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GAS INSPECTOR
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TOWN OF NORTH ANDOVER
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PERMIT FOR WIRING
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wiring in the building of .........................................
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Fed--..;� ............. Lic. No. Z��,RV ............. ....... ........ ....... )(��
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BOARID OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked CPO
,[Rev. 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work- to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12.00
12 � 2MT/CA
(PLEASE PPJNT IN TNK OR =E ALL INFOR.W TIOAT) Date:
City or Town of- North Andover , To the Inspector of Wires:
By this application the undersi6ed gives notice of his or her intention to perform the elecrrical work described below.
Location (Street & Number) 28 Nadine Ln
Owner or Tenant Ram Bandredi Telephone No. 9 78-66T=5
Owner'sAddress ?.RNadine Ln, North Andover, MA 01845-5932
Is this permit in conjunction with a building permit? Yes F7 No (Check Appropriate Box)
Purpose of Building Residential - I family Utility Authorization No. .
Existing Service Amps Volts Overhead Undgrd No. of Meters
New Service Amps Volts Overhead D Undgrd No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Anld WMV RUkr
No. of Recessed Luminaires
;, v —
lNo. of Ceil.-Susp. (Paddle) Fans
Ff v bw wuiv= by ine i fo-etca-1,01" Or Wires.
Transformers KVA
No. of Luminaire Outlet I s
lNo. dfHot Tubs
KVA
No. of Luminaires
: 4.Generators
Above r -i In-
ISwimming Pool gmd. L_J and.
R" o. otTmergency Lighting
Battery Units
No. ofReceritacle Outlets
No. -of Oil Burners
FIRE ALARMS JNo. of Zones I
No. of Switches
No. of Gas Burners
No. of Detection and
Initiatint Devices
No. of Ranges
No. of Air Cond. Toial
Tons
No. of Alerting Devices
No. of Waste Disposers
HeatPump
. Totals:
Ntnrnber�Tons
1.
_�KW
No. of Self -Contained
Detection/Alerting Devices
-L
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No. -of Dishwashers
Space/Area Heating KW
a,
'Loca, Ei Munidip�l
Connection D Other
No. of Dryers
No. of Water
Heaters KW_
Heating Appliances KW
0. of No. of
Signs Ballasts
Security Systems:*
No. of bevices or Eouivalent
Data Wiring:
No. of Devices or Eatrivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications WMng__: .
No. of Devices orEouivalent
OTHER:
3 oc. c_�o Attach additional detail if desired, or as required by the Inspector of Wires,
Estimated Value of Eirctrical Work: — (When required by municipal policy.)
Work to Start: I 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 uniess
the licensee provides proof of liability insurance including "compieted operation" coverage or its substantiai equivalent. The
Undersigned certifies that such coverage is in force, and has exhibited proof of same to the p=dt issuing office.
Cl IECK ONE: INSURANCE El ROND [] OTHER [I (Specify:) Liberty Mutual
I certift, under the pains and penafties ofperjury, Mar the information- on dzis appiication is true and compiera.
F1 RM NAME: rwiees N.E., 4.1-C ::::7 4 LIC. NO.:- 1012RA
Licensee: Richnni F Cayer Signaturek&&Z&� (ZW
.4, LIC. NO.:
(JJ applicable, enter "exempt " in the lice-nse number line.) 7 Bus. Tel. No. -
Address: Alt TeL No.: 781-359-26(
* Per M.G.L. c. 147, s�;5-or-Y?P=�luwedrPrue"qumgsubZ=eanP3orf Public Safety "S" License: Lic. No.
0 VNIN ERIS INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
ruClLliredbylaw. Bymy signature below, 1hereby waive this requirement. lainthe(checkone)Elowne7 L7 - er'sag'
0% . viier/Auent own ent-
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Telephone No. PERMIT FEE: S 2�.00
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jORT 'NDOVER
TOWN OF NORTWA
PERMIT FOR PLUMBING
This certifies that
has permission to perform
..........
plumbing in the buildings of
,,�eF1' -� North Andover, Mass.
at .....
Fee�4 ....... Lic. No.. I .............
L U M B,4 INSPECTOR
Check # 0 34-2
8459
FIXTURES
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
1101111 Andover i t2t9ffi9i -T,
CItyrTown:j MA. Da Fermit# 11
'Building LocationJ 28 Nadine Ln I Ram Bandre i
Owners Name:
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Type of Occupancy: Commercial 17'. Educational L] industrial Institutional Residential
New: D Alteration: Renovation: D. Replacement: 17" Plans Submitted: Yes�jl No( f
FIXTURES
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Check One Only Cerlqqolte
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I 2finnal rgy vierviceS
Installing Company Name:1--
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Name of Licensed Plumb r..
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INSURANCE COVERAGE:
I have a current liability ins . urance policy or its substantial equivalent which meets the requirements of MGL Ch. 142 Y
If you have checkbd'Yyes, please indicate the type of coverage by Checking the appropriate box below.
