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Home My WebLink AboutMiscellaneous - 66 JAY ROAD 4/30/2018 (4) " a �7 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B - Certificate of Compliance 242-1477 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP A. Project Information Important: When filling out 1. This Certificate of Compliance is issued to: forms on the computer, use Carlo Alpuerto only the tab key Name to move your 66 Jay Road cursor-do not use the return Mailing Address key. North Andover MA 01845 City/Town State Zip Code 2. This Certificate of Compliance is issued for work regulated by a final Order of Conditions issued to: Carlo Alpuerto '8d0' Name June 16, 2010 242-1477 Dated DEP File Number 3. The project site is.located at: 66 Jay Road North Andover Street Address City/Town Map 98A Parcel 58 Assessors Map/Plat Number Parcel/Lot Number the final Order of,Condition was recorded at the Registry of Deeds for: Property Owner(if different) Essex North 12075 87 County Book Page Certificate 4. A site inspection was made in the presence of the applicant, or the applicant's agent, on: Date wpafrm8b.doc-rev.12/23/09 WPA Form 86,Certificate of Compliance-Page 1 of 3 Massachusetts Department of Environmental Protection ILIBureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1477 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP B. Certification Check all that apply: ® Complete Certification: It is hereby certified that the work regulated by the above-referenced Order of Conditions has been satisfactorily completed. ❑ Partial Certification: It is hereby certified that only the following portions of work regulated by the above-referenced Order of Conditions have been satisfactorily completed.The project areas or work subject to this partial certification that have . been completed and are released from this Order are: ❑ Invalid Order of Conditions: It is hereby certified that the work regulated by the above-referenced Order of Conditions never commenced. The Order of Conditions has lapsed and is therefore no longer valid. No future work subject to regulation under the Wetlands Protection Act may commence without filing a new Notice of Intent and receiving a new Order of Conditions. ® Ongoing Conditions: The following conditions of the Order shall continue: (Include any conditions contained in the Final Order, such as maintenance or monitoring, that should continue for a longer period). Condition Numbers: 74 C. Authorization Issued by: North Andover 1q116 Conservation Commission Date of Issuance This Certificate must be signed by a majority of the Consation Commission and a copy sent to the applicant and appropriate DEP Regiona ffice(See http://www.mass.gov/dep/about/region/findyour.htm). Signature : I wpafrm8b.doc•rev.12/23/09 WPA Form 86,Certificate of Compliance•Page 2 of 3 LlMassachusetts Department of Environmental Protection Bureau of Resource Protection -Wetlands DEP File Number: WPA Form 8B — Certificate of Compliance 242-1477 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP D. Recording Confirmation The applicant is responsible for ensuring that this Certificate of Compliance is recorded in the Registry of Deeds or the Land Court for the district in which the land is located. Detach on dotted line and submit to the Conservation Commission. To: --------------------------------------------------------------------------------------------------- North Andover Conservation Commission Please be advised that the Certificate of Compliance for the project at: 66 Jay Road 242-1477 Project Location DEP File Number Has been recorded at the Registry of Deeds of: Essex North County for: Carlo Alpuerto Property Owner and has been noted in the chain of title of the affected property on: Date Book Page If recorded land, the instrument number which identifies this transaction is: i h If registered land, the document number which identifies this transaction is: Document Number Signature of Applicant wpafrm8b.doc rev.12/23/09 WPA Form 86,Certificate of Compliance•Page 3 of 3 z FORM U - LOT RELEASE FORM POO INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from � This does not relieve 'n s Boards and Departments having jurisdiction have been obtained. Th the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION*********""`�'* "'**"`��`"`�` APPLICANT C V PHONE b?S' LOCATION: Assessor's Map Number PARCEL SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONLY** R MMENDATIONS F TOWN AGENTS: ONSERVATION ADMINI RATOR DATE APPROVED DATE REJECTED �?s O COMMENTMc 44� r i � V l �'1 TOWN PLANNER — COMMENTS C � Yfzv- 3 I s; M, FOOD INSPECTOR-HEALTH SEPTIC INSPECTOR-HEALTH COMMENTS PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm FORM U - LOT RELEASE FORM POO INSTRUCTIONS: This form is used to verify that all necessary approvals/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and/or landowner from compliance with any applicable or requirements. *****************************APPLICANT FILLS OUT THIS SECTION**********************'` APPLICANT C- 15 VLh ,-.3 PHONE LOCATION: Assessors Map Number A PARCEL Jar S SUBDIVISION LOT (S) STREET ST. NUMBER OFFICIAL USE ONLY %ONSERVATION MENDATIONS F TOWN AGENTS: ADMINI RATOR DATE APPROVED DATE REJECTED O COMMENTS A)02 L h TOWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT RECEIVED BY BUILDING INSPECTOR DATE Revised 9197 jm SECTION 4-WORKERS COMPENSATION(KG.L.C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide thisZdavitwill ry in the denial of the issuance of the building it. Si ned affidavit Attached Yes.......❑ No.......C SECTION 5 Description otProposed Work cbeelcall. bk New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) ❑ Tdditi on ❑ Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: o L SECTION 6-ESTIMATED CONSTRUCTION COSTS ` Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed b 't applicant 1. Building (a) Building Permit Fee Af Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbing Building Permit fee(a)x(b) 4 Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN -OWWIRS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner/Authorized Agent of subject property Here y authorize to act on My behalf,in all matters relative to work authorized by this building permit application. Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION 1 as Owner/Authorized Agent of subject property Herebv declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name Si ature of Owner/Agent Date NO, OF STORES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIMBERS iST2NU3 RD SPAN DIMENSIONS OF SILLS DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHMEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE