HomeMy WebLinkAboutBuilding Permit #824 - 284 SALEM STREET 6/20/2006_ 110FTN
OF �. °. .
OL - -
TOWN OF'NORTH ANDOVER
_ APPLICATION FOR PLAN EXAMINATION
CHU
APPROVE® Date Received:
Permit NO: I
DateIssued:
I Y w ENNO ORTANT: Applicant must complete all items on this page
_ =LOCATION'
_ Print
PROPERTY � Vb'NER !V( d
Print
MAP NO • PARCEL: 3 ZONING DISTRICT:
I
rvnu A 117Q!U' "V RiT11 nINC HISTORIC DISTRICT VES ❑
TYPE OF IMPROVEMENT
PROPOSED_ USE
��
i'
Residential
Non- Residential
New Building
J One family
OWNER: Name: �j�iU: e.� ��.�}ImK- �
Addition
= Two or more family
Industrial
Alteration
No. of units:
�,rR pair, replacement
C Assessory Bldg
D Commercial
i_. Demolition
Supervisor's Construction. License: Z �%� Exp.
Date: 3' Z q 'O
! P- Mo'x�tng (relocation)'
Other ' L- _ -
C; Others:
Foundation only
Address: Reg. No.
DESCRIPTION OF WORK TO BE FFE ORMED
��
Naf�
Identification Please Type or Print Clearly)�'
OWNER: Name: �j�iU: e.� ��.�}ImK- �
Phone?->�tO
Signature
Z r6
Address: L
CONTRACTOR Name: 1J90 Lb, E'EN
Phone: G4' /' J''Z01
Address: Z 1 tjLw ,, t l �'✓E- 19 "d P SCA WA
Supervisor's Construction. License: Z �%� Exp.
Date: 3' Z q 'O
Home Improvement License: b <j 3 3 Exp.
Date: 'l "
ARC 1-11TEC'T,ENGIN EI',R Name: Phone:
Address: Reg. No.
FEE SCHEDULE: BULDLVG PERAfIT.- $10.00 PER $1000.00 OF THE TOTAL ESTIMATED COST RASED ON
5125.00 PER S.F.
Total Project Cost :$ x10.00 -=FEE:$
Check No.:�(1 __ Receipt No.:FT T-7 1
Location C�) ' Y sa s /
No.Date 0-20-0&
t"/
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ "Z-6, ?--
Foundation Permit Fee $
Other Permit Fee $ ti
TOTAL $
Check # 124L
Building Inspector
KEEN CONSTRUCTION CO.
n 21 HEWITT AVENUE
NORTH ANDOVER. MA 01845
Tel: (978) 691-5201
Fax: (978) 682-3231
PHONE DATE
97q-- 5--31,06
> C/S = Customer Supplied S + I = Supply + Install
We hereby submit specifications and estimates for work to be performed and materials to be used:
/4- ,4
NS 1637
All home improvement contractors and subcontractors
engaged in home improvement contracting, unless
specifically exempt from registration by Provisions of
Chapter 142A of the general laws, must be registered with
the Commonwealth of Massachusetts. Inquiries about
registration and status should be made to the Director,
Home Improvement Contract Registration, One Ashburton
Place, Room 1301, Boston, MA 02108 (617) 727-8598.
Owners who secure their own construction related
permits or deal with unregistered contractors will
be excluded from the Guaranty Fund Provision of
MGL c. 142A.
REGISTRATION NO. F.I.D. NO.
MA. H.I.C. 108383 04-325-8052
.......... ............... _"..- _.... ....... __._�_.' _
ted permits: _
adv! I_r, , 4 -,43 k1A `�.—� �`n � ''�' rX P*i•_ 7` )Cc
t
1-1--A C
.111-1.11.1 ........................
WORKSCHEDULE.............................................................................. ............ ... ............... ....
