission. Note: General Condition 8 of the Order of Conditions requires the applicant, prior to commencement of work, to record the final Order(or in this case, the Extension Permit for the Order of Conditions) in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property. In the case of recorded land,it shall be noted in the Registry's Granter 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, it shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done. Detach page 3 of Form 7 and submit it to the Conservation Commission prior to the expiration of the Order of Conditions subject to this Extension Permit. To: North Andover Conservation Commission Please be advised that the Extension Permit to the Order of Conditions for the project at: 242-1114 Project Location DEP File Number has been recorded at the Registry of Deeds of: County for: Property Owner and has been noted in the chain of title of the affected property in accordance with General Condition 8 of the original Order of Conditions on: Date Book Page If recorded land the instrument number which identifies this transaction is: Instrument Number If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpafcrm7.doc•rev.7114/04 Page 3 of 3 Massachusetts Department of Environmental Protection L11Bureau of Resource Protection - Wetlands DEP Regional AddressesMassachusetts Wetlands Protection Act M.G.L. c. 131, §40 Mail transmittal forms and DEP payments,payable to: Commonwealth of Massachusetts Department of Environmental Protection Box 4062 Boston, MA 02211 DEP Western Region Adams Colrain Hampden Monroe Pittsfield Tyringham 436 Dwight Street Agawam Conway Hancock Montague Plainfield Wales g Alford Cummington Hatfield Monterey Richmond Ware Suite 402 Amherst Dalton Hawley Montgomery Rowe Warwick Springfield,MA 01103 Ashfield Deerfield Heath Monson Russell Washington Phone:413-784-1100 Becket Easthampton Hinsdale Mount Washington Sandisfield Wendell Belchertown East Longmeadow Holland New Ashford Savoy Westfield Fax:413-784-1149 Bernardston Egremont Holyoke New Marlborough Sheffield Westhampton Blandford Erving Huntington New Salem Shelburne West Springfield Brimfield Florida Lanesborough North Adams Shutesbury West Stockbridge Buckland Gill Lee Northampton Southampton Whately Charlemont Goshen Lenox Northfield South Hadley Wilbraham Cheshire Granby Leverett Orange Southwick Williamsburg Chester Granville Leyden Otis Springfield Williamstown Chesterfield Great Barrington Longmeadow Palmer Stockbridge Windsor Chicopee Greenfield Ludlow Pelham Sunderland Worthington Clarksburg Hadley Middlefield Peru Tolland DEP Central Region Acton Charlton Hopkinton Millbury Rutland Uxbridge 627 Main Street Ashburnham Clinton Hubbardston Millville Shirley Warren Ashby Douglas Hudson New Braintree Shrewsbury Webster Worcester,MA 01605 Athol Dudley Holliston Northborough Southborough Westborough Phone: 508-792-7650 Auburn Dunstable Lancaster Northbridge Southbridge West Boylston Fax: 508 792-7621 Ayer East Brookfield Leicester North Brookfield Spencer West Brookfield Barre Fitchburg Leominster Oakham Sterling Westford TDD:508-767-2788 Bellingham Gardner Littleton Oxford Stow Westminster Berlin Grafton Lunenburg Paxton Sturbridge Winchendon Blackstone Groton Marlborough Pepperell Sutton Worcester Bolton Harvard Maynard Petersham Templeton Boxborough Hardwick Medway Phillipston Townsend Boylston Holden Mendon Princeton Tyngsborough Brookfield Hopedale Milford Royalston Upton DEP Southeast Region Abington Dartmouth Freetown Mattapoisett Provincetown Tisbury 20 Riverside Drive Acushnet Dennis Gay Head Middleborough Raynham Truro Attleboro Dighton Gosnold Nantucket Rehoboth Wareham Lakeville, MA 02347 Avon Duxbury Halifax New Bedford Rochester Wellfleei Phone: 508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater Fax: 5Q8-947-6557 Berkley East Bridgewater Hanson Norton Sandwich Westport Bourne Easton Harwich Norwell Scituate West Tisbury TDD: 508-946-2795 Brewster Edgartown Kingston Oak Bluffs Seekonk Whitman Bridgewater Fairhaven Lakeville Orleans Sharon Wrentham Brockton Fall River Mansfield Pembroke Somerset Yarmouth Carver Falmouth Marion Plainville Stoughton Chatham Foxborough Marshfield Plymouth Swansea Chilmark Franklin Mashpee Plympton Taunton DEP Northeast Region Amesbury Chelmsford Hingham Merrimac Quincy Wakefield 1 Winter Street Andover Chelsea Holbrook Methuen Randolph Walpole Arlington Cohasset Hull Middleton Reading Waltham Boston,MA 02108 Ashland Concord Ipswich Millis Revere Watertown Phone:617-654-6500 Bedford Danvers Lawrence Milton Rockport Wayland Fax: 617-556-1049 Belmont Dedham Lexington Nahant Rowley Wellesley Beverly Dover Lincoln Natick Salem Wenham TDD:617-654-6868 Billerica Dracut Lowell Needham Salisbury West Newbury Boston Essex Lynn Newbury Saugus Weston Boxford Everett Lynnfield Newburyport Sherborn Westwood Braintree Framingham Malden Newton Somerville Weymouth Brookline Georgetown Manchester-By-The-Sea Norfolk Stoneham Wilmington Burlington Gloucester Marblehead North Andover Sudbury Winchester Cambridge Groveland Medfield North Reading Swampscott Winthrop Canton Hamilton Medford Norwood Tewksbury Woburn Carlisle Haverhill Melrose Peabody Topsfield wpaform7.doc•DEP Addresses•rev.2/16/06 Page 1 of 1