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Miscellaneous - 52 OLYMPIC LANE 4/30/2018 (2)
52 OLYMPIC LANE \ 210/106.B-0111-0000.0 4 I � I I Datel. ................. NcR TOWN OF NORTH ANDOVER a % PERMIT FOR WIRING �SACHU`s� This certifies that . . .1. a C�C ... . ............ ................................................... ........................ has permission to perform Q...... .... C ... ..................... wiring in the building of........... ��p,.. ..................................... at ......... . 0` .. .... ` p.,North Andover-,Mass.n ...................................... Gl_- ... r .... t Fee.. ,............Lic. o. .. ."1.b.. ....... f'.:..`.............. ............... ELE&mcALINSPECTOR Check# D r� i `-\ Commonwealth of Massachusetts Official Use Only AI Olt z Department of Fire Services Permit No. Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.l/07j (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 MK OR TYPE ALL INFORMATION) Date:d /f/>7. 1) - 13 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) �;L Q , /,1,r C ->a <z Owner or Tenant A.,A.- Telephone No. Owner's Address Is this permit in conj unction with a building permit? Yes ❑ No ❑ (Check Appropriate Box) ! Purpose of Building Utility Authorization No. - Existing Service 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: 6^/9/,IP C 0 G/9 J a �' '````� �^' Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Cell: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- Q.o mergency Lighting rnd. rnd. 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. Tonal No.of Alerting Devices No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: .................................. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection No.of Dryers Heating Appliances KW Security Systems:Y No.of WaterNo.of No No.of Devices or Equivalent Heaters KW .of Data Wiring: Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: OTHER: 1 No.of Devices or E uivalent 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: Inspections to be requested in accordance with AMC 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/ BOND ❑ OTHER ❑ (Specify:) I ceriify, tinder the ains artclpenalties ofperjury,that the information on this application is true and complete. _ FIRM NAME: . C,c ��o v G C l LIC.NO.: Licensee:,4 ,t f 1Kf-0c1 J'2Q c,, e f Signature LTC.NO.: (Ifapplicable nter `exempt"in the license number line.) Bus.Tel.No.- . Address: f L!TTL 6-X-1¢1Y.4 mac-j A 0 /L h&01^-�— ///1 X. Alt.Tel.No. *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 norm ly required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE:$ ❑ 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 th*.T 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 if 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. ❑ 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 extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑Permit Extension Act—Permit/Date Closed: Trench Inspection Pass❑' Failed 0 Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass 0 Failed Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass n Failed(] Re-Inspection Required($.)❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ]FINAL WSPJKCTION. Pass Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: t cr Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF ME IMAC,MA. .......dweinhold@townofinerrimac.com Q The Commonwealth oflMlassachusetis Department oflndustriglAccidents Office of Investigations 600 Washington. Street Boston,MA.02111 Uf www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name(Business/Organization/Individual): U C S /Z5-b l 20 ci� c f Address: Z 7 ,;7 / City/State/Zip: 7-/h /� Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F1 am a sole proprietor or partner- listed on the attached sheet. �• E]Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g• Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.] employees.[No workers' 13.0 Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information. 7 Homeowners who submit this affidavit indicating they Aire doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that checkthis box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. lam 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: F, a/2.T l�' /����Jo c•U� job Site Address: U ��� r C '� " �� City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ,j ailure to secure coverage as requiredunder 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 maybe forwarded to the Office of 'Investigations of the DTA.for insurance coverage verification. lido hereby cert under the pains and penalties ofperfury that the information provided above is true and correct - SiF-rn e / Date: W/,/% l 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 - - Contact Person: ___ Phone#: A y. Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or.written." An employeils defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a j oint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any ofits political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapterhave beenpresented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the N members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permithicense number which will be used as a reference number. In addition,an applicant ,. that must submit multiple permit/license applications in any given year,need only.submit one affidavit indicating current policy information(ifnecessary)and under"Job Site Address"the applicant should write"all locations in (city or r town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CoMToRweatthofMassar leas Department of ladustdal Accidents Office ofInvestigatitom 6.00 Wasbiugtoai Street Boston?MA 021 X 1. `QJ,#617-727-4900 eA 406 or 1-8777MASSAFB Revised 5-26-05 Faze#617"727"7749 w' i COMMONWEALTH OF MASSACHUSETTS B4Aft F ELECTRICfANS ISSUES TH:E FOLLOWING LICENSE AS A: REG JOURNEYMAN ELECTRICIAN a Z L©UIS KOUTROUBIS 14 LITTLE NAH' RD Z !!W ANT U jJ NAHANT MA''01908-1 122` 27938 :: 07/`31/ 6 80139 Date .LAW -?�-.1. 4 •' TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that . . . . . . . ()64. ) has permission to perform . . . . . . . . . . wiring in the building of . . . . . . D-L. d /-/U./. . . . . . . . . . . . . . . ... . . . at . . .,T2 . . .y./?f��.�-. . . . . . . . . . . ,North Andover, Mass. fee . � Lic. No. �2 T�1% . . . . . . . ELCTRICAL INSPEC OR Check# d 2 11034 X Commonwealth of Massachusetts Official Use only Permit No. j Department of Fire Services P. Occupancy and Fee Checked kip BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] leaveblank 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: August 20, 2012 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) 52 Olympic Lane Owner or Tenant Rai Dudani Telephone No. Owner's Address 52 Olympic Lane North Andover MA Is this permit in conjunction with a building permit? Yes ❑ No (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service 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: Fire septic pump,float switches and high water alarm panel. Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Tota Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ In- El o.o Emergency mg d. d. Batte Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection an Initiating Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump i Number I TonsKW No.of Self-Contained Totals: .. ...................... ............... ............. Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Mumcipal ❑ Other Connection No.of Dryers Heating Appliances KW 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 4 Total HP 1/40 Te No.ofDev Devices or Wiring: - No.of Devices or E uivalent OT14ER: 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: 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 permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I cert, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: David W Meehan LIC.NO,.: 81296A Licensee: ;David W Meehan SignatLIC.NO.: 8126A (If bl applicae, enter "exempt"in the license number line) Bus.Tel.No.: 978-587-7518 Address: 4 Mulberry.Drive Peabody,MA.01966 .Alt.Tel..No.: 978-535-4022 *Security System Contractor License required for this work;if applicable,enter the license number here: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally re- quired by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent Signature Telephone No. PERMIT FEE. $ The Commonwealth of Massachusetts Department of Industrial Accidents P IT Office of Investigations 600 Washington Street Boston, ALL 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leoibly Name (Business/Organization/Individual): Dmt 1 it y) Address: 4 Myk1�o_ff Y City/State/Zip: e_kA O AY 1 M h, 019U) Phone Are you an employer?Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor and I TT / ' ❑New construction employees(full and/or part-time).* have hired the sub-contractors 6. 2. I am a sole proprietor or partner- listed on.the attached sheet.t 7• ElRemodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity, workers' comp. insurance. qBuild'mg addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10 Electrical re airs or additions required.] officers have exercised their p 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.]t employees. [No workers' comp.insurance required_] 13.❑Other 'Any applicant that checks boz#l must also fill out the section below showing their workers'compensation policy information. t l{omeowners 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 sheetshowing the name of the sub-contractors and their workers'comp.policy information. I ant 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: 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 y under the pains and penalti s of perjury that the information provided above is true and correct. Si nature. / Date: F Phone#: ..Ag_ Official use only. Do not write in this area,to be completed by city or town official i City or Town: Permit/License# Issuing Authority(circle one): i.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: vPLR r ilk Federal Emergency anag Memen Washington, D.C. 20472 AND S'�G March 22,2004 MPR F.� MS. ROSEMARY CONNELLY SMEDIL CASE NO.:04-01-0378A CHAIRMAN,BOARD OF SELECTMEN,TOWN OF COMMUNITY: TOWN OF T D \ __50Z i NORTH ANDOVER MASSACHU TTS N DF t4`8 NORTH ANDOVER TOWN HALL COMMUNITY NO.:250098 �EF�CE 120 MAIN STREET NORTH ANDOVER,MA 01845 DEAR MS.CONNELLY SMEDIL: 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 1-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 Revision based on Fill (LOMR-F) 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 LOMR-Fs. 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,P.O. Box 2210, Merrifield,VA 22116-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip/. Sincerely, Doug Bellomo,P.E., CFM,Acting Chief Hazard Identification Section,Mitigation Division Emergency Preparedness and Response Directorate LIST OF ENCLOSURES: LOMR-F DETERMINATION DOCUMENT(REMOVAL) cc: State/Commonwealth NFIP Coordinator bcc: Merli,I Community Map Repository Office Chron Region Contractors Case File Dr.Paul Weinstein MT-TS-HS MT-TS-HS Program Specialist Proj.Eng. �-- Pafn oc , P)nn9 S So-w Y , Head-tit ge 1-of 2Date:March 22, 2004 Case No.:04-01-0378A LOMR-F / �p��C1 T w ° Federal Emergency Management Agency 0 ski°41 Washington, D.C. 20472 ND LETTER OF MAI' REVISION BASED ON FILL DETERMINATION DOCUMENT (REMOVAL) COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER,ESSEX Lot 4, Ingalls Crossing, as described in the Quitclaim Deed, Document No. COMMUNITY COUNTY,MASSACHUSETTS 24720, recorded in Book 4367, Page 243,filed on October 27, 1995, by the Register of Deeds, Essex County, Massachusetts - COMMUNITY NO.:250098 NUMBER:25009800090 AFFECTED NAME: TOWN OF NORTH ANDOVER, MAP PANEL ESSEX COUNTY, MASSACHUSETTS DATE:06/02J1993 FLOODING SOURCE: UNNAMED PONDING AREA APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:4266,-71.053 SOURCE OF LAT&LONG:PRECISION MAPPING STREETS 6.0 DATUM:NAD 83 DETERMINATION OUTCOME 1% ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FLOOD FLOOD GRADE ELEVATION SECTION FROM THE ZONE ELEVATION ELEVATION (NGVD 29) SFHA (NGVD 29) (NGVD 29) 4 Ingalls Crossing 52 Olympic Lane Residential Structure X(unshaded) 100.2 feet 105.0 feet _ Special Flood Hazard Area(SFHA)-The SFHA is an area that would be inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year(base flood). ADDITIONAL CONSIDERATIONS(Please refer to the appropriate section on 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 Revision based on Fill for the property described above. Using the information submitted and the effective National Flood Insurance Program (NFIP)map,we have determined that the structure(s) on the property(ies) is/are not located in the SFHA, an area inundated by the flood having a 1-percent chance of being equaled or exceeded in any given year(base flood). This document revises 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 oh 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,P.O.Box 2210, Merrifield,VA 22116-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip/. Doug Bellomo, P. .,CFM,Acting Chief Hazard Identification Section,Mitigation Division Version 1.3.4 Emergency Preparedness and Response Directorate 62175103 0300730316YOE00003007303 Page 2 of 2 Date:March 22, 2004 Case No.:0401-0378A LOMB-F ,,YARr zi ° Federal Emergency Management Agency 0 �4Washington, D.C. 20472 LAND SEG LETTER OF MAP REVISION BASED ON FILL 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 1 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 the FEMA Map Assistance Center toll free at(877) 336-2627 (877-FEMA MAP)or by letter addressed to the Federal Emergency Management Agency, P.O. Box 2210, Merrifield,VA 22116-2210. Additional information about the NFIP is available on our web site at http://www.fema.gov/nfip/. Doug Bellomo,P. .,CFM,ActingChief Hazard Identification Section, Mitigation Division Version 1.3.4 Emergency Preparedness and Response Directorate 62175103 0300730316YOE00003007303 05/01/1999 05:24 9787940707 NORTH ANDOVER MEDICA PAGE 02 FEDM&EMERCENCyMAKAGEMvITAGENCY O.M.B. No.3067-0077 NATIONAL FLOOD WWRANCE PROGRAM Expires July 31,2002 ELEVATION CERTIFICATE ResdlheYntlldloit�on 1.7. SECTION A-PROPERTY OWNIM IKIM 11ATI0N BUILDS orNNEz's NU1ME pi PAUL D.WEINSTEINBUILDING STREET ADDRE9$(hducil p APr,u<#��errd►a t jidg No.)OR P.O.ROUTE AND BOXH10. „,,, ;BZ OLYPMM LATE ..... 8TAlE � MY NORTH ANDOVER IM PROPERTY DESCFJMM(I.ot end B m*Nuc'b@m Taos Pero-NWrnber,Lnd Dae"oa,etc.) MAP 1088, PARCEL 111 BU6.nm USE(a .,ReWder BeL NwAu dw tlAl,Adman,Acmemy,air-Uae a canawrb arm t n wmwy) RESIDENtIAl. piwnow) HORIZatQTAL DATl1Ak sOUFi,CE —GPS(TypeX of-w-##i'or sumo ®NAD 19V ❑NAD 1883 ®Ut9G8 Orad Map [3Otoer N42`3Q'39.82”,E71�3"127'Q' SECTION B•FLOOD WSURANCE RATE MAP R"NO IMTpN B1.NFP COM4lttBTY NMME 800NM1Wff—NUhmt M COUNTY NAME Bb.STATE NORTMAtDWERTONMOF 2oM EM MM 84 MMP AND PANE. BS.SUFFIX 97.FFM PANG u9.BASE FL00D AITONMSI NUM ER 86.FRFMOMDATE CTNBF0MM DATE B&ROODMNE(S) owmAO,umdewooNooft ?b0013B 9 C M4 6293 I A B10,Ind'aahe the aowoe dire Base Flood BnvAbn ff 1T dab orbaee bod depth mftW h 89. El FTS Prdte ®FIRM ❑ Debmhed ❑OBrer(Dseoibe B11.ktdcals the Mwakbn dd m used ter the EFE in Bs®NG11D 1989 ❑NAVD 1988 C]0ltw DerrabeX B12 Is he bulking bmbd in a Coastal gaoler Reeotsoee 9jalem(CBR am orOth&Mm Pmbded Ama(OPAn ❑Yea ®NIo DMOVIlion Deb SECTION C-IRS DING ELEVATION INFORMATION PAM MQl1NM Cl.Buldtg elevefbns w tweed ore❑ConWA n ❑&MV Under0wducW ®Frmshed C WAxkn 'A new Bwdbn Cerium-will be mquYed*#=owmhdion o(dw buldhg Is oompleb. (2 t9uidng Diagram Number3 Co*dit Iwl-rg dwgram moatstr&t)the baking tbrvhido the oer0,11 i b betg oor. -seapagesS"7.tno diagram y +b be Pmwkio a skebh orphobppk) C3.Bweiom-Zonae AI AM AE,AH,A(vM B-EI VE,V1 V3D,V(v&ME�AR AWA,Alm AR/At-AM,ARIAK ARIAO Complete M rm C&-e4 below amo*g b the bJ tg*pm,apedred in dem C2 Sib toe dsh n used►the datum's dbwtfiom ire dein uaedlorthe 8FE in Section Q mmwt the dahxn b to used for the BFE.Showfled meaetnentenb and ddw axmxobn edmi lom Use the epace provided orthe Conxrlerb arae d 8sLtm D or Section G3 m ap -pri-e,b doamerd the d&m oorwmbm Ddw= CorarerabrrCorrxroents a waWnredarencemarkusedM•Dmstheelevatmn3letenoemadsusedeppeaonfftaRRW? ®Yes ❑No o a)Topdbdbm1 r(indrsdhgbasementorerd=m) —t(M) 14 OF o b)Top of nod highs*= o C)Bofbm d bweet horfaortel erludtxal member(V zor>se ori il(m) $ F o d)Abd+ed gmg,(bP d slab) n(m) o e)Lowest ebvafim d marhlnery wdorequpmeit LM s M*9 fie bA*g(Dearrbe In a Cormwft ansa) o -a.t(m) o h)Na dpermene t aperi go(food verde)wlhh 11t abate adJeoeni grade o)Tod ares of all pamanent%&-*ge Mood verb)In C3•h eq,h(eq cm) SECTION D-SURVEYOR.ENGINEER,ORARCH1ECT CBt FCA710N I - Thle oertlf"tbn Is to be algned and aaaled by a land surveyor,engineer,or arohited authorised by law to oertty elevation htflormatlon, 1 o9r*that the inlomiallon In Seetlons A,B,and C on fhle oert*AKe reprasents my best efforts fo irrrterp*tris date avadabb. � t, I understand diet an false stalamentme be punishable b Hne arimplfgwment under 18 U.S.Code Section 1001. CERnRER"S NAME FRANK S,GILES,P.LS. LICENSE NUMBER4t713` ' U TITLE AND SURVEYOR COMPANY MV&FP" (y B SURVEY CITY STATE aP 000E 50DEEIVAEADOwRoA0 NORTHANDOVER MA 01M S DATE TEIEPI-lo = p srz4A1 97aOMM TOWN OF NORTH ANDOVER tkoRlrk U1 , . , Office of the Building Department 00 Community Development and. Services 0 27 Charles Street North Andover, Massacliusetts 01845 4SSACMUSE D. Robert Nicelta, Telephone(978)688-9545 Building Commissioner FAX(1978)688-9542 February 4, 2002 Paul Weinstein 52 Olympic Lane North Andover, MA 01845 Dear Mr. Weinstein: Please be advised that upon review of the documentation submitted to this department relating to elevation certificate, on page 4 of the instructions it is noted that community information is (optional). The surveyor or engineer who completed the plot plan and the application is the responsible person for the accuracy of the information submitted to FEMA. I hope that this letter answers your questions in regards to this process and wish you luck in the proposed change. Respectfully, Michael McGuire Local Building Inspector Michael McGuire,Local Building Inspector James Decola,Electrical Inspector James Diozzi,Gas/Plumbing Inspector Planning Department. 688-9535 Consen,,,ition Dcprtmait 688-9530 Health Department 688-9540 Zoning Bond of.Appeak 688-9541 fcl d 9.2 EER 9.4 IPLVb d 11.0 EER ARI 10.3 IPLVb 340/360 10.1 EER ARI 365 11.2 IPLV 13.1 EER 13.1 IPLV elation. h a supplemental heating section PHOM E CALL FOR r- OATEV-�// TIME/ �'P.M. M PHONED ORETURNEDF PHONE / y` � YOUR CALL AREA CODE JlfU MB EkR _ ^� EXTENSION MESSAGE 0 / SCALL 1fUG CALL AGAIN �� CANIS TO �Uv/ ,(' G SEE YCILI /) �Gvcf e4-f f'�'l pSS'Q/"� SEE YOUANTS R s w S.e C n-c z�-d, iversa!' 48003 1 I � � I I I I I ' I , t - I I � I i I ' � I I I IIwo o I , Ric TELECOMM CORP. Certified Solutions Provider Voice,Data,Video and Fiber Optics d VelIVA II �J JA N �. v � S r P.O.Box 1330 17 Batchelder Road Seabrook,NH 03874-1330 TEL: (603)474-3900 PAX.- (603)474-7755 Ric TELECOMM CORP. fife lutiom,From'der r Voice,Data,Video and Fiber Optics G1-I- 3of7J "s � r) r1 3 36 aG a7 wan AA s . �.�Ft �psSn� OLY���C. P.O.Box 1330 17 Batchelder Road Seabrook,NH 03874-1330 TEL: (603)474-3900 FAX.- (603)474-7755 4 •v / 40_:1. Dewberry ��(�� 8401 Arlington Blvd. Transmittal Fairfax,VA 22031 To: Mr. Mike McGuire Date: 02/13/2003 Project No: Town of North Andover Project: 27 Charles Street Reference: Dr. Paul Weinstein North Andover, MA 01845 cc: Attention: We Transmit: the following: for: ® as per your request ❑ prints ❑ your approval ❑ as requested by ❑ under separate cover ® copies ❑ your review and comment ❑ by mail ❑ reports ® your file/use ❑ as approved by ❑ by messenger ❑ studies ❑ revision and submission ❑ by pick up ❑ reproducibles ❑ distribution ❑ as submitted for approval by ❑ by overnight carrier ❑ product literature ❑ computations Copies Date Number Description 1 Tax Assessor's Map 1 Site Plan 1 Elevation Certificate 1 Effective FIRM with Tax Map, Site Plan, and Void FIRM overlain on it Comments: Mr. McGuire Here are the materials Dr. Weinstein submitted to FEMA in support of his request for a Letter of Map Revision based on Fill (LOMR-F). Signed: TroThiel n, Federal Programs If enclosures are not as noted, please notify us at once (70 )84 0685 03/26/2000 23:36 9767940707 T. IVIIti IV) 0NORTH ANDOVER MEDICA 4Y V040PAGE 02' N0, 762 P. 2 F RAI.1WRIWENeY"NA"''MENT AQiNCY M COUNITY ACKNOWLZDGMENT FORM 0x.4 Na M'.01'e' ta am ftwaPM r o a"M� a gdrnale f a aerie O.dA hoa►par^MOaue• The bunion E b rae0ottd b •4viallon lino ane rnatnwelnm9 the naaow data,and allftsto In ftdoe fee pnM for the aooyreey of tM b wleas a wwMd OM9 o r&W tfu►rdsr °aft.w as .ane ayb�� tarn Yo�� Manapsmnq C ata and ally euqq��eaiOna for"JON tl+l,bw,�ea a u�light comer of hb.�nn e�op��� ►aQuired own or rwln to under ILMI hlhptorl CC 90472,P� R,&,m Ndorrraltan Coa�a0na Faftnm sorra E�apM'9 Tfss form rnvst Flw jIevranoe Pro�Iwn Flats de net rend yaaa,r 7 f9�to died r"lows nevop�h shy is ti's atltwa addraas. fde reQutst to ue a P"wV tet 6►MA Mich iiiwa wb,�,aatr�a w ,�an °p1�lar ory s.ctton,p ss diThe form rnuet co�pbbd a►Qnw by VN on"rss IaN for ltaodplatn mina ��(��aa awkin 11). �Omant M a�had faaoarty myM in qIt spew=pna.bad oameM h fee oonarra,sh T11a Canrvpa oonlaatltlgr nunlba►and Ole A. 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RM 9 x yam. fit f 'f L+< �K`•i t`'+..,,a A1 '^ CC,ESS P f. ZONE X �'r z ♦ .tom c 'fi +. GRAVEL ROAD ; , j zi ZONE X IN � � u� { " 1 t• ZONE X tax PQ �0 � t ZONE X E ,' r Vit. CES fi , p,C S ZONE X 101ZONE b r:: 98 X f Atr . ZONE X ZONE AE JOINS PLAN OF LAND NOTES: LOCATION *FEMA(FIRM)COMMUNITY 52 OLYMPIC LANE 250098 009 C NORTH ANDOVER, MA THIS PROPERTY IS LOCATED IN ZONE A FOR A NON-ELEVATED FLOOD ZONE *ASSESSORS MAP 106B PARCEL 111 PAUL WEINSTEIN *DEED BOOK 4367 PAGE 243 SCALE:.i"=60' DATE:MAY 20,2001 *SEE PLAN#7865 0' 60' 120' 180' A631091 SCOTT L.GILES, P.L.S. FRANK S.GILES,P.L.S. 1a) q02 p 3t^w. 50 DEERMEADOW ROAD NORTH ANDOVER,MA. y (978)683-2645 s6o n/� s SUBJECT PROPERTY: PAUL D.WEINSTEIN / .Q✓ 52 OLYMPIC LANE 1 N NORTH ANDOVER,MA 01845 PARCEL 111 ASSESSORS MAP 106B,PARCEL 111 LOT 4 64,514 S.F. 64,511 S.F.(CALC) OF + �p�y�fl�AAN "✓C o S. G N »3 N 4 � p FESSIoN� y qN�SURVV ti LOT 3 pS4R0 a p�„ LOT 5 cn LOCP G O n � on #52 o o� �o D=30009'20" R=285.00' L=150.00' QIG �5`0000 S+141 BENCHMARK RM 9(NGVD) ELEVATION=103.819 SEE FENIA(FIRM) COMMUNITY MAP 250098 009 C C:\CLENTS\WEFNSTEINPAUL.DRG 03/26/2000 23:36 9787940707 NORTH ANDOVER MEDICA PAGE 01 ' (Click here ane type addrbo) , TO; Fox; 978-688-95 From:. Dr.Psul weinsteia Tf-5 Dab: :46/1003 Re: 'FEMA letter per; 2 CC: 0 Urpsnt ®For Review ❑Please Owww t D Plaoee Reply ❑Plewss Rsyrola a � C C oor>rs udon,I am faking Coma=*/Admmvbogernen ft"to be BWW by local offidW w N wny auwdom plawaw call No olnow-878-784x000 Nprw.g/$d98.1068 Cell 508458.2579 r Thankyou Paul WeirlsWr MD 52.Olympic Lms I 05:24 9787940707 NORTH ANDOVER MEDICA PAGE 03 lmfmml as � blbneeiA tafli......d!E�oii sM1 ;;; WandaBlti tJoaORP.O.ROUTEAlq BOX t10. ZP CODE X895(tdudl�Apl SrATE MA 0*6 SECTION D•aJRVE1fOR,@IGMiEFR ORARCHTEC'f Kim am*n CerdiaAetr oomnt ollolr,CL)►awanoe agerfbon"V,and C3)bolting owner: on dte adg0 of d,e non ebvaied'A'good sone end the etavetions have been elbred eub � e asWon dthe Flf>ORIIA Map&Beead onto a4*g mrdooro the bddig 11 not K*db MMOUM CAedchereM2 +� ONE-BUS OG ELEVATION NK MATION NOT REQUIRED FOR ZONE AO AND 7ANE A A(wtltMaut 8FE),=0*N b"El!Hu.gh E4.lithe 6evedon Certlbale a kyffrled ti r UN 0 SUppo ft inbnnelbn br a LOMA Or LIOMRf, (umber 2(Saleci%buking durum nnetsirrierb dw buift brvvtJrh ft oe�tp , isb ft oorrtpieled—sw l 6 end 7.KrodQw a mm* m Hoar(idudtrra basement orendoe�ra)otthe buldh9 i 3 N(m)�in(om)®d�ae u ❑bebw( )be f"�1Bd ac> erdt�rada Nee „„es.8�opennge(eee Pape 7),the neahphertbororeievaied loon(elavadon b)d die bolting b 7 tt(m)6 h(rm)shwa tb highest ad)eoentgtadie. 3h and C3.lonfv tdbm. . d ro Hood depth number ie avalable,le fha bP dare bolbm borela�ratied h aooadaioe wlh tAe oortunurrq/etbodplah maneAertrerrtad'r�aroe'� ❑Uriarown.The toad dkW musttokkm*n in Sedan G SECTION F-PROPERTYOWNER(OROWNER'S 'A 9CMMAIM orahnersa&oftd mpreeerMewtio=nPMNSeotbrsA,E C(ItemsC3.h and C3janty),and EbrZoneA(VahanaFBV,bwWormnsrU*- )AO mustaign hese.The AatemerrlB in SwiDr a A.B,C,and E n oared lot a beetd aw knowledge. .YS OR OWNERS AUTHORIZED FdMkESENTATNES NAME IN CITY STATE ZP CODE NORTHANDOVER MA 01845 OATS + sr�o, s76sesaa66 ( 64, ` OK42tOhedc here iaeachnten� SECTION HCOMTOM PP'IIONAg Is e�rort and by Tan orerdinenoe b a*nhi*rdb mmmuniVs todpbin muwpement adr m=can aonpleb Sadbr,s A,B,C(or E�and G of lds Ebvelbn >the appicebie lem(s)and eqn bebw., ion In Sedbn C was taken from odrerdoaxne i*n drat hee been etgrred and embossed by a lben9ed asveyor,ertgiw or aRfAidwtn is-I by i law b cib*elevation Ui mvftn pndtrA;the am and date d fb dwdDn data n the Corr ma*area below.) r aftW axnplabd Seethn E for a bukft toasted inZone A 4*W a IEMA4wW oraodnttur*4oued BFI orZone A0. g d radon(Imms 0408)ie pro AW for tborl &management purpoeea 32I t5.DAIEPERWtIBM (35.DAIECOMPOCAlEOFOOMIANCEKXXXPMCYW peenieeuedfor, ❑NewCo*ucAbn ❑&btenWirrgx wmen ultoweatba(rrdudlr>g beeemerQ tithe buidng m _._ft(m) Datum: AO)depth ddoo*ig at ft bolting alb I& ._:_k(m) Deltas: 'S NAMETIRE 7 n.._ ... ; VIE TIIEPHONE i DATE 3 Q Chad tmffAmtff" 3.9g ';• _ ___ _- - 1996' s " ,.,. ;,, p; ` * Z14,. 1 "• ,_ 14 96 `" .9319. w +" 123 1,4 2 #� P 1)9• tai 191986 I 207 206 205 116 , ....115 . 14 122 0 .� 131 130 t 95 4, ` T c� 20 <v r 8 , 11 43.U7 . 7 s 121 " 47 �j_ y 10 _ 120 .� 132 26 b R 5 48 49 ,� 20 'J43 'Jd �,� ��s 6 114 a a 139 133 27 46 50 ,,. �� 113 ,>: ,.. q �A5 94 y 45 4 3 6 7 8 51 197 :08 7 �'. B 152 ,A 134 2' ,+ Z 44 3 ' m,s •'H 2' ~�3 209 3 112 5 si OL yngplC 137 tiS s $ -° � 196 s3.084 136 135 . SpIS T 152 moo' 210 137 8 I s� 4)b7A 140139 138 3: ao S-9 6391 „� IC 211 6 17937 141 36 33 15 34 33 3 110 1 �, - t 16 212 142 37 .� 218 7 3 2 109 a�5v7 o9ev ^�+ J, 42 3.37', 151 h� 43.661t. 38 °'144• 4r� > 13 "3; � 17 ++2 31 3 ' 9 2 ..s 143 c 12 131 17 a 2 1181 s 178 177 x F 21 a �� 22 . m 60 2 „ a 2 180 179 y 219 blbd' F •c A 107 n - A . 106 'moo ,.8 ` 217 a w s t 10 ° 146 19 ° 183 11 l.0 4. 76 148 147 ,.9. _ 63 _ ' yt o�� lbs :� 175 6 4 220 py x1 pops yQ n p jj1. 1 9c sr .�^ r 174 30 222 150 149 ;1`�`QU I6, 93 61 41 6„ 3 168 loAl+xe g '`¢`b 173 „ s e Ise M1- 25 S, A •,•gi: Is, 70 r �p,G 7.74,2 III i;� 32 153 5 , 9 92 m ,,� .� 4 y 24 .r°++ g �., 91 .2 c ir03� 169 171 172 165 221 100 $ + 1026 '�`'" 9. 90_ .3 �. , 64 9 `4 cg : 170 Y 3.30- 3 u y0p 2 99 °'17 \' 1.14 Ac. ).oaAc. 105 S�' 65 29 3" 22 21 " 23 x 103 .35 66 '0�<< 39 167 166 tig r .OZAC. L37 98 ,s�` .�6 = 89 3.ozAc I.03AC I.Ier 1.622ar Ir 163 L0- ,.s 7 6 y 59 I63c S .ss 86 > 68 38 6 oi� d 55 300 1.07 a2 56 57 104 058 37 154 `a`PC ,B 67 p.rs 2..7„r. 3t %IN 164 W 54 R + 88 ` 69 53 23 Sze f 161 w ; W r N us "s \ % ! 1. ,� 84, ,m�. 37 ,n ,eq Isc f.. Lmto � 6 � ,� 36 SB 97 / f T 'y7 55A g3 7l ZfQAC / 215 5. �� - 333 15, 82 87 f2A � 1.0]ec. ss 6 26 80 81 g3 85 3..89- �. sst q 5 12 58 n p)� 2.39AC. G $ _ 78 34 btibti °s 3 it ��a 2 10 `° 1.01 AC 1.01 AC 242 3.82 AC 3.63 AC ,b 3 - `Pc 1 %° 2u a. lots 162 238.zv z2A A, _ 239 2, 28 9 ^� 33 2c 27 24 s ✓A 216 237 2.03AC 2. 4 l.o r `'�!•G S 20BAC LzaAC. IIAC .,AC. lU� SPC 160 41 3 214 �^ 79 9 Pc•• 236ox a a m 1.02 `'• 11 1.73AC 2Q.O AZ 2cp 6,9 .P� 1.03AC ac. ,97 ,® r 43 235 LOAC 1.47 AC L03 AC. - 73 3.Ohc 262AC. Q� 1.73 AC.t� I L1ZAC f ,95 P`• 31 b 1.10- +Yv" 4 L07AC 232 231 230 ,.22 AC. o 0. 223 224, v LWAC Btbs72 g _ 74 ' Louc. 233 229 ''3AC 76 ia \` u u "a $0' t�gaQ L63 Ac. z c/l 234 A S 13 32 F I.onc. , % �' 160 52 `� t3 LOAC 1N 225 1.02 AC. 1.06 AC. J 228 1. I.Z3AC. 156 9 �� 18.227 226 B \ B �i�} 0 75 2,e 159 3 3 gt 1.0 AC ' 0 , '.27 AC ultt 1 `y'R 1i SCALE 1"=400' SEE PLAT 106 D 157 1.21 AC i l O V L 58 ► F E B 1 4 2002 Dewberr i i Davis LL(;