X
A liability insurance policy L_j —
Other type of indemnity 1 11 B o n d
L__J1
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not hav the I insurance coverage required by Chapter 142 of the
Massachusetts General Laws, and that.my signature on this permit application waives this requirement.
Check One Only
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Owner L
Agent 71,
.....ULPY arurythataijot he details and information I have submitted (or entered) regarding this application are true and accurate to the host nf mv
F.... ..V —win a[IU IFMLaliauons perFormea under the permit issued for this application will be in Compliance with all
-4V i-JUFfluing Loue ana kLnapter -igz ot the General Laws.
By Type of License:
Title!
Plumber 6i'694it'lulie of-Licensded Piur#ber
Cityrrowni Master MP 8857
A Journeyman F-19 License Number:
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TOWN OF NORTH ANDOVER
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PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas in-stallation—"--e-� ..................
.. . . .. ....
in the buildings of ..........................................
at .......................... North Andover, -Mass.
------------------------
Fee!� ..... Lic.
....... . ..... .. ..........
Check # 6 6 2-
7089
=IYTI IP=iz
MASSACHUSE77S UNIFORM APPLICATION FOR PERMIT TO DD GAS F1 t7ING
Xn#h Andover !M9/09—,
C411 own:
Date: Permit#
Bandiedi
28 liadine Ert Rain
Building Locatic
Ownem. Name,
Type of Da=upancy:
Comrnercial� dl.102b0naV industrial: i P Stiti-ItiOn2l Residential
New: Alteration:
Renovation.� Repiacement:� Plans Submitted: Yes Nc'�
=IYTI IP=iz
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes*--lNo--�`
If you have checked Yes, pie2se indicate the type of coverage by checking the appropriate box below.
X
A liability insurance poiicy� Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance covemae required by Chapter 142 of the
7
Massachusetts Gener-21 Laws. and that my sionature-on this permit application waives this recluirement
Check One Only
Owner Aaent
Sion2TUre of Owner or Owners Aoent
By checkinq this box F—); I hereby certify that all of the demiis and information I have suomitted.(or entered) regarding this application are true and
accurate to the best of my Knowledge and that all piumbing work and installations performed under the oermit issued tor this a.D.Dimation will be in
comDiiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chaoter 142 of I the General Laws.
1-7ypeof License:
By
Plu
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7itie Gas Fitter 8�nature of Licens4d Piumb. /Gas Fitter -
Master
�itv Journeyman
iiown�
LP instalier License Number:
APPROV—=D (OFFICE USE ONLY�
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SUB BSIVIT.
BASEMENT:
1'15' F OR
2"' FL OR
3 FLOOR
Th FLOOR
1
5'h FLOOR
—LO
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7' FLOOR
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National
Gria
Energy
Services
Check One Only Certifit:jde
Installing Company
Name:
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61
Second
Avenue
Burlington
Corporation
At4ess:
"CityrTown:'
4state:l M A
781-359-2745
Flartnershio
78t-359-2100
Buibiness Tel:.
F2X:
AndrX.M
T
upming
i.Firm/Company
Name of Licensed Plumber/G2s Fitter:��
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL. Ch. 142 Yes*--lNo--�`
If you have checked Yes, pie2se indicate the type of coverage by checking the appropriate box below.
X
A liability insurance poiicy� Other type of indemnity Bond
OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance covemae required by Chapter 142 of the
7
Massachusetts Gener-21 Laws. and that my sionature-on this permit application waives this recluirement
Check One Only
Owner Aaent
Sion2TUre of Owner or Owners Aoent
By checkinq this box F—); I hereby certify that all of the demiis and information I have suomitted.(or entered) regarding this application are true and
accurate to the best of my Knowledge and that all piumbing work and installations performed under the oermit issued tor this a.D.Dimation will be in
comDiiance with all Pertinent provision of the Massachusetts State Plumbing Code and Chaoter 142 of I the General Laws.
1-7ypeof License:
By
Plu
mber
7itie Gas Fitter 8�nature of Licens4d Piumb. /Gas Fitter -
Master
�itv Journeyman
iiown�
LP instalier License Number:
APPROV—=D (OFFICE USE ONLY�
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Date....
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TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
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This certifies that z . ..... 4 ......................
has permission to perform ...... 4z.1
...............
wiring in the building of ......... M-E'M L.V ..........
AW -A .. ...........................
at .......... ......................... ........... North Andover, Mass.
aJ2
Fee..Z.&O .......... Lic. No/. .............
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Check # —I -4-5y ELEcrRicAANSP V R
me
-Commonwealth of Massachusetts Official Use Only
Permit No.
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS fRev- 11/991 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK'
All wcrk to be performed in accordance with the Massachusetts Electrical Code (MEC), 52 MR I
(7>LEASEPPJNTIN1NK0R7TPPE LLNFORMATION) Date:,// 761.9
City or Town of: / 4% 71-1 4&6g?,d 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) XZ4,�o 1,V,4'
Owner or Tenant '01ne In I- Telephone No.
ownees Address 9 f s 9:a Se 770n� S 7 1YaW171 exli4oa Id
Is this permit in conju 7ca with a building permit? Yes P9 No El (Check Appropriate B.ox),*W40Ptirxf$ 7
Purpose of Buildin 7AIdAL Utility Authorization' No. 907,?6-K
Existing Service
_Z/400 Amps I;V lacX- Volts Overhead [I UndgrdO No. of Meters
New Service Amps
Number of Feeders and Ampacit]
Location and Nature of Proposed
Volts Overhead [D Undgrd [:1 No. of Meters
'rnmnletinn afthe folloning table may be wived by the Inspector of Wires.
