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Miscellaneous - 1100 Acorn Drive-Bldg 11
nos 1100 ACORN DRIVE-BLDG 411 FILE DUILUI ' I �I i �I. t f f i I t i i f I i I f� MASSACHUSETTS PROPERTY INSURANCE UNDERWRITING ASSOCIATION Two Center Plaza Boston,Massachusetts 02108-1904 (617)723.3800 Ma Only(800)392-6108,FAX(8001851.8424 1/2/2016 Form of Notice of Casualty Loss to Building Under Mass.Gen.Laws,Ch,139,Sec.313 NORTH ANDOVER BUILDING COMMOSSIONER NORTH ANDOVER TOWN HALL NORTH ANDOVER MA 01845 Re: Insured: GUSTAVO L.&ELSA N.MENDIETA Property Address: 1103 ACORN DRIVE,NORTH ANDOVER,MA 01845 Policy Number: 0965840 Type Loss: Furnace/Boiler Date of Loss: 12130/2015 i Claim Number: 402542 I i II Claim has been made involving loss,damage or destruction of the above captioned property,which may either exceed$1000.00 or cause Massachusetts General Laws,Chapter 143,section 6 to be applicable. If any notice under Massachusetts General 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 or file number. MPIUA Claims Division i! CMA00021 i Libqy .Mutual® Liberty Mutual Insurance New England Region Central Property Unit INSURANCE 75 Sylvan Street Danvers,MA 01923 Tel:(800)566-0323 August 6,2015 Town of North Andover Attn:Building Inspector 120 Main Street North Andover,MA 01845 Re: Property Address:1100 Acorn Dr,North Andover,Ma 01845 Policy Number:H6521825012540 Underwriting Company: LAI Insurance Corporation Claim Number:031633131-0001 Date of Loss:2/26/2015 Attn: Town/City Official Pursuant to M.G.L. c. 139, § 3B, please be aware that a homeowners insurance claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or causes the condition of a building or other structure to render Mass. General Laws, Ch. 143, � 6 applicable. You are required to notify Liberty Mutual by certified mail in accordance with Mass. General Laws Ch. 175, 599, if you intend to initiate proceedings designed to perfect alien pursuant to Mass. General Laws, Ch. 139, S 3A &B, or Mass. General Laws, Ch. 143, � 9, or Mass. General Laws,Ch. 111,� 127B. This letter should not be construed as a waiver or estoppel of any of the terms,conditions or defenses afforded by the policy or applicable law. Please direct your notice to the attention of the undersigned and include a reference to the above captioned property address,policy number,claim number,and date of loss. Sincerely, Liberty Mutual Support Liberty Mutual Insurance New England Region Central Property Unit 1-800-566-0323 I Page 1 of 2 Date: April 24.2015 � Case No.:15-0140 t LOMB-F 04'4l'- A � Federal Emergency Management Agency o �s ND S 5 Washington,D.C.20472 qSG LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Reserve,Phases II and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 18278,in the Office of the Registry of COMMUNITY MASSACHUSETTS Deeds,Essex County, Massachusetts i I COMMUNITY NO.:250098 AFFECTED NUMBER.25009CO381F MAP PANEL DATE:7/312012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.622, -71.061 SOURCE OF LAT&LONG:GOOGLE EARTH PRO DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ . WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION j SECTION THE SFHA ZONE .ELEVATION ELEVATION (NAVD 88) NAVD 88 (NAVD 88 1011-1106 Acom Structure X — 117.6 feet — Drive (Building 11) (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 given year(base flood). ADDITIONAL CONSIDERATIONS(Please referto the.appropriate section on Attachment 1 forthe 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(jes) isiare 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 NRP 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304-4605. ., Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 2 of 2 Date: April 24,2015 Case No.:15-01-1019A LOMR-F O�VAR . Federal Emergency Management Agency Washington,D.C.20472 iAND 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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605, Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 1 of 2 9 Date: April 24,2015 Case�Eo.:tS-01-101SA I LOMB-F 0�4 Rr a `rt Federal Emergency Management Agency 44 ND SEG Washington,D.C.20472 Ig - LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Reserve,Phases II and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 16278,in the Office of the Registry of COMMUNITY MASSACHUSETTS Deeds,Essex County,Massachusetts I COMMUNITY NO.:250098 AFFECTED NUMBER:25009CO381F MAP PANEL DATE:7/3/2012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.622, -71.061 SOURCE OF LAT&LONG:GOGGLE EARTH PRO DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88 (NAVD 88 1011-1106 Acorn Structure X — 117.6 feet — Drive (Building 11) (unshaded) i 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 referto 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 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration I Page 2 of 2 Date. April 24,2015 71case No.:15-01-1019A LOMR-F O�NR Federal Emergency Management Agency Ft4 ` Washington,D.C.20472 qNo SE 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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605. f. . .._ -... -_- _ C— Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 1 of 2 Date: April 24,2015 Case _ - No.:lsdll 1019A t LO'striR F oF,p Federal Emergency Management agency Ds Washington,D.C.20472 4 LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY OrSIC RIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Resenie,Phases It and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 16278,in the Office of the Registry of COMMUNITY MASSACHUSETTS Deeds,Essex County,Massachusetts COMMUNITY NO.:250098 AFFECTED NUMBER:25009CO381F MAP PANEL DATE:7/3/2012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.622, -71.061 SOURCE OF LAT&LONG:GOOGLE EARTH PRO DATUM:NAD 83 DETERMINATION j OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK! WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88 (NAVD 88 1011-1106Acorn Structure X — 117.6 feet — Drive (Building 11) (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 forthe additional considerations listed below.) PORTIONS REMAIN IN THE SFHA ZONE A i i 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 is 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration i I Page 2 of 2 lute: April 24,2015 Case No.:15-01-1019A LOMR-F obi 7��� V. Federal Emergency Management Agency Washington,D.C.20472 q'VD 5� 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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Pagel of 2 Date: April 24,2015 Case No.:1"1-1019A r LOMR-F Federal Emergency Management .Agency ��9xn S�co4 Washington,D.C.20472 LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Reserve,Phases II and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 16278,in the Office of the Registry of MASSACHUSETTS Deeds,Essex County,Massachusetts COMMUNITY COMMUNITY NO.:250098 AFFECTED NUMBER:25009CO381F MAP PANEL DATE:7/3/2012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.622, -71.061 SOURCE OF LAT&LONG:GOOGLE EARTH PRO DATUM:NAD 83 i DETERMINATION i OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88 (NAVD 88 1011-1106 Acorn Structure X — 117.6 feet — Drive (Building 11) (unshaded) Special Flood Hazard Area (SENA) - 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) islare not located in the SFHA, an area inundated by the flood having a 1-peroent 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 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 2 of 2 [rate: April 24,2095 Case No.:15-01-1019.A LOMB-F RT j Federal Emergency Management Agency � Washington,D.C.20472 FtaND S 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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 1 of 2 Date: April 24,2015 Case No.:15-01-1019A LOMR-F _._ OF'pXRrFA. T Federal Emergency Management Agency F�- ND 5 J4� Washington,D.C.20472 qSSG 5� LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT REMOVAL COMMUNITY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Reserve, Phases II and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 16278,in the Office of the Registry of COMMUNITY MASSACHUSETTS Deeds,Essex County,Massachusetts COMMUNITY NO.:250098 AFFECTED NUMBER:25009CO381F MAP PANEL DATE:7/3/2012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.622, -71.061 SOURCE OF LAT&LONG:GOOGLE EARTH PRO DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88) (NAVD 88 1011-1106 Acorn Structure X — 117.6 feet — Drive (Building 11) (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 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 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304.4605. Luis Rodriguez,P.E-,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 2 of 2 Date: April 24,2015 Case No.:15-01-1019A LOMR-F O$VAAR7\�,D _ Federal Emergency Management Agency Ft c°4� Washington,D.C.20472 qJVD SE 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, StatelCommonwealth,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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration i Page 1 of 2 Date: April 24,2015 Case No.:11"140,119A LOMB-F Federal Emergency Management Agency Washington,D.C.20472 tgNv s�c >� e LETTER OF MAP REVISION BASED ON FILL DETERMINATION DOCUMENT REMOVAL COMMUMTY AND MAP PANEL INFORMATION LEGAL PROPERTY DESCRIPTION TOWN OF NORTH ANDOVER, Oakridge Village/Maplewood Reserve,Phases II and V,as shown on ESSEX COUNTY, the Plat recorded as Plan No. 16278,in the Office of the Registry of MASSACHUSETTS Deeds,Essex County,Massachusetts COMMUNITY COMMUNITY NO.:250098 AFFECTED NUMBER:25009CO381F MAP PANEL DATE:7/3/2012 FLOODING SOURCE:LOCAL FLOODING APPROXIMATE LATITUDE&LONGITUDE OF PROPERTY:42.522, -71.061 SOURCE OF LAT&LONG:GOOGLE EARTH PRO DATUM:NAD 83 DETERMINATION OUTCOME 1%ANNUAL LOWEST LOWEST BLOCK/ . WHAT IS CHANCE ADJACENT LOT LOT SUBDIVISION STREET REMOVED FROM FLOOD FLOOD GRADE ELEVATION SECTION THE SFHA ZONE ELEVATION ELEVATION (NAVD 88) NAVD 88 (NAVD 88) i 1011-1106 Acorn Structure X — 117.6 feet — Drive (Building 11) {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 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 �i 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) islare 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 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, LOMC Clearinghouse, 847 South Pickett Street, Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration Page 2 of 2 Date: April 24,2015 Case No--.15-01-1019.A LOMR-F OEVA.R\H Federal Emergency Management Agency Washington,D.C.20472 9INV D 5E 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,LOMC Clearinghouse,847 South Pickett Street,Alexandria,VA 22304-4605. Luis Rodriguez,P.E.,Chief Engineering Management Branch Federal Insurance and Mitigation Administration r DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 PROPERTY INFORMATION FORM Expires Februo yz8,tot4 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.63 hours per response.The burden estimate includes the time for reviewing Instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form.This collection is required to obtain or retain benefits.You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form.Send comments regarding the accuracy ofthe burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015).NOTE:Do not send your completed form to this address. . This form may be completed by the property owner,property owner's agent,licensed land surveyor,or registered professional engineer to supporta 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.In order to process your request,all information on this form must be completed in its entirety,unless stated as optional.Incomplete submissions will result In processing delays.Please check the item below that describes your request: ❑ LOMA A letterfrom DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill(natural grade)would not be Inundated by the base flood. ❑CLOMA - A letter from DHS-FEMA stating that a proposed structure that is not to be elevated by fill(natural grade)would nct be Inundated by the base flood if built as proposed. ®LOMR-F A letter from DHS-FEMA stating that an existing structure or parcel of land that has been elevated by Hfill would not be inundated by the base flood. A letter from DHS-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(including the subject property)placed that raises 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 Ifthe practice does not alter the existing(natural grade)elevation,which is at 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 been placed on your property to raise ground that was previously below the BFE? Yes ❑ No If yes,when was fill placed? April/2005 ± Will fill be placed on your property to raise month/year , ground that is below the BFE? ❑Yes- ❑ No If yes,when will fill be placed? / month/year *If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructions). 1. Street Address of the Property(if request is for multiple structures or units,please attach additional sheet referencing each address and enter s reet names 77bl7frl 1101.1106 Acorn Drive 2. Legal description of Property(Lot,Block,Subdivision or abbreviated description from the Deed): Assessors Map 108C Block 39 Lots 1101-1106 3. Are you requesting that a flood zone determination be completed for(check one): ® Structures on the property? What are the dates of construction?June 2005(MM/YYYY) ❑ 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.For the preferred format of metes and bounds descriptions,please refer to the MT-1 Form 1Instructions.) ❑ The entire legally recorded property? 4. Is this request for a(check one): ® Single structure ❑ 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: ) In addition to this form(MT-1 Form 1),please complete the checklist below.ALL requests must include one copy of the following: rINC-FFM a Fnrm nAA11-7F FFR rt, ®Copy ofthe effective FIRM panel on which the structure and/or property location has been accurately plotted(property inadvertently located in the NFIP regulatcryfloodway will require Section 8 of MT-1 Form 3) ®Copy of the Subdivision Plat Map for the property(with recordation data and stamp of the Recorder's Office) OR ®copy of the Property Deed(with recordatlon data and stamp of the Recorder's Office),occompnoled by'a tax assessor's map or other certified map showing the surveyed location of the property relative to local streets and watercourses.Them a p should include at least one street intersection that is shown on the FIRM panel. ®Form 2—Elevation Form. If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it maybe submitted In lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot elevation must be provided on Form 2. ®Please include a map scale and North arrowon ail 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 For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may Include a copy of an Incidental Take Permit,an Incidental Take Statement,a"not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S.Fish and Wildlife Service(USFWS),or an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or listed species or designated critical habitat.Please refer to the MT-1 Instructions for additional information. - Please do not submit original documents.Please retain a copy of all submitted documents for your records. DHS-FEMA encourages the submission of all required data In a digital format(e.g.scanned documents and images on Compact Disc[CD]).Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result in processing delays.For additional Information regarding this form,Including where to obtain the supporting documents listed above,please refer to the MT-1 Form Instructions located at http://www.fema.gov/plan/prevent/fhm/dl mt-1.shtm. processing Fee(see instructions for appropriate mailing address;or visit http://w.w.fema.gov/fhm/frm_fees.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 lot(s)/structure(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 LOMR-F following a CLOMR-F) ®$42S(single lot/structure LOMR-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 lot/structure LOMB-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 Program. All documents submitted in support of this request are correct to the best of my knowledge.I understand that any false statementmay be punishable byline or imprisonment under Title 18 of the United States Code,Section 1001. Applicant's Name(required): Oakridge Village-Maplewood Reserve Company(if applicable):Affinity Realty 8 Property Management Mailing Address(required): 63 Atlantic Ave Daytime Telephone No.(required):978-686-4800 Boston,MA 02110 C/o Joe Swl err Fax No.(optional):978-685-0521 E-Mail Address(optional):®By checking here you may receive _ correspondence electronically at the email address provided): joseph0affitnityrealry.com 51gna r fA plicant(re wired) Dale(required) t DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.166D-0015 ELEVATION FORM Expires Februory2g,2o10 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.25 hours per response.The burden estimate includes the time for reviewing Instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form.This collection is required to obtain or retain benefits.You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form.Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must he completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor.A DHS-FEMA National Flood Insurance Program(NFIP)Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),including on attached decker garage.For requests to remove an entire parcel of land from the SFHA,provide the lowest lot elevation; or,ifthe request involves an area described by metes and bounds,provide the lowest elevation within the metes and bounds description.All measurementsare to be rounded to nearest tenth of a foot. In order to process your request,all information an this form must be completed In Its entirety.Incomplete submissions will result in processing delays. 1. NAP Community Number: 250098 Property Name or Address: 1101-1105 Acorn Drive 2. .Are the elevations listed below based on®existing or E]proposed conditions? (Check one) 3. 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 ❑other,(explain) 4. Has DHS-FEMA identified this area as subject to land subsidence or uplift?(see instructions) ❑Yes ®No If yes,what is the date ofthe current re-leveling? / (month/year) 5. What is the elevation datum?®NGVD 29 ❑NAVD 88 ❑Other(explain) 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+/-ft.=FIRM Datum 6. Please provide the Latitude and Longitude of the most upstream edge of the structure(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ®WGS84 ❑NAD83 ❑NAD27 Lat.42.6224 Long.-71.0608 Please provide the Latitude and Longitude of the most upstream edge cf the property(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ❑WGS84 ❑NAD83 ❑NAD27 Lat. Long. Lowest Address Lot Number Block Lowest Let I Adjacent Base Flood BFE Source Number Elevation' Grade To Elevation Structure 1101-1106 Acorn Drive Building 11 118.4' 113.2' FEMA Simplified Method 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 flne or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name:John M.Morin License No.:39836 Expiration Date:June 30,2016 Company Name:The Morin-Cameron Group,Inc. Telephone No.:978-887-8586 Email:john@ marincameron.com Fax No.978-887-3480 �,V1H OF M f Signature: Date: ggc1`� /� a'Ll1h & jS o� JO GRIN ym CIVIL y o No.39836 'For requests involving a portion of property,include the lowest ground elevation within OAF qFG/STEFL�� the metes and bounds description. 