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Q
Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
Ll WPA Form 7 — Extension Permit for Orders of Conditions 242-1093
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 Ranger Development
computer, use
only the tab Name
key to move 65 Fagship Drive
your cursor- Mailing Address
do not use the North Andover MA. 01845
return key. City/Town State Zip Code
2. Property Owner(if different):
Same
Name
rerun
Mailing Address
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:
8/15/01
Date
for work at:
65 Flagship Drive Map 107C Parcel 76
Street Address Assessor's Map/Plat Number Parcel/Lot Number
recorded at the Registry of Deeds for:
Essex North 2400 154
County Book Page
Certificate(if registered land)
is hereby extended until:
8/15/05
Date
i
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):
Date
Issued by:
North Andover
I
Conservation Commission
wpafonn7.doc•rev.12/15/00 Page 1 of 3
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Massachusetts Department of Environmental Protection
DEP File Number:
Bureau of Resource Protection - Wetlands
WPA Form 7 — Extension Permit for Orders of Conditions 242-1093
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
Ll
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 EP Regional Office(see Appe ).
Signatures:
on �/ ' Of u f a0l�y
Day Month an ear
before me personally appeared
04+ MBesse
to me known to be the person described in and who executed the foregoing instrument and acknowledged
that he/she executed the same as his/her free act and deed.
Notary Public My comms
DONNA M.WEDGE
NOTARY PUBLIC .
COMMONWMTH OF MASSACHUSETTS
Comm
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.
wpaform7.doc•rev.12/15/00 Page 2 of 3
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LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1093
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
C. Recording Confirmation (cont.)
To:
Conservation Commission
Please be advised that the Extension Permit to the Order of Conditions for the project at:
242-1093
Project Location DEP File Number
has been recorded at the Registry of Deed 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
theinri
o g al 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
wpaformTdoc-rev,12/15/00 Page 3 of 3
LlMassachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands
WPA Appendix A - DEP Regional Addresses
Massachusetts 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
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 Lancater 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 Royalslon Upton
i
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 NewBedford Rochester Wellfleet
Phone:508-946-2700 Barnstable Eastham Hanover North Attleborough Rockland West Bridgewater
Fax:508-947-6557 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
Andover Chelsea Holbrook Methuen Randolph Walpole Lowell Street,
Arlington Cohasset Hull Middleton Reading Waltham �
Wilmington, MA 01 7
g 88 Ashland Concord Ipswich Millis Revere Watertown
Phone:978-661-7600 Bedford Danvers Lawrence Milton Rockport Wayland
Fax: 978-661-7615 Belmont Dedham Lexington Nahant Rowley Wellesley
Beverly Dover Lincoln Natick Salem Wenham
TDD:978-661-7619 Billerica Dracut Lowell Needham Salisbury West Newbury
Boston Essex Lynn Newbury Saugus Weston
Boxford Everett Lynnfield Newburyport Sherbom 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
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