No.'of Recessed Fixtures
------- --
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
;Z
Swimming -Pool Above Ei In-
p -r n d. grnd.
No. Of Emergency Lighting V
Battery Units
No. of Receptacle outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
'1,ep
tTo. of Detection and
Initiatine Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
Number
ITO us
I KW
No. of Self- ontained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
ISecurity
Municipal
Local ConnectionEl Other
No. of Dryers
Heating Appliances KW
Systems:
NO. of Devices or Equivalent
N—o. _o? Water KW
Heaters
of
No. of Ballasts
Si�ns
Data Wiring
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
OTHER:
V
AllaCisadditionatoetaititaejirea, orasrcquireabytheinipeelor j "Z*
INSURANCE COVERAGE: Unless waived by the owner, no permit for the performance of electrical work may issue unless
the licensee provides pr9of of liability insurance including "completed operatioif' coverage or its substantial equivalent. The
undersigned certifies that such coverage is in force, and has eiWbited proof of same to the permit issuing office.
(M.CK ONE' INSURANCE [3 BOND D OTHER (Specify: 1.11X011 a
(Ex;(irationDate)
Estimated Value of Eiectrical Work- (When required by municipal policy.)
Work to Start: /,;t - /- 0 9 Inspectio;.s to be requested in accordance with MEC Ru le 10, and upon completion.
I cerdfy, under Ithne,,pains an d penalties ofpeoFury, th at th e in orm ation on th is application is tru e an d complete.
t-7-701- 01 LIC. NO.: /I J 71
0 /W 1/_Z6
FIRM NAME: X1Z X
Licensee: � �4,�A , �thlefe lo Signat LIC.NO.:_)F1qha_2 00
Signatu e ep one o.
13 7
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Federal Emergency Management Agency
Washington, D.C. 20472
April 24, 2007
MS. GEETA BANDREDDI CASE NO.: 07-01-0631A
28 NADINE LANE ' COMMUNITY: TOWN OF NORTH ANDOVER, ESSEX
NORTH ANDOVER, MA 0 1846 COUNTY, MASSACHUSETTS
COMMUNITY NO.: 250098
DEAR MS. BANDREDDI:
This is in reference to a request that the Federal Emergency Management Agency (FEMA) determine
if the property described in the enclosed document is located within an identified Special Flood
Hazard Area, the area that would be inundated by the flood having a I -percent chance of being equaled
or exceeded in any given year (base flood), on the effective National Flood Insurance Program (NFIP)
map. Using the information submitted and the effective NFIP map, our determination is shown on the
attached Letter of Map Amendment (LOMA) Determination Document. This determination document
provides additional information regarding the effective NFIP map, the legal description of the
property and our determination.
Additional documents are enclosed which provide information regarding the subject property and
LOMAs. Please see the List of Enclosures below to determine which documents are enclosed. Other
attachments specific to this request may be included as referenced in the Determination/Comment
document. If you have any questions about this letter or any of the enclosures, please contact the
FEMA Map Assistance Center toll free at (877) 336-2627 (877 -FEMA MAP) or by letter addressed
to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA
22304-6439.
Sincerely,
W -4y. /? dz�.� 12—
William R. Blanton Jr., CFM, Chief
Engineering Management Section
Mitigation Division
LIST OF ENCLOSURES:
LOMA DETERMINATION DOCUMENT (REMOVAL)
cc: State/Commonwealth NFIP Coordinator
Community Map Repository
Region
Page I of 2
rDate: April 24, 2007
lCase No.: 07-01-0631A
LOMA
Federal Emergency Management Agency
JVD S Washington, D.C. 20472
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
COMMUNITY
AND MAP PANEL INFORMATION
LEGAL PROPERTY DESCRIPTION
TOWN OF NORTH ANDOVER,
Lot 4, Willow Tree Development, as shown on the Easement Plan
ESSEX COUNTY,
recorded as Plan 12547, in the Office of the Registry of Deeds,
MASSACHUSETTS
Essex County, Massachusetts (TM:25; TL:122)
COMMUNITY
COMMUNITY NO.: 250098
NUMBER: 2500980006C
AFFECTED
MAP PANEL
DATE: 6/2/1993
FLOODING SOURCE: PONDING
APPROXIMATE LATITUDE & LONGITUDE OF PROPERTY: 42.662, -71.115
SOURCE OF LAT & LONG: PRECISION MAPPING STREETS 7.0 DATUM: NAD 83
DETERMINATION
OUTCOME
1%ANNUAL
LOWEST
LOWEST
BLOCK/
WHAT IS
CHANCE
ADJACENT
LOT
LOT
SECTION
SUBDIVISION
STREET
REMOVEDFROM
FLOOD
FLOOD
GRADE
ELEVATION
THE SFHA
ZONE
ELEVATION
ELEVATION
(NGVD 29)
(NGVD 29)
4
Willow Tree
28 Nadine Lane
Structure
X
236.4 feet
241.6 feet
Development
(unshaded)
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 qiven year (base flood).
ADDITIONAL CONSIDERATIONS (Please refer to the 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 structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a I -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 SFHA. Information about the PRP and how one can apply is enclosed.
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 (877) 336-2627
(877 -FEMA MAP) or by letter addressed to the Federal Emergency Management Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA
22304-6439.
William R. Blanton Jr., CFM, Chief
Engineering Management Section
Mitigation Division
Page 2 of 2
T-
Date: April 24, 2007
7Case No.: 07-01-0631A
LOMA
TARr
Federal Emergency Management Agency
Washington, D.C. 20472
QND S
LETTER OF MAP AMENDMENT
DETERMINATION DOCUMENT (REMOVAL)
ATTACHMENT 1 (ADDITIONAL CONSIDERATIONS)
PORTIONS OF THE PROPERTY REMAIN IN THE SFHA (This Additional Consideration applies to the
preceding 1 Property.)
Portions 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.
ZONE A (This Additional Consideration applies to the preceding I Property.)
The National Flood Insurance Program map affecting this property depicts a Special Flood Hazard Area that was
determined using 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.
This attachment provides additional information regarding this request. If you have any questions about this attachment, please contact th
FEMA Map Assistance Center toll free at (877) 336-2627 (877 -FEMA MAP) or by letter addressed to the Federal Emergency Management
Agency, 3601 Eisenhower Avenue, Suite 130, Alexandria, VA 22304-6439.
mx— /?
William R. Blanton Jr., CFM, Chief
Engineering Management Section
Mitigation Division
-;�o
A,ft
0
Federal Emergency Management Agency
Washington, D.C. 20472
4NI) S
ADDITIONAL INFORMATION REGARDING
LETTERS OF MAP AMENDMENT
When making determinations on requests for Letters of Map Amendment (LOMAs), the Department of
Homeland Security's Federal Emergency Management Agency (FEMA) bases its determination on the flood
hazard information available at. the time of the determination. Requesters should be aware that flood
conditions may change or new information may be generated that would supersede FEMA!s determination. In
such cases, the community will be informed by letter.
Requesters also should be aware that removal of a property (parcel of land or structure) from the Special
Flood Hazard Area (SFRA) means FEMA has determined the property is not subject to inundation by the
flood having a I -percent chance of being equaled or exceeded in any given year (base flood)- This does not
mean the property is not subject to other flood hazards. The property could be inundated by a flood with a
magnitude greater than the base flood or by localized flooding not shown on the effective National Flood
Insurance Program (NFIP) map.
The effect of a LOMA is it removes the Federal requirement for the lender to require flood insurance
coverage for the property described. The LOMA is not a waiver of the condition that the property owner
maintain flood insurance coverage f6r the property. Only the lender can waive the flood insurance purchase
requirement because the lender imposed the requirement. The property owner must request and receive a
written waiverfrom the lender before canceling the policy. The lender may determine, on its own as a
business decision, that it wishes to continue the flood insurance requirement to protect its financial risk on the
loan.
The LOMA provides FEMA!s comment on the man I datory, flood insurance requirements of the NFIP as they
apply to a particular property. A LOMA is not a building permit, nor should it be construed as such. Any
development, new construction, or substantial improvement of a property uinpacted by a LOMA must comply
with all applicable State and local criteria and other Federal criteria.
If a lender releases a property.owner from the flood insurance requiremen� and the property owner decides to
cancel the policy and seek a refund, the NFIP will refund the premium paid for the current policy year,
provided that no claim is pending or has been paid on the policy during the current policy year. The property
owner must provide a written waiver of the insurance requirement from the lender to the property insurance
agent or company servicing his or her policy. The agent or company will then process the refund request.
Even though structures are not located in an SFHA, as mentioned above, they could be flooded by a flooding
event with a greater magnitude than the base flood. In fact; more than 25 percent of all claims paid by the
NFIP are for policies for structures located outside the SFHA in Zones B, C, X (shaded), or X (unshaded).
More than one-fourth of all policies purchased under the NFIP protect structures located in these zones. The
risk to structures located outside SFHAs isiust not as great as the risk to structures located in SFHAs. Finally,
approximately 90 percent of all federally declared disasters are caused by flooding, and homeowners
insurance does not provide financial prot . ection from this flooding. Therefore, FEMA encourages I the widest
possible coverage under the NFIP. i
LOMAENC-1
6'r ,
The NFIP offers two types of flood insurance policies to property owners: the low-cost Preferred Risk Policy
(PRP) and the Standard Flood Insurance Policy (SFIP). The PRP is available for I- to 4 -family residential
structures located outside the SFHA with little or no loss history. The PRP is available for
townhouse/rowhouse-type structures, but is not available for other types of condominium units. The SFIP is
available for all other structures. Additional information on the PRP and how a property owner can quality
for this type of policy may be obtained by calling the Flood Insurance Information Hotline, toll free, at 1-800-
427-4661. Before making a final decision about flood insurance coverage, FEMA strongly encourages
property owners to discuss their individual flood risk situations and insurance needs with an insurance agent
or company.
FEMA has established "Grandfather" rules to benefit flood insurance policyholders who have maintained
continuous coverage. Property owners may wish to note also that, if they live outside but on the ffinge of the
SFHA shown.on an effective NFIP map and the map is revised to expand the SFHA to include their
structure(s), their flood insurance policy rates will not increase as long as the coverage for the affected
structure(s) has been continuous. Property owners would continue to receive the lower insurance policy rates.
LOMAs are based on minimum criteria established by the NFIP. State, county, and community officials,
based on knowledge of local conditions and in the interest ofsafety, may set higher standards for construction
in the SFRA. If a State, county, or community has adopted more restrictive and comprehensive floodplain
management criteria, these criteria take precedence over the minimum Federal criteria.
in accordance with regulations adopted by the community when it made application tojoin the NFIP, letters
issued to amend an NFIP map must be attached to the community's official record copy of the map. That map
is available for public inspection at the community's official map repository. Therefore, FEMA sends copies
of all such 1etters to the affected community's official map repository.
When a restudy is undertaken, or when a sufficient number of revisions or amendments occur on particular
map panels, FEMA initiates the printing and distribution process for the affected panels. FEMA notifies
community officials in writing when affected map panels are being physically revised and distributed. In
such cases, FEMA attempts to reflect the results of the LOM on the new map panel. If the results of
particular LOMAs cannot be reflected on the new map panel because of scale limitations, FEMA notifies the
community in writing and revalidates; the LOMAs in that letter. LOMAs. revalidated in this way usually will
become effective I day after the effective date of the revised map.
LOMAENC-I
Location
No. Date
(711
Building Inspector
Div. Public Works
TOWN OF NORTH ANDOVER
1,401174 1
Certificate of Occupancy
$
00-
i +4
Building/Frame Permit Fee
$ 6
04
CHU
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
TOTAL
$
(711
Building Inspector
Div. Public Works
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North Andover Building Department
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of IVIGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a propedy licensed solid waste disposal facility as defined by IVIGL
c 11, S 150 A.
The debris will be disposed of in:
I
CA —AkUq
(Location of FaS�iFjiy)
uate
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
z
The Commonwealth of Massachusetts,
Department of Industrial Accidents
Office of Investigations
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
I Name —Jh Y V, M( -'(?,KV ReZzse Print 'I
Name: aR
Location:
citV Phone
I am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any c2pac;ty
I am an employer providing workers' compensation for my employees working on this job.
nv name:
Address
Citv: Phone "-*.
insurance Co. Pclicv #
Comoanv name:
Address
Citv: Phone #*
Insurance Cc. Policv
= secure coverage as required under Sec, -ion 25A or MGL 152 czn lead to the imposition of c.�minal penalties of a fine up to $1,5GO.00
an d1c r on e years' i mc. ns cnm ent as we! I as dvii p en alties in te f arm of a STO P WC RK C) RC ER an d a fin e or' (S 100. 00) a d ay ag ai nst rn e. I
understand that a c--c.y cf this statement may be forwarded to the Office of Investigations of the DIA for c--verage verification.
I do hereby certY,1 under the pains and i1enalti . es a �o eq ur-
f ' / that the information provided a�,cve is true and ccrrec,�
Signature Date 1�- 7-,7L
Print name ls:�� Phone
t
Official use only do not wrfte in this area to be ccrnpleted by city crcwn official'
City or Town Permit/Licensinc
Building Dept
[7 C.�eck d immediate respcnse is required Licensing Board
Selectman's office
Ccntac.1)oerscn: Phone Health Department
F -i Other
6:1
OQ
, ITIP,
-LOT RELEASE FORM
FORM U
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.
ICANT FILLS OUT THIS SECTIGN****...
M) 1D 0, Y�, V2,
APPLICANT PHONE'%
LOCATION: Assessor's Map Number PARCEL
SUBDIVISION LOT (S)
STREET S T. N U M B E R
*************OFFICIAL USE
6__�rl CIP51N.) DECK Ik;Coe_�,fVSQ__
RECOMMENDATIONS OF TOWN AGENTS:
V// r
CO RVATION ADMINISTRATOR DATE APPROVED
nATI= P1= IPCTED
COMMENTS
t
TOWt4)PLANNER .
