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Miscellaneous - 185 INGALLS STREET 4/30/2018
V -V -----f AIML 19 0 W"Pl Safety Insurance Fonn ,of Notice of Casualty Loss to Building ` Under MASS. GEN: LAWS, Ch.'. 139, Sec: 3B To: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectman City Hall City Hall N ANDOVER, MA 01845 N ANDOVER, MA 01845 RE: Insured: FRANK'T BOWMAl and TERI BOWMAN` Property Address: 185 INGALLS ST, N ANDOVER, MA Policy Number: HMA 0125623 Claim Number: BOS00040425 Date of Loss: 12/9/2013 Company: Safety Indemnity Insurance Company Claim has been made,involying loss, damage or destruction of the above -captioned property, which may either exceed $1,000.00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicA6.1. I If any notice under Mass. Gen. Laws, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer and include a reference to the captioned insured, location, policy number, date of loss and claim number. Allan Leavitt Claim Examiner 12/11/2013 Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone:'(617)`951-0600 EXT321-3 Fax.!'(617) 531=8891 Email: `AllanLeavittASafetyInsurance com Location 5 _ qc�// -5 S No. —05-06 Date NOeTq TOWN OF NORTH ANDOVER Of .■o ,�1p0 • OL ..ips A Certificate of Occupancy $ C�9 "<Buildin /Frame Permit Fee $ ALL_ sE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 89 Check #. 15447 Ald r64 / � IBuilding Inspector W1 H ANDOVER j il,'DING DEPARTMENT N'TO CONS: RUCT REPAIR, R19NO ATE, OR DEMOLISH . A ONE OR TWO FAMILY DW ELLING 021, PERhLT NUMBER: , �� � DATE ISSUED: A / SIGNATURE: 69 Building Commissioner/I for of Buildings Date SECTION 1- SITE INFORMATION 1.1 PropertAddress:" I [tel 1.2 Assessors Map and Parcel Map Number Number: Parcel Number 1.3. Zoning Information: _ �1 Zoning District Proposed Use 1.4 Property Dimensions: Lot Are6 (so Fronto ft 1.6 BUILDING SETBACKS ft Front Yard, . - - _ Side -Yard Rear Yard Required Provide Re4iircd `'' Provided Regred Provided 1.7 Water Supply M.G.LC.40. 54) Public ❑ Private Zone 1. Flood ood Zona Infounalion: Outside Flood Zone 0 \ 1.8 Municipal Sewerage Disposal System: 0 On Site Disposal System SECTION 2 - PROPERTY OWNERSILIP/AUTHORIZED AGENT 1.1 Vw�ner of Record c� 1 Y�tirt 20 X_j yl A n Name (Print) AddressforService !Jz 5�j Signature Telephone 2.2 Owner of Record: Name Print 0 Address for Service: wgriature Telephone SECTION 3 - CONSTRUCTION SERVICES 311 Licensed Construction Supervisor: Not Applicable 0 - r.1BSe Licensed Construct' Su rvisor. CS 'O 6 S s 70 License Ndmber � � 'S� _•: �-mac Lam. t.� :.:.. , Address',,,r. Expiration D e Signature Telephone 3.2 Regist ed Home Improvement Contractor Not Applicable 0 Company Name { Registration Number Add ss 1 It d Lr S i S Expiration D e 3i n to Tele hone 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 this affidavit will result in the denial of the issuance of the tuil'ngpermit. Signed affidavit Attached Yes ..... X No ....... ❑ SECTION 5 Descri tion of Proposed Work check an applicable) New Construction ❑ Existing Building Q Repair(s) ❑ Alterations(s) ❑ Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: X G4-ea1 1`2Ac /�.S �v rbo wt 1'�Cs V SECTION 6 - ESTIMATED CONSTRUCTION COSTS' Item Estimated Cost (Dollar) to bez Completed by permit applicant I . Building (a) Building Permit Fee Multiplier 2 Electrical Ij 700 µ .. (b) Esturiated. Total Cost of k -co on 3 Plumbing OD Building Permit fee tel x tnl 4 ', Mechanical HVAC 5 Fire Protection 6 Total 1+2+3+4+5 , �" D O Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT L (,A L �v i�r"�'41 as Owner/Authorized Agent of subject property S ' rC', Hereby authorize �l r; I �^ v LC4R act on My,br_half, in all matters_telative work authorized by this building permit application. St ture of Owner Date SECTIO 7b OWNEIPJAUTH2EWED AGENT DECLARATION as Owner/Authorized Agent of subject opeereb H de are that the statements and information on the for oing application are true and accurate, -to the best of my knowledge and be i Print Ame /<�% �L > �i D 6 Signaof er/A ent Date Jim imam= NO. 'OF STORIES SIZE > a ;< BAS NT OR SLAB s RD SIZE OF FLOOR TINMERS 1 -a x/ O 2 3 SPAN �- DIMENSIONS OF SILLS X G DIMENSIONS OF POSTS DIMENSIONS OF GIRDERS HEIGHT OF FOUNDATION ''/ ' ( THICKNESS l7 SIZE OF FOOTING f X MATERIAL OF CHIMNEY IS BUILDING ON SOLID OR FILLED LAND f'ait IS BUILDING CONNECTED TO NATURAL.GAS LINE N 6 =' FORM - U I LOT RELEASE FORM OT14 �►� �2'^ SutirwZ -k '� 4pAvs« a INSTRUCTIONS: This form is used to verify that all -necessary approval / permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT J D Y✓l PHONE 41 I F c/o 9S' ZlI SJ ASSESSORS MAP NUMBER M 10S' 7, LOT NUMBER SUBDIVISION LOT NUMBER STREET n c�rz I I S STREET NUMBER OFFICIAL USE ONLY ........■........■. .......... WEN . was ...,.......a..■r....,,:......■.J,...man .....u...■ RECOMVIEND ATIONS TOWN AGENTS _�_ Zz/;� V� DATE APPROVED CONSFXVATTON AD TOR DATE REJECTED DATE APPROVED TOWN PLANNER COMMENTS FOO INSPECT'OR - HEALTH 4,( v' 1� 3 t,� SEPTIC INSPECTOR - HEALTH DATE REJECTED DATE APPROVED DATE REJECTS. D DATE APPROVED G /tit, DATE RECTED COMMENTS � "f" ��/ �. (�'V JEO S - C✓ / /,P,.t_ 1 H4 < — PUBLIC WORKS - SEWER / WATER CONNECTIONS DRIVEWAY PERMIT FIRE DEPARTMENT DATE APPROVED DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE U) M C m m 0 v y d C � CA CO) � O c� z CO) Cc) �• o = = y > CO 110 O 0 0 o CD p CD o CL c� d CD CCD O C��D C CD y dv y �• O S v y O 1 z CD o CD O CD C �E�o d 2 �• CA O Q 0 FL" o5CD CO) =:tm 0 m cli 0 H Q G n m Z ?-O H •-4 =r m a�M = y m O m y p OCD CA m m a -0to cn so n oticCA L :� r C� a. nom RCL��` 3 o?? ►� Cn oc CD : V1 CD • OO O N _ N O d d G'i .� - Ju a 0 erg+. cn N ` y :� O V1 o u4 0= CD, u a 0 �h Z � ? OcoCD o � co Cl) a � � o m � R An oq 1 C3 C=Ile CL's O' c -)F'• ' o � CO) O CD N �1 O o=+ 7 b m G ov I'd w o C ov Cil Ot w G b Go b m C a- G p- 0 G� C7 d CA O x 071 y o � � M F y 0 0 c Y t „ao_. +._ s.� �.. a s. r►. w � \..� cr�s.-A'c'o R' M NEW ENGLAND ENGINEERING SERVICES INC October 13, 2001 Tom Bowman 185 Ingles Street North Andover, MA 01845 Re: Title 5 inspection: 185 Ingles Street, North Andover, MA. Dear Mr. Bowman: Enclosed is your original copy of the Title V report for your property referenced above. The report shows that -the systemap ssed the inspection. A copy of this report has been sent to the town. If there are any questions regarding the report, please call me at my office, 686-1768. Sincerely, Benja m C. Osgood Jr. I.T. President 60 BEECHWOOD DRIVE - NORTH. ANDOVER, MA 01845 - (978) 686-1768 - (888) 359-7645 - FAX (978) 685-1099 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Boston, Mass. 02111 Workers' Compensation Insurance Affidavit Print Location: am a homeowner performing all work myself Ot am a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. Company name: Josue o� �I�100y,C- e1 W wc� Failure to secure coverage as required under section 25A or MCL 152 can lead to the Imposition and/or one years' imprisonment as well as civil penalties in the form of a STOP WORK Ol2DEf2 and a fine ofp$100 t� otafla daenalties ns up to $1,SOO.pp understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage veri ication against me. 1 do herby certify un er the pal and .7/Nes perjury Met the information provident above is true and correct Signature ,, G j% Print name__I_1 -4 o se Official use only do not write in this area to be completed by city or town official []Check if irnmediate response is required Building Dept Contact person. Phone #. '4 WORKMAN'S COMPENSATION 0 Building Dept p nsing Board El Selectman's office ` I] Health Department Other D. Robert Nieetta, Building Co"Imissieller TOWN 9'i N F NORTH ADOVE: Office of the .Budding Department Commin ty Development and Senices 27 Charles Street North Andover, Massachusetts 19.1845 DEBRIS DISPOSAL FORM Telephone (978) 688-9545 FAX (9', 8) 688-9542 In accordance with the provisions of MGL c 40 s 54, and as'a condition of building permit # the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, .s 150a. The debris will be disposed of at / in: '71� r4 (Site location) permit Michael McGuire, Local Building Inspector James Decola, Electrical Inspector James Diozzi, Gas/Plumbing Inspector vir.(y— t]N�Jc^ qr Zv�Os ` I�pyT. �?t.Y - ,-AvOC. - - Tom. •`� wxa _.I�� ' a ' r¢ ..ero -rri!r �tooe2 2 � 1!0° O'e' Pzai kdh- 3t-fr46proms 1-T ,l P dk U-0 � g PHIL . d,�►v_,5 Vzo 4tr�l: HnY� . Ziiyl� o�► TCG�C I i, �� DC C- j -2x6 PT St�t Silt sc"I LL ho �3�iTs lI 1© roVOh �(` ` —) r BOISE CASCADE - BC CALCTm 2001a DESIGN REPORT - US Monday, March 18, 200211:01 File Triple -1 314" x 18" V -L DF 2800 Name: g®r',✓'/o/my, Untitled Job Name - Customer - Address - Specifier - Designer - HANK MARTINEAU City, State, Zip - Company: - PELHAM BUILDING SUPPLY Code Reports - ICBO 5663, NER 442 Misc: - "-10 12 BO 95 lbs LL 5259 lbs DL General Data ID Version: US Imperial Member Type: - Roof Beam Number of Spans - 1 Left Cantilever - No Right Cantilever - No Slope Tributary Repetitive Construction Type Live Load Dead Load Part Load Duration 0/12 12-00.00 n/a n/a 42 PSF 15 PSF 0 PSF 115 Disclosure The completeness and accuracy of the input must be verified by anyone who would rely on the output as evidence of suitability for a particular application. The output above is based upon building code -accepted design properties and analysis methods. Installation of Boise Cascade engineered wood products must be in accordance with the current Installation Guide and the applicable building codes. To obtain an Installation Guide or if you have any questions, please call (800)232-0788 before beginning product installation. Total Horizontal Load Summary ID Description S Standard 1 2nd fllor load 2 outside wall 3 attic light storage 4 roof from addition Controls Summary Control Type Value -18-00-00 61 9504 lbs 5259 lbs Load Type Ref. Start End Live Dead Trib. Dur. Unf.Area Load Left 00-00-00 18-00-00 42 PSF 15 PSF 12-00-00 115 Unf.Lin. Load Left ' 00-00-00 18-00-00 180 PLF 60 PLF n/a 100 Unf.Lin. Load Left 00-00-00 18-00-00 0 PLF 80 PLF n/a 100 Unf.Lin. Load Left 00-00-00 18-00-00 120 PLF 60 PLF n/a 115 Unf.Lin. Load Left 00-00-00 18-00-00 252 PLF 180 PLF n/a 115 Moment 66431 ft -lbs End Shear 12302 lbs Total Deflection 0284 (0.759") Live Deflection U441 (0.489") Max. Defl. 0.759" (Limit: 1") Span/Depth 12.0 % Allowable Duration 91.4% @ 115% 59.6% @ 115% 63.3% 54.3% 75.9% Bearina Suaaorts Name Type Dim. (L x W) BO Wall/Plate 3-1/2" x 5-1/4" B1 wall/plate 3-1/2" x 641,C' (CAUTIONS: Bearing BO cannot support a load of 14763 lbs. Bearing B1 cannot support a load of 14763 lbs. Loadcase Span Location 3 1 - Internal 3 1 -Left 3 1 3 1 3 1 1 Value % Allowed Case Material 14763 lbs 189.0% 3 Spruce -Pine -Fir 14763 lbs 189.0% 3 Spruce -Pine -Fir NOTES: Design meets Code minimum (U180) Total load deflection criteria. Design meets Code minimum (U240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Member Slope = 0, consider drainage. Page 1 of 1 BCIS and Versa -Lam® are registered trademarks of Boise Cascade Corp. MECcheck Compliance Report Massachusetts Energy Code MECcheck Software Version 3.2 Release Ia TITLE: Bowman CITY: North Andover STATE: Massachusetts HDD: 6322 CONSTRUCTION TYPE: 1 or 2 Family, Detached HEATING SYSTEM TYPE: Other (Non -Electric Resistance) DATE: 03/15/02 DATE OF PLANS: 3/13/02 PROJECT INFORMATION: Addition to existing single family home COMPANY INFORMATION: Moore Const NOTES: 14x12 sunroom not heated COMPLIANCE: Passes Maximum UA = 58 Your Home = 57 1.7% Better Than Code Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R -Value R -Value U -Factor UA Ceiling 1: Flat Ceiling or Scissor Truss 216 38.0 0.0 6 Wall 1: Wood Frame, 16" o.c. 336 13.0 0.0 22 Window 1: Wood Frame, Double Pane with Low -E 41 0.350 14 Door 1: Glass 22 0.350 8 Floor 2: All -Wood Joist/Truss, Over Unconditioned Space 216 30.0 0.0 7 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building -plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the Massachusetts Energy Code requirements in MECcheck Version 3.2 Release Ia. The heating load for this building, and the cooling load if appropriate, has been determined using the applicable Standard Design Conditions found in the Code. The HVAC equipment selected to heat or cool the building shall be no greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Builder/Designer Date MECcheck Inspection Checklist Massachusetts Energy Code MECcheck Software Version 3.2 Release la DATE: 03/15/02 TITLE: Bowman Bldg. Dept. Use Ceilings: [ ] I 1. Ceiling 1: Flat Ceiling or Scissor Truss, R-38.0 cavity insulation Comments: I Above -Grade Walls: [ ] I 1. Wall l: Wood Frame, 16" o.c., R-13.0 cavity insulation Comments: I Windows: [ ] I 1. Window 1: Wood Frame, Double Pane with Low -E, U -factor: 0.350 For windows without labeled U -factors, describe features: # Panes Frame Type Thermal Break? [ ] Yes [ ] No I Comments: Doors: [ ] I 1. Door 1: Glass, U -factor: 0.350 # Panes Frame Type Thermal Break? [ ] Yes [ ] No Comments: I Floors: [ ] I 1. Floor 2: All -Wood Joist/Truss, Over Unconditioned Space, R-30.0 cavity insulation I Comments: Air Leakage: [ ] I Joints, penetrations, and all other such openings in the building envelope that are sources of air leakage must be sealed. [ ] I When installed in the building envelope, recessed lighting fixtures shall meet one of the following requirements: 1. Type IC rated, manufactured with no penetrations between the inside of the recessed fixture and ceiling cavity and sealed or gasketed to prevent air leakage into the unconditioned space. 2. Type IC rated, in accordance with Standard ASTM E 283, with no more than 2.0 cfm (0.944 L/s) air movement from the the conditioned space to the ceiling cavity. The lighting fixture shall have been tested at 75 PA or 1.57 lbs/ft2 pressure difference and shall be labeled. I Vapor Retarder: [ ] I Required on the warm -in -winter side of all non -vented framed ceilings, walls, and floors. Materials Identification: [ ] I Materials and equipment must be identified so that compliance can be determined. [ ] I Manufacturer manuals for all installed heating and cooling equipment and service water heating ' equipment must be provided. [ ] I Insulation R -values and glazing U -values must be clearly marked on the building plans or specifications. Duct Insulation: [ ] Ducts shall be insulated per Table J4.4.7.1. Duct Construction: [ ] All accessible joints, seams, and connections of supply and return ductwork located outside conditioned space, including stud bays or joist cavities/spaces used to transport air, shall be sealed using mastic and fibrous backing tape installed according to the manufacturer's installation instructions. Mesh tape may be omitted where gaps are less than 1/8 inch. Duct tape is not permitted. [ ] The HVAC system must provide a means for balancing air and water systems. Temperature Controls: [ ] Thermostats are required for each separate HVAC system. A manual or automatic means to partially restrict or shut off the heating and/or cooling input to each zone or floor shall be provided. Heating and Cooling Equipment Sizing: [ ] Rated output capacity of the heating/cooling system is not greater than 125% of the design load as specified in Sections 780CMR 1310 and J4.4. Circulating Hot Water Systems: [ ] Insulate circulating hot water pipes to the levels in Table 1. Swimming Pools: [ ] All heated swimming pools must have an on/off heater switch and require a cover unless over 20% of the heating energy is from non-depletable sources. Pool pumps require a time clock. Heating and Cooling Piping Insulation: [ ] HVAC piping conveying fluids above 120 OF or chilled fluids below 55 °F must be insulated to the I levels in Table 2. Table 1: Minimum Insulation Thickness for Circulating Hot Water Pipes. Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pining; System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 Insulation Thickness in Inches by Pipe Sizes Heated Water Non -Circulating Runouts Circulating; Mains and Runouts Temperature ( F) Up to 1„ Up to 1.25" 1.5" to 2.0" Over 2" 170-180 0.5 1.0 1.5 2.0 140-160 0.5 0.5 1.0 1.5 100-130 0.5 0.5 0.5 1.0 Table 2: Minimum Insulation Thickness for HVAC Pipes. Fluid Temp. Insulation Thickness in Inches by Pipe Sizes Pining; System Types Range F 2" Runouts 1" and Less 1.25" to 2" 2.5" to 4" Heating Systems Low Pressure/Temperature 201-250 1.0 1.5 1.5 2.0 Low Temperature 120-200 0.5 1.0 1.0 1.5 Steam Condensate (for feed water) Any 1.0 1.0 1.5 2.0 Cooling Systems Chilled Water, Refrigerant, 40-55 0.5 0.5 0.75 1.0 and Brine Below 40 1.0 1.0 1.5 1.5 NOTES TO FIELD (Building Department Use Only) ' Numbep CS 005370 4Birthdate= bW411953 f Ex -Mit": 651-14Y202 Tr. t1b: 241.44 ✓le �aavno.ur o�✓Liamac/uiaela Board of Building Regulations and Standards se, HOME IMPROVEMENT CONTRACTOR Registration. 124604 Expiration 07/24/2003 Type Individual. MOORE CONSTRUCTION JOSEPH MOORS 11 GARLAND LNC' PELHAM, NH 03076 Administrator o rj i y f. k t �, f. S; � �:, � ;:t �� i,, j &19)(.0 -IC mw r i?M —.O—,Bt------- w0 4 X r0 ;c H k U.S. DEPARTMENT OF HOMELAND SECURITY -FEDERAL EMERGENCY MANAGEMENT AGENCY O.MJLNO.1660-0037 APPLICATION FORMA FOR SINGLE RESIDENTIAL LOT OR STRUCTURE AMENDMENTS 'TOEVkw 30, 2010 NATIONAL FLOOD INSURANCE PROGRAM MAPS PAPERWORK REDUCTION ACT Publicreporting burdenen for this farmll is seto average 24 haws per response. The burden estimate Includes the time for reviewing tnstrudions, searching existing data sources, gathering and maintaining the encoded data, and completing, reviewing, and submitting the tomo. You are not regtdred to respond to this collection of Mfonrralton unless a valid OIC — h n number Is dispiI M the upper right corner of this form. Sand comments regarding the accuracy of the burden esdmat 1l rd any suggestions for nkkm g this burden to: hdonnation CollscUons Men egament. U.S. Department of Homeland 8swrUy, Federal Emergency Management Aim►, 500 C Street, S.W., Washington DC 20472, Paperwork Reduction Project (16604034 Submission of this form is required to obtain or retain benefits under the National Flood Insurance This form should be used to request that the Department of Homeland SecurWs Federal Emergency Management Agency (FEMA) remove a single structure or legally recorded parcel of land or.portions thereof. described by metes and bowls, cer8flad by a registered professional - i ffi ar or licensed land surval from a designated Spacial Flood Naleard Area (SFHA), an area flat would be Inundated by the Hood having a 1%4ha rce of beft equaled or exceeded In arry'given year (bap flood), via I~ of Map'Ametwiment (LOMA). It shall not be used for requests submitted by dsyslopenk for rsqusats involving multiple structures or lots, for property In alluvial fan areas or coastal high hazard areas (V zones), or requests Im olvirg the placement of 01. (NOTE: Use MT -1 forms for such nqussta . Fill Is defined as maim *cm any source (including the subject property) placed that raises the grade to or above the Base Flood Elevation (BFE)- The common mon practice of removing unewlable existsg meta l (topsoil) and bsckflllirg with soled structural nuderiai is not considered the placement of fin V the practice doss not altar the sxile ft (natural grade) elevation, which is at or above the BFE Also, fill that Is placed before the dots of the fust National Flood Insurance :.. -. . FIP showirm the area In an SFHA is considered natural grade. . LOMA: A lett w*orn'DM*EMA NOW that an existing structure or parcel of land that has not been elevated by tfil:would not be inundated by the base flood. A - This section may be cotnp"isted by the property owner or by the property owner's agent In order to process your request, all information on this torn must be completed in its entirety. Incomplete submissions may result in processing delays. 1. Has fill been placed on your property to raise ground that was previously below the BFE? © No ❑ Yes - if Yes, STOP!! - You must complete the MT -1 application forms; visit tdaJlwwwfema.aov/olallorevenUthmldi mt-1-shtm or all the FEMA Map Assistance Canter toll free: (Bre-FEiA k WkP) 118-1.336-2627j 2 Legal description of Property (Lot, Block, Subdivlslon; complete description as it appears in the Deed Is not necessary) and street addressof the Property: i8S .vo a-rH & Are you requesting that the flood zone designation be removed from (Check ore): ❑ Your entire legally recorded property? ❑ A portion of your legally recorded property? (A certified mates and bounds description and: map of the area to be removed, r are certified by a registered. professional engineer or licensed land surveyorequired. For the preferred for at of metes and bounds descriptions, please Marto the M%EZ Instructions.) A structure on your property? what Is the daft of construction? % 9 G%3 Al documents submitted in support of this request are correct to the beat of my knowledge. I understand that any false statement may be punhom bis by fire or Imprisonment under TNis 18 of the United States Code, Section 1001- Applicant's Name: E -mall address: D G U M L A,5 7, Md' ►� JA t lits 44> Mailing Adlress oiaude Company rant•.If Daytime Telephone No.: J div Sv4V / gLo�'� 9 78 -J-159--is3 6 � Fax No. D R �-Lu T a �, 6Cr Signature of Applicant (required)Date DHS - FEMA Form 81-82, SEP 07 MT -EZ Form - Page 1 of 3 Wb 90:80 LOOZ '90 ABW 'AepunieS / Saturday, May 05, 2007 08:03 AM BK 4535 PG 301 QCZTCLAIJ�[ DisD Y®, FrederU* P. Flett i Jennifer A. Flett. husband A wife. both of 185 Ingalls Street. *o tb Andover, NA. for consideration paid, and in full consideration of 5910 MMW N=ff FM 2E01>. M A 00/100 [$ 295.000.00 ) Dollars, grant to Frank *T. Bowan A Teri N. Bowman. husband i Yife as tenants b) the entirety. both of 185 Ingalls Street, North Ameovor, M. with QUXTCLAJN CVVJRVJ PS that aertain perael of land with the buildings there= situated in North Aodaver. Bamm County. Massachusetts shown as Lot #3 an a Plan of Land located is nw h Andover. for B. E J. BoiUkws, Inc.• dated ane 1, 1 roewded an June. l . im in the North Hum District Begistry of Deeds as Plan,18658. Heferemoe is made to said . Plan for a more detalled desc rl" of the premises. the preatses are conveyed subject to an easement to New.Nng 04, Poser Caspagy as depicted an said plan as well as any eammmL, right of-aay or restriction of �• if any. y Meaning and intending to convey to Same preaiaea as conveyed. to the Grantors by deed of James A. Hargan dated August 13. 1993 recorded in 03 0? said Deads in Book 3806. Page 120. H UN ao AN 28'96 P12:04 ry 6 - mw Ir M. .0." 1� X w r st NAOA116 U4Y-4WV-AW11Y 045-S 6/Jr-7 . 1 ?:,x4, LoT k U.S. DEPARTMENT OF HOMELAND SECURITY ELEVATION CERTIFICATE Federal Emergency Management Agency National Flood Insurance Program Important Read the instructions on pages 1-8. OMB No. 1660-0008 Expires February 28, 2009 SECTION A - PROPERTY INFORMATION U'PtOrsursnce Company use: 1 FRANK 'T. 4' TER i M. RoLAY mAA/ A2. Building Street Address (including Apt, Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. Ctty �C/oR TN A A/ Dbvi= AStateztP code O / S 4 S A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) DLSED G04>1< 4525 ?q. 301 PLAQ s1: 865Y Lo -r *# 3 A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) F�! L s i DL -to T l A L A5. LatitudelLo gitude: Lat.: 4 2 ° 3 8 " 5-1.3 ,. Long. O 1 I - 03 - 0 Q .'1 ' � Horizontal Datum: ❑ NAD 1927 ® NAD 1983 A6. Attach at bast 2 photographs of the building If the Certificate Is being used to obtain flood Insurance. A7. Building Diagram Number -2-(,v o o PC ry 1 ry 6's A8. For a building with a crawl space or enclosure(s), provide: A9. For a building with an attached garage, ��� provide: a) Square footage of crawl space or endasure(s) sq ft a) Square footage of attached garage � sq ft b) No. of permanent flood openings in the crawl space or b) No. of permanent flood openings in the attached garage enclosures) walls within 1.0 foot above adjacent grade walls within 1.0 foot above adjacent grade c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b sq in SECTION B - FLOOD INSURANCE RATE MAP (FIRM)'INFORMATION B1. NFIP Community Name & Community Number.. 82. County Name 63. State A/oQTiA A v Z5009$ 1 CC 15's it M B4. Map/Panel Number B5. Suffix 86. FIRM Index ST. FIRM Panel B8.. Flood B9. Base Flood Elevation(s) (Zone Date 1 EffeclhreJRavised Date Zone(s) AO, use base flood depth) O o o q J ukxt Z/ qq3 k,, 2 /9q-7 A //2.q 810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered In Item B9. _ ❑ FIS Profile ❑ FIRM ❑ Community Determined Other (Describe) L O Al A G �4S # O -O / - d Z 5 D A 611. Indicate elevation datum used for BFE in Item 89: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) 812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings' ❑ Building Under Constrkxcion' Finished Construction 'A new Elevation Certificate will be required when construction of the building Is complete. C2. Elevations - Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-g below according to the building diagram specified in Item A7. Benchmark Utilized RM \0 117,111 FI it P1 M 10f vertical Datum Conversion/Comments Fd)Affil�R NJk yor W,4 Tic R 77�")11- Check the measurement used. tadied f bottom floor (including basement, crawl apace, or enclosure floor) 1 16 ® feet ❑ meters (Puerto Rico only) f the next higher floor 1 Z -•feet ❑ meters (Puerto Rico only) m of the lowest horizontal structural member (V Zones only) _❑ feet ❑ meters (Puerto Rico only) garage (top of slab) .. 116 •�❑ feet ❑ meters (Puerto Rico only) st elevation of machinery or equipment servicing the building l I b �� feet ❑meters (Puerto Rico only) (Describe type of equipment in Comments) 0 Lowest adjacent (finished) grade (LAG) l) E► E§ feet E] motors (Puerto Rico only) g) Highest adjacent (finished) grade (HAG) feet _ ❑ meters (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a lend surveyor, engineer, or architect aubmxtzsd by law to certify elevation infornatlon. I certify that the information on this Con0 ale represents my best efforts to Interpret the date available. I understand fhat any false statement may be punlaheble by fine or imprisonment under 18 U.S. Code, Section 1001. (Check here N comments are provided on bads of form. Certttier's Name A A :D A 1A Q License Numbe353 83 ""° Ift 0 w W ca R `"°�'��"A lio s vR V M y♦ IyG Address6 2 G R l e - lc r- T L City E izAc V r ate M ZIP code© 1826 Signature n 4A Datet Aolo 9 Telephone 9 7,q-q-Tq- r5c3 6 FEMA Form 81-31, February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding infonneton from Section A. For Insurance. Company use: wilding Street Address (Including ApL, Unit, Suite, andfor Bldg. No.) or P.O. Route and Box No. Policy Humber /85'city �.NGRGLS AloRrR AIVDouriz StateM r� BI,t" Catipany NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED.) Copy both sides of this Elevation Certificate for (1) community official, (2) Insurance agentkompany, and (3) building owner. CommoTqL suR j xr. PbzoPLrRnz L ;C1I�o.`L 5.. 3.5' 141 14t_v- TN f=►J 'al =tom l(. ..9.'-i,+K i nam LoMn CAst-#' 64-10-o'ZSo 'BonAMC /k/ 4 E SAME ?otoQI"6 ARCk .4N -1A -0rjLY wLslt Agr4rZr, / I C/ 0' 10 Check here if attachments SECTION E VBUILDINO ELEVATION INFORMATION (SURVEY NOT RE UIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 -E5. If the Certl1k ate Is Intended to support a LOMA or LOMR-F request, complete Sections A. B, and C. For Items E1 -E4, use natural grade, H available. Check the maasnaement used. In Puerto Rioo only, enter maters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent Waft (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is _ E3 is* 11 meters ❑above or ❑ below Inns HAG. b) Top of bottom floor (including beownent, crawl space, or enclosure) is _ ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Ssctigp A Items 8 iii /or 9 (see Roo 8 of Instructions), the next higher floor (elevation C2b in the dograms) of the building is _ ❑ feet L,J meters U above or 0 below the HAG. E3. Attached garage (top of slab) is ❑ feet. ❑ maters [:] above or below the HAG. E4. Top of platform of machinery and/or equipment servicing the building in _ Q feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only, If no flood depth number is available, is the hop of the bottom floor elevated in accordance with the communky's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this Information In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A. B, and E for Zone A (without a FEMA -Issued or community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are coned to the beat of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Cthedk here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the oommunity's floodplain management ordinance can complete 5 and G of this Elevation Certificate. Complete the applicable kern(s) and sign below. Check the measurement used in Items G8. and G9. 01. ❑ The Information In Section C was taken from other documentation that has been signed and eeeled by a Noeneed surveyor, engineer, or architect who is authorized by law to certify elevation irdormalicn. (Indicate the sours and date of the elevation data In the Comments area below.) G2. ❑ A community official completed Section E for a building boated in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The following infomretlor► (items G4.