0 Please note:lithe Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be issued for the structure only. DHS-FEMA Form 086-0-26A,FEB 11 Elevation Form MT-1 Form 2 Page 1 of 2 Continued from Page 1. Lowest Adjacent Lowes[Lo[ Base Flood Address Lot Number Block Number Grade To - 8FE Source Elevation- Structure Elevation This certification is to be signed and sealed by a licensed land surveyor,registered professional engineer,orarchitect authorized by law to certify elevation information.All documents submitted in supportofthis request are correct to the best of my knowledge. I understand that any false statement maybe punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name: - License No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: "For requests involving a portion of property,include the lowest ground elevation within the metes and bounds description. Seal(optional) Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be Issued forthe structure only. ~ DHS-FEMA Form 086.0-26A,FEB 11 Elevation Form MT-1 Form 2 Page 2 of 2 i =DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O_miB.NO.1660-0015 COMMUNITY ACKNOWLEDGMENT FORM Expires February 28,201 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response.The burden estimate includes the time for reviewing Instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form.This collection is required to obtain or retain benefits.You are not required to respond to this collection of information unless a valid 0048 control number is displayed on this form.Send comments regarding the accuracy of the burden estimate and any suggestions far reducing this burden to:Information Collections Management,Department of Homeland Security, Federal Emergency Management Agency,1800 South Bell street,Arlington,VA 20598-30DS,Paperwork Reduction Project(166t}f1015)-NOTE:DOnot send your completed form to this address. This form must be completed for requests involving the existing or proposed placement of fill(complete Section A)OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory Roodway(complete Section 8). This form must be wmpleted and signed by the official responsible far floodplain management in the community.The six digit NFIP community number and the subject property address must appear in the spaces provided below.Incomplete submissions will result In processing delays.Please refer to Ute MT-1 instructions for additional Information aboutthis form. Community Number:250098. Property Name or Address:1101.1106 Acom Drive r ESTS INVOLVING THE PLACEMEN70F FILL mmunity official responsible forfloodplaln management,I hereby acknowledge that we have received and reviewed this Letterof Map asedon Fill(LOMR-F)or Conditional LOMR-F request.Based upon the community's review,we find the completed or proposed project s designed to meet all of the community floodplain management requirements,including the requirement that no fill be placed in the floodway,and that all necessary Federal,State,and local permits have been,or in the case of a Conditional LOMR-F,will be obtained. ional LOMR-F requests,the applicant has orwill document Endangered Species Act(ESA)compliance to FEMA prior to issuance of the onitional LOMR-F determination.For LOMR-F requests,I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved Independently of FEMA's process.Section 9 ofthe ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm an endangered species,a permit is required from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 ofthe ESA. For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination. For LOMR-F requests,we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: Community Official's Name and Title:(Please Print or Type) Telephone No.: Gerald Brown,Buildin Inspector 978-688-9545 Community Name: Commu'nity Official's Signature:(required) Date: North Andover i B.PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY As the community official responsible forfloodplain management,I herebyacknowledge that we have received and reviewed this request fora LOMA.We understand that this request is being forwardedtoDHS-FEMA to determine if this property has been Inadvertently included in the regulatoryfloodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatoryfloodway.We find thatthe completed or proposed project meets oris designed to meetall of the community floodplain management requirements. Community Comments: Community Official's Name and Title:(Please Printer Type) Telephone No.: Community Name: Community Official's Signature(required): Date: DHS-FEMA Form 086-0-268,FEB 7f Community Acknowledgment Form MT-1 Form 3 Page 9 of 1 FEDERAL EMERGENCY MANAGEMENT AGENCY PAYMENT INFORMATION FORM Community Name:North Andover Project Identifier: 1101-1106 Acom Drive THIS FORM MUST BE MAILED,ALONG WITH THE APPROPRIATE FEE,TO THE ADDRESS BELOW OR FAXED TO THE FAX NUMBER BELOW. Please make check or money order payable to the National Flood Insurance Program. Type of Request: LOMC Clearinghouse. ®MT-1 application 847 South Pickett Street ❑MT-2 application} Alexandria,VA 22304-4605 Attn.:LOMC Manager FEMA Project Library ❑EDR application 847 South Pickett Street Alexandria,VA 22304-4605 FAX(703)212-4090 Request No.(if known): Check No.: _ 6�1?�9 Amount: 425 ❑ INITIAL FEE* ❑ FINAL FEE ❑ FEE BALANCE** ❑ MASTER CARD ❑ VISA ® CHECK ❑ MONEY ORDER *Note: Check only for EDR and/or Alluvial Fan requests(as appropriate). **Note:Check only if submitting a corrected fee for an ongoing request. COMPLETE THIS SECTION ONLY IF PAYING BY CREDIT CARD CARD NUMBER EXP.DATE ITTT]� — — m 1 2 3 4 5 6 7 8 9 1D 11 12 13 14 15 16 Month Year Date Signature NAME(AS ITAPPEARS ON CARD): (please print or type) ADDRESS: (for your credit card receipt-please print or type) DAYTIME PHONE: c �` FEMA Form 81.107 Payment Information Form ` 80139 ~ The Morin-Cameron Group,Inc. Im Bank 447 Boston Street;Suite 12 TD , America's Most Convenient Banken 978-887.- 01983 7 978- 8586 53.7054-2113 CHECK DATE 1/21/15 s PAY Four hundred twenty-five&-----------------------------------------------00/100 dollars ,i AMOUNT TO National Flood Insurance Program $425.00 8 11rt4 AUTHORIZED SIONA AE 11 ii'06013riti° o: 2bi37054SI: 825245L055it' The Morin-Cameron Group,Inc. 60139 Oakridge Village 2937(1101-1106 Acord Drive,North Andover) $425.00 II 60139 I NCTDLTIII USE WITH915soENVL— 30 -1000 DEET 7 METER .ov`• --- 1 Pao a� ,ktack- ' T EN (ALL L xtskoo"TIONSI PANEL! t M aUAWW ,4m, afF1Ef 9 vm . r s ' r ,! Nouolouew;Tha 9 A'Nd++�bvm;ahc*artx below a dY ,t mart�ilt#y Ise# rc s ;'a X". hast?be a �a? rx.�a bao*ub�am MAPRUMBER 004003$1 F FICTWE OATE ° 1 2012 s 3 '� 5. M1� 'F$idAY 6E OrySi$TpRAtEI4'tCt `Jt# Awy n10p. tt OAU � C 4'Cx37G hen7es n+2 +k'tk Ystn data on the e � � � t`�Ffyod lneurartce �� •o.�" .Rin�]rcax�'e cfan:..tprP �$.:}$g`#° G ;{at+�„�'�Wyn!!N msc.tama.9ov { fa u5(35 �JAP �' • M 1 / ji BEADING,MASSACHUSETTS + 42071-E1-7M-025 1 I CONTOUR UlaRVAL 9 h TEAS 1987 !! O I l HA1tOIVA1.(3L'wnc VSNT]CA1 DAT OP 19]9 SCALLS,.I 500 � 41 O � � P! � Base (100 Year) Elevation Deteri Simplified Method: Building #11 (1101-1106 F 33.6m - 33.0m = 0.6n 4- ( BFE = 33.0 m + 1.5 m = I �`BLoCs.t J o "q o cn � � I DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0 13 PROPERTY INFORMATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, i searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this 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. In order to process your request,all information on this form must be completed in its entirety,unless stated as optional. Incomplete submissions will result in processing delays. Please check the item below that describes your request: ❑ LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill(natural grade)would not be inundated by the base flood. ❑ CLOMA A letter from DHS-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 as proposed. FLOMR-F A letter from DHS-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 DHS-FEMA stating that a parcel of land or proposed structure that will be elevated by fill would not be inundated by the base flood if fill is placed on the parcel as proposed or the structure is built as proposed. Filiis defined as material from any source(includingthe subject property)placed that raises 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 been placed on your property to raise ground that was previously below the BFE? Yes ❑ No If yes,when was fill placed? April/2005 ± Will fill be placed on your property to raise month/year ground that is below the BFE? ❑ Yes* ❑ No If yes,when will fill be placed? / h month/year *If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructions). 1. Street Address of the Property(if request is for multiple structures or units,) 1 ��� nter street names below): 1101-1106 Acorn Drive 2. Legal description of Property(Lot,Block,Subdivision or abbreviated descript -� Assessors Map 108C Block 39 Lots 1101-1106 3. Are you requesting that a flood zone determination be completed for(check ,1 V1 11 INC, &Z- ® Structures on the property? What are the dates of construe ❑ A portion of land within the bounds of the property?(A certi t` 1/t. ��J removed,certified by a licensed land surveyor or registered r 11` of metes and bounds descriptions,please refer to the MT-1 Foi ❑ The entire legally recorded property? 4. Is this request for a(check one): ® Single structure ❑ Single lot ❑ Multiple structures(How many structures are involved in yoi ❑ Multiple lots(How many lots are involved in your request?List the number ) In addition to this form(MT-1 Form 1),please complete the checklist below. ALL requests must include one copy of the following: DHS-FEMA Form 086-0-26,FEB 11 Property Information Form MT-1 Form 1 Page 1 of 2 1 a ® Copy ofthe effective FIRM panel on which the structure and/or property location has been accurately plotted(property inadvertently located in the NFIP regulatory floodway will require Section B of MT-1 Form 3) ® Copy of the Subdivision 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 Recorder's 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. The map should include at least one street intersection that is shown on the FIRM panel. ® Form 2—Elevation Form. If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot elevation must be provided on 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 For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may include a copy of an Incidental Take Permit,an Incidental Take Statement,a"not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S.Fish and Wildlife Service(USFWS),or an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or listed species or designated critical habitat.Please refer to the MT-1 instructions for additional information. Please do not submit original documents. Please retain a copy of all submitted documents for your records. DHS-FEMA encourages the submission of all required data in a digital format(e.g.scanned documents and images on Compact Disc(CDl). Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. Incomplete submissions will result in processing delays.For additional information regarding this form,including where to obtain the supporting documents listed above,please refer to the MT-1 Form Instructions located at http://www.fema.gov/plan/prevent/fhm/dl mt-l.shtm. Processing Fee(see instructions for appropriate mailing address;or visit http://www.fema.gov/fhm/frm fees.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 lot(s)/structure(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 LOMR-F following a CLOMR-F) ®$425(single lot/structure LOMR-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 lot/structure 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 Program. 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 Title 18 of the United states Code,Section 1001. Applicant's Name(required): Oakridge Village-Maplewood Reserve Company(if applicable): Affinity Realty&Property Management Mailing Address(required): 63 Atlantic Ave Daytime Telephone No.(required): 978-686-4800 Boston,MA 02110 c/o Joe- Fax agFax No.(optional): 978-685-0521 E-Mail Address(optional):®By checking here you may receive correspondence electronically at the email address provided): joseph@affinilyrealty.com Date(required) Signature of Applicant(required) DHS-FEMA Form 086-0-26,FEB 11 Property Information Form MT-1 Form 1 Page 2 of 2 DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 ELEVATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden forthis data collection is estimated to average 1.25 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must be completed for requests and must be completed and signed by a registered professional engineer or licensed land surveyor. A DHS-FEMA National Flood Insurance Program(NFIP)Elevation Certificate may be submitted in lieu of this form for single structure requests. For requests to remove a structure on natural grade OR on engineered fill from the Special Flood Hazard Area(SFHA),submit the lowest adjacent grade(the lowest ground touching the structure),including on attached deck or garage.For requests to remove an entire parcel of land from the SFHA,provide the lowest lot elevation; or,if the request involves an area described by metes and bounds,provide the lowest elevation within the metes and bounds description.All measurements are to be rounded to nearest tenth of a foot. In order to process your request,all information on this form must be completed in its entirety. Incomplete submissions will result in processing delays. 1. NFIP Community Number: 250098 Property Name or Address: 1101-1106 Acorn Drive 2. . Are the elevations listed below based on ®existing or ❑proposed conditions? (Check one) 3. 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 ❑other,(explain) 4 t 4. Has DHS-FEMA identified this area as subject to land subsidence or uplift?(see instructions) ❑Yes E No i If yes,what is the date of the current re-leveling? / (month/year) 5. What is the elevation datum?®NGVD 29 ❑NAVD 88 ❑Other(explain) 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+/-ft.=FIRM Datum 6. Please provide the Latitude and Longitude of the most upstream edge of the structure(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ®WGS84 ❑NAD83 ❑NAD27 Lat.42.6224 Long.-71.0608 Please provide the Latitude and Longitude of the most upstream edge of the property(in decimal degrees to the nearest fifth decimal place): Indicate Datum: ❑WGS84 ❑NAD83 ❑NAD27 Lat. Long. Lowest Address Lot Number Block Lowest Lot Adjacent Base Flood BFE Source Number Elevation* Grade To Elevation Structure 1101-1106 Acorn Drive Building 11 118.4' 113.2' FEMA Simplified Method 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 may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name: John M.Morin License No.: 39836 Expiration Date: June 30,2016 Company Name; The Morin-Cameron Group,Inc. Telephone No.: 978-887-8586 Email:john@morincameron.com Fax No.978-887-3480 Signature: Date: For requests involving a portion of property,include the lowest ground elevation within the metes and bounds description. Seal(optional) ) Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a determination will be issued for the structure only. DHS-FEMA Form 086-0-26A,FEB 11 Elevation Form MT-1 Form 2 Page 1 of 2 Continued from Page 1. J AddressLowest Lot Lowest Adjacent Lot Number Block Number Grade To Base Flood Elevation* Elevation BFE Source Structure 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 may be punishable by fine or imprisonment under Title 18 of the United States Code,Section 1001. Certifier's Name: License No.: Expiration Date: Company Name: Telephone No.: Email: Fax No. Signature: Date: 'For requests involving a portion of property,include the lowest ground elevation within the metes and bounds description. Seal(optional) Please note:If the Lowest Adjacent Grade to Structure is the only elevation provided,a I determination will be issued for the structure only. DHS-FEMA Form 086-0-26A,FEB 11 Elevation Form MT-1 Form 2 Page 2 of 2 DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.NO.1660-0015 COMMUNITY ACKNOWLEDGMENT FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.38 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy ofthe burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security, Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form must be completed for requests involving the existing or proposed placement of fill(complete Section A)OR to provide acknowledgment of this request to remove a property from the SFHA which was previously located within the regulatory floodway(complete Section B). This form must be completed and signed by the official responsible for floodplain management in the community. The six digit NFIP community number and the subject property address must appear in the spaces provided below. Incomplete submissions will result in processing delays.Please refer to the MT-1 instructions for additional information about this form. Community Number: 250098. Property Name or Address: 1101-1106 Acorn Drive A. REQUESTS 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(LOMB-F)or Conditional LOMR-F request. Based upon the community's review,we find the completed or proposed project meets or is designed to meet all of the community floodplain 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. For Conditional LOMR-F requests,the applicant has or will document Endangered Species Act(ESA)compliance to FEMA prior to issuance of the I Conditional LOMR-F determination.For LOMR-F requests,I acknowledge that compliance with Sections 9 and 10 of the ESA has been achieved independently of FEMA's process.Section 9 of the ESA prohibits anyone from"taking"or harming an endangered species. If an action might harm i an endangered species,a permit is required from U.S.Fish and Wildlife Service or National Marine Fisheries Service under Section 10 of the ESA. For actions authorized,funded,or being carried out by Federal or State agencies,documentation from the agency showing its compliance with Section 7(a)(2)of the ESA will be submitted.In addition,we have determined that the land and any existing or proposed structures to be removed from the SFHA are or will be reasonably safe from flooding as defined in 44CFR 65.2(c),and that we have available upon request by DHS-FEMA,all analyses and documentation used to make this determination, For LOMR-F requests,we understand that this request is being forwarded to DHS- FEMA for a possible map revision. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Gerald Brown,Building Inspector 978-688-9545 Community Name: Comm ity Official's Signature: (required) Date: North Andover / G B. PROPERTY LOCATED WITHIN THE REGULATORY FLOODWAY 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 DHS-FEMA to determine if this property has been inadvertently included in the regulatory floodway. We acknowledge that no fill on this property has been or will be placed within the designated regulatory floodway. We find that the completed or proposed project meets or is designed to meet all of the community floodplain management requirements. Community Comments: Community Official's Name and Title: (Please Print or Type) Telephone No.: Community Name: Community Official's Signature(required): Date: DHS-FEMA Form 086-0-26B,FEB 11 Community Acknowledgment Form MT-1 Form 3 Page 1 of 1 FEDERAL EMERGENCY MANAGEMENT AGENCY PAYMENT INFORMATION FORM Community Name: North Andover Project Identifier: 1101-1106 Acorn Drive THIS FORM MUST BE MAILED,ALONG WITH THE APPROPRIATE FEE,TO THE ADDRESS BELOW OR FAXED TO THE FAX NUMBER BELOW. Please make check or money order payable to the National Flood Insurance Program. Type of Request: LOMC Clearinghouse ®MT-1 application 847 South Pickett Street ❑MT-2 application} Alexandria,VA 22304-4605 Attn.:LOMC Manager FEMA Project Library ❑EDR application 847 South Pickett Street Alexandria,VA 22304-4605 FAX(703)212-4090 Request No.(if known): Check No.: Amount: 425 ❑ INITIAL FEE* ❑ FINAL FEE ❑ FEE BALANCE** ❑ MASTER CARD ❑ VISA ® CHECK ❑ MONEY ORDER *Note: Check only for EDR and/or Alluvial Fan requests(as appropriate). **Note:Check only if submitting a corrected fee for an ongoing request. COMPLETE THIS SECTION ONLY IF PAYING BY CREDIT CARD CARD NUMBER EXP.DATE 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 m m i Month Year j Date Signature NAME(AS ITAPPEARS ON CARD): (please print or type) ADDRESS: (for your credit card receipt-please print or type) DAYTIME PHONE: FEMA Form 81-107 Payment Information Form I K- DEPARTMENT OF HOMELAND SECURITY-FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B.No.1660-001s-y� PROPERTY INFORMATION FORM Expires February 28,2014 PAPERWORK BURDEN DISCLOSURE NOTICE Public reporting burden for this data collection is estimated to average 1.63 hours per response. The burden estimate includes the time for reviewing instructions, searching existing data sources,gathering and maintaining the needed data,and completing and submitting the form. This collection is required to obtain or retain benefits. You are not required to respond to this collection of information unless a valid OMB control number is displayed on this form. Send comments regarding the accuracy of the burden estimate and any suggestions for reducing this burden to:Information Collections Management,Department of Homeland Security,Federal Emergency Management Agency,1800 South Bell Street,Arlington,VA 20598-3005,Paperwork Reduction Project(1660-0015). NOTE:Do not send your completed form to this address. This form may be completed by the property owner,property owner's agent,licensed land surveyor,or registered professional engineer to support Letter of Map Amendment(LOMA),Conditional Letter of Map Amendment(CLOMA),Letter of Map Revision Based on Fill(LOMR-),or Conditional Letter of Mapa Revision Based on Fill(CLOMR-F)for existing or proposed,single or multiple lots/structures. In order to process your request,all information on this form must be completed in its entirety,unless stated as optional. Incomplete submissions will result in processing delays. Please check the item below that describes your request: ❑ LOMA A letter from DHS-FEMA stating that an existing structure or parcel of land that has not been elevated by fill(natural grade)would not be inundated by the base flood. ❑ CLOMA A letter from DHS-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 as proposed. ® LOMR-F A letter from DHS-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 DHS-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(including the subject property)placed that raises 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 notconsidered 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 been placed on your property to raise ground that was previously below the BFE? Yes ❑ No If yes,when was fill placed? April/2005 Will fill be placed on your property to raise month/year ground that is below the BFE? ❑ Yes* ❑ No If yes,when will fill be placed? / month/year *If yes,Endangered Species Act(ESA)compliance must be documented to FEMA prior to issuance of the CLOMR-F determination(please refer page 4 to the MT-1 instructions). 1. Street Address of the Property(if request is for multiple structures or units,please attach additional sheet referencing each address and enter street names below): 1101-1106 Acorn Drive 2. Legal description of Property(Lot,Block,Subdivision or abbreviated description from the Deed): Assessors Map 108C Block 39 Lots 1101-1106 3. Are you requesting that a flood zone determination be completed for(check one): ® Structures on the property? What are the dates of construction?June 2005(MM/YYYY) ❑ 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.For the preferred format of metes and bounds descriptions,please refer to the MT-1 Form 1 Instructions.) ❑ The entire legally recorded property? 4_ Is this request for a(check one): ® Single structure ❑ 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: ) In addition to this form(MT-1 Form 1),please complete the checklist below. ALL requests must include one copy of the following: DHS-FEMA Form 086-0-26,FEB 11 Property Information Form MT-1 Form 1 Page 1 of 2 a ® Copy of the effective FIRM panel on which the structure and/or property location has been accurately plotted(property inadvertently located in the NFIP regulatory floodway will require Section B of MT-1 Form 3) ® Copy of the Subdivision 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 Recorder's 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. The map should include at least one street intersection that is shown on the FIRM panel. ® Form 2—Elevation Form. If the request is to remove the structure,and an Elevation Certificate has already been completed for this property,it may be submitted in lieu of Form 2. If the request is to remove the entire legally recorded property,or a portion thereof,the lowest lot elevation must be provided on 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 For CLOMR-Fs,the following must be submitted in addition to the items listed above: ❑Documented ESA compliance,which may include a copy of an Incidental Take Permit,an Incidental Take Statement,a"not likely to adversely affect" determination from the National Marine Fisheries Service(NMFS)or the U.S.Fish and Wildlife Service(USFWS),or an official letter from NMFS or USFWS concurring that the project has"No Effect"on proposed or listed species or designated critical habitat.Please refer to the MT-1 instructions for additional information. Please do not submit original documents. Please retain a copy of all submitted documents for your records. DHS-FEMA encourages the*submission of all required data in a digital format(e.g.scanned documents and images on Compact Disc[CD]). Digital submissions help to further DHS-FEMA's Digital Vision and also may facilitate the processing of your request. incomplete submissions will result in processing delays.For additional information regarding this form,including where to obtain the supporting documents listed above,please refer to the MT-1 Form Instructions located at http://Www.fema.gov/plan/prevent/fhm/dl mt-l.shtm. Processing Fee(see instructions for appropriate mailing address;or visit htt.p://www.fema.gov/fhm/frmfees-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 lot(s)/structure(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 lot/structure LOMR-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 lot/structure 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 Program. 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(required): Oakridge Village-Maplewood Reserve Company(if applicable): Affinity Realty&Property Management Mailing Address(required): 63 Atlantic Ave Daytime Telephone No.(required): 978-686-4800 Boston,MA 02110 c/o Jo2 'ja►I GnA r Fax No.(optional): 976-685-0521 F-Mail Address(optional):®By checking here you may receive correspondence electronically at the email address provided): joseph@affinityrealty.com Date(required) Signature of Applicant(required) DHS-FEMA Form 086-0-26,FEB 11 Property Information Form MT-1 Form 1 Page 2 of 2 ❑ 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 "IJ' on the prescribed forin.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 shalLbe limited as to the time of ongoing construction activity,and may be.deemed-by.the-Inspector-of-Wires abandoned.and_iavalid-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 24D 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 J "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: Date...... ....................... 40RTAI TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA This certifies that ............. has permission to perform ......V��k .................................. ...................................... wiring in the building of.........1 IV .......... at..... k,, .......................;North Andover,Mass. .................................................. Fee IZ-5...... I-1c.No. ........... /ELECTRICAL INSPECTOR Check # 9229 Commonwealth of Massachusetts officialese Department of Fire Services Permit No, Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev.9/05] eave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEe),527 CPM 12.00 (PLEASE PRINT 1N INK OR TYPE AL�11ON) Date: City or Town of: rX/� To the Ins ector of Wires.- By ires:By this application the undersigned gives notice of his or heyintention to perform the electrical work described below. Location(Street&Number) Owner or Tenant i 6 Telephone No.aZ—d,:2�7 49 13 Owner's Address l C ,j" Is this permit in conjunction with a building permit? Yes ❑ NOX (Check Appropriate Box) Purpose of Building Utility Authorization No. Existing Service Amps / Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps / Volts I Overhead❑ Undgrd ❑ No.of Meters ' Number of Feeders and Ampacity Location and Nature of Proposed Eiecoical Work: sv J 7 Completion o the foilowin tab l may be waivedby the IruDector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.o Tota] Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Swimming Pool Above ❑ n- ❑ o.o Emergency iganng rid. d. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners o.o Deteefinnand Initiatin .Devices No.of RangesNo.of Air Cond. Tons l No.of Alerting Devices No.of Waste Disposers eat Pump _umber Tons K - No.o -e outained Totals: — -� `� Detection/Alerting Devices No.of Dishwashers S ace/Area Heating Municipal P b KW Local❑ Connection Other • No.of Dryers Heating Appliances KW ecurityystems:* No.of Devices or E uivalent No.of Water KWNo.of No.of Data Wiring: Heaters Signs Ballasts No.of Devices or E5mivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunicationsirisgg No.of Devices or E uivalent OTHER: 413-0 Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of lectr al Work: % Q. (When required by municipal policy.) Work to Start: d 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. CHECKONE: INSURANCE [Z. BOND ❑ OTHER ❑ (Specify:) EXPIRATION DATE 9/30/2010 I certify,under the pains and penalties ofperjury,that the information o is app ' is true and complete. FIRMNAME: HELCO ELECTRIC INC 1AC•NO A6-238 Licensee: Signature LIC.NO.: (If applicable,enter"exempt"in t6 lice a nwnber line.) Bus Tel.No.:9 7 B—S-�2—7 S 0 0 Address: ZERO CENTENNIAL DRIVE, PEABODY, MA 01 9 Alt.Tel.No.• 4'09 — Z /`ee`� *Security System Contractor License required for this work;if applicable,enter the Iicense number here: 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 EJ owner's gent. Owner/Agent ._ Signature Telephone No. PERMITTEE: S r i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations -600 washington-Streef .Foston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Flectricians/Plumbers Antalicant Information Please Print Lecq Name (BusinesslOrgeriza6mLIndividu2l): Helco Electric, Inc. Address: Zero Centennial D:'i ve City/State/Zip: Peabody, MA 01960 Phone#: •"978-532-7500 Are ou an employer? Check the appropriate box: Type of project(required); 1.VI am a employer /� 4. ❑ I am a general contractor and 6, ❑New construction employee (rul d/arPart-time).* have hired the su"h-contractors n 2.❑ I am a sole proprietor or partner- listed on the attached sheet, $ 7. ❑Remodeling ship and have no employees These sub-contractors have 8. El.Demolition wonting for me in any capacity, workers' comp,insurance. 9, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its . required.] officers have exercised their 10,Q'Electrical repairs or additions. 3.❑ I am a homeowner doing all work right of exemption per MGL 11,❑Plumbing repairs or additions myself.[No worlars' comp. c. 152,§•1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers'• 13,❑ Other comp,insurance required.] *My apnli cant that checks box#1 must also fill out the section belowshowing their workers'compensation policy information t Homeowners*ho submit this affidavit indicating they arc doing all work and then hire outside contractors mustsubmita ---- " �Contraetors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy infonaatien. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: At 1 ant ; r• Charter Insurance Co. w Policy'r or Sear"-ins.Lic. W=.-00060101 _ Expiration Date:,_ .9/30/2010 �¢ Job Site Address: City/State/Zip: ,/t-7 & a//ue�,, 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 Lac I ` of up to c250.00 a day agamst the violator. Be advised that a copy of this statement may be forwarded to the.Ofnce of Investigations of the DIA f insurance coverage v ation.. Y Ido hereby certify and the pains- d pen fres of per ry that the information provided above 's true a• correct Signature: Date: Phone : ?8—5 3.2—7 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4,Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone tt: 1 `��Sukus af'♦ CERTIFICATE OF USE & OCCUPANCY TOWN OF NORTH ANDOVER Building Permit Number 223j9/29/1005) Date. August 25, 2006 THIS CERTIFIES THAT I THE BUILDING LOCATED ON 1101,1102,1103,1104,1105,1106 Acom Drive formerly known as 2357 Turnpike Street Bldg11 >,1 MAY BE OCCUPIED AS Town Houses—6 units IN ACCORDANCE WITH THE PROVISIONS OF THE MASSACHUSETTS STATE BUILDING CODE AND SUCH OTHER REGULATIONS AS MAY APPLY. Certificate Issued to: Valley Realty LLC 231 Sutton Street Ste 1B North Andover Ma 01845 I Bu. ding Inspector i FORTH Townof � t � Andover No. 11% Z3 __ 3 �� - t dover, IVlassot ?� S' O COCHICHEWICK V �d A0RATEO kip `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System VA l BUILDING INSPECTOR THIS CERTIFIES THAT.... .� .. ......QM! y....... .V..!.... !. co f Foundation ........................................ has permission to erect.........../...... ................... buildings on ... .��..... 157... r/+�+ ...�Cs S Rough to be occupied as..... ..... +�'fl.......3...s +�'.y....T'e W V �V sr• ...... ................................................................. , v provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Fina this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of 144 Buildings in the Town of North Andover. SORA 4 C , /7- 33 %31? ws 3 ' P ING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rou Final �� � PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTION S E ELECTRICAL INSPECTOR TS Rough ........................................... Service BUILDING INSPECTOR ina /j Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To Be Done FlRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner �C Street No. SEE REVERSE SIDE Smoke Det. r 4 �' 9q,,cao.uews 'oPA� 41 -g44Cm�S' APPLICATION FOR CERTIFICATE OF OCCUPANCY/INSPECTION 2z 9- v Buildlna Permit# I110Z 1108 t1j4 Ito's- ADDRESSILOCATION OF PROPERTY: ooi) My- t3 t 1 Map lob A�(parcel (-P c0- Lot umber SUBDIVISION l:� ! DATE REQUESTED FILED/READY FOR INSPECTION I CLOSING DATE ON PROPERTY: FIVE(5)DAYS NOTICE PRIOR TO CLOSING DATE IS REQUIRED ALL WORK AND SIGN-OFFS MUST BE COMPLETED WITHIN THIS TIME FRAME. A RE- INSPECTION FEE OF TWENTY DOLLARS$20.00)WILL BE CHARGF.D IF THE STRUCTURE DOES NOT MEET ALL APPLICABLE CODES. SIGNED ROUTING CONSERVATION PLANNING 0 JPW-WATER METER E21 0,�, -3/016 -bEWERIWATER CONNECTION a NOTE DPW MUST INDICATE THAT THE WATER METER HAS BEEN INSTALLED PRIOR TO SUBMITTAL OF THE OCCUPANCYAN,SPECTION REDDEST DPW-- l�OLAX Signature File: OC form revised 2006 �._ --_'.� - � -, r� . (i- � �-�/ 1 t i� „-- �,` 1 ,� � � �- � � �_J _ , ._` . � _- , � � t Date... .. ................... Of RT" TOWN OF NORTH ANDOVER PERMIT FOR WIRING SA This certifies that ........ ............................. ...... ................................ has permission to perform ........... -`7 wiring in the building of............ .... /TL ....................................................... it...... �R.........................,North Andover,Mass. .. ..... ................... -ee... Lic. No.............. ........................ . 1..... 'heck # JS—Z 7 Z,7:3 7713 I` J I �onsn+onwaaCth o� cWach�a�atEi Official Use Only Permit No. ? 71.E i � _.CJeParfinan�o��}ira JLfVrcaJ Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS (Rev. 1/07) leave blank) APPLICAT. ON FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 C R 12.00 (PLEASE PRINT IN LANK OR TYPE ALL INFORMATION) Date: D o2 City or Town of: /l ,911AM 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) ff L d 2r� �2l✓e Owner or Tenant / l E yg eL /V, �L° /SlJ��I Z Telephone No. 7kl )s6'e-2037 Owner's Address , Can& 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 i Location and Nature of Proposed Electrical Work: Se c u r i or t rt, to rm S Li STPm Completion of the followin table may be waived by the lns ector of Wires. No.of Recessed"�Luminaires No.of Ceil:Susp.(Paddle)Fans o ota � Trr ansformers KVA '�• No.of Luminaire Outlets No.of Hot Tubs Generators KVA v Above n- o.o Emergency ig ►ng No.of Luminaires Swimming Poo! rnd. ❑ grnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No.of Switch hes No.of Gas Burners i*To.o Detection an Initiating Devices No.of Ranges No.of Air Cond. TotaTonal No.of Alerting Devices No.of Waste Disposers TI—eat ump um_er ons_ o.oSelf-Contained.. P Totals: - _. _.. Detection/AlertingDeces No.of Dishwashers Space/Area Heating KW Local❑ Connection al ❑ Other No.of Dryers Heating Appliances KW eCNo o'f De ices or Equivalent No.of Water KW o.o o.o Data Wiring: * Iteaters Signs Ballasts No.of Devices or Equivalent s.Wiring: No.Hydromassage Bathtubs No.of Motors Total E{P a ecommunicatton No.-of Qevices or Equivalent OTHER: ' /9(� Attach additional detail if desired or as required by the Inspector of Wires. Estimated Value of Electrical Work: CIS (p 6(When required by municipal policy.) . Work to Start: 4•(,410 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:) certify,under the pains and penalties of perjury,that the information on this application is true and complete FIRM NAME: ScrVCCPS LIC.NO.: 15-33 C— r Licensee: -1. 7-4 O/Z- Signature IC.NO.: (Tapplicable,enter "exempt"in the license numer line.) / Bus.Tel.No.: "4 Address: L l AJTT �� 14/(t5 'UH �'��p AIt.:Tel.No. _ 'Per M.G.L.c. 147,s.57-61;security work requires Department of Public Safety"S"License: Lic.No. S C% et ' 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. IIS i �� U�D�J�L�';Y%0�2CUG'l�G�,�2 s✓�����.1d GZGf2GGd�GGd Department•of {public Safety One-Ashburton Place, Rm 1301 _ Boston, Ma 02108-1618 License: SEC SYS CERT. CLEARANCE Number: SS CC 002577 Expires; 12/23/2007 ©Irtt�ciate; 12/23/1971 Restricted To: 00 WILLIAM M TAYLOR JR i 18 CLINTON DR HOLLIS NH 03049 Tr. no: 67.0 Keep top for feceirl and change of address noliflcallon., , ! PPS-CAI i! 50M•O.Voo•PCE/90 , . n f I �j'� ✓/11 TDO�i�i�,0•il!(�tlllr/! O�ir'Gl1JJ lti/illJemi .. DEPARTMENT OF PUDLIC SAFETY License: SEC SYS CERT.CLEARANCE Numbor: SS CC 002577 pirihdaioc.12/23/1974 COMMONWEALTH OF MASSACHUSETTS ` Explies: 12/23/2007 Tr.nc: f17.0 Restrlcled: 00 " . REGISTERED STEM TECHNICIAN WILLIAM M TAYLOR.JR•L 's: 18 l_II!TON DR :.•R''%''i;' ISSUES THIS LICENSE TO HOLLIS, NH 03049 M TAYLOR JR CommisslQner DIG SAFE CALL CENTER: (Heo)3a4-723 WILLIAM a 27 STONEHENGE RD APT 6 NH 03053-2437 LONDONDERRY ' o7/s1�10 291%,6Y: i .`"; 10099 U SAM ZAX ASSOCIATES Phonc: (617) 479-7415 CONSULTING ELECTRICAL ENGINEERS Fax: (617) 770-1423 E-Mail: mzax@zaxengineering.com 1400 Hancock Street- PO Box 690353 Quincy, MA 02169 i ELECTRICAL FINAL AFFIDAVIT i I, or my authorized representative, have observed the work associated with Permit No.6063, as in accordance with Section 116. of 780CMR dated September 6,2005, for Building #11 located in North Andover, MA. and To the best of my knowledge, information, and belief, the work has been done in conformance with the approved i plans and with the provisions of the Massachusetts State Building Code and all other pertinent laws and regulations of the Town of North Andover. we4.4. James P. Stroke 20068 SHO ENGINEER - MASS. REG. NO. JAMES P. u, 1400 Hancock St., Quincy, MA 02169 o STROKE ym► ADDRESS G T P August 15,2006 �► S�NAL���* Date Then personally appeared the above-named James P. Stroke And made oath that the above statement by him is true. I, Before m My Commission expires �d 2 20 0 R()6EF%T F.KRIM JR. Notary Public Commonwealth of Maa>f1shtatoft My CommMlon Exphw October 24,200 I i I CHAN KRIEGER & ASSOCIATES 8 Story Street Cambridge MA 02138 . 617 354 5315 tel 617 354 3252 fax . www.chankrieger.com ARCHITECTURE and URBAN DESIGN Lawrence A.Chan,AIA Alex Krieger,FAIA Tom Sieniewicz,AIA Alan Mountjoy,AIA Patrick Tedesco,AIA AFFIDAVIT ARCHITECTURE To: Building Inspector Date: 8/15/06 Town of North Andover Re: Oakridge Village—Building#I I j i Subj.: Building completion I, Thomas M. Sieniewicz, being a registered architect in the Commonwealth of Massachusetts, attest, as being the architect of record, that I have personally supervised the preparation of architectural plans and specifications for the project noted above. To my best knowledge, the plans and specifications comply with the requirements as set forth in the current Commonwealth of Massachusetts Building Codes. Myself or a representative of this firm has made approximately 60 site visits to review the construction and I hereby attest that, to the best of my knowledge, the construction has been completed in accordance with our plans and specifications. ��yED AACHiJ Sincerel A Na.79B9 W CAMBR►�E. � FRAWESOMENDERSON Notary Public 9lTH of COMMONWEALTH of MASSACHUSETIN My Commission Expires 1 MOrCh 22.2013 Thomas M. Sieniewicz, AIA, AICP Massachusetts Registration#7969 I IIS RobertCumm1S �' -9Ssoci ,eL 181 Bow Bog Road Bow, NH 03304 (03) 224-7453 bobcfm(W-comcast.net (603)224-7467 i CONSTRUCTION AFFADAVIT Subject: Maplewood Reserve Building 11 Off of Route 114 N. Andover, MA I certify to the best of my knowledge, information and belief that the automatic sprinkler system installed to provide protection for the building are installed in accordance with 780CMR, MSBC 6th Edition and NFPA 13R. Work associated with the fire alarm system is not within the scope of the sprinkler contractor. Installing Contractor: Hampshire Fire Protection (603) 432-8221 Engineer Name: Robert B. Cummings Company Name: Robert Cummings & Associates, PLLC Address: 181 Bow Bog Road Bow, New Hampshire 03304 f Telephone: (603) 224-7453 i MA Registration No. : 39299 f P Date : August 14, 2006 j `' R 0j -'. S-" FS�tEP ?1 f. lut of� Pdo �S i 9 C+ n* ,.,,�f'NAL Ell�,,5/"moo , r f RECEIVED AUG 14 2006 TOM BUILDING CORPORATION I 3�7YIli GF Mc1f�TiFf ANDER i9�`�IIC�N QDNTRiOI, i 19 It mua,>Ec,4(�Ct4TM2MI fJ 0�Tfi �{N 9 L ;2 y�• �: NAIVE W TuRarm MAT111✓�a�P�rEer;,_..11d 1 ZL71 FB>i�n�l,� �o[�sl N(r' IN vion # t1 c 1NE MAB&# $T147E CL7IGAA ��A L`1T�D pi6dFEES81aF1lA.IET�lQIt P1Y'C�TTr!'T4iAfi i UrAMMS AND allAWS 6CAT00 MIG; j I - I FFM PWMM1 � RK1111111111M O MI>R , 2�U�G- I I :� If J. aft, f�107pp1�#11R �AiB F'18F:�op�+�aa�rl!9afsa� $ BCp1�rR�Yf�nt.� d�4(iljla Gf C�1Yl�4►hpROs�4 Qr9R31I�! .. dwwwft .MOOMR p �d10f IIrMwolf and� I-�a�N'l��uk3�1�Y�p lfl If 1Yii11T$F 4 mt611dIP� PUF W4Ni TO 8FCTX M 111L2:T I&@I L WJBW- 1A1115M?(.ARCGRM f i jN OF0 414 TOGS MER MTN PRWN4Pff0UWA&ffS10TH1j NOM M99N 'R WJ-U IM TUR. UPON caw—ETM GF TF€WklW I ALL s9lJMfT A F ft Mf mWT AS_, Gf0 Rfs17 'a�4TlSFPi CJ;iAi+L�fl�ll AMR}RFd401i�S$C7f 19E PST t=DiR �} �Li2ij, 0 DUBIN (/ �-�4Y SI0.29370 StAteED Nip.. R!4 eEF RF KaE TML. i&& �F CGfSTFR� SSfONALE�� Afa.Y P9JBLIC 1sS1'' rUM $ 3 r� KAREN J.DUDLEY s Notary Public W( Commonwealth of Massachusetts s My Commrsion Expires Nov 17,2011 I t ISD AF 9 f STRUCTURAL FINAL AFFIDAVIT To the Inspectional Services Commissioner: I certify that 1,or my authorized representative,have inspected the work associated with Permit No. dated ,locus Oakridge Village and Maplewood Reserve Building No. 11 -Turnpike Street,North Andover, MA Ward (on the dates given below or on at least occasions during construction),and that to the best of my knowledge, information, and belief the work has been done in conformance with the permit and plans approved by the Inspectional Services Department and with the provisions of the Massachusetts State Building Code. i i William D. Lovallo,P.E. Engineer-Massachusetts Reg.No. 36883 LeMessurier Consultants Inc. " Company �o a oa WILLIAM D. LOVALLO RUCTURAL 675 Massachusetts Avenue, Cambridge,MA 02139 6883 �fe, aEo Address asloNA a �+ (617) 868-1200 Telephone Inspection Dates: 1/19/06, 5/25/06 I 31 May 2006 i Then personally appeared the above-named William D. Lovallo and made oath that the above statement by him is true. Oore me, i Notary Public oP My Commission expires V Oa6 i i r 4133 SOUTHERLAND A&OT Lmhak a HOUSTON TX 77092-4416 COMFORT PHONE(713)460-7300 SYSTEMS U0 FAX(713)460-7301 C May 22,2006 Tocci Buildign Corp. 660 Main Street Woburn,Ma. 01801 Re: Completion of Mechanical Services—Compliance Certificate Project: Oakridge Village—Andover,Ma. Phase II Building 11 I The mechanical installation for the building referenced above has been completed using plans and specifications prepared by this office. Periodic observations visits were made by qualified individuals from this office to check for general conformation of this installation with our plans and specifications.In my opinion based on our experience, knowledge,information and belief.Installation of the mechanical system and operations has been performed in general conformance with plans and specifications prepared by this office. I We further believe that we have met those requirements in so far as our responsibility for design,review of shop drawings,and periodic observations of the work for conformance is concerned. Please feel free to contact us of we may be of further assistance. Respectfully I � Felix F.Adeokun,P.E. E f P'O�A OF A%sY oy 9 o FELIX F. ADEOKUN m MECHAN 74 S � Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: Da kf,qe V� 11Qge INSPECTION DATE: 7- 31-06 0 UNIT NO.: 5,"? LeiL1 FLOOR: Al[ WING: T BUILDING NO.: REMARKS: r�L JQ�`'` 1 f.�r? / 1 .5 F14' a L J / . cc(i) OriVe //o q I //o4 coalPzere A 7e.127e.5 .Se - - Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final 'Plumbing and/or gas-final Other: Date: Date '7 - S/" 6 Date: Inspector Inspector Inspector Fire Dept- ' oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O Inspector Inspeetor Inspector i , Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: k r I tF' i/1 ��� P INSPECTION DATE:. UNIT NO.: See Br'/nc*L0OR:_ C[ WING: — BUILDING NO,: REMARKS: I Re - Te15-,4- Po r- 6a S Til 6 PSZ' I /1O/. IIQ.z , 11193 : /1oz/, //D�", //06 -a orrl Drive - - I Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date:- Date: Date: Inspector inspector Inspector Electrical-rough- Plumbing and/or s-roug - Other: Date: Date: 3 " 6 Date: Inspector Inspector Inspector I i Electrical-final Plumbing and/or gas-final Other. Date: Date: Date: Inspector Inspector Inspector I Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O# Inspector Inspector Inspector j Form t9%Action Prean,885-7000 .> Town of /f NORTH ANDOVER i 4 BUILDING PERMIT INSPECTION REPORT i PERMIT NO.: PROJECT: J- INSPECTION DATE: � / I UNIT NO.: { ' 1 �� FLOOR: WING: BUILDING NO.: r I � � t I REMARKS: J , t i i i i Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: I Inspector Inspector Inspector �^ 7 M 57L S Electrical-trough- J v Plumbing and/or gas-rough- Other: Date: _.2 — Date: Date: Inspector ( y Inspector Inspector i Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: 1 I Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O# Inspector Inspector Inspector „.�,.. �- .wC• T ,•a -. t` .. .. ,'ti..r .y', ti., ” ,r , h .. ..:.y. i/.} - - ., .t- .. r..+. ...r. .T�"...:. 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Town of c.0 NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: Qa k r t d6 F V01/44<2INSPECTION DATE: UNIT NO.: 1101 — //06 FLOOR: Ali WING: BUILDING NO.: l REMARKS: /-eta � /� 6 u/n I f S (-✓Gt t s°r �`?�i S + R r Se r S' irrom meter R M 9"h rnual, a�/ units r© t✓g-ier Beater Roam S Air ?e-5 t r-d To /15 PSE , Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbin ,and/or gas- ough- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspector Form#995 Action Press,585-7000 , , .ra^ �'n--^'�'.r-.�....,r+. . -.s ... �}..ti..-w.vim.-,•-,..y- � . _ .. . ..r,e.., ..� - - - -..�_. - ., ._. ..-..r•,w...'..r. wo•M Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: l�Q K f d�P V l/a4 P INSPECTION DATE: UNIT NO.: //06 FLOOR: A I- WING: BUILDING NO.: // REMARKS: w asp)pe Frons mel-er bars To Men4aalLaL Rooms, TeS fed To 3 Psr . u n i i- AxS 110/4 //0,7., //0, , //054 //O-S; //06 . Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or as-rough- Other: Date: Date: -.2 3 -06 Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# Inspector Inspector Inspectors Form#995 Action Press,685-7000 f, ` Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT:_0a k Ir ida e V r 1144 P INSPECTION DATE: UNIT NO.: 1101- 1106 FLOOR: A I t WING: BUILDING NO.: REMARKS: 13 Ila * 11 - 6 u n fS Sanatary luaste + VPh P/ Pel. -rAroma h Roo r a n.L fall- 7=- uLLr U n r � #�S 110/ 00-x, d 103 , 1101 110.5, 1106 i 1 r r y Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- lumbin ,and/or gas- ough- Other: Date: Date: 2 -21 -O 6 Date: Inspector Inspector Inspector r Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O# ° Inspector Inspector Inspector Form#995 Action Press,685-7000 �o c Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: ©Gt k f t d4LJ ✓, lat?a INSPECTION DATE: 2'2l-O 6 11 j UNIT NO.: 1101- 1106 FLOOR: Q N WING: BUILDING NO.: REMARKS: �Ldq • /I 6 units ti. iwa-F,�!' PAPP ,•� .ndrv,duct C �!/)� f S , P� Ped �- Te s ted ro 2S Pss uni'f #'S /la /102, Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Clumbin and/or gas rough- Other: Date: Date: 2 -2 /' 6 Date: Inspector Inspector Inspector Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: -Cof 0# n Inspector Inspector Inspector* Form#995 Action Press,685-7000 JP SI.• �- 40i 6� O Town of _! ` •�__,���� NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: boa PROJECT: 11.�- .'--')-INSPECTION DATE: UNIT NO.: /a Y/J•j-# FLOOR: WING: BUILDING NO.: �� f REMARKS: 1I I I Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector » Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-,-roug�h!- Plumbing and/or gas-rough- Other: Date: 7'��� d Date: Date: Inspector �;�-7 Inspector Inspector j i Electrical-final Plumbing and/or gas-final Other: Date: Date: Date: j i ' Inspector Inspector Inspector I j Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O# Inspector Inspector Inspector 4,4 x o Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: 6JPROJECT: '� I�` i./0) ,7' '7 INSPECTION DATE: UNIT NO.: 0 0)l FLOOR: J t / WING: BUILDING NO.:—// REMARKS: t i,1.-41--. f � Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Ele�__ -final Plumbing and/or gas-final Other: Date: `"06 Date: Date: ",----'Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of 0# Inspector Inspector Inspector ... Town of C NORTH ANDOVER i BUILDING PERMIT INSPECTION REPORT PERMIT NO.: PROJECT: 1 �' ' INSPECTION DATE: UNIT NO.: FLOOR: _5 �` r� 3 WING: 6) ` BUILDING NO.: �( I i REMARKS: �r�, •t �.... Z_ ��C �,2. , -L-'' I i i Excavation-depth and soil conditions Framing- Other: Date: Date: Date: i Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector i Electrical-rough- Plumbing and/or gas-rough- Other: I Date: Date: Date: Inspector Inspector Inspector Eleinal / Plumbing and/or gas-final Other: Date: 7=_t,;(-()6, =_/5( ()b Date: Date: �,--/Inspector 4+2:k. Inspector Inspector " I Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of O# Inspector Inspector Inspector y h,h Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: 60-2 PROJECT: �' 'k— c' �' '��� INSPECTION DATE: 7- l '(p6 UNIT NO.: FLOOR: WING: *04 < BUILDING NO.: i I REMARKS: 1` �--• '�.I C )/'L. �--- 1 I I I /y I I Excavation-depth and soil conditions Framing- Other: Date: Date: Date: a Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector ElectcEal-final Plumbing and/or gas-final Other: Date: // ' ! Date: Date: I Inspector / I Inspector Inspector Fire Dept- oil burner,tank, stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of 0# Inspector Inspector Inspector .ao Town of NORTH ANDOVER L BUILDING PERMIT INSPECTION REPORT PERMIT NO.: a3 PROJECT: IL *4' INSPECTION DATE: 7. 1 { A UNIT NO.: E FLOOR: r (,' ' WING:—" -)"'N BUILDING NO.: � + REMARKS: i i i I l i Excavation-depth and soil conditions Framing- Other: i Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: , Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector rElectr a f[�al� Plumbing and/or gas-final Other: Date: Date: Date: -_^Inspector / ��Y? Inspector Inspector — Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of 0# Inspector Inspector Inspector Town of NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.: Sad PROJECT: t IL( INSPECTION DATE:_ 7- h UNIT NO.: FLOOR: t WING: ! J �� f BUILDING NO.: REMARKS: Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector cEl cetrical—final Plumbing and/or gas-final Other: Date: � `� Date: Date: Inspector UL?' Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of o# Inspector Inspector Inspector Town of 1 NORTH ANDOVER BUILDING PERMIT INSPECTION REPORT PERMIT NO.:-60(,->- PROJECT: t� `�- ` -' INSPECTION DATE: ` UNIT NO.: � FLOOR: -� WING: r, BUILDING NO.: REMARKS: T_ A.., ,J �a Excavation-depth and soil conditions Framing- Other: Date: Date: Date: Inspector Inspector Inspector Footings and foundations and drains- Insulation- Other: Date: Date: Date: Inspector Inspector Inspector Electrical-rough- Plumbing and/or gas-rough- Other: Date: Date: Date: Inspector Inspector Inspector Alec icalfinal Plumbing and/or gas-final Other: Date: 7— ,f ey... z. )6 Date: Date: Inspector Inspector Inspector Fire Dept- oil burner,tank,stove,smoke detectors Final inspection Certificate of Use and Occupancy Date: Date: Date: C of 0# Inspector Inspector Inspector Sent By: TOM BLDG CORP; 7819355500; Dec-3-04 9:15AM; Page 1/1 ' ------ Tit�'iO1»11 m iNaam tlAi� f1�(f8 � DO;WrbWt&kWusW fti*,* ms's' a►aat�an02111 ft%m==Aftw !Vane h2a pboes Print e ft. A Cb f am o faal�ep„�,�i�rt>;ng aY wpk►n!'�. � � y r� f am e axle ppm wd!lave�opt! �in anti 040* i f an an empi%w pm" 'Oomph for rry«npbyee.,,,,a,,�an tt�ls job. CRY a r 3s � co c G.,J OD 4/9r i am +lei•eourscaw�rIge m und.r3*cvuj,.M Qrtft 1agto me Ndwall�y�'1n ol.se�.a-dliP Ja�bbsfoun�fa i—md 00 saf.afk�ewbSt.400,00 OW Nrld fA�O aopp d thh se�e� �^�►be tarwartJed eo the p�r�p W�1 f�� � �►+ gok�tink l dviiw�rgr wwlarlN PM►�wnd�er�les dPsJ�y D1110'e�d0►meEbn p a0ovq y fu.arxtta►ec� SI�r�11luro � p"dame Jr aRk1d wmq� 00 nd WMU h e$Wansi b!� dlY ate+dOdr COY ar Town " I C CftA 7,FROMM M#Pvt o in roqu vd 0 &rWV Dept 0 UWMOVamd cowkw Q3 � ♦ p Oftr i i i North Andover Building Department Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit Number is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. The debris will be disposed of in: (Loc ion of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector FORM U - LOT RELEASE FORM f 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 APPLICANT � ' / d��� PHONE LOCATION: Assessors Map Number PARCEL1�A/0' SUBDIVISION Lap) /7tv--v -3 9 STREET ST,NUMBER OFFICIAL USE ONLY* RECOM#AENDATIONS OF TOWN AGENTS: CONSERVATION ADMINISTRATOR DATE APPROVED DATE REJECTED COMMENTS 'OWN PLANNER DATE APPROVED DATE REJECTED COMMENTS FOOD INSPECTOR-HEALTH DATE APPROVED DATE REJECTED SEPTIC INSPECTOR-HEALTH DATE APPROVED DATE REJECTED COMMENTS 1� PUBLIC WORKS-SEWERIWATER CONNECTIONS DRIVEWA E /J 9 23 8- FIRE DEPARTMENT dG DUMPSTER PERMIT RECEIVED BY BUILDING INSPECTOR DATE FORM U-Rwhod 6.06 JMC NORTH Town of = : K _ 4Andover 0 No. VNEW 13 $ P0 1qLoVIVA dover, Mass., COCKICKEWICK �ADRATED P`? '4S E BOARD OF HEALTH Food/KitchenPERMIT T D . lSeptic System C BUILDING INSPECTOR THIS CERTIFIES THAT....�................ ......... ........ ........ .......... .....................�...,. ..,.............................................. Foundation has permission to erect...........�...... ................... buildings on... .��..... ... � �ks Rough 400 Te w v V Chimney tobe occupied as..... ..... �.....I.....�5...........y................................ .....5........................................................ provided that the person accepting this permit shall irS every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. M&A 4 C , &*7w 33 .3f 3 ' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS 1 UNLESS CONSTRUCTION ST TS ELECTRICAL INSPECTOR � Rough Air ....... ......... ..................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. 11 SEE REVERSE SIDE Smoke Det. i NORTH Town of t 4Andover 0 .......... w c^ No. - 13 �C90 LA o dover, Mass., � S COCHICHEWICK ^ A0RAT E '9S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT C BUILDING INSPECTOR ....11A.4..�....... ....M�./...y.......34 ....... .. ................................................. Foundation /bV • has permission to erect........... ...... ................... buildings on... .��..... t, , ...*r........ ...LIC. Rough ,� 3 s� Chimney �y rewv vs tobe occupied as..... ............... .....I........................... ... . . . .................... ........................................................................ provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. 100 A 140 , /7- 33 .3114 PLUMBING INSPECTOR i VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S TS Rough ......................................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 1 398 APPLICATION FOREWATER SERVICE CONNECTION North Andover, Mass. 2 Qi��15 Application by the undersigned is hereby made to connect with the town water main in AF' subject to the rules and regulations of the Division of Public Works. Ave— or Street, The premises are known as No. !�f �� � ' � Street su division lot no. �{ � Owner Address Contractor A JA ant's Signature i PERMIT TO CONNE T WITH WATER MAIN �,jJ,�(,� C The Board of Public Works hereby grants permission to U<TK _ t to make a connection with the water main at_ subject to the rules and regulations of the Division of Public Works. Street 1/7 Board of ublic Works By f I i Inspected by Date See back for rules and regulations 2035 APPLICATION FOR SEWER SERVICE CONNECTIONS North Andover, Mass. Application by the undersigned is hereby made to connect with the town sewer main in f—� L'D��IIf Street, subject to the rules and regulations of the Division of Public Works. AV61 The premises are known as No. fi (t C9 C J� Street or subdi*isi o. rj x Owner Address i Contractor / ppplic' s Signature I PERMIT TO CONNECT WITH SEWER MAIN The Division of Public Works hereby grants permission to �U ✓ � Ci�t� to make a connection with the sewer main at Street subject to the rules and regulations of the Division of Public Works.. �-- Division of Public Works By C , ,16,Z Inspected by Date See back for rules and regulations V& H Town of tAndover O No. Z Z :_ - =r_ 1,44 a S' OEM ��0 _ dower, Mass., • COCHICANe WIcK 1� 7,q RATED P' �y `S E BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System DING INSPECTOR da M*NY. �� V • �. BUIL THIS CERTIFIES THAT....�............... ......... ........ ........ ... . .............�..... ......................,....................... { :: � Foundation 1 has permission to erect................ ................... buildings on.... .� ....#j ...�r �.xe S Rough to be occupied 8s �� 44 w V V 406 Chimney �..... ...... .... .... .............................I......................... provided that the person accepting this permit shall I every respect conform to the terms of the application on file in Final this office, and to the previsions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. MR A 4 4 / /7w 33 •3l q, 3 ' PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION ST.)? TS Rough ........................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy Building GAS INSPECTOR Rough Display in a ConspicuousPlaceon the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE 11 Smoke Det. 11 TOWN OF NORTH ANDOVER s= °L° OFFICE OF , !' n BUILDING DEPARTMENT s ^ ' 400 Osgood Street �•9S',,.o ";<5 North Andover Massachusetts 01845 S�CHuse Telephone(978)688-9545 Gerald A.Brown Fax (978)688-9542 Inspector of Buildings AFFIDAVIT FOR FINAL COST OF CONSTRUCTION In accordance with the provisions o the Massachusetts State Building Code, Article 1, Section 110.4 and 114.2,the total estimated cost of the construction including all related construction costs* of the building located at // c v,c,v $ 933 89d amounts to being the person referred to as the owner identified below, do solemnly swear that the statements made herein are strictly true and correct and made in good faith. *Related construction costs included all work donewith or concurrently with the work contemplated by the Building Permit including demolition, plumbing, heating; electrical, air conditioning, painting, carpentry, landscaping, site improvement, etc. Furnishings and portable equipment are not part of the total construction costs. COMMONWEALTH OF MASSACHUSETTS Signature of Owner s.S. s + 11. _20 Then personally appeared the able named La t^ " j d r Iand Made an oat t at t e above statement is true. Before,Me, NotQ Public OFFICIAL USE: Final Cost: Original Estimate cost of genei a Baskato&Lev que tet.. rc,CPA� Te $BUS.`:FSS MAtiaGLHF"JT rcYa)ouiSG]EFvc Fi August 15, 2006 Mr. Gerald Brown Inspector of Buildings Town of North Andover Office of Building Department 400 Osgood Street North Andover,MA 01845 Dear Mr. Brown: Attached are the Affidavits for Final Cost of Construction for Buildings 6-10 the remaining buildings in Phase I not previously submitted and all of the buildings 11-15 in Phase II Meadows. A breakdown of these costs is reported below. Bldg# Direct Costs Site Work Finish Work Total Phase I 6 $1,302,100 $ 264,802 $ 216,011 $ 1,782,913 7 $ 58,507 -0- -0- $ 58,507 8 $ 69,510 -0- -0- $ 69,510 9 $ 758,859 $134,605 $ 109,804 $ 1,003,268 10 $ 90,130 -0- -0- $ 90,130 Phase II 11 $ 755,553 $ 124,785 $ 53,554 $ 933,892 12 $ 63,921 -0- -0- $ 63,921 13 $ 787,967 $ 141,662 $ 60,796 $ 990,425 14 $ 753,197 $ 121,263 $ 52,042 $ 926,502 15 $ 442,475 $ 75,332 $ 32,330 $ 550,137 Sincerely, Linda M. Levesque,CPA, MST n O 33 WALKER ROAD• NORTH ANDOVER•MASSACHUSETTS 01845 • (978)688-0676 •FAx(978)688-4542 •www.b-Itax.com Date��.�/�.`lG........ It- t. NpRTp pf o� TOWN OF NORTH ANDOVER F • PERMIT FOR GAS INSTALLATION SSACHUSEt This certifies that . .\,16 �. :.f./.3 C f �. . . . . . . . . . . . . . .. . . . . . . has permission for gas installation . . /'-.`:�. . . . . . . . . . . . . . . in the buildings of '2. ( .:!. . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . , North Andover, Mass. Fee. .. . .. . . . . .3�f7. Lic. No.94<:� �! Y'N GASINSPECTOR Check# /GC ) , 368 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO ( GASFlTTING Print or Type) ass. Cate I Z— j LI —a Mt 9 �� Permit - Building Location �1�� t Owner's Name V40Q- Re L If (�L J C I loo A"(--,, 4r-)C Type of Occupancy + New,(� Renovation ❑ Re ace � 'merit ❑ Plans Submitted: Yes No C] N ¢ , W y N N U u7 ¢ V) W N. W O OU Q f. Q U ~ < Q y-- m N W ¢ O O d 2 W = U t" V1 W < ¢ C Q W r C1 < W r b m SUB—dSIAT. J . FF BASEMENT I I 1STFLOOR I I I l 240 FLOOR I I ( I ( I 3RO FLOOR I_ t 4TH FLOOR I I I STH FLOOR 6TH FLOOR 1 7TH FLOOR 1 I STH FLOