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Miscellaneous - 24 CROSSBOW LANE 4/30/2018 (2)
PO Box 55098 Boston, MA 02205-5093 �� Saget},tnsurr • E•li rasa 8� gars AW Form 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 NORTH ANDOVER, MA 01845 NORTH ANDOVER, MA 01845 ._RE:- Insured:' NEIL MANNING and JANET MANNING Property Address: 24 CROSSBOW ROAD, NORTH ANDOVER, MA Policy Number: HMA 0391309 Claim Number: BOS00060693 Date of Loss: 3/1/2015 Company: Safety Indemnity Insurance Company Claim has been made involving 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 applicable. 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. Stephen Desrosiers Claim Examiner Safety Insurance Company Homeowners Claims Unit P. O. Box 55098 Boston, MA 02205-5098 Phone: (617) 951-0600 EXT 3546 Fax: (617) 531-6658 Email: StephenDesrosiers@Safetylnsurance.com 5/8/2015 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance-with the provisions of M.G.L. c. 143, § 3L, the Permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. Ager a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or-corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall-be limited as to the time of..ongoing construction activity, and may be_deemed_by.the.Inspector_of_Wires abandoned_and_invalid.ifhe—.. _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or-the installing entity stated on the permit application. \ F1 The Permit Extension Act was created by Section 173 of Chanter 240 of the Acts of 2010 and extended by Sections.74 and 75 of Chapter 238 of / 1 the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending'through August 15, 2012. Eule 8—Permit/Date Closed: /r,'Dote: Reapply for new permit rmit Extension Act — Permit/Date Closed: "9860 Date..... �. ry:.. �.... TOWN OF NORTH ANDOVER 00, A PERMIT FOR WIRING This certifies that .....................1:,A..�................................................. has permission to perform ......... t k&n z. , ............. wiring in the building of .......................................... at .. ........��.?.�.�� ow ..... !................. . orth Andover, Mass. Fee.. :�?�:? -eo'Lie. No.. .?� ............. . .......... �.l ' CAl. iNSPWWR Check # F. l omnson:veal�ic o� ///a� icu�iu6e{ Official Use Only c Permit No. 6 67 ` _ �Jcaa�t`menf o��ire �ervica� _ Occupancy.and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. I/07] Heave blaik) APPUCATMN FOR PERMIT TO PER ORM ELEO�'h, t �h. All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION,1 Date: / c`'- City or Town of: /1,4zr1*/94042&41 To the Inspector offires. By this application the undersigne6 gives no::ce of his or leer intention to perform the electrical work described below. Location (Street & Number) dW G°,[��C,S'�bj� /— Owner or Tenant. Owner's Address IS this pe: mi, in cprunction with a building perm;t? Purpose of Building Telephone.No. Yes ❑. -'No (Check Appropriate Box) Utility Authorization No.. Existing Service Amps / Volts Oe -head ❑ Undyrd L No. of Meters New Service Amps J 'Volts Overhead ❑ 'vrdgrd ❑ No. of Meters .Number of Feeders and Ampacity Location and Nature .of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No. ofRecessed Luminaires No. of Ce.l: Susp. (Paddle) Fans o. of Tonal Transformers KS A No. of Llan ina:. e UL its No. of Ho` ubs Generators KVA . No. o: sur :*rel: ec . °win,min 000 In= g grr.6, grnd. o: o . ,mergency ignlm� g' ` Battery Units 4 No.. of Receptacle Cti !ets oLOil.Burners` FIRE ALARIV�S No o; Vanes __ _INo. No. of Switches No. of Gas Bu ners o, of �'etect on a,-16; . Initiating Devices No. of Ranges Nc. of Ai:' C::ad.. 'ora. Na. Gz-.Ing Devices "Pons No. of Waste Dis users p Heat Pump .--umber -'__.•"_'•"•"•__"._-1Detect:orJAietiri ' >C.W o: o el' Co:itained ,Tons Totals: Devices I No. of Dishwashers Space/Area Heatin nxt g !Loch: —I Pr iLic:p ii F1 her f-� Cirtrrection r No, of Dryers _ I 'rig Appliances _ KW • Security S stems '' No. .ices or Louie; fent li j of Water KW i _ c. of tel` e. of —'Data Wiring: 1 Heaters I Signs Ballasts ' No. o:' Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total Hp Teleco:::munrestioa Wiring: No. oT Devices or Equivalent OTHER: d O 77779 /j'' l flttach additiol?al detail ifdesired, or as required t�� life inspector of P`ires. Estimated Value of Electrical Work: 1G' (When rcouired by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule I0,'and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permitfor th.-performance of electrical work n:ay issue unless the licensee provides proof of liability insura n e inchir;ing "comp:e :�d operation" ccverage or its substantia: equiva.eat. "t.e undersigned certifies that such coverage is in `erce, :na has exhibited nrocf of same to the permit issuing office, CHECK ONE: rNSURANCE '_s010D t- OTELR E' (Srecify:) I certify, under the pains and penalties ofpajury, :hat tf."njortrrction. on :'his ;.ipplication is.true and complete: FIRM NAME: Zai �e�v�r� _g =`� _ t LIC. NO.: C � Licensee: _ f � a. tS'bneh� t iI(: NO : J (If applicable, enter "exempt ".in the license number (�,e) Bus Te] hrc, �:a� � 6 f' Address: � '� Gr -' :"� : U �,� �- ; °,1 �c 'fir U :3C� — .— *Per M.G.L. c. 14.7, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. n0 53 . _ OWN::R'S=NSU.RANC's'',,VAIVsR: I am aw:.ire that the L icen$ee does Trot have the liability insurancecoverage normaliy reg,iired by law. By my signature below, I hereby waive this requirement. 'I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent D �7 Signr,ture �_ Telephone No.. PERW1 T FEE: $ �zs a r7+ �. :!^" ;' •l OEPARTPtEN7GF PUBLIC .� SYSTEM CONTRACTOR.;,. i ��..,. _ ,'.A_REGISTERED - .:-= :r_... _. _ I . l=' •.l.,r Number. SS CO 000_.53 : m•. ��"j .i SSUESTHEABOVELIC .'�__ ;.„..• -. ro - .-_��•.�• Expires: 01:07-'20'.', Tr. no: 11'.^ w L A-7. DT.SECURITY,SERVICES•,-1NC_.:'...0: =.:1hAR K.': --A : B R 0 P H Y, S R S -License: AOT SECURITY SERVICE :A.l.p iUNIVERSITY. AVE - : P;1ARK P. BRLPHY SR ESTWQOD MA':.02.090-231.1,:'..., 111 ORS_ ST 140R 1 .2062 07/31/13 Commissioner C • : - - -- _ ... - . r:. ; : -' . • ' Fold. Than DGIZO along Au Pererodons _ a � ro C1 w L 0 Ir Date.................................. TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that ............................................................ .. has permission to perform:......`. ............................. ...................... wiring in the building of ........... L . �If .... ................... --... at... .-Ja... ..............................i... ,I - ,North Andover, Mass. Fee ...... Lic. No .�.O6. ..............aELicrRl�;L Check #ti 8286 pyre r3c'� os _A# f Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Onlyn Permit No. d 5O Occupancy and Fee Checked [Rev. 1/07] (leave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN.INK OR TYPE ALL INFORMATION) Date: S11 G City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street &Number) 2 y CressI- a w �--•ol, Owner or Tenant /�4,, /,s J qA) AJ ,,"U q Telephone No. G, i) _ g21- 4 go> Owner's Address S1+111 __ Is this permit in conjunction with a building permit? Yes �' No ❑ (Check Appropriate Box) Purpose of Building .Lv ► v -C- Tt4 P C- I Toc) 1 S H e` D Utility Authorization No. _ Existing Service 2®G Amps 2.2© Volts Overhead ❑ UndgrdIL-20- No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: tcc, A&4 3P *-tic �. ► �, Su�,o ( �ac�c+� Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil.-Susp. (Paddle) Fans o. of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires Swimming Pool Above ❑ n- rnd. grind. No. of Lmergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners No. of etection an Initiating Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump rN umber I Tons -K-W— No. o elf- ontame Totals: I Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Conneectiun ctiippi on [:]Other No. of Dryers HeatingAppliances KW pp Security Systems: • No. of Devices or Equivalent No. of Water KW No. of No. of Data Wiring: Heaters , Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications firing: No. of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of K'ires. Estimated Value of Electrical Work: 3 (When required by municipal policy.) Work to Start: I ( . a 7 Inspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned certifies that such coverage is in force, and has exhibited proof of same to the p�rmit issuing office. CHECK ONE: INSURANCE ©BOND r_1OTHER (Specify:) t— eL"t �. 1 certify, under the pains and penalties of perjury, that the information on this application is )rue and complete. FIRM NAME: N 5���•-. o, Ix t C, G� #3,e LIC. NO.: Licensee: Signature1 LIC. NO.: (If applicable, enter "exempt" n the license number line.) Bus. Tel. No.: 0()F Address: S� Alt. Tel. No.: 'XI -321 1i *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lie. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE. $ S °� Signature Telephone No. barn C��- S l � N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 w �s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (pusiness/Organization/Individual): S74V111'22 �j Address�'�'" v9, - CLS r City/State/Zip: V\A ii , a I'> 3a Phone #: Are you an employer? Check the appropriate box: 1. ❑ 1 am a employer with 4. ❑ I am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2.rI am 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 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ZNew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ 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. f 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. #: Expiration Date: Job Site Address: ICity/State/Zip: 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 certify under the pains and penalties of perjury that the information provided above is true and correct. Phone #• Official use only. Do not write in this area, to be completed by city or town official 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 1" Contact Person: Phone #: 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance -with the provisions of M.G.L. c. 143, § 3L, the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth, and applications shall be filed on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L. c. 143, § 3L. Permits shall -be limited as to the time of ongoing construction activity, and may be_deemed_bythegnspector_of-Wires abandoned_and_invalidaf he _ or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written request of either the owner or.the installing entity stated on the permit application. 51e,/ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections .74 and 75 of Chapter 238 of the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was "in effect or existence" during the qualifying period beginning on August 15, 2008 and extending1hrough August 15, 2012. le 8 — Permit/Date Closed:, *Note: Reapply for new permit, e. ermit Extension Act — Permit/Date Closed: Y, .M J� y Date ..... ..,.9.... TOWN OF NORTH ANDOVER 10 0 PERMIT FOR WIRING %hos certifies that.......... ..:r2--�. T...... r ................................. has permission to perform�..4�,..`. r l...... ...... wiring in the building of --I? `.... ................................................ at.. ..� ................... .. v'j— ..........PE�CTRICAL North Andover, Mass. ?� Vim Fee `- ?.`.......... Lic. No.//15.4945 ....................... . ............... IN6ECTOR Check # i Commonwealth of Massachusetts Department of Fire Services BOARD OF FIRE PREVENTION REGULATIONS Official Use Only Permit No. O 3/a Occupancy and Fee Checked 34— [Rev. 1/071 leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code (MEC), 527 CMR 12.00 (PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date: ?' dam _ 0 F' City or Town of: NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) Owner or Tenant J a fM e_ Owner's Address 64 U60556AU Is this permit in conjunction witp a building permit? Yes ❑ Purpose of Building a PM1 sw Telephone No. & % ;j 7/- yT07 No KJ (Check Appropriate Box) Utility Authorization No. ExistingService Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: apfo, �' R Completion of thefollowing table may be waived by the Inspector of Wires. No. of Recessed Luminaires No. of Ceil: Susp. (Paddle) Fans No: of Total Transformers KVA No. of Luminaire Outlets No. of Hot Tubs Generators KVA No. of Luminaires • Swimming Pool Above ❑In- ❑ rnd. rnd. o. o Emergency Lighting Battery Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches • No. of Gas Burners No. of Detection and Initiatin Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Totals: Number ** * I Tons KW ** No. of Self -Contained Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal El other Connection No. of Dryers Heating Appliances KW Security Systems:* No. of Devices or Equivalent No. of Water KW Heaters No. of No. of Signs Ballasts Data Wiring: No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: No. of Devices or Equivalent OTHER: '-c. Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work:�� , (When required by municipal policy.) Work to Start: �— a77-01WInspections to be requested in accordance with MEC Rule 10, and upon completion. INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including "completed operation" coverage or its substantial equivalent. The undersigned.certifies that such coverage is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE X BOND ❑ OTHER ❑ (Specify:) I certify, under t aims and enal 'e f erjury at t e Information on this application is true and complete. FIRM NAME: +� C�I1�e��titl ,2Cf ,`C. A ►'> > �� y/�,�,, LIC. NO.: Licenseel�P; CV40-I J , DOA I6LA Signature %/ ./����// LIC. NO.: (Ifapplic le,e� ter "exempt" i the se mbe line.) ,� Bus. Tel. No.:I t ✓�9 Address: LP�_ckn/ 4e � Ile/ �jl'/4 Alt. Tel. No.: OS *Per M.G.L c. 147, s. 57-61, security work requires Department of Public Safety "S" License: Lic. No. OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below, I hereby waive this requirement. I am the (check one) ❑ owner ❑ owner's agent. Owner/Agent PERMIT FEE: $,3.5'�°= Signature Telephone No. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers plicant Information Please Print Legibl, Name (Business/Organization/Individual): Address: City/State/Zip: &&-z 1, `CG l Yd- 1 Phone #: Z/ f ez 7 Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I employeesi(full and/or part-time).* have hired the sub -contractors 2. I am a sole proprietor or partner- listed on the attached sheet. + ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] f These sub -contractors have workers' comp. insurance. 5. ❑ 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.❑ Electrical repairs or additions 11.❑ 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� 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. #: Expiration Date: Job Site Address: City/State/Zip: I 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 certify under the pains and penplties of perjury thai the information provided above is true and correct. Phone #: U / �i /o� Official use only. Do not write in this area, to be completed by city or town official, ! City or Town: Permit/License # Issuing Authority (circle one): 1. 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LL �1 l w Q Rx Date/Time NOV-05-2007(MON) 09:03 NOV-05-2007 08:12 WOODSTRUCTURES 2072822423 i P. 002 2072822423 P.002 'NOISE Double 1-3/4" x 16" VERSA -LAM@ 2.0 3100 SP Roof Beam1RB01 SC CALL® 9.5 Design Report - US 1 span I No cantilevers 10112 slope Friday, November 02, 200714:33 Build 91 Job Name; NEIL MANNING Address: 24 CROSS BOW LANE City, State, Zip: NORTH ANDOVER, MA Customer. JACKSON Code reports: ESR -1040 12 _. 20-00-00 BO DL 1358 its SL 3200 lbs, File Name: 10-26-07 Description: RB01 Specifier. DENNIS T Designer: BRIAN BIRKINBINE Company: WOOD STRUCTURES INC Misc: 22787 ft -lbs B1 DL 1358 lbs SL 3200 lbs Total of Horizontal Design Spans a 20-00-00 Load Summary Live Doad snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Tri b. 1 Standard Load Unf. Area (psf) Left 00-00-00 20-00-00 15 40 08.00-00 For roof members with slope (114)/12 or less final design must ensure that ponding instal will not occur. F'or roof members with slope (1/2)/12 or less final design must account for Rain -on -Snow surcharge load. Notes Design meets Code minimum (L/180) Total load deflection criteria. Design meets Code minimum (1-/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Minimum bearing length for BO is 1-3/4". Minimum bearing length for B1 is 1-3/4". Entered/Displayed Horizontal Span Length(s) = Clear Span + 112 min. end bearing + 1/2 intermediate bearing Member Slope = 0, consider drainage. Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (888)234-0056 before installation. BC CALCO, BC FRAMERO , AJST". ALLJOISTS , SC RIM BOARDTm, BCI®, BOISE GLULAM-, SIMPLE FRAMING SYSTEMA. VERSA -LAM®, VERSA -RIM PLUS0, vERSA-RimO, VERSA -STRAND®. VERSA-STUDA are trademarks of Boise Wood Products, L.L.C. Connection Diagram Load Controls Summar f� value %Allowable Duration Case g an Location Pos. Moment 22787 ft -lbs 53.0% 115% 3 1 - Internal End Shear - 3917 lbs 32.0% 115% 3 1 -Left Total Load Defl. L/350 (0.687") 51.5% 3 1 Live Load Defl. L/498 (0.482") 48.2% 3 1 Max Defl. ' 0.687" 68.7% 3 1 Span / Depth' 15.0 n/a 0 1 For roof members with slope (114)/12 or less final design must ensure that ponding instal will not occur. F'or roof members with slope (1/2)/12 or less final design must account for Rain -on -Snow surcharge load. Notes Design meets Code minimum (L/180) Total load deflection criteria. Design meets Code minimum (1-/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Minimum bearing length for BO is 1-3/4". Minimum bearing length for B1 is 1-3/4". Entered/Displayed Horizontal Span Length(s) = Clear Span + 112 min. end bearing + 1/2 intermediate bearing Member Slope = 0, consider drainage. Disclosure Completeness and accuracy of input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (888)234-0056 before installation. BC CALCO, BC FRAMERO , AJST". ALLJOISTS , SC RIM BOARDTm, BCI®, BOISE GLULAM-, SIMPLE FRAMING SYSTEMA. VERSA -LAM®, VERSA -RIM PLUS0, vERSA-RimO, VERSA -STRAND®. VERSA-STUDA are trademarks of Boise Wood Products, L.L.C. Connection Diagram • -r-,• • � c "'f' Disclaimer: _ The supplier acknowledges that it has requested JSN Associates, Inc to review a pre-engineered building product identified as above for 1 :- the span and loading conditions shown on this calculation sheet. JEFFREY S. • • ; , The supplier further acknowledges that JSN Associates, Inc. will u NAWROCKI a not engineer, design, manufacture or erect said item and is not STRUCTURAL responsible in any way for defects or deficiencies. Therefore, the No. 34168 a minimum = 2" c = 12" b minimum = 3" d =12" supplier waives all claims against JSN Associates, Inc. arising in in ' lit AfQIST�AL� any way from any defects, deficiencies, errors or omissions the Member has no side loads. load determination, design, fabrication or erection of said item. sIou&CE Connectors are; 16d,Common Nails Note: Adequate design of supporting structure must be provided by others f Page 1 of 1 �/ Date/Time NOV-05-2007(MON) 09:03 2072822423 P.003 ,;�10V-05-2007 08:12 WOODSTRUCTURES 2072822423 P.003 b BOISE` Double 1-314" x 7-1/4" VERSA -LAM® 2.0 3100 SP Roof Beam1RB02 BC CALL® 9.5 Design Report - US 1 span I No cantilevers 10/12 slope Friday, November 02, 200714:33 Build 91 . 92 EE 08-00-00 .. .-. - BO 611 DL 768 lbs' DL 768 lbs SL 1760 lb's SL 17601bS Total. of Horizontal Design Spans = 08-00-00 Load Summary File Name: 10-26-07 Job Name: NEIL MANNING Description: RB02 Address: - 24 CROSS BOW LANE Specifier. DENNIS T City, State, zip: NORTH ANDOVER, MA Designer: BRIAN BIRKINSINE Customer; JACKSON Company: WOOD STRUCTURES INC Code reports: ESR -1040 Misc: U238 (0.404") 92 EE 08-00-00 .. .-. - BO 611 DL 768 lbs' DL 768 lbs SL 1760 lb's SL 17601bS Total. of Horizontal Design Spans = 08-00-00 Load Summary Live Dead Snow Wind Roof Live Tag 00SCripGon Load Typo Ref. Start End 100% 90% 115% 133% 125% Trib 1 Standard Load Unf. Area (psf) Left 00-00-00 08-00-00 15 40 01-00-00 2 RIDGE , Conc. Pt (lbs) Left 04-00-00 04-00-00 1358 3200 n/a members with slope (1/4Y12 or less final design must ensure that ponding will not occur. For roof members with slope (1/2y12 or less final design must account for surcharge load. Notes Design meets Code minimum (L/180) Total load deflection criteria. Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". Minimum bearing length for 61 is 1.1/2". Rain -on -Snow Entered/Displayed Horizontal Span Length(s) = Clear Span + 112 min. end bearing + Disclosure Completeness and accuracy of Input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design propertles and analysis methods. Installation of BOISE engineered wood products must be in accordance with current InstallaWn Guide and applicable building codes. To obtain Installation Guido or ask questions, please call (888)234.0056 before installation. SC CALCO, BC FRAMER®, AJST", ALUOISTO , BC RIM BOARD-, BCI®. BOISE GLULAM-, SIMPLE FRAMING SYSTEM®, VERSA LAM®. VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUDS are trademarks of Boise Wood Products, L.L.C. 1/2 Intermediate bearing Disclaimer: Member Slope =, 0, consider drainage. The supplier acknowledges that it has requested JSN Associates, Inc-" to review a pre-engineered building product identified as above for Connection Diagram the span and loading conditions shown on this calculation sheet. r..l b r...0 The supplier further acknowledges that JSN Associates, Inc. will ,.H not engineer, design, manufacture or erect said item and is not responsible in any way for defects or deficiencies. Therefore, the • supplier waives all claims against JSN Associates, Inc. arising in c ' any way from any defects, deficiencies, errors or omissions in the ;:. load determination, design, fabrication or erection of said item. • • Note: Adequate design of supporting structure must be provided by others a minimum = 2" c = 3-1/4" b minimum = 3" d = 12" Connection design assumes point load is 'topaoaded'. For connection design of 'side -loaded' point loads, please consult a technical representative or professional of Record. Member has no side loads. Concentrated loads are not considered in side load analysis. Connectors are' 16d Common Nails Page 1 of 1 JEFFREY 8. NAWROCKI STRUCTURAL No. 34168 \arsTEa% i Load Controls Summary Value % Allowable Duration Case span Location Pas. Moment 9607 ft -lbs 99.7% 115% 3 1 - Internal End Shear 2485 lbs 44.8% 115% 3 1 - Left Total Load Defl. U238 (0.404") 75.7% 3 1 Live Load Defl. U341 (0.282") 70.5% 3 1 Max Defl. 0.404" 40.4% 3 1 Span/ Depot 13.2 n/a 0 1 members with slope (1/4Y12 or less final design must ensure that ponding will not occur. For roof members with slope (1/2y12 or less final design must account for surcharge load. Notes Design meets Code minimum (L/180) Total load deflection criteria. Design meets Code minimum (L/240) Live load deflection criteria. Design meets arbitrary (1") Maximum load deflection criteria. Minimum bearing length for BO is 1-1/2". Minimum bearing length for 61 is 1.1/2". Rain -on -Snow Entered/Displayed Horizontal Span Length(s) = Clear Span + 112 min. end bearing + Disclosure Completeness and accuracy of Input must be verified by anyone who would rely on output as evidence of suitability for particular application. Output here based on building code -accepted design propertles and analysis methods. Installation of BOISE engineered wood products must be in accordance with current InstallaWn Guide and applicable building codes. To obtain Installation Guido or ask questions, please call (888)234.0056 before installation. SC CALCO, BC FRAMER®, AJST", ALUOISTO , BC RIM BOARD-, BCI®. BOISE GLULAM-, SIMPLE FRAMING SYSTEM®, VERSA LAM®. VERSA -RIM PLUS®, VERSA -RIM®, VERSA -STRAND®, VERSA -STUDS are trademarks of Boise Wood Products, L.L.C. 1/2 Intermediate bearing Disclaimer: Member Slope =, 0, consider drainage. The supplier acknowledges that it has requested JSN Associates, Inc-" to review a pre-engineered building product identified as above for Connection Diagram the span and loading conditions shown on this calculation sheet. r..l b r...0 The supplier further acknowledges that JSN Associates, Inc. will ,.H not engineer, design, manufacture or erect said item and is not responsible in any way for defects or deficiencies. Therefore, the • supplier waives all claims against JSN Associates, Inc. arising in c ' any way from any defects, deficiencies, errors or omissions in the ;:. load determination, design, fabrication or erection of said item. • • Note: Adequate design of supporting structure must be provided by others a minimum = 2" c = 3-1/4" b minimum = 3" d = 12" Connection design assumes point load is 'topaoaded'. For connection design of 'side -loaded' point loads, please consult a technical representative or professional of Record. Member has no side loads. Concentrated loads are not considered in side load analysis. Connectors are' 16d Common Nails Page 1 of 1 JEFFREY 8. NAWROCKI STRUCTURAL No. 34168 \arsTEa% i Rx Oate/Time NOV-05-2007(MON) 09:03 2072822423 P.004 r—+NOV-05-2007 08:13 WOODSTRUCTURES 2072822423 P.004 a "WE" Double 1-314" x 5-1/2" VERSA -LAM® 2.0 3100 SP Roof Beam1R603 EC CALL® 9.5 Design Report - US 1 span I No cantilevers 10112 slope Friday, November 02, 200714:34 Build 91 12 •• - - � T " Y 7 Y T Y .. Y � Y�Y Y�Y Y Y Y ti t •• 03-06.00 BO B1 DL 715 lbs DL 715 lbs SL 1670 lbS SL 1670 lbs Total of Horizontal Design Spans = 03-06-00 Load Summary Lire Dead Snow wind Roof Live 1 Standard Load Unf. Area (psf) Left 00-00-00 03-06-00 15 40 2 RIDGE, Cone. Pt. (Ibs) Left 01-09-00 01-09-00 1358 3200 Controls Summary value File Name: 10-26-07 Job Name: NEIL MANNING Description: RD03 Address: 24 CROSS BOW LANE Specifier: DENNIS T City, State, Zip: NORTH ANDOVER, MA Designer, BRIAN BIRKINBINE Customer: JACKSON Company: WOOD STRUCTURES INC Code reports: ESR -1040 Misc: U803 (0.052") 12 •• - - � T " Y 7 Y T Y .. Y � Y�Y Y�Y Y Y Y ti t •• 03-06.00 BO B1 DL 715 lbs DL 715 lbs SL 1670 lbS SL 1670 lbs Total of Horizontal Design Spans = 03-06-00 Load Summary Lire Dead Snow wind Roof Live 1 Standard Load Unf. Area (psf) Left 00-00-00 03-06-00 15 40 2 RIDGE, Cone. Pt. (Ibs) Left 01-09-00 01-09-00 1358 3200 Controls Summary value "AAllowable Duration Load Case Span Location Pos. Moment 4055 ft -lbs 70.9% 115% 3 1 - Internal End Shear,2353 lbs 55.9% 115% 3 1 - Left Total Load efl. U563 (0.075") 32.0% 3 1 Live Load Defl. U803 (0.052") 29.9% 3 1 Max Defl. , 0.075" 7.5% 3 1 Span / Depth 7.6 n/a 0 1 For roof members with slope (114Y12 or less final design must ensure that ponding instal will not occur. For roof members with slope (1/2)/12 or less final design must account for Rain -on -Snow surcharge load. n/a Disclosure Completeness and accuracy of input must be verified by anyone who would rely on Output as evidence of suitability for particular application. Output here based on building code -accepted design properties and analysis methods. Installation of BOISE engineered wood products must be in accordance with current Installation Guide and applicable building codes. To obtain Installation Guide or ask questions, please call (888)234-0056 before installation. BC CALC®. BC FRAMER®, AJS'", ALLJOIST®, BC RIM BOARD-, BCI® , BOISE GLULAM*-, SIMPLE FRAMING Notes SYSTEM®, VERSA-LAM0, VERSA -RIM PLUS®, VERSA -RIM®, Design meets Code minimum (U180) Tbtal load deflection criteria. VERSA -STRAND®, VERSA -STUD® aro Design meets Code minimum (U240) Live load deflection criteria. trademarks of Boise wood Products, Design meets arbitrary (1") Maximum load deflection criteria. L.L.C. Minimum bearing length for 80 is 1-1/2". Minimum bearing length for B1 is 1.1/2". Entered/Displayed Horizontal Span Length(s) = Clear Span + 1/2 min. end bearing + 1/2 intermediate bearing Disclaimer: Member Slope = 0, consider drainage. The supplier acknowledges that it has requested JSN Associates, Inc. to review a pre-engineered building product identified as above for Connection Diagram the span and loading conditions shown on this calculation sheet. 1--� b r- r d .-� The supplier further acknowledges that JSN Associates, Inc. will a Inot engineer, design, manufacture or erect said item and is not o�+! SCS 1 • r • • `; responsible in any way for defects or deficiencies. Therefore, the as JEFFREY S. I supplier waives all claims against JSN Associates, Inc. arising In c,� ;:; Pp 9 9 NAWROCKI « cl any way from any defects, deficiencies, errors or omissions in the STRUCTURAL • f • a load determination, design, fabrication or erection of said item. No. 34166 Note: Adequate design of supporting structure must be provided by others *�o,,drstt:aE®_4�� a minimum = 2" c = 1-1/2" 7tr b minimum = 3" d =12" Connection design assumes point bad is 'top -loaded', For connection design of'side-loaded' point loads. please consult a technical representative or professional of Record. Member has no side loads. Concentrated loads are not considered in side load analysis. Connectors are: 16d Common Nails Page 1 of 1 TOTAL P.004 0 Date. TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING This certifies that .. _ .... `� " ... .. .... . has permission to perform plumb' n i the buildings of .A `�' .�l% . I�.ff h ......... !C at . _�L............. ........ , North Andover, Mass. Fee��. .1. Lic. No. � .............................. //1�- PLUMBING INSPECTOR Check # �= / 5;78 MASSACHUSETTS UNIFORM APP (Print or Type) And, 7/Mass. Building Locatio New ❑ Renovation A .IC TION FOR PERMIT TO DO PLUMBING ate Permit #1 Owner's Name Type of Occupancy esidential Replacement Plans Submitted: Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg. &Pig. CO. Inc. Check one: Certificate Address_ 35 Pleasant Street 12 Corporation 714 Stoneham, Ma 02180 p Partnership Business Telephone 781 -438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Gbneral Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapte 142 of,the General Laws. By. Title igna ure of LicensedPlumber ' City/Town Type of License: Master lX Journeyman ❑ APPROVED (OFFICE USEO ) License Number 8 3 2 2 v r N N N O Z ►- o W W o VI Y Z J J (n ♦- W = Q N = = O Z W Z a (b� W W v rr W ►O- r W a En OR Q J in ix J z cc cc a x W 4) w ~ z U> a x F- 3 3 O x°' o z= of >' ►' x z a O o O H a x = z a W W u Y F- O 3 ri o J, a a x a a SUES—BSMT. BASEMENT IST FLOOR 2ND FLOOR 3RD FLOOR , 4TH FLOOR 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg. &Pig. CO. Inc. Check one: Certificate Address_ 35 Pleasant Street 12 Corporation 714 Stoneham, Ma 02180 p Partnership Business Telephone 781 -438-7776 n Firm/Co. Name of Licensed Plumber Gordon Switzer INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No ❑ If you have checked yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy IN Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. Gbneral Laws, and that my signature on this permit application waives this requirement. Check one: Owner ❑ Agent ❑ I hereby certify that all of the details and information I have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this application will be in compliance with all . pertinent provisions of the Massachusetts State Plumbing Code and Chapte 142 of,the General Laws. By. Title igna ure of LicensedPlumber ' City/Town Type of License: Master lX Journeyman ❑ APPROVED (OFFICE USEO ) License Number 8 3 2 2 v r r i t" � O z m J SL O O O r r a o LU z cc cc O LL z O F- d U J W a Q i t" � 0 r i BUYER- p- I ep, LAQ> 70 THE ( TLA (•j AND ITS TITLE ","ERS. I 177A Ic T--iQ tJG(/ L moizT, _iNc• 1 Z 8_? -7 MORTGAGE INSPEC110N PLAN 0 P_ T44 MASSACHUSETTS I CERTIFY THAT I HAVE EXAMINED THE PREMMS AND THE BUILDINGS SI}OWN DO ( ) CONFORM TO THE ZONIN 111 AND AMENDMENTS, (.*.(FRONT, SIDE, h REAR YARD SETBACK ONLY OF 'N�Z'j'I� FJ�c -':5 MIEN CONSTRUCTED. I FURTHER CER11 AT THI PROPERTY IS /��DT LOCATED IN THE ESTABUSHED FL001) .HAZARD AREA. COMMUNITY PANEL NO.: Z4 W(,n 6D -0X DATE: G - EXAMINATION OF TIIE RECORDS IS MADE: ONLY SUBSEQUENT TO TIIE RECORDED DATE OF THE .LATEST DEED AND DOES NOT INCLUDE VERIFYING TIRE ACCURACY OF THE DEED DESMPTION 'PREVIOUS TO ITS DATE OF RECORD. 7111S COMPANY IS NOT RESPONSIBLE FOR ANY INDENTURES MADE SUBSEQUENT TO TIIE RECORDED DATE OF THE LATEST DEED OF RECORDED. WINENEVER BUILDINGS ARE SI'10WN LESS THAN ONE FOOT FROM TIIE PROPERTY LINE IT 15 ADVISED THAT A MORE PRECISE SURVEY BE MADE TO VERIFY "HEST✓ MEASUREMENTS. NDTE: THIS CERTIFICATION IS BASED ON TFIE LOCATION OF SURVEY MAF*<nS OF OTIIERS, AND DOES NOT REPRESENT A PROPERTY SURVEY._A"A". THIS CERTIFICATION TO BE �}B�IF0R4,P9RTGA(;E PURPOSES ONLY. OFFSETS ��. WN � . OT TO DE USED FOR THEE � LISH' �, 0 PROPERTY LINES c) CIIIISF., III .1575J ST Y � FRED W. CHASE., R.L.S. #t5755 DEM BOOK PAGE Z I CERT. NO. PLAN BK PACE PLAN DATED JL-) Ly i 9 SCALE: 1 "• 410 BRADFORD ENGINEERING P.O. BOX 1244 HAVERHIL. MA, 01831 TEL (608) 373-2396 CO. 4 FEDERAL EMERGENCY MANAGEMENT AGENCY PROPERTY INFORMATION FORM 0 -MB. NO. 3067-0147 Eepires Seplesrb- 30, 2005 I PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1.63 hours per response. The burden estimate incudes 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, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (3067-0147). 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 the above address. This form may be completed by the property owner, property owner's agent, licensed land surveyor, or registered professional engineer to support a request for a Letter of Map Amendment (LOMA), Conditional Letter of Map Amendment (CLOMA), Letter of Map Revision Based on Fill (LOMR-F), or Conditional Letter of Map Revision Based on Fill (CLOMR-F) for existing or proposed, single or multiple lots/structures. Please check the item below that describes your request ❑LO MA A letter from FEMA stating that an existing structure or parcel of land that has not been elevated by fill natural rade would not be inundated by the base flood. ❑ CLOMA A letter from FEMA stating that a proposed structure that is not to be elevated by fill (natural grade) would not be inundated by the base flood if built asproposed- LQMR-F A letter from FEMA stating that an existing structure or parcel of land that has been elevated by fill would not be inundated by the base flood. A letter from FEMA stating that a parcel of land or proposed structure that will be elevated by fill ❑ CLOMR-F would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. Fill is defined as material from any source placed to raise the ground to or above the Base Flood Elevation (BFE). The common construction practice of removing unsuitable existing material (topsoil) and backfilling with select structural material is not considered the placement of fill if the practice does not alter the existing (natural grade) elevation, which is at or above the BFE. Fill that Is placed before the date of the first National Flood Insurance Program (NFIP) map showing the area in a Special Flood Hazard Area (SFHA) is considered natural grade. Has fill tieen placed on your property? ® Yes ❑ ii No if yes, when was fill placed? Oq I ! Ctgi monthlyear Will fill be placed on your property? ❑ Yes 04 No If yes, when will fill be placed? I monthlyear 1. Street Address of the Property (if request is for multiple structures, please attach additional sheet): 9. 