•G9.) is provided for conrmrnfly, floodplain -management purposes. G4. Permit Number 0. Date Permit Issued M. Date Certificate Of Compl anoe/Ooaupency Issued GT. This permit has been Issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (Including basement of the building: feet imeters (PR) Datum G9. BFE or (in Zone AO) depth of flooding at the building este: ❑ feet 0 -meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check her, if attachments FEMA Form 81.31, February 2006 Replaces all previous editions Building Photographs Continuation Page For piaurance Company Use: Budding Street Address (including Apt, Unit Suite, andlor Bldg. No.) or P.O. Route and Box No. Poky Number Cityb,' State ZIP�de Cwp WNAlCNumber ot r k+ Atjvov� 11 A ���y3 If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." view FIZoN—r V / C -W Building Photographs See Instructions for Item A6. For bmianoe CamWy Lkw: Building Sireet Address (including Apt, Unit, Suite, srAADr Bldg. No.) or P.O. Route and Box No. Pa&W Number 135 Zti64 Lis S City State ZIP Code CmWwyNNCNwnbv /109Mq A'NPOULR -- Or'1 X}, 6 / S 4y If using the Elevation Certificate to obtain NFIP flood Insurance, affix at least two building photographs below according to the instructions for Item .A6. Identify all photographs with: date taken; 'Front View" and "Rear View'; and. If required, 'Right Side View" and "Left Side View." If submitting more photographs than will tit on this page, use the Continuation Page, following. lei Pagel of 2 Date: June 10, 2004 Case No.: 04 -01 -MOA LOMA OtipA� r�F,f, . Federal Emergency Management Agency Washing( ui, D.C. 20472 IV ID 58G LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND, MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, ESSEX COUNTY, MASSACHUSETTS Lot NCrossbow Lane, as described in the Deed, recorded in Book 1820, COMMUNITY Page)0, filed on June 8, 1984, by the Register of Deeds, Essex County, Massachusetts COMMUNITY NO.: 250098 NUMBER: 2500980009C AFFECTED NAME: TOWN OF NORTH ANDOVER, MAP PANEL ESSEX COUNTY, MASSACHUSETTS DATE:06102f1993 FLOODING SOURCE: UNNAMED PONDING AREA APPROXIMATE LATITUDE b LONGITUDE OF PROPERTY: 42.646, -71.054 SOURCE OF LAT 8 LONG: PRECISION MAPPING STREETS 6.0 DATUM: NAD 83 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST LOT BLOCK/ `KHAT IS CHANCE ADJACENT LOT SECTION SUBDIVISION STREET REMOVED FROM THE FLOOD FLOOD GRADE ELEVATION ZONE ELEVATION (NGVD 29) ELEVATIONSFHA (NGVD 29) (NGVD29) N _ 10 Crossbow Lane Residential _ Structure X (unshaded)1 E12.9fee:t[ 115:0 feet Special Flood Hazard Area (SFHA) - The SFHA is an area that would be inundated by the flood having a 1 -percent chance of being equaled or exceeded in any given year (base flood). ADDITIONAL CONSIDERATIONS (Please refer to the appropriate section on All 1 for the additional considerations listed below.) PORTIONS REMAIN IN THE SFHA ZONE A This document provides the Federal Emergency Management Agency's determination regarding a request for a Letter of Map Amendment for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP) map, we have determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1 -percent chance of being equaled or exceeded in any given year (base flood)" This document amends the effective NFIP map to remove the subject property from the SFHA located on the effective NFIP map: therefore, the Federal mandatory flood insurance requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financial risk on the loan. A Preferred Risk Policy, (PRP) is available for buildings located outside the the PRP and how one can apply is enclosed. SFHA. Information about This determination is based on the flood data presently available. The enclosed documents provide additional information regarding this determination. If you have any questions about this document, please contact the FEMA Map Assistance Center toll free at (1377) 336-2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifield, VA 22116-2210. Additional information about the NFIP is on our web site at hftp://www,fema.gov/nfip/. available Dou�183,119mo. FM, Acling Chief Hazard identification Section, Mitigation Division Version 1.3.4 Emergency Preparedness and Response Directorate 62174303 0300640516YOE00003006405 AM5" �'i i P 't,2 i M2 e i, e l � U.S. DEPARTMENT OF HOMELAND SECURITY, FEDERAL EMERGENCY MANAGEMENT AGENCY� 0 -MB. NO.1660-0015 ACOM MI /ACKNOMEDGMENT FORM EvimDecmber31, 2010 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting -burden for this form is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing -instructions,.' searching existing data sources, gathering and amidami g the needed data. and completing, reviewing, and submitting the form. You are not required . to respond to this collection of information unless a valid OMB control number appears in the upper right corner of this form. Send comments .regarding the accuracy of the burden estimate and any suggestions for reducing tt is burden to. tnfonna ion Collections Management, U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (1660.0015), Submission of the form is required .to obtain or .retain benetits under the INIationai Flood Insurance Program. Please do not send your completed surveyfo.