HomeMy WebLinkAboutMiscellaneous - Old Salem Village�J
Ll)Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1337
( i 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
Key Lime, Inc.
computer, use
Name
only the tab
key to move
1538 Turnpike Street
your cursor -
Mailing Address
do not use the
North Andover
return key.
City/Town
2.
Property Owner (if different):
iemm
Same
Name
Mailing Address
City/Town
B. Authorization
MA 01845
State Zip Code
State
Zip Code
The Order of Conditions (or Extension Permit) issued to the applicant or property owner listed above on
January 11, 2006
Date
for work at:
Old Salem Village Salem Turnpike Route 114 M 1078
Cie Parcel 16 & 73
Street Address Assessor's Map/Plat Number Parcel/Lot Number
recorded at the Registry of Deeds for:
Essex North 10118 281
County Book Page
certuncate pt registered land)
is hereby extended until:
January 11, 2010
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):
Issued by:
North Andover
Conservation Commission
Date
12/4/08
Date
wpaform7.doc • rev. 1/07
Page 1 of 3
F�
Ll'Massachusetts Department of Environmental Protection
Bureau of Resource Protection - Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1337
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
wpaform7.doc • rev. 1/07
U. Authorization (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 (see
http://www.mass.gov/der)/about/region/findvour.htm).
Signatures:
Notary Acknowledgement
Commonwealth of Massachusetts County of
�
On this Day 3 c/
Essex North
Dace
Month Year
Before me, the undersigned Notary Public, personally appeared
t'3.9�J r ii%%C1v�Gf Gc;
Name of Signer
proved to me through satisfactory evidence of identification, which was/were
Massachusetts License
iNuun of eviaence or mentmcation
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
7,1DONNA M. WEDGE
NOTARY PUBLIC
TALTH OF MAS;ANOS-ETT$
m. Expires Aug. 7. 2009 .
North Andover
City/Town
Place notary seal and/or any stamp above
Conservation Commission
Signature of Notary Public
Printed Name of Notary Public
?/nExpires
--2610My Com issi (Date)
Page 2 of 3
L11Massachusetts Department of Environmental Protection
Bureau of Resource Protection -Wetlands DEP File Number:
WPA Form 7 — Extension Permit for Orders of Conditions 242-1337
Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Provided by DEP
G. 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
L,onservation uommission
Please be advised that the Extension Permit to the Order of Conditions for the project at:
Old Salem Village, Salem Turnpike, Route 114 242-1337
Project Location DEP File Number
has been recorded at the Registry of Deeds of:
Essex North
County
for:
Key Lime, Inc.
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
If recorded land the instrument number which identifies this transaction is:
ibuumeni v4umDei
If registered land, the document number which identifies this transaction is:
Document Number
aiynawre orHppucant
Page
wpaform7.doc • rev. 1/07
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