14 ( covs bow Lv oe. , /Noc4-1. Arjo vec- , A414 D Ley a 2. Legal description of Property (Lot, Block, Subdivision) (if a street address cannot be provided): 3. Are you requesting that the SFHA designation be removed from (check one): ❑ the entire legally recorded property? ❑ a portion of land within the bounds of the property (a certified metes and bounds description and map of the area to be removed, certified by a licensed land surveyor or registered professional engineer, are required)? ® structures on the property? What are the dates of construction? i Gt$y 4_ Is this request for a (check one).- ne):single singlestructure single lot ❑ multiple structures (How many structures are involved in your request? List the number: ) ❑ multiple lots (How many lots are involved in your request? List the number: ) FEMA Form 81-87, SEP 02 Property Information Form NFT -1 Form 1 Page 1 of 2 !�J n addition to this form (MT -1 Form 1), ALL requests must include the following: J• Copy of the Plat Map for the property (with recordation data and stamp of the Recorder's Office) OR • Copy of the property Deed (with recordation data and stamp of the Recorders Office), accompanied by a tax assessor's map or other certified map showing the surveyed location of the property relative to local streets and watercourses • Copy of the effective FIRM panel andfor Flood Boundary and Floodway Map (FBFM) (if applicable) on which the property location has been accurately plotted (property inadvertently located in the NFIP regulatory floodway will require Section B of MT -1 Form 3) • Form 2 - Elevation Form. If an Elevation Certificate has already been completed for this property, it may be submitted in addition to Form 2. Please include a map scale and North arrow on all maps submitted. For LOMR-Fs and CLOMR Fs, the following must be submitted in addition to the items listed above: • Form 3 -Community Acknowledgment Form Prooessino Fee (see instructions for appropriate mailing address; or, visit httpg vrww.fema goviplantprevent/fhmffrlm tees shtm for the most current. fee schedule) Revised fee schedules are published periodically, but no more than once annually, as noted in the Federal Register. Please note: single/multiple iot(sYstruciure(s) LOMAs are fee exempt. The current review and processing fees are listed below: Check the fee that applies to your request: ❑ $325 (single lot/structure LOMB F following a CLOMR-F) ❑ $425 (single lotlstructure LOMB F) ❑ $500 (single lot/structure CLOMA or CLOMR-F) ❑ $700 (multiple lot/structure LOMR-F following a CLOMR-F, or multiple lot/structure CLOMA) ❑ $800 (multiple iottstructure LOMR-F or CLOMR-F) Please submit the Payment Information Form for remittance of applicable fees. Please make your check or money order payable to: National Flood Insurance Proaram. All documents submitted in support of this request are correct to the best of my knowledge. I understand that any false statement may be punishable by fine or imprisonment under Title 18 of the United States Code, Section 1001. Applicant's Name: Ne.;j (_ ASO.&f(' A1,16e. ctvlhi!►q Please Print or Type JJ Mailing Address: 44 C W056.100vi Lin N0vTK Ajv� , 01A E -Mail Address: (optional) Company: 17? Daytime Telephone No.: &J-1 S•71 --y507 (C 1 97% Gq& -72'al Xaa CV) Fax No.: q7$ �,gG,00(pA /1 MaAf% 01 W ' ile9Ca"ntnsf'= nem Data Signottt �ree of Applicant (required) r If you have any questions concerning FEMA ;policy, or the NFIP in general, please contact the FEMA Map Assistance C,dnter toil free at 1 -877 -FEMA MAP (1-877-336-2827), or visit the Flood Hazard Mapping website at http:Nwww.tema.gov/ptantprevenUfhm. FEMA Form 81-87, SEP 02 Property Information Form MT4 Form 1 Page 2 of 2 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.S NO. 3067-0147 ELEVATION FORM F.4iv+rsS**mba30,2005 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 1 hour 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 OMs 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, Federal Emergency Managamard Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (3067-0147). 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 the above address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A FEMA National Flood Insurance Program (NFIP) Elevation Certificate may be submitted in addition to this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fin from the Special Flood Hazard Area (SFHA), submit the lowest adjacent grade (the lowest ground touching the structure), including an attached deck or garage. For requests to remove an entire parcel of land from the SFHA, provide the lowest let elevation; or, if the request involves an area described by metes and bounds, provide the lowest elevation within the metes and bounds description. 1. NFIP Community Number. Property Name or Address: 25'o098 2Y cRosSl30X. 4-ANe. NOGZ7-79 .4 AJDOL, e Hf} 2. Are the elevations listed below based on ® existing or ❑rp oposed conditions? (Check one) N6vD 29 3. What is the elevation datum? If any of the elevations listed below were computed using a datum different than the datum used for the effective Flood Insurance Rate Map (FIRM) (e.g., NGVD 29 or NAVD 88), what was the conversion factor? Local Elevation +I- ft. = FIRM Datum 4. For the existing or proposed structures listed below, what are the types of construction? (check all that apply) ❑ crawl space ❑ slab on grade ® basement/enclosure D other (explain) 5. Has FEMA identified this area as subject to land subsidence or uplift? (see instructions) ❑ Yes® No If yes, what is the data of the current releveling? I (month/year) Lowest :Lot Number Block Number Lowest Lot Elevation Adjacent Grade To Base Flood For FEMA Use Only A � Structure Elevation VlzI `1-15 '` //0 t13.S 112.9 This certification is to be signed and sealed by a licensed land surveyor, registered professional engineer, or architect authorized by law to certify elevation information. All documents submitted in support of this request are correct to the best of my knowledge. i understand that any false statement maybe punishable by fine or imprisonment under Tide 18 of the United States Code, Section 1001. Cer Mees Name: M Lr� A * O License No.: 3 5 3 S 3 Expiration Dom: Company Name: v sUdz J Telephone No.: `?78 _45y - I.536 Fax No.: 9Z S _ y 5 _ 15-p "$ Signature: Date: 7/0 SA IV pyjN OF a? JAMES AHO SS% su nal) FEMA Form 81-87A, SEP 02 Elevation Form MT -1 Form 2 Pape 1 of 2 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 I FFo�r� In umanoia Company Use _I ♦I �.JIJL- A.. -W- ►1-v Poft Number A2. Building Strad Address (inowi hg Apt., Unit, Suit*, arWor Bldg. No.) or P.O. Route and Book No. City _ n n Stalls d ZIP Cods Q $ Y5 AC Building Use (e.g., Residential, Non -Residential, Addition, Acosssory, etc.) s N i— A5. LatihidWtongitudeLet. 1-12 - 3 S - `! 3 Long. 0-2 ° - 03 - I3.8 ' Horkwtal Detum: NAD 1927 [&NAD 1983 A6. Attach at least 2 photographs of the building If the Certificate Is being used to obtain flood imurwm. A7. Building Diagram Number 7 (NO O pL_-Pj j ./6S) A8. For a building with a crawl specs or anclosure(s), provide: A9. For a building with an attached garage, provide: a)Square � crawl s or *nctosure(a) sq ft a) Square footage of attached garage G 7 Z sq tit b) No. of permanent flood openings In the crawl space or b) No. ofpermanentflood openings in the attached garage enclosure(s) walls within 1.0 foot above adjacent grade wafts within 1.0 foot above adjacent grade c) Total net area of flood openings In AS.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 /lNumber /� �7 82. County Nam`e/� 1 / 83• State A ,/� O T,S / /1 /1 1, Clfl i,, D _ 60 64. MaplPanel Number 85. Suffix 88. FIRM Index - I B7. FIRM Panel Date 68. Flood Zone(s) 69. Base Flood 9WOU n(s) (Zone AO, use bass flood depth) .o ❑ feet feet ❑ meters (Puerto Rico only) ❑ (Puerto Rico only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building Date Eflac"Revised /9q (Describe type of equipment In Comments) r IZ 9 aoo 9 c Ji,ti� Z !9 .J�NI- L meters ❑ (Puerto Rico only) B10. Indicate an source of the Base Flood Elevation (BFE) date or base flood depth emarm in — oa. ❑ FIS Profile ❑ FIRM ❑ Community Determined 0Other (Dsscrdbs) GO M A SAM- 811. OZ B }� 811. Indicate elevation datum used for BFE In Item 89: ❑ NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe) CvM � cq,r� � oy-o/-o ZSo R 612. Is the building located In a Coastal Bander Resoxoes System (CBRS) area or Otherwise Protected Arae (OPA)7 ❑ Yes ® No Designation Date ❑ CBRS ❑ OPA SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations aro based on: ❑ Construction Drawings° ❑ Building Under Carm*ucW ® Finished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones Al -A30, AE, AH, A (wkh BFE), VE, V7 V30, V (with BFE), AR, AR/A, ARAE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.8 -g below according to the building diagram specified In Item A7. 27- SO Vertical Datum N G (/ C) Z 9 Benchmark Utilized LAC Conven"VComments Check the measurement used. a) b) C) d) e) 9) Top of bottom floor (including basement, crawl space, or enclosure floor) //Y ,D ❑ test ❑ feet ❑ meters (Puerto Rico only) ❑ meters (Puerto Rloo only) Top of the nod higher floor Bottom of the lowest horizontal structural member (V Zones only) / ZZ- //3 .o ❑ feet feet ❑ meters (Puerto Rico only) ❑ (Puerto Rico only) Attached garage (top of slab) Lowest elevation of machinery or equipment servicing the building .5❑ / i 5' . o ❑ feet maters ❑ mature (Puerto Rico only) (Describe type of equipment In Comments) 113 ❑ meters (Puerto Rico only) Lowest ad)oosnt (fkhis wM grads (LAG) Highest adjacent (finishad) grads (HAG) 1113 , i fefeet feel meters ❑ (Puerto Rico only) SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CER71FICA71ON This certification is to be signed and sesied by a land surveyor, 4091n0er, or architect authorized by law to cartlfy elevation information. I ro0rtlty that f1h0 Initomhaticn on this CarEllicata n6pres0r►t11 my beat efforts to kgwprot Me data 18 ode, Soetb» ,001. * -q oir*'Zr"underatand Nut any 111180 swamOnt may b0 punislhabb by Mho or bnP'iaw►me •'1 (� Check here t comments are provided on back of form. ,J/-jMles V A00 Certlfie's Nameucehse romper A 14o syR vr y / A) 6 Title c -y AJ E C"npsnywm R "o .....� 353 AddressG .Z f /z Ic.1e-,L- T LstNL� TJRAc-vr 'Fq cam, `o i z 6 Signature �Y/r J�/3 /�-0% Date TslePthorme l i 8 Y5 - / S 3 6 FEMA Farm 81-31 February 2006 See reverse side for continuation. Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: Build Slmbt Address (including ApL, Unit, Suite, and/or Bldg. No.) or P.O. Route and Boot No. Policy Number Z C72 0S,.r gown G�in�Cr' city State �! 84�SCode Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both aides of this Elevation Certificate for (1) community official, (2) Insurance aMUcompany, and (3) building owner. Comments 6 F; CS I IZ.S ccvo45-w<L-h., FD2om LoliA cqS'Lr F WILIM (-c--r P R o PL- a l NU *1;�z 7-(�: .4 /o cgosLT& a) L4/uL'- A ZL 0 PPoS' 17L s�L� 00064-C MRP Chack here it SECTIO - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zonas AO and A (wNhout BFE), wnplets Items E1 -E5. tf the Certificate M Intended lowppo t S LOMA or LOMR-F mquost, complete Soctkm A, B, and C. For Nems E1-64, use natural grads. 9 available. Check the measurement used. In Puerto Rion only. enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjscent Wade (HAG) and the lowest adjacent grade (LAG). _ ❑fest ❑meters ❑above or below the HAG. a) Top of bottom floor (including basement, crawl space, or enclosure) le b) Top at bottom floor (Indudkhg basement, crawl space, or enclosure) is _ ❑ fast ❑ meters ❑ above or below the LAG. E2. For Building Diagrams 6.8 with permanent flood openings provided In Secl90.A Items 8 Poor 9 (see We 8 of Instructions), the need higher floor (elevation C2.b in the diagrams) of the building is . _ ❑ feet lJ meters U sbovs ar [,J below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment serviclng the building Is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO any: If no flood depth number is available, is the by of the bottom floor elevated In accordance with the community's floodplalh managemerit ordinance? ❑ Yes ❑ No ❑ Unknown. The local oHlolel 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 oommunky-issued BFE) or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. Property Owners or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments G1. ❑ G2. ❑ G3. ❑ SECTION G - COMMUNITY INFORMATION (OPTIONAL) Df im who Is autnonzeo oy naw or aramanw w-n,wo,w- his Elevation Certificate. Complete the applicable kern(s) and sign below. Check the measurement used In Items G8. and G9. The information in Section C was taken from other docurnantation that has been signed and sealed by a licensed survayor, engineer, or architect who is audwrized by low to certify elevation iefornnaUm. (Indkote fro source and date of the elevation dote in the Comments area below.) A community official completed Section E for a building laceled In Zone A (without a FEMA -Issued or cornmunky4swW BFE) or Zone AO. The kigwing knfamnatdon (kerns G4.-039.) is provided for community floodplain management PurPoses• G7. This permit has been l"ued for. ❑ New Combat "on ❑ Substantial Improvement G8. Elevation of as4x* lowest floor (Including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at the building On: [].f" ❑ maters (PR) Datum ❑ feet ❑ meters (PR) Datum Local Official's Name TWO Community Name Telephone Signature Date Comments i Check here ff attec hments Replaces all previous editions FEMA Form 61-31, February 2006 i Building Photographs See Instructions for Item A6. For kmfsnw Company Uw: Building Street Address (Including Apt, Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. PokW Nmbw ZIP Code �+PWy wuC I�mt�r State CityA--�ofL7-M A ANDDU O/�`� If using the Elevation Certificate to obtain NFIP flood insurance, affix at least two building photographs below accgrding to the instructions for Item A6. Identify all photographs with: date taken; 'Front Vk W' and 'Rear View"; and, if required, 'Right Side View" and "Left Side View.' If submitting more photographs than will fit on this page, use the Continuation Page, following. F'R o rJ -F VIrw G /T ~� Building Photographs See Instructions for Item A6. For hauranw Corrger►y Use: Building Street Address (including Apt, Unit, Suite, wda Bldg No.) or P.O. Route and Box No. Pdky "bnr Z L A N L State ZIP Code �y�H'rr�e.r city A/ c rz -7 ti D v U e- /-1 r 61,91-1-5- 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 Vk W' and "Rear View"; and, if required, "Right Side View" and "Left Side View." If submitting more photographs than will fit on this page, use the Continuation Page, following. �2crA-z v/6LA" 24 crossbow lane north andover ma Search Maps Maps Search the map FEind businesses Get directions Search Results My Maps Print ® Email cis Li 24 Crossbow Ln Q X00 Trafic h.9ap sateuite North Andover, MA 01845 F 4 `t:�O L3 Lor -os f4 zY Gtzosssow C,hNt_ Thursday, May 31, 2007 09:22 AM Page 1 of 2 Gate: June 10, 2004 Case No.: 04-01.0260A LOMA °^ Federal Emergency Management Agency �0 Washingtmi, D.C. 20472 �l4MD S6G LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER. ESSEX Lot N. Crossbow Lane, as described in the Deed, recorded in Book 1820, COMMUNITY COUNTY. MASSACHUSETTS Page 10, filed. on June 8, 1984, by.the Register of Deeds, Essex County, Massachusetts COMMUNITY NO.: 250098 NUMBER: 2500180009C AFFECTED NAME: TOWN OF NORTH ANDOVER, MAP PANEL ESSEX COUNTY, MASSACHUSETTS DATE: 0610211993 FLOODING SOURCE: UNNAMED PONDING AREA APPROXIMATE LATITUDE i LONGITUDE OF PROPERTY: 42.646, -71A54 SOURCE OF LAT b LONG: PRECISION MAPPING STREETS 6.0 DATUM: NAD 83 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST WHAT IS CHANCE ADJACENT LOT LOT BLOCK/ SUBDIVISION STRLET REMOVED FLOOD FLOOD GRADE ELEVATION SECTION FROM THE ZONE ELEVATION ELEVATION (NGVD 29) SFHA (NGVD 29) (NGVD 29) N — — 10 Crossbow Lane Residential Structure X (unshaded) 112.9 feet 115.0 feel — Special Flood Hazard Area (SFHA) -The SFHA is an area that would be inundated by the flood haying a 1-percent chance of being equaled or exceeded in any given year (bass flood� ADDITIONAL CONSIDERATIONS (Please refer to tate appropriate section on Attachment 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 flood having a 1-percent chance of being equaled or exceeded in structures) on the property(iss) is/are not located In the SFW►, an area inundated by the any given year (base Hood). 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 ins mwm requirement does not apply. However, the lender has the option to continue the flood insurance requirement to protect its financW risk on the ban. A Preferred Risk Policy (PRP) is available for buildings located outside the SFHA. Information about the PRP and how one can appy is enclosed- This determination is based on'ft flood data presently available. The endosed documents provide additional information regarding this determination. If Assistance Center toll free at (877) 336-2627 (877-FEMA MAP) or by letter you have any questions about this document, please contact the FEMA Map addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifield, VA 22116-2210.' Additional information about the NFIP is available on our web site at http:/Avww.ti m -gov/nW. DouO Bellomo, P. CFM. Acting Chief Version 1.3.4 Hazard IdenMficatbn Section, Mitigation Division Emergency Preparedness and Response Directorate 62174303 0300640516YOE00003006405 2of2 Date: June 10, 2004 ICase No.: 041-01-0250A Federal Emergency Management Agency Washington, D.C. 20472 LETTER OF MAP AMENDMENT DETERMINATION DOCUMENT (REMOVAL) ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS) LOMA PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the preceding 1 Property.) Dortions of this property, but not the subject of the Determination/Comment document, may remain in the Special Flood Hazard Area. Therefore, any future construction or substantial improvement on the property remains subject to Federal, State/Commonwealth, and local regulations for floodplain management. SONE A (This Additional Consideration applies to the preceding 1 Property.) rhe National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that was determined ising the best flood hazard data available to FEMA, but without performing a detailed engineering analysis. The flood elevation used to make this determination is based on approximate methods and has not been formalized through the standard process for establishing base flood elevations published in the Flood Insurance Study. This flood elevation is subject to change. _ ccue u. This attachment provides additional Information regarding this request. If you have any questions about this attacnment, pwaac P.O. Box 221 Assistance Center toll free at (877) 336-2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, Merrifield, VA 22116-2210. Additional Information about the NFIP is available on our web site at http://www.fem@.gOvlrifip/. —rte Doug Bellcmo, P�CFM. Acting Chief Version 1.: Hazard Identification Section. Mitigation Division 62174303 0300640516YOE000030064 c—amanry Preparedness and Response Directorate Sk 10736 P0332 05-01-2007 0 03 s SUP We, A tately Fridistud and tdaYridland, of 35 Winchester Street, Brookline, Norfolk minty, Massachusetts, For consideration paid in the amount of Five sixty Thousand ($560,000,00) Dollars t: To: bell C. Manning and Janet 'l rie Manning, Husband and Wife as Tenants by the Entirety, of 1430 Johnson Stre4 North Andover, Essen. County, Massachusetts., - A&Ad4e 4 hsove.T`k&o( 9S &-k Wti s Quitclaim Coverts A =Wu mel oaf hind togedw with the buildings therm situated on Crossbow Lam, North Andover*; Esse. County, Massachusetts, bounded and described as follows: S- OUTH" ESTERLy by the Northeasterly line of Crossbow Lane, in three courses, 128.27 feet, 1.24.54 feet and 25.00 feet; NORTHWESTERLY RLY by Lot N as shod on the Mari hereinafter mentioned, 360.11 feet; NORIREASTERLy by a stone wall a distance of 17.06 feed and SbUTIMASTERLLY, SOU MWESTERLY, SOUTHEASTERLY, SOUTHWESERLY and SOUT EASTERL"Y,.resl ciively, in five courses, 143.38 feet, 20.114 feet, 64.00 fejt, 20.00 feet, and 85.1111 feet. Said parcel corktains 43,595 square feet of laud, more or less, according to said plan and is shown as Lot 21 on a plan entity "Plan of Land ib. North Andover, Mw Prepared for Charles E. Rooney & :Marc Construction," sedge: 110=01, slated Nov.. 3, 1983, Revised: Apr. 18, 1994 and Apr. 25, 1994, recorded with sex North District Registry of Deeds as Plan Number 9438. Said.premises are conveyed together with the right to use the streets and shownways on said plan for all purlroses for athicki streets and mays are coiorily►'used � the Town ofNorth Andover in common with others lawf1illy entitled thereto until conveyed to: the Town of Nortb Andover. I' Said premises are conveyed subject to any restrictions, reservations and. conditions of record insofar as the same are now in force and applicable. Eeing the same premises conveyed`to us recorded in Bonk 3294, Page 1.29. MASSACHUSETTS STATE FAV' : TAX Essex North ftsistr!' Me# 05-rypsi.-2037 0 03. po �. f t y .. CiI7s 331 i tic : 1361 J _ � x553.60 Cons: €, 6Grflt3O,00. i 0 Ing al -- a HIS Ty Q Ye�`�.. $ •� � � 'sae-' `�1 r � � r g _ �** w Inc, FEDERAL EMERGENCY MANAGEMENT AGENCY O.M=3067-0147COMMUNITY ACKNOWLEDGMENT FORM F-vir I PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this form is estimated to average 0.88 hour 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, Federal Emergency Management Agency, 500 C Street, SW, Washington DC 20472, Paperwork Reduction Project (3067-0147). 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 the above 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 located previously within the regulatory floodway (complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The community number and the subject property address must appear in the spaces provided below. Community Number- Property Name or Address: A. REQUESTS i INVOLVING THE PLACEMENT OF FILL As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this Letter of Map Revision Based on Fill (LOMR-F) or Conditional LOMB -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 fill 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 existing or proposed structures to be removed from the SFHA be are or will reasonably safe from flooding as defined in 44CFR 65.2(c), and that we have available upon request by FEMA, all analyses and documentation used to make this determination. For LOMR-F requests, we understand that this request is being forwarded to FEMA for a possible map revision. Community Comments: I Community Official's Name and Title: (Please Print or Type) i Telephone No.: Community Name: i Community Official's Signature: (required) Date: B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY I As the community official responsible for floodplain management, I hereby acknowledge that we have received and reviewed this request for a LOMA. We understand that this request is being forwarded to 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 community floodplain management requirements. Community Comments: Community Official's Name and Tide: (Please Print or Type) Telephone No.: Community Name: I Community Official's Signature (required): Date: FEMA Form 81-876, SEP 02 Community Acknowledgment Form MT -1 Form 3 Page 1 of 1 Location ' C?�d?.0 SSd'31�U.J No. ( Date 0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ sACNUs t� Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ f i TOTAL $ D ((j f } Building Inspector` :?= 8559 Div. 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C : d �m CO CD H CA m CO n 0 Cs �o sr �. m o c cl)� •..• m m :h mC4 o O � o m m o'o a'fl �o 0 0; ca c o CD c o �o m ow OM H 7d t� t7l G) w fD n O w O '0�• Z p w p X C w 0' W r z O goo n Q0 O d vz y 0 0 c z y � vz y 0 0 c I TOWN of NORTH ANDOVER AFFIDAVIT line Illi . C110 I Qnbmtcr law ! u 1 � � - c•• . ■ w • srlw • s • : w • ara n••.• � r. w • •• owti • �• t CII' _ _ Type of Work: "o `lle-e r Est. Cost !Y Address of Work aC/l e�11�w Owner Nasse: g±�d P" Date of Permit Application: 7�!� I hereby certify that: Registration is not required for the following reason(s): Fir office Use Only Work excluded by law Famit ND. --Job under $1,000 Date Building not owner -occupied _Owner pulling own permit Other (specify) Notice is'.hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WrM UNREGISTERED CffMCIORS_- FOR APPLICABLE HOME IMPROVEMMr WORK DO NOT HAVE ACCESS TO THE ARBITRA- TION PROGRAM OR GUARANIY FUND UNDER MGL c. 142A. Signed urier panalties of perjury: I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR: Notwithstanding the above notice, I hereby apply for a permit as the owner of the',above property: at"W 4e,14 Da a Owner Name KENNETH R. MAHONY Director Town of North Andover t NORT►, OFFICE OF 3? o �t, COMMUNITY DEVELOPMENT AND SERVICES ° . p r 146 Main Street North Andover, Massachusetts 01845 (508) 688-9533 HC`iEO�%NER LICENSE EXEMPTION Please print. DATE 7 l Ps— JOB LOCATION Number_ A//^, �- �/� Street address o Section of town "HOMEOWNER" - Ie�� 1?"/Ae? 4, 646''' /�-�S� 1 �_0 7-S – �V VF Name Home phone PRESENT MAILING ADDRESS A� L 4 Work phone City/Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1:1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he;'she resides or intends to reside, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to,such use and/or farm structures. A person wao constructs more than one home in a two-vear period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDDiG OFFICL�L Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 1?7.0, Construction Control. BOARD OF ,APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 Julie Parrino D. RobertIN' Wchaci Howard Sandra Starr Kathleen Bradley Colwell 4` 4 C, Ail C-1�3 rq tri A(O'k 63e�o� GeA�r£ izo='r- ►z:� MAS E-xk<-k. xS�c`�l o� t-kD v1 24 CESS 4, � o2'tt Co lK 000 i. lK . . 6 q cross LOO � Location o2 A) AAj e_ No. �'% % Date -5 % o. TOWN OF NORTH ANDOVER t,�.o .