� aboie.acrd�. This form must be.completed for requests Involving the eAstigg or proposed placement of fill (complete Section A).OR to provide acknowledgment of this request to -remove a property from the SFHA-which was previously located within. the. regulatory floodway (complete Section.B). This form must be completed and signed by the offirciai responsible for floodplain management in the .community. The six digit .1NFIP .community -ruanber andthe strbjecd Pr"erty ad mustappearinifte spaces pronnded-below him.. fete submissions may-resudtin processing delays. Community Number. Property Name or Address: A. REQUESTS INVOLVING THE.PLACEMENTOF FILL As the community official responsible for floodplain managemeiL I hereby acknowledge that we -have received and reviewed this Letter of Map Revision Based on Fill (LOMB -F) or Conditional LOMR-F request Based upon the community's review, we find the completed or proposed project meets or is designed to meet all of the community floodplain managementrequirements, including the requ bwned that -no fin be.plac ed.in the regulatory floodway, and that all -necessary Federal, State, and -local permits have been, or in the case of a Caudifibonal LOMB -F, wig be obtained. in addition, we have determined that the land and any existing or proposed structures tobe renwved fiom the SFHA are or wit be reasonably safe from flooding :as defined in 44CFR 65.2(c), and that we have available upon request by DHS -FEMA, all analyses and documentation used to make this determination. For LOMR-F requests, we •understand that-this-request.is being. forwarded to DHS-FEMA.for.a possible map revision. For LOMR-F or Conditional LOMR-F requests -that#rave the>potenhal=to impact an endangered species, docunm abm will be submitted toshow the we have complied with Sections 9 and 10 of the Endangered Species Act (ESA). Section 9 ofthe-ESA prohibits anyone frac 'WW or hamming an endangered species. if an action might harm an endangered species, a permit is required from U.S. Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized, .ftmdedor:being carried by federal or State agencies,.doc umentation from the agency showing -its compliance with Section 7(a)(2) of the ESA will be submitted. Community Comments: Comrr�umity O � fs � and Tlte: (Please Print or Type) �l T No.: ENephonfe. N/ Communiityyn Name.- sSignature- (required) Date: Ger B. 'PROPERiY'LOCATED' WfrHIN THE REGt1LATORY FLOODWAY As the -community offcial resporsble for floodplain pr—w. ) hereby acpimwiedge.ftt wee iave rempted and .rem—wed the rimed We LOMAT . We understand that this request is being forwarded to -DHS -FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed . or proposed project meets or isdesigned to meet all of the cornmurAy floodplain nmrnagerngrd requirements- equiirements-Community CommunityComments. Community Official's Name and Title: (Please Prirrt or Type) Telephone No.: Community Name: Cormmmdy OWKWs Sigma (required): fie: -DHS -FEMA Fomn8a-87$, DEC 07 Cemmueurty AcknowkWWnent FGFm MT -11 Form 3 Page 1 of 9 U.S. DEPARTMENT OF HOMELAND SECURITY - FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. NO. 1660-0015 • COMMUNITY ACKNOWLEDGMENT FORM DuesDecember31,2610 PAPERWORK BURDEN DISCLOSURE NOTICE I Public reoorting.burden for this form is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing.instructions, searching existing data sources, gathering and maintaining the needed data, and completing, reviewing, and submitting the form. You are not required to respond to this collection of information unless a valid OMB control number appears in the upper right comer of this form. Send comments regarding -the accuracy -of the burden estimate and any, suggestions -for reducing this burden to: Information Collections Management; U.S. Department of Homeland Security, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (166D-0015). Submission of the form is required to obtain or retain benefits under the National Flood Insurance Program. Please do not send your completed survey`to..ifie:aiiove:address: _This form must be completed for requests involving the existing or proposed placement of fill (complete Section A) OR to provide acknowledgment of this request -to remove a property from -the SFHA which was previously located within the regulatory floodway (complete -Section 'B). This form must be completed and signed by the official resporsible for floodplain management in the community_ The six digit NFIP comrnunity -number and,the subject property address mus# appearinthe �es:provilded below. Incomplete submissions may result in processing delays. Community Number: Property Name or Address: A. REQUESTS INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management, l hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on Fill (LOMR-F) or Conditional LOMR-F request. Based upon the community's review, we find the completed or proposed project meets or is designed to meet all of the community floodplain management requirements, including the requirement that no fiA be placed in the regulatory floodway, and that all necessary Federal, State, and local permits have been, or in the case of a Conditional LOMR-F, will be obtained. In addition, we have determined that the land and any exis ing or Proposed stru#taes to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c), and that we have available upon request by DHS -FEMA, all analyses and documentation used to make this determination. For LOMR-F requests, we understand that this request is being forwarded to DHS -FEMA for a possible map revision. For LOMR-F or Conditional LOMR-F requests that have -the potential -to impact an -endangered species; documentation wid be•subnoed to show that we have complied with Sections -9 and 40 -of -the Endangered Species Act (ESA). Section 9 of the ESA prohibits anyone from'ialdW or harming an endangered species. If an action might harm an endangered species, a permit is required from U.S. Fir and Wildfife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized, funded, or being carried out'by federal or State agencies, documentation from the agency showing its compliance with Section 7(a)(2) of the ESA will be submitted. Community Comments: Community Official's Name and Tide: (Please Pdntor Type) Telephone No.: Community Name: Community Officers Signature: (required) Date: B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY AAs the rnmmi mrtv nfferial racnnncihlo for t}nneinEaire mareartarreoart f horphv a�rnanutQrj a thatwe have received ani„at the torn fact t?r a 1 f)MA _......_..--r_.._._._ .-...-__r._......_..�_.._.., i __....-... ...- --......_.... g_ ...__ .._ .._. -- ...._ . _M ,. We understand that this request is being forwarded to DHS -FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed .or-proposed.project meets or is designed to meet all of the cornmumly tloodpl m managemerd requirements. Community Comments: V CrT— Y\ Cy \ 00r, v---, Community Official's Name and Title: (PleasePrint or Type) Telephone No.: Community Name: Community Official's Signature (required): Date: -DHS --FEMA-Form 81 -87B; -DEC 97 Corrnmmity Actrnowledgmerit Fort MT -1 Form 3 Page 1 -of 1 Date : -�- 3 - C' I ".O RT :'ti, TOWN OF NORTH ANDOVER ° PERMIT FOR PLUMBING This certifies that ...................... has permission to perform ... i A .............. plumbing in the buildings of ... .................. at ...(.. ...�� .� !! C. �. �................ . North Andover, Mass. s Fee. ? ..... Lic. No. ,/?4/.0 S. ; .. i :��'� ...... . �UMBING INSPECTOR Check # 1 5249 N MASSACHUSETTS UNIFORM APPUCATION FOR PERMIT To DU PLUMB " ? �rtnt or Tyt+el tnsta�g Company bene fi QCs � �p tis CKdc ane: CertM=te Address o�c 1 �Z 0 c pmuon �rvytcw�. M A o (OPIParbutrship a BusinessTdWwne j k 37q 7t 7 0 FWMIC L Ham of Ucensed Phnnber _ MSURAMM COVERAGE: 1 to" a RabRty hrsrrra = POKY or ftsu AW" eq*Ma t which meets the MVAft is 0f L'IGL Ch. 142. Yes !do ❑ If yw have ecked ym please kaedte the type covatage tydwdft the appropriate box. A Vabft mance pdtcy #k Other type d Wemr ty 0 Bond 13 OWNER'S MSURANCE WANER: t am aware that the licensee doss not have the inswance coinage reQuked by Chapter 142 of the MasL General laws. and that try suture an this p enu t apptcagan waives this requlremenL Check one. Owner ❑ Agerd ❑ thereby carte that sA d the dads and artarrtat� i i+aae sNbnrGted for aMeredl b atwre � mr truo and acanaM to tb� t+�..-t of �m hrcndedge and tf;it plrrntbiwork and mora parlor- g ! malar the tremA isfor thh vLvkaGm vil be in conivfianm with a0 DeAarertt pra+ errs of W Mu saus site ftmelag and 09aft 142 of on taws By of tiw�ted TGIe'10i0or / 3811 Date. TOWN OF NORTH ANDOVER PERMIT FOR WIRING Thiscertifies that .......... �............... n.......f.......................................... has permission to perform ......... ......................................... wiring in the building of .......�............................................. ST at ..... / / .... S'.......... .. ,�'.. ...................... ....... , North Andover, Mass.Fee .../..... Lic. No.//.1..1 - /0 ....?vim:...... LECTRICALI PECTOR Check #� �% Official Use Only "' f Permit No. �fC �tnZl�'7Zk/�rfl'� d� nI�S.S��fZtS�?'7.S Occupancy & Fee Checked BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Town of North Andover The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number cttl Owner or Tenant !�(W✓t^� N Owner's Address--�-9 Is this permit in conjunction with a building permit Yes 6A Purpose Date �L�- 10 2 To the Inspector of Wires: No ❑ (Check Appropriate Box) Existing Service � Amps Voits Overhead New Servile Amps Voits Overhead ❑ Number of Feeders and Ampac'ity "'"�e f Location and Nature of Proposed Electrical Work Utility Authorization No. Undgmd ❑ No. of Meters Undgmd ❑ No. of Meters OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including C mpleted Operations Coverage or its substantial equivalent YEA- NO = have submitted valid proof of same to the Office YES NO = If you have checked YES please indicate the type of imcp�erage by checking the appropriate box INSURANCE. = BOND = OTHER = .(Please Specify) 'MQ -3 (Expiration Date) Estimated Value of Elect 'cal Work$ Work to Start 5 --JW 4 Inspection Date Resquested Rough a Final Signed under the Penalties of periq,yr FIRM NAME E-A, RaSeV- E(P-0&C.-�-a"O, n P -/ `, fl LIC. NO. AVY3 NO. o}(21,7-6 Bus. Tel No. U7q?do�7 Address Alt Tel. No. !v3 3� �4?r OWNER'S INSURANCE WAIY€R: I am aware that the Licenses does not have the insurance coverage or Its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this rggpirement Owner Agent (Please Check one) Telephone No. PERMIT FEE $2,�' (Signature of Owner or Agent) Total No. of Lighting Outlets ) No. of Hot fuse No. of Transformers KVA r Above ❑ In ❑ No. of Lighting Fixtures l Swimming Pool grnd ❑ grnd ❑ Generators KVA No. of Receptacles Outlets a No. of Oil Burners No. of Emergency Lighting Battery Units No. of Switch Outlets 13 No of Gas Burners FIRE ALARMS No. of Zone No. of Detection and —� Total No. of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.1f Di sal No. Pumps Tons KW No. of Sounding Devices No./ of Self Contained No. of Dishwashers I S ace/Area Heating KW Detection/Sounding Devices ❑ Municipal ❑ Other No. of Dryers Heating Devices KW Local Connection No. of No. of Low Voltage No. of Water Heaters KW Signs Bailases Wiring No., Hydro Massage Tuds No. of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including C mpleted Operations Coverage or its substantial equivalent YEA- NO = have submitted valid proof of same to the Office YES NO = If you have checked YES please indicate the type of imcp�erage by checking the appropriate box INSURANCE. = BOND = OTHER = .(Please Specify) 'MQ -3 (Expiration Date) Estimated Value of Elect 'cal Work$ Work to Start 5 --JW 4 Inspection Date Resquested Rough a Final Signed under the Penalties of periq,yr FIRM NAME E-A, RaSeV- E(P-0&C.-�-a"O, n P -/ `, fl LIC. NO. AVY3 NO. o}(21,7-6 Bus. Tel No. U7q?do�7 Address Alt Tel. No. !v3 3� �4?r OWNER'S INSURANCE WAIY€R: I am aware that the Licenses does not have the insurance coverage or Its substantial equivalent as required by Massachusetts General Laws. And that my signature on this permit application waives this rggpirement Owner Agent (Please Check one) Telephone No. PERMIT FEE $2,�' (Signature of Owner or Agent)