.Contra r w beg�i.ne �tt�,y� ,work or order the materials before the third day following the signing of this Agreement, unless specified here i wri ' Cont for will begin the work on or
about �—V-6date). Barring delay caused by circumstances beyond Contractor's control, the work will be completed by �, date). The Owner hereby
acknowledges and agrees that the scheduling dates are'appraximate and that such delays that are not avoidable by the Contractor shall not be considered as violations of this Agreement.
WARRANTY
The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period off °` following completion and shall
comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is
discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied,
repaired, or replaced, such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work.
We Propose hereby to furnish material and labor - complete in accordance with above specifications, for the sum of : d
y.r M �' o �:> o at 4,772 OL �- dollars($ Z 6 Z
, 3s L
).
Payment to be ode as follow ,
��o ($ aD0 aj uupon signing Contract; KENNETH B. KEEN
e Name of Contractor / Designated Registrant
% ($ S ) upon completion of /r- #4&: 6DMN --. —21 HEWITT AVE.
D� Street Address
% ($ upon completion of ��•`n P /G ANDOVER, MA 01845
City / State
opo ($ -shall be made forthwith upon (978) 691-5201 (978) 682-3231
completion of work under this contract. Phone Fax
Notice: No agreement for home improvement contracting work shall require a
down payment (advance deposit) of more than one-third of the total contract price Name n! Salesman
or the total amount of all deposits or payments which the contractor must make, in
advance, to order and/or otherwise obtain delivery of special order materials and Aut a i at e
equipment, whichever amount iS greater. Note: his proposal may be withdrawn by us if not accepted within days.
Acceptance of Proposal - I have read both sides of this document and all attached documents and accept the prices, specifications and conditions stated.
I understand that upon signing, this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above.
You, the Buyer, may cancel this transaction at any time prior to midnight of the third business day after the date of
this transaction. Cancellation must be done in writing.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
✓/ze CJanvnaaiuuec� _��aciuusea
BOARD OF BUILDINREGULATIONS
3icqnse,.-CONSTRUCTION SUPERVISORNumber CSS 058245
Iz lies '03/24/2008 Tr. no. 13436
1 . KENNET�BAKEENV� ��x P
21 HEWITT AVE i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Mt.'Office of Investigations
1
�leiv ; 600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): N e e- Ceodn. uCT! D
Address: Z ( t1 E ui
City/State/Zip: j J, d1,Ad6JLrL, Phone #: 9 72 -60/ / -:5 1 a
Are you an employer? Check the appropriate box:
❑ I am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
t. ®'ram a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. workers' comp. insurance.
[No workers' comp. insurance
required.]
❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. remodeling
8. ❑ Demolition
9. ❑ Building addition
10. El Electrical repairs or additions
11. [1 Plumbing repairs or additions
12.❑ Roof repairs
13. ❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. M
Expiration Date:
Job Site Address: 7 '� V �� _ City/State/Zip: jV k p by
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certifyL.!inder the pis and penalties of perjury that the information provided above is true and correct.
Phone #: C? % O �' • j 4
Official use only. Do not write in this area, to be completed by city or town of
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more.than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs'persons fo do maintenance'coristruotion or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be. deemed to be an employer.
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct'buildings in tehcommonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number: y
The Commonwealth of Massachusetts .
Department of Industrial Accidents' `J
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 5-26-05
www.mass.gov/dia
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- Town of North Andover E NTN L
Q St{,L9 6 'YQ
° Office of the Planning Department °A
Community Development and Services Division * s
27 Charles Street
�l �gano �r
North Andover, Massachusetts 01845
Telephone (978) 688-9535
Town Planner Fax (978) 688-9542
Any appeal shall be filed
Within (20) days after the
Date of filing this Notice
In the Office of the Town
Clerk
Notice Of Decision
c�
This is to certify that twenty (20) days
have elapsed from date of decision, filed
without filing of I. =_
Date
Joyce A. Brodshow
Town Clark
Date: September 22, 2004 `
Date of Hearing. Septem1w, 7, 20044
Decision: September 21, 2004
Petition of David Palmer, 284 Salem Street, North Andover, MA 01845
Premises Affected: 284 Salem Street, North Andover, MA 01845
Referring to the above petition for a Watershed Special Permit. The application was
determined to be complete and was noticed and reviewed in accordance with the
procedures for review and approval in accordance with the Rules and Regulations
Governing the Subdivision of Land and M.G.L. Chapter 40-A, sec 11
So as to allow: The re -permitting of reconstruction of a driveway, installation of a storm
water management system, reconstruction of an existing deck and landscaping activities on the
site located within the Non Discharge and Non -Discharge Zones of the Watershed Protection
District.
After a public hearing given on the above date, the
the Watershed Special Permit, based upon the folia
Cc: Applicant
]Engineer
Abutters
DPW
Building Department
Conservation Department
Health Department
ZBA
4in Board voted to APPRO
co ns:
Alberto Angles, Chk1 man
George White, Vice Chairman
Felipe Schwarz, Clerk
John Simons
James Phinney
ATTEST:
A True Copy
. c Y4",e -
BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PI.TMftQ-r4§35
284 Salem Street
Special Permit - Watershed Protection District
The Planning Board makes the following findings regarding the application of David
Palmer, filed on July 19, 2004. The area affected is located at 284 Salem Street in the R-3
Zoning District, Map 37D, Lot 39. The lot was created in 1984 and is subject to the
Watershed Protection District provisions for lots created on or prior to October 24, 1994.
The applicant is requesting a Watershed Special Permit for the re -permitting of
reconstruction of a driveway, installation of a stormwater management system,
reconstruction of an existing deck and landscaping activities on the site. Proposed activities
will be located within the Non -Disturbance and Non -Discharge Zones of the Watershed
Protection District. Public hearings were held on September 7, 2004.
History: The project was previously approved by the North Andover Planning Board,
decision dated December 19, 2001. Activities did not commence within the 2 year permit
period, therefore, the applicant re -filed the project with minor changes.
FINDINGS OF FACT:
In accordance with 4.136 the Planning Board makes the finding that the intent of the Bylaw,
as well as its specific criteria, are met. Specifically the Planning Board finds:
1. That as a result of the proposed construction in conjunction with other uses nearby,
there will not be any significant degradation of the quality or quantity of water in or
entering Lake Cochichewick. The Planning Board bases its findings on the
following facts:
a) The structure is Lied into public sewer.
b) A covenant will be placed in the deed restricting and limiting the types of
fertilizers that can be used on the site.
c) The topography of the site will not be altered substantially.
d) The limit of clearing is restricted to the minimum necessary to construct the
structure and appurtenances. All activities will be conducted in previously
disturbed areas.
e) Buffer zone restoration plantings will be conducted on the property, as required
by the North Andover Conservation Commission.
2. There is no reasonable alternative location outside the Non -Discharge Buffer Zone,
for any discharge, structure or activity, associated with the proposed project.
3. In accordance with Section 10.31 ofthe North Andover Zoning Bylaw, the Planning
Board makes the following findings:
a) The specific site is an appropriate location for the proposed use as all feasible
storm water and erosion controls have been placed on the site;
b) The. use will not adversely affect the neighborhood as the use is accessory to an
existing single family;
c) There will be no nuisance or serious hazard to vehicles or pedestrians;
d) Adequate and appropriate facilities are provided for the proper operation of the
proposed use; stormwater mitigation structures will be installed on site and
maintained in perpetuity;
e) The Planning Board also makes a specific finding that the use is in harmony with
the general purpose and intent of the North Andover Zoning Bylaw.
Upon reaching the above findings, the Planning Board approves this Special Permit based
upon the following conditions:
2) SPECIAL CONDITIONS:
a) This Special Permit is being issued for the proposed activities submitted with this
filing only.
b) This decision must be filed with the North Essex Registry of Deeds. The following
information is included as part of this decision:
• Town of North Andover Planning Board Application for Watershed Special
Permit filed by David Palmer, 284 Salem Street, North Andover, MA;
• Drainage Calculations for Residential Landscaping Improvements at 284
Salem Street, North Andover, MA, prepared by McKenzie Engineering
Group, Inc. dated May 21, 2004;
• Plans entitled:
Plan to Accompany Notice of Intent, Sheets 1-2, prepared by McKenzie
Engineering Group, Inc., dated March 24, 2004, revised August 17, 2004;
d) The Town Planner shall approve any changes made to these plans. Any changes
deemed substantial by the Town Planner would require a public hearing and
modification by the Planning Board.
e) Stormwater management structures must be maintained in perpetuity by the
homeowners and in accordance to the maintenance schedule outlined on Sheet 2 of
the record plans.
3) PRIOR TO ANY WORK ON SITE:
a) A performance guarantee of two thousand dollars ($1,000) in the form of a check
made out to the Town of North .Andover must be posted to insure that construction
will take place in accordance with the plans and the conditions of this decision and
to ensure that the as -built plans will be submitted.
b) The decision must be filed with the North Essex Registry of Deeds. One certified
copy of the recorded decision must be submitted to the Planning Department.
c) Erosion controls as shown on the referenced plan must be installed and must be
reviewed and approved by the Town Planner.
d) The site shall have received all necessary permits and approvals from the North
Andover Conservation Commission, Board of Health, and the Department of Public
Works and be in .compElance with the above permits and approvals.
e) Wetland resource area boundary flags must be in place and reviewed by the Town
Planner.
4) PRIOR TO THE ISSUANCE OF A BUILDING PERMIT:
a) Only organic or slow release lawn or garden products shall be used in lawn care or
maintenance within 325' of Lake Cochichewick or within 325' of wetland resource
areas. The applicant shall incorporate this condition as a deed restriction, and a copy
of the recorded deed shall be submitted to the Town Planner and included in the file.
b) The Planning Board must endorse the final site plan mylars and three copies of
the signed plans must delivered to the Planning Department.
5) PRIOR TO THE RELEASE OF THE PERFORMANCE BOND:
a) The applicant shall submit an as -built plan stamped by a Registered Professional
Engineer or Land Surveyor in Massachusetts that shows all construction, limits of
disturbance, existing topography, storm water mitigation structures and other
pertinent site features. This as -built plan shall be submitted to the Town Planner and
the Department of Public Works for approval. The applicant must submit a written
stamped and signed, certification letter from the design engineer stating that the site
was constructed in accordance with the approved plan, in addition to certification
that the drainage structures have been properly installed. Any and all changes from
the original plans must be clearly identified in the letter.
b) The Planning Board must by a majority vote make a finding that the site is in
conformance with the approved plan.
6) In no instance shall the applicants proposed construction be allowed to further impact
the site than as proposed on the plan referenced in Condition 4e.
?) No open burning shall be done except as is permitted during burning season under the
Fire Department regulations.
8) The Contractor shall contact Dig Safe at least 72 hours prior to commencing excavation.
9) The provisions of this conditional approval shall apply to and be binding upon the
applicant, it's employees and all successors and assigns in interest or control.
10 ) This Special Permit approval shall be deemed to have lapsed September 21, 2006
(two years from the date of issuance) exclusive of the time required to pursue or await
determination of any appeals, unless substantial use or construction has commenced
within said two year period. Substantial use or construction will be determined by a
majority vote of the Planning Board.
cc: Applicant
Engineer
File
J1
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reran
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
A. General Information
From: North Andover
1. Conservation Commission
DEP File Number:
242-1257
2. This issuance is for (check one): ® Order of Conditions ❑ Amended Order of Conditions
3. To: Applicant:
David
Palmer
a. First Name b. Last Name
284 Salem Street
d. Mailing Address
North Andover
e. City/Town
4. Property Owner (if different from applicant):
c. Company
MA.
f. State
01845
g. Zip Code
a. First Name b. Last Name
i
c. Company
d. Mailing Address
e. City/Town
f. State g. Zip Code
5. Project Location:
284 Salem Street
North Andover
a. Street Address
b. City/Town
Map 37D .
Lot 39
c. Assessors Map/Plat Number
d. Parcel/Lot Number
Latitude and Longitude, if known (note:
electronic filers will click for GIS locator):
e. Latitude f. Longitude
6. Property recorded at the. Registry of Deeds for (attach additional information if more than one parcel):
Essex North
a. County
b. Certificate (if registered land)
5808
313
c. Book
d. Page
7. Dates: 5/28/04
6/23/04 7/14/04
a. Date Notice of Intent Filed
b. Date Public Hearing Closed c. Date of Issuance
8. Final Approved Plans and Other Documents (attach additional plan or document references
needed):_
as
Plan to Accompany Notice of Intent- (Sheet 1)/ Construction Details (Sheet 2).
a. Plan Title
-
Bradley C. McKenzie
Bradley C. McKenzie, P. E.
b. Prepared By
c. Signed and Stamped by
6/1/04
1" = 10"
d. Final Revision Date
e. Scale
See attached
f. Additional Plan or Document Title
g. Date
9. Total WPA Fee Paid: $ 82.50
a. Total Fee Paid
b. State Fee Paid c. City/Town Fee Paid
wpaform5.doc • rev.. 7/14/04
Page 1 of 8
Massachusetts Department of Environmental Protection
I Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
B. Findings
�. Findings pursuant to the Massachusetts Wetlands Protection Act:
DEP File Number:
242-1257
Following the review of the above -referenced Notice of Intent and based on the information provided
in this application and presented at the public hearing, this Commission finds that the areas in which
work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that
apply:
a. ® Public Water Supply b. ❑ Land Containing Shellfish c. ® Prevention of Pollution
d. ® Private Water Supply e. ❑ Fisheries f. ® Protection of Wildlife
Habitat
g. ® Groundwater Supply h. IZ Storm Damage Prevention i. ® Flood Control
2. This Commission hereby finds the project, as proposed, is: (check one of the following boxes)
Approved subject to:
® the following conditions which are necessary in accordance with the performance standards set forth
in the wetlands regulations. This Commission orders that all work shall be performed in accordance
with the Notice of Intent referenced above, the following General Conditions, and any other special
conditions attached to this Order. To the extent that the following conditions modify or differ from the
plans, specifications, or other proposals submitted with the Notice of Intent, these conditions shall
control.
Denied because:
❑ the proposed work cannot be conditioned to meet the performance standards set forth in the wetland
regulations. Therefore, work on this project may not go forward unless and until a new Notice of Intent is
submitted which provides measures which are adequate to protect these interests, and a final Order of
Conditions is issued. A description of the performance standards which the proposed work cannot
meet is attached to this Order.
❑ the information submitted by the applicant is not sufficient to describe the site, the work, or the effect
of the work on the interests identified in the Wetlands Protection Act. Therefore, work on this project may
not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information
and includes measures which are adequate to protect the Act's interests, and a final Order of Conditions
is issued. A description of the specific information which is lacking and why it is necessary is
attached to this Order as per 310 CMR 10.05(6)(c).
Inland Resource Area Impacts: Check all that apply below. (For Approvals Only)
Resource Area
3. ❑ Bank
4. ❑ Bordering Vegetated
Wetland
5. ❑ Land Under
Waterbodies and
Waterways
Proposed
Alteration
a. linear feet
a. square feet
a. square feet
e. cu.yd dredged
Permitted Proposed Permitted
Alteration Replacement Replacement
u. linear reel c. linear Teel
U. Z)quare feet c. square reel
b. square feet c. square feet
f. cu.yd dredged
U. 111lu U Ieet
U. aquaie feet
U. squdtC feet
wpaform5.doc • rev. 6/9/04
Page 2 of 8
•
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, X40
b. Findings (cont.)
Resource Area
6. ❑ Bordering Land Subject
to Flooding
Cubic Feet Flood
Storage
7. ❑ Isolated Land Subject
to Flooding
Cubic Feet Flood
Storage
8. ® Riverfront area
Scl ft within 100 ft
Scl ft between 100-200 ft
DEP File_ Number:
242-1257
Proposed
Permitted
Proposed
Permitted
Alteration
Alteration
Replacement
Replacement
a. square feet
b. square feet
c. square feet
d. square feet
e. cubic' feet
f. cubic feet
g. cubic feet
h. cubic feet
a. square feet
b. square feet
c. cubic feet
d. cubic feet
e. cubic feet
f. cubic feet
2,994
2, 994
a. total sq. feet
b. total sq. feet
1,817
1,817
c. square feet
4 777
d. square feet
. »>
Coastal Resource Area Impacts: Check all that apply below. (For Approvals Only)
9. ❑ Designated Port Indicate size under Land Under the Ocean, below
Areas
1o. ❑ Land Under the
Ocean a. square feet b. square feet
11. ❑ Barrier Beaches
12. ❑ Coastal Beaches
13. ❑ Coastal Dunes
14. ❑
Coastal Banks
15. ❑
Rocky Intertidal
a. square feet
Shores
16. ❑
Salt Marshes
17. ❑
Land Under Salt
Ponds
18. ❑ Land Containing
Shellfish
19. ❑ Fish Runs
20. ❑ Land Subject to
Coastal Storm Flowage
Indicate size under Coastal Beaches and/or Coastal Dunes below
a. square feet
b. square feet
c. c/y nourishmt.
d. c/y nourishmt.
a. square feet
b. square feet
c. c/y nourishmt.
d. c/y nourishmt
a. linear feet b. linear feet
a. square feet b. square feet
c. cu.yd dredged d. cu.yd dredged
a. square feet b. square feet c. square feet d. square feet
Indicate size under Coastal Banks, inland Bank, Land Under the
Ocean, and/or inland Land Under Waterbodies and Waterways,
above
a. cu.yd dredged b. cu.yd dredged
wpaform5.doc • rev. 7/14104
Page.3 of 8
•
LAILAMassachusetts Department of Environmental Protection
I
- Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1257
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
C. General Conditions Under Massachusetts Wetlands Protection Act
(only applicable to approved projects)
1. Failure to comply with all conditions stated herein, and with all related statutes and other regulatory
measures, shall be deemed cause to revoke or modify this Order.
2. The 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 *?,14 G Ya$
unless either of the following apply: /c
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. If this Order is intended to be valid for more than three
years, the extension date and the special circumstances warranting the extended time period are
set forth as a special condition in this Order.
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. Any fill shall contain no trash, refuse,
rubbish, or debris, 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. This.Order is not final until all administrative appeal periods from this Order have elapsed, or if such
an appeal has been taken, until all proceedings before the Department have been completed..
8. No work shall be undertaken until the Order has become final and then has been recorded 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, 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 the registered land, the Final Order shall also be noted on the Land Court
Certificate of Title of the owner of the land upon which the proposed work is done. The recording
information shall be submitted tgthis.,Con_servation Commission on the form at the end of this Order,
which form must be stamped by the Registry of Deeds, prior to the commencernent:of work.
9. A sign shall be displayed at the site not less then two square feet or more than three square feet in
size bearing the words,
"Massachusetts Department of Environmental Protection" [or, "MA DEP"] ✓
"File Number 242-1257
wpaform5.doc • rev. 7/14/04
Page 4 of 8
LA
If you need more
space for
additional
conditions,
select box to
attach a text
document
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number:
242-1257
C. General Conditions Under Massachusetts Wetlands Protection Act
10. Where the Department of Environmental Protection is requested to issue a Superseding Order, the
Conservation Commission shall be a parry to all agency proceedings and hearings before DEP.
11. Upon completion of the work described herein, the applicant shall submit a Request for Certificate of
Compliance (WPA Form 8A) to the Conservation Commission.
12. The work shall conform to the plans and special conditions referenced in this order..
13. Any change to the plans identified in Condition #12 above shall require the applicant to inquire of the
Conservation Commission in writing whether the change is significant enough to require the filing of a
new Notice of Intent.
14. The Agent or members of the Conservation Commission and the Department of Environmental
Protection shall have the right to enter and inspect the area subject to this Order at reasonable hours
to evaluate compliance with the conditions stated in this Order, and may require the submittal of any
data deemed necessary by the Conservation Commission or Department for that evaluation.
15. This Order of Conditions shall apply to any successor in interest or successor in control of the
property subject to this Order and to any contractor or other person performing work conditioned by
this Order.
16. Prior to the start of work, and if the project involves work adjacent to a Bordering Vegetated Wetland,
the boundary. of the wetland in the vicinity of the proposed work area shall be marked by wooden
stakes or flagging. Once in place, the wetland boundary markers shall be maintained until a Certificate
of Compliance has been issued by the Conservation Commission.
17. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully
stabilized with vegetation or other means. At no time shall sediments be deposited in a wetland or
water body. During construction, the applicant or his/her designee shall inspect the erosion controls
on a daily basis and shall remove accumulated sediments as needed. The applicant shall immediately
control any erosion problems that occur at the site and shall also immediately notify the Conservation
Commission, which reserves the right to require additional erosion and/or damage prevention controls
it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of
work line has been approved by this Order.
Special Conditions:
See attached
wpaform5.doc • rev. 7/14/04
Page 5 of 8
Massachusetts Department of Environmental Protection
L11
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
DEP File Number:
242-1257
Li. t-indings under Municipal Wetlands Bylaw or Ordinance
Furthermore, the North Andover
hereby finds (check one that applies):
Conservation Commission
2. ❑ that the proposed work cannot be conditioned to meet the standards set forth in a municipal
ordinance or bylaw specifically:
a. Municipal Ordinance or Bylaw b. Citation
Therefore, work on this project may not go forward unless and until a revised Notice of Intent is
submitted which provides measures which are adequate to meet these standards, and a final Order of
Conditions is issued.
3. ® that the following additional conditions are necessary.to comply with a municipal ordinance or
bylaw:
North Andover Wetland Protection Bylaw Chapter 178
a. Municipal Ordinance or Bylaw b. Citation
The Commission orders that all work shall be performed in accordance with the following conditions
and with the Notice of Intent referenced above. To the extent that the following conditions. modify or
differ from the plans, specifications, or other proposals submitted with the Notice of Intent, the
conditions shall control.
If you need more c. The special conditions relating to municipal ordinance or law are as follows:
space for p 9 p y
additional
conditions, See attached
select box to
attach a text
document
E. Issuance
This Order is valid for three years, unless otherwise specified as a special condition pursuant to General
Conditions #4, from the date of issuance.
7/14/04
1. Date of issuance
Please indicate the number of members who will sign this form:
This Order must be signed by a majority of the Conservation Commission. 2. Number of signers
The Order must be mailed by certified mail (return receipt requested) or hand delivered to the applicant. A
copy also must be mailed or hand delivered at the same time to the appropriate Department of
Environmental Protection Regional O Ice, if not filing electronically (see AppendixA , and the property
owner, if different from applicant.
Signatur s:
wpaform5.doc • rev. 7/14/04
Page 6 of 8
Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Form 5 - Order of Conditions
1 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
t. issuance (cont.)
Notary Acknowledgement
Commonwealth of Massachusetts County of
On this q
of
Day
Essex North
DEP File Number:
242-1257
2 OY
Month Year
Before me, the undersigned Notary Public, personally appeared
S(� o 4-f /7Irg sse
Name of Document Signer
proved to me through satisfactory evidence of identification, which'was/were
uescripuon or evioence of iaentitication
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
City/Town
Place notary seal and/or any stamp above
This Order is issued to the applicant as follows:
❑ by hand delivery on
Conservation Commission
ignature of Notary Public
D67A a K %%t -7D Q:r—
Printed Name of Notary Public
DONNA M. WEDGE
NOTARY PLq=
My Commiss ( THIM
i4h ExpYes Atg. 7.2009
® by certified mail, return receipt requested, on
Date Date
t-. Appeals
The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject
to this Order, or any ten residents of the city or town in which such land is located, are hereby notified of
their right to request the appropriate DEP Regional Office to issue a Superseding Order of Conditions.
The request must be made by certified mail or hand delivery to the Department, with the appropriate filing
fee and a completed Appendix E: Request of Departmental Action Fee Transmittal Form, as provided in
310 CMR 10.03(7) within ten business days from the date of issuance of this Order. A copy of the request
shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to
the applicant, if he/she is not the appellant.
The request shall state clearly and concisely the objections to the Order which is being appealed and how
the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands
Protection Act, (M.G.L. c. 131, § 40) and is inconsistent with the wetlands regulations (310 CMR 10.00).
To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts
Wetlands Protection Act or regulations, the Department has no appellate jurisdiction.
wpaform5.doc • rev. 7/14/04
Page 7 of 8
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CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE:1 "=40' DATE.4/11/06
Scott L. Giles R. P. L. S.
Frank. S. Giles R. P. L. S.
50 Deer Meadow Road
North Andover, Mass. A-.
(9
I CERTIFY THAT I OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS
SHOWN COMPLY
WITH THE ZONING
BYLAWS OF
NORTH ANDOVER
WHEN BUILT
OF THE BUILDING INSPECTOR ONLY app
AND SUCH USE IS FOR THE g
DETERMINATION OF ZONING 3972
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CONFORMITY OR NON -CONFORMITY so *AL L
WHEN CONSTRUCTED.
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CERTIFIED PLOT PLAN
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SCALE. -I"=40' DATE:4/11/06
Scott L. Giles R. P. L. S.
Frank. S. Giles R. P. L. S.
50 Deer Meadow Road
North Andover. Mass. /
I CERTIFY THAT I OFFSETS SHOWN ARE FOR THE USE . I
THE OFFSETS
SHOWN COMPLY
WITH THE ZONING
BYLAWS OF
NORTH ANDOVER
WHEN BUILT
OF THE BUILDING INSPECTOR ONLY
AND SUCH USE IS FOR THE
DETERMINATION OF ZONING
CONFORMITY OR NON -CONFORMITY
WHEN CONSTRUCTED.
co
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CERTIFIED PLOT PLAN
LOCATED IN NORTH ANDOVER, MASS.
SCALE. -I"=40' DATE -4/11/06
Scott L. Giles R. P. L. S.
Frank. S. Giles R. P. L. S.
50 Deer Meadow Road
North Andover, Mass.
A --
1 CERTIFY THAT OFFSETS SHOWN ARE FOR THE USE
THE OFFSETS OF THE BUILDING INSPECTOR ONLY
SHOWN COMPLY
WITH THE ZONING
BYLAWS OF
NORTH ANDOVER
WHEN BUILT
AND SUCH USE IS FOR THE K6.
DETERMINATION OF ZONING
CONFORMITY OR NON -CONFORMITY
WHEN CONSTRUCTED.
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r' Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 5 - Order of Conditions 242-1257
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40
G. Recording Information
This Order of Conditions must be recorded 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, the
Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land
subject to the Order. In the case of registered land, this Order shall also be noted on the Land Court
Certificate of Title of the owner of the land subject to the Order of Conditions. The recording information
on Page 7 of this form shall be submitted to the Conservation Commission listed below.
North Andover
Conservation Commission
Detach on dotted line, have stamped by the Registry of Deeds and submit to the Conservation Commission.
---------------------------------------------------------------------------------------------------------------------------
To:
North Andover
Conservation Commission
Please be advised that the Order of Conditions for the Project at:
Z$q- 5aterns 5i
Project Location
242-1257
DEP File Number
Has been recorded at the Registry of Deeds of:
County Book Page
for:
Property Owner
and has been noted in the chain of title of the affected property in:
Book
Page
In accordance with the Order of Conditions issued on:
'7-Iy-04.
Date
If recorded land, the instrument number identifying this transaction is:
Instrument Number
If registered land, the document number identifying this transaction is:
Document Number
� P,
of Applicant
wpaform5.dcc • rev. 7/14/04
Page 8 of 8
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