•,yC 3j op Certificate of Occupancy $41 Building/Frame Permit Fee $ ©� " s�C Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL Building Inspector Div. Public Works U V f-. f'. x 11 FORM U - LOT RELEASE FORM 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'`i`i`i`******************* APPLICANT �`ru`� PHONE 07V 1��'�"'�� LOCATION: Assessor's Map Number /dcc/5, PARCEL SUBDIVISION LOT (S) STREET��� ST. NUMBER �� ********* ****** *************** *OFFICIAL USE ONLY**,,'***********-******* RECOMMENDATIONS OF TOWN AGENTS: CONSERV ION ADMINISTRATOR COMMENTS TOM PLANNER COMMENTS FOOD INSPECTOR -HEALTH v TIC INSPrCTOR-HEALTH COMMENTS DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED- 5 Z �C9 DATE APPROVED DATE REJECTED DATE APPROVED DATE REJECTED PUBLIC WORKS - SEWER/WATER CONNECTIONS J a MAY I 010 9 I' SII.- `^ fi - � �• DRIVEWAY PERMIT17-, M FIRE DEPARTMENT s I' RECEIVED BY BUILDING INSPECTOR DATE APR 2 9 Ir,9 f E . Revised 9197 Jim ' 14-i ,►vu c >=� .-_::it, � W FAM 0 V) w c -n m 5 0 (1) :1)m 3 m o o 0 :133 � o 0 m C C �( n i c (10 ;� m n 70 On L c O v z Z n Z n v M �Z �` c T Vrl T Poo W 1 I � y v nt O O _� f O aci POL _ = po M CL eD a -o v -• H H t eD W FAM 0 V) w c -n m 5 0 (1) :1)m 3 m o o 0 :133 � o 0 m C C �( n C w � � c c (10 ;� m n 70 On L c O v z Z n Z n c O M �Z �` c T „ T T T 1 I v CA W N 0 c c� i Town of North Andover E �oRT►, , OFFICE OF 3� 0 `�. to , e y tiOOL . COMMUNITY DEVELOPMENT AND SERVICES0 10 I 4L 27 Charles Street : �Q North Andover, Massachusetts 0184504A•Fo "� Cy WILLIAM J. SCOTT SSAcHUsti Director (978) 688-9531 Fax (978) 688-9542 HONIEOWNER LICENSE EYELIPTION Please print. / DATE JOB LOCATION "HOMEOWNER" Ye'zo rJ 4d— 441 Number Street address Section of town 070-16Y,5 '5 ?. �em l 5?7gl 97j-- �4 Yd' Name �I `/ Home phone Work phone PRESENT MAILING ADDRESS �% ` City/Town State Zip code The current exemption for "homeowners" was extended to include owner -occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code Sec- tion 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is; or is intended to be, a one to six family dwelling, attached or detached structures ac- cessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner . Such "homeowner" shall submit to the Building Official, on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of No. Andover Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICL-kL Note: Three family dwellings 35,000 cubic feet, or larger, will be required to comply with State Building Code Section 127.0, Construction Control. i BOARD OF APPEALS 688-9541 BUILDING 688-9545 CONSERVATION 688-9530 HEALTH 688-9540 PLANNING 688-9535 C/) m T m U) 0 CD O N CD 0 d O H b C H :o 0 CD CD �D CD y a O CD 0 CD Ki C T ?-�o w _ O to o Q N � o C q V� mm C ) CL m C ym'0 _0 z c O•w = .cu d•► O LA. T CL CL CD N co COO) CD o-10 O ? m O _> > m � O C CCU y C! .m co a D � :\ CL -„. • nk. � �zou n. C CO)�J f CD cc aS aw CD -3 o•► CO) D1 N •� 7 1 N C ta ? N O CO) CDCl O O CD co CD o cu cco d� ate: �� C a o_cn m �v C/)o w ro � m O � � � G b � � W G � pGp T C r � a z wa ai n cn tea+ n ro 7' 9 Co Z z o G 3 J z qvV q A Rot, m 15- 1- 2 I- I Aly, ;.j IV "? -19 ,v It le OL ------------------------ Z 0 0 0 0 0 yu Q 0 E Location No. A Date ��,CO #4Y FNl TOWN OFA/;I �RT Fd1RVER n Certificate of Occupa9(9; 0 Building/Frame Permit Fee $ C�VtQr Foundation Permit Fee $ Other Permit Fee $ Sewer Connection Fee $ Water Connection Fee $ TOTAL $ Building Inspector Div. Public Works PER1111" NO. `'76 APPLICATION FOR PERMIT TO BUILD - NORTH ANDOVER, MASS. 4✓ V 1'I L. - v Ll� j/PAGE 1 MAP 4d0. /S V LOT NO. 2 RECORD OF OWNERSHIP IDATE BOOK 'PAGE Z99E SUB DIV. LOT NO. LOCATION �Q$� �I J 'NER'S A� �r�er- PURPOSE OF BUILDING _JJ NAME /../�� NO. OF STORIES SIZE �/� / X /O OWNER'S ADDRESS ✓G• BASEMENT OR SLAB ARCHITECT'S NAME SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME SPAN DISTANCE TO NEAREST B ILDING DIMENSIONS OF SILLS DISTANCE FROM STREET INCE FROM LOT LINES - SIDES REAR �.f- POSTS Gip€1tS AREA OF LOT FRONTAGE HEIGH OF FOUNDATION �' THICKNESS 15 BU,ILDING NEW SIZE OF FO X S BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND '~WILL BUILDING CONFORM TO REQUIREMENTS OF CODE bIDR IS BUILDING CONNECTED TO TOWN WATER 'BOARD OF APPEALS ACTION. IF ANY �A V IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS SEE BOTH SIDES PAGE I FILL OUT SECTIONS 1 - 3 PAGE 2 FILL OUT SECTIONS 1 - 12 .,i ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING I ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS /A. PLANS MUST BE FILED AND APPROVEDBYBUILDING INSPECTOR DATg.FI ED SIGNATURE CZF 14(VNErt OR AUTHORIZED AGENT FEE vv PERMIT GRANT 2-1 19 ! 2-- s 181992 ; I OWNER TEL. N CONTR. TEL # _ CONTR. LIC. #-� -�-� 3 PROPERTY INFORMATION LAND COST ST. BLDG. COST EST. BLDG. COST PER SQ. FT. EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. 4 APPROVED BY BOARD OF HEALTH PLANNING BOARD BOARD OF SELECTMEN BUILDING RECORD �. 1 OCCUPANCY 12 SINGLE FAMILY STORIES MULTI. FAMILY OFFICES APARTMENTS _ CONSTRUCTION 2 FOUNDATION —I 8 INTERIOR FINISH CONCRETE B 1 2 13 CONCRETE BL'K. PINE BRICK OR STONE HARDWD _ PIERS PLASTER _ DRY WALL UNFIN. 3 BASEMENT AREA FULL FIN. B'M'TAREA _ '/, '/2 V, FIN. ATTIC AREA NO B M -T FIRE PLACES _ HEAD ROOM MODERN KITCHEN _ 4 WALLS I 9 FLOORS CLAPBOARDS CONCRETE EARTH HARDW D COM MON ASPH. TILE B 1 2 �_ 3 _ _ DROP SIDING WOOD SHINGLES ASPHALT SIDING ASBESTOS SIDING VERT. SIDING STUCCO ON MASONRY _ STUCCO ON FRAME BRICK ON MASONRY BRICK ON FRAME ATTIC STRS. & FLOOR I_ CONC. OR CINDER BILK. WIRING STONE ON MASONRY _ STONE ON FRAME SUPERIOR 1.I POOR _ ADEQUATE NONE 5 ROOF 10 PLUMBING GABLE HIP BATH (3BATH (3 FIXE TOILET RM. (2 FIX.) _ GAMBREL M ANSARD I FLAT SHED WATER CLOSET _ ASPHALT SHINGLES LAVATORY _ _ WOOD SHINGES KITCHEN SINK SLATE NO PLUMBING TAR & GRAVEL STALL SHOWER _ _ ROLL ROOFING MODERN FIXTURES _ TILE FLOOR TILE DADO 6 FRAMING I 11 HEATING WOOD JOIST PIPELESS FURNACE FORCED HOT AIR FURN. TIMBER BMS. & COLS. STEAM STEEL BMS. & COLS. HOT W'T'R OR VAPOR WOOD RAFTERS _ AIR CONDITIONING _ RADIANT H'T'G UNIT HEATERS 7 NO. OF ROOMS GAS OIL ELECTRIC B'M'T 2nd _ Ist 13rd NO HEATING THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA- RAGES. ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN. .% .. • S m o / m m T 'n =orINTI v - W AZ > 'a a _ mN........� - - n _ H- _ .. N Q t � 0 � O � Z v n r rri W O ►b V) V) a-• ti O 3•CZ� O4 3• � O � � ,Z^ V , � rt Ib H r O to 'z .. • o_ m m` =r\ m o / m m T 'n =orINTI o=ro m c j\\' 3 c 7 s 3 C - W AZ > 'a a _ mN........� - - n _ H- _ .. N Q t � WI O V) rA ul w T m T o mT m �t 0 m vPoo p ? I N y d v � O O 5 v y v n c H f e O p O � a A �D C• A` O a In WI O V) rA ul w T m T o mT m �t 0 m p ? N d C n v n c O In ^� H M _ 70 4 m FORM U - IAT RELEASE FORM 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 local or state law, regulations or requirements. **`**************Applicant fills out this section***************** /APPLICANT: D r"r'/ ���e Phone LOCATION: Assessor's Map Number 14945'g Parcel Subdivision s� / Lot(s) Street �i -f� lxr St. Number ************************Official Use Only************************ RECQ.,F-M NDATIONS OF TOWN AGENTS: Date Approved r conservation Administrator Date Rejected V Comments Date Approved Town Planner Date Rejected Comments (/ Date Approved Health gent Date Rejected Comments Public Works - sewer/water connections driveway permit Fire Department t� r [ i � Received byBuilding Inspector I, 1 81%2 ��-% Date (Please print) DATE &� JOB LOCATION Num "HOMEOWNER" Town of North Andover BUILDING DEPARTMENT Homeowner License Exemption 4� e/r"� 5ttree/t Address ection of town Ncffie Home© Phone Work Phone PRESENT MAILING ADDRESS ���%���U �CGr. /6/�%L��_ City Town State Zip code The current exemption for "homeowners" was extended to include owner occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. (State Building Code, Section 109.1.1) DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one to six family dwell- ing, attached or detached structures accessory to such use acid/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official, on a form acceptable to the Bulding Official, ..that he/she shall be responsible for all such work performed under the ',,.building permit. (Section 109.1.1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of .North Andover Building Department minimum inspection procedures and requirements and that he/she will comely with said procedures and ...requirements. / .,HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICI Note: Three family dwellings 35,000 cubic feet, or larger, cai e required to comply with State Building Code Section 127.0, Construction Control. )�- _ 1 MAY 1. 81992 a -�'—� ��N rte• � � � � `� ��illitrr /N �xls t�^ l \�F '9 /Soo GA/ SEafyc TA/yK r RAnf/9t�1: Ca�S t`o • �'�'��ar11MY•v.�F.W7etirM•a�y+�lM4M/rM1�M'�• �� v Al i -.r it 18 199i_