COMMENTS
FOOD INSPECTOR -HEALTH
SEPTIC INSPECTOR -HEALTH
COMMENTS
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
DATE APPROVED
DATE REJECTED
PUBLIC WORKS - SEWERIWATER CONNECTIONS
DRIVEWAY PERMIT
FIRE DEPARTMENT
RECEIVED BY BUILDING INSPECTOR
Revised 9\97 jm
DATE
Location At -'aw /11
No.. Date
t�.
tv
NT2
8373
M
,e� — �! — �
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
Building/Frame Permit Fee
$
Foundation Permit Fee
$
Other Permit Fee
$
Sewer Connection Fee
$ A�Rv,,!::�o
Water Connection Fee
$ /,o 77.1'o
IUIAL 4i 4�U 1_1 4- "
ildin Ins ctor
Dlv�6ic
Jb Works
Cx
Location LAW.
No. Date
TOWN OF NORTHANDOVEM
Certificate of Occupancy $
Building/Frame PermitFee $
Foundation Permit Fee $
Other Per it Fee $
Sewer Connection Fee $ E --
Water Connection Fee $
TOTAL $ --)o
Building Inspector
'KTO Div. Public Works
8300
A -A
No. T16t Date (60 (.1-9
( V
&ORT
TOWN OF NORTH ANDOVER
Certificate of Occupancy
$
t�z Z.
Building/Frame Permit Fee
$
AC 0.
Foundation Permit Fee
$
co -fS
Other Permit Fee
$
Sewer Connection Fee
$
Water Connection Fee
$
LZ
TOTAL
$
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RECOMRIE-NDAMIMNS 01F M AG=S:
C:-- = e.-. r -s
04A&h a A_4 �k&u
Planner -
Date Amuraved
Date Approved 469
Cate Rejected
Date Approved
Food Tln,5s;,��c 0 Date Rejected
_4ec --
Date Arnroved
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D a t- e
M
U REIZA E FORK
INSTRUCTIONS: This form Is used to verify that all necessary
approvals/permits from Boards and Departments
having jurisdiction
have been obtained. Thi does not relieve the applicant and/or -
landowner from cq�zp�iance with any applicable
local or state law,
regulations or rie ic
*****Appli&��4Ckills out.this section****
1110Q I Re75-
APPLIC.XNT: EYE(og&E�21'
Pl---e
LOCATION: Assessor's Maz Number C9 5
Parcel ;L
Subdivision
Lot(s)
Street
St. Number F -S
* * * ** ** *** ***** *** * *** **n— ff
RECOMRIE-NDAMIMNS 01F M AG=S:
C:-- = e.-. r -s
04A&h a A_4 �k&u
Planner -
Date Amuraved
Date Approved 469
Cate Rejected
Date Approved
Food Tln,5s;,��c 0 Date Rejected
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szec- Or-;:=
Date Rej ected
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FND.
/*
FOUNDATION LOCATION PLAN
CLIENT. SCOTT CONSTRUCTION
THIS CERTIFICATION IS MADE AND LIMITED
TO THE ABOVE CLIENT.
LOCATION:NADINE LANE — NORTH ANDOVER
SCALE.- 1"=30' DATE. -6123195
CHRISTIANSEN 19 SERGI "o""'ONAL ENGINEERS
0, LAND SURVEYORS
160 SUMMER Sr. HAVERHILL.MA. 01850 TEL 508-573�-0310
1 Q 1995 BY CHRIS77ANSEN & SERGI INC.
�o
1 CERTIFY THAT THE PRIMARY STRUCTURE SHOWN CONFORMS To
THE HORIZONTAL SETBACK REOUIREMEN7S OF THE LOCAL
APPLICABLE ZONING BY-LAW's IN EFFECT WHEN CONSTRUCTED.
(THIS CERTInCATION DOES NOT CONSIDER ANY OTHER
RESTRIC71ONS SUCH AS COVENANTS.WETLANDUASEMENrS.
ORDERS OF CONDITIONSETC.)
THIS DRAWING SHALL NOT BE USED BY THE CLIENT FOR ANY
PURPOSE OTHER THAN THAT OUTLINED ABOVE.EXCEPT WITH THE
WRITTEN PERMISSION OF CHRISTIANSEN & SERGI INC.
FURTHERMORE THIS DRAWING IS THE COPYRIGHTED PROPERTY
OF CHRISTIANSEN & SERGI INC. AND ANY UNAUTHORIZED USE
IS PROHIBITED.CHRIS77ANSEN & SERGI TAKES NO RESPONSIBILITY
FOR THE UNAUTHORIZED USE Or THIS DRAWING OR ANY INFOR-
MA710M CONTAINED HEREON.
DWG.NO.: 94015014
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CERTIFICATE -OF- USE & OCCUPANCY
Town -Qf North Andover-.-,,___-,-,-,.
Building Permit Number 244
Date SEPTEMBER 1 1 ()q 5
THIS CERTIFIES THAT
THE BUILDING LOCATED ON 28 NADINE- LANE (lot 14)
MAY BE OCCUPIED AS SINGLE FAMILY DWELLING W/1 -CAR IN ACCORDANCE
GARAGE
W]TH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND
SUCH OTHER REGULATIONS AS MAY APPLY.
6 Willow Tree Development
CERTIFICATE ISSUED TO
2 Rogers Rd.
dim& ADD H verAiill, Ma
016
i 'L W
4SACHUS Building Inspector
P'lrk- .
'Vew
Perjoval/011
plat),
BUS/448'r rell - ) /
NWhe ce , ephone -
L& -L.11 -ted py Z
chec* one.
1 IIIIIIIIJIVce 'Lies
COVLL.
1140,t. partneii
ent/1,14'I -. Fj",n,,c P
A eh"Ld 11)SWR
r ins 08. P/I POil,
-tle
�141`)ce %jr h
ownel? pwi the
CY type Cw,,,,t/4/ eq(jtva
erage by Cho Ch
U11AIVI other /erd eck
the WA I V,,
422 Gel) cklr)g Yet
ew we., of ir)de,,,,, Y NO
Wi;,; 11", .11"re thm
1h, t 1041 11cer) "Wit
it, SLUO
life
g1m 44� nd
d 0
0"
nj
th
hl
a 111ty that /8
1 11:11 Spe_
lol 4#0 11 1 "4
(pi rhatso
Si"I 4)f ularke cck.
pplill
42 1/on
Owner Chock "va Lbrage
state 04 Ons I I 011e: this
of ir"'Jif ed bif
(:he
Of Lice Pier it Opp
of (618 01) at
forl-Ice t)se: *dl Acd/z
(Ise 04 it
Master Of 4pp/A�; Or) 4lill III, C
0jolim Ili to 14 bast of
0-�Tnajj gl)4 1161941*4`1ft "I as
'arise ,&—a Air— 14 --1
"L
7 5 0
Date.�/-?h F ...........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATIOA
This certifies that --pu<A1 14 co
....................... T.
en
Co
has permission for gas installation 13 ................
in the buildings of S -o. ..................
at ................ North Andover, Mass.
Fee.�,;'.—. . . . Lic. No.k,�'.:/� ? .... ..........................
GASINSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
Date.
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
,Jhis certifies that ............................................
has permission for gas/ installaaktiop
..................
in the buildings of
.... ...............................
at ... ................ .. V ..... North Andover, Mass.
Fee'-�. . ' Lic. No ........... .......
A$jNSPEOT��R-1
Check# (--16- Y,/
4303
MASSACHUSEWSUN EFORM APPLICATON FOR PERNUr TO DO GAS FTrr]NG
(Type or print) Date
NORTH ANDOVEI� MASSACHUSETTS 11W
Building Locations Permit #
Owner's Name
New Renovation Replacement M
9-.."
/ Amount $
Plans Submitte/ F]
(Print CILej& one: Certificate Installing Company
or,ypy,,,., m C�-& Corp.
Name ell -W-
Address Partner.
Business Telephone -2 47 S--
Firm/Co
�fame of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check one:
i4lave a current liability Insurance policy or it's substantial equivalent. Yes,. [3' No[]
Ifyou have checked yes, pleaWseindi5,,�e jype coverage by checking the appropriate box.
Liability insurance policy Other type of indemnity [3 Bond
Owner's Insurance Waiver: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the
Mass. General Laws, and that my signature on this permit application waives this requirement.
Check one:
Signature of Owner or Owner's Agent Owner r-3 'Agent 0
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 mistallatior
ji perforTned under Permit Issued for this application will be in
compliance with all pertinent provisions of the Massacbusg"te Ga§ C9de.an4,ghapter 142 9f the General Laws.
City/Town
(OFFICE USE ONLY)
Siggatum of Licensed Plum�bb�eOr Gas Fitter
[3--P-1—urnber . _ /�� z
M Gas Fitter =e Number
R-Nlua�sler
Jo me
Journeyman
60U2
Date.4�- /I.-. 6'� . . .....
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ...
has permission to
wiring in the building of ............ . .. ...................................
...... J/2 -
at ... C9:4F. .............. North Andover, Mass.
Fee../,�)
.......... ! ........ Lic. No . ........ ... ...... ) ............... ..........
ELEcrRICAL INSPeCTOKIO--
Check #
4
n
C, Tionwealth of Massachusetts Official 1100itly
Permit No. 609 -
Department of Fire Services
Occupancy andYee Checked 4(5;—o
BOARD OF FIRE PREVENTION REGULATIONS [Rev.11/991 (leaveblank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (MEQ, 5;Z MR 12.01), .
(PLEASE PRINT IN 17VK OR WALL FORMA ON)l Date: (5/0_15
City or Town of: n 'T K:1,4 (0 V t yTo the Inspe&or �f Wires:
By this application the undersigne'd -gives not' his -1--i er intention to p rforin the electrical work described below.
Location (Street & Nppber) �;Z 9 VC
Owner or Tenant
Owner's Address
Is this permit in conjunction with a building permit?
Purpose of Building
Existing Service Amps Volts
New Service — Amps Volts
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Telephone No.
.� Ax, t —
Yes [] No A (Check Appropriate Box)
Utility Authorization No.
Overhead Undgrd No. of Meters
Overhead Undgrd No. of Meters
Cnmnlptinn nfthp fnllnufina tahlp mnu hp tunivod hi; tho lnenotn� �fWi
No. of Recessed Fixtures
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA
No. of Lighting Outlets
No. of Hot Tubs
Generators KVA
No. of Lighting Fixtures
Swimming Pool Above Ei In- Ei
2rnd. grnd.
No. of Emergency Lighting
Batte[y Units
No. of Receptacle Outlets
No. of Oil Burners
FIRE ALARMS
INo. of Zones
No. of Switches
No. of Gas Burners
ad
Initiating Devices
No. of Ranges
Total
No. of Air Cond. Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
J.Nu
ns
JKW
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
M-"
r-1 unicipa' [I Other
ection
No. of Dryers
Heating Appliances KW ($�bcurit�y
Sy=stem
nte. s�:;�
No. of Be _ 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
IOTHER:
Attach additional detail ij desired, or as required by the Inspector of Wires.
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: INSURANCEA BOND [I OTHER [I (Specify)
(Expiration Date)
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: Inspections to be requested in accordance with MEC Rule 10, and upon completion.
I certift, under the, d dties of perjury, that the informatior on this application is true and complete.
FIRM NAME: y"I YN ��Oyy\.P_ Szcuir '% LIC. NO.: 7 a (3 5 C,
--':S-<) Signa ure LIC.NO.:55C00QI1q
Licensee \, Y\_`��Y\Y\ e- r
(If applicable, enter "eoxpt " �'the hc,�r se_�� 7_ 7_
I _Zber lin Bus.TeLNo.,J S-(.5 -Q�q3
Address: 155 9- P L M Alt. Tel. No.:
OWNER'S INSURANCE WAIVER: I am awa tl�, dotes r, ility insurance coverage normally
required by law. By my signature below, I hereby waive this requirement. I am the (check one) [I owner 0 owner's t
Owner/Agent
Signature Telephone No. PERMIT FEE: $
01 4f Tommonwealo of
Mepartment of Public %fetv
BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00
Office Use Oni
Permit No.
Occupancy& Fee Checked
3/90 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code, 527 CVR 12:00
1
(PLEASE PRINT IN INK OR TYPE ALL INFORMATION) Date V21 2�;,
Tj* or Town of NORTH ANDOVER To the lxs�dctor of Wires:
The udersigned applies for a permit to pe.rformi th
Location (Street & Number)
Owner or Tenant
Owner's Address
below.
Is this permit in conjunction with a building permit: Yes 2""' No El (Check Appropriate Box)
Purpose of Building /1'-Q- S i d-t"i at Utility Authorization No. S10!q 2 1 r
Existing Service - Amps Volts Overhead 17 Undgmd 0 No. of Meters
Now Service �60 Amps � A/ ).J(O Volts Overhead 7 Undgmd N No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work
No. of Lighting Outlets
No. of Hot Tubs
Total
No. of Transformers KVA
of Li ghting Fixtures
Above
Swimming Pool grnd.
In -
grnd.
Generators KVA
,116.
No. of Emergency Lighting
o. of Receptacle Outlets
140
No. of Oil Burners
Battery Units
No. of Switch Outlets
No. of Gas Burners
FIRE ALARMS No. of Zones
No. of Detection and
Initiating Devices
No. of Sounding Devices
No. of Self Contained
No. of Ranges
Total
No. of Air Cond. tons
No. of Disposals
No.of Heat Total Total
Pumps Tons KW
No. of Dishwashers
Space/Area Heating
KW
Detection/Sounding Devices
Local Municipal D Other
11 Connection
No. of Dryers
Heating Devices KW
No. of No. of
Low Voltage
No. of Water Heaters
KW
Signs Ballasts
Wiring
No. Hydro Massage Tubs
No. of Motors Total HP
OTHER:
INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts general Laws
I have a: current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES Ll""NO [Z I
have submitted valid proof of same to the Office. YES T, -'NO 0 if you have checked YES, please indicate the type of coverage by
checking the app riate box.
INSURANCE V71BONO 7 OTHER r_-5 (Please Specify) (Expiration Date)
Estimated Value of Ele t I al Work $
Work to Start 7 bo C/ I- Inspection Date Requested: Rough Final �JJl a
Signed under theoendiltles of perl
FIRM NAME 14 C 0 LJ -Xi - Te L) �e S -L rz f.. , 44 i C, 4 LIC. NO.4-J 6 13
1 4 114.
Licensee -,1AC_CfJJ-t.J 1404S Signature %edz& _LIC. NO.
liz� Tel. No./., 3_
Address Alt. Tel. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its substantial equivalent as re-
quired by Massachusetts General Laws, and that my signature on this permit application waives this requirement. Owner Agent
(Please check one) PERMIT FEE$
(Signature of Owner or Agent) Telephone No.
Date ..... xl.� /
2403
tD ..+6 TOWN OF NORTH ANDOVER
0
0
PERMIT FOR WIRING
$SAC14US
CU
e ... .. A ... ....................................
This certifies that ......
has permission to perform ............. ...... ...............................
wiring in the building of ......... ........
..................... .. .........................
dover, Mass.
at ....... ................... .. .......................
. .... North An
Fee. r-�. ... Lic. .................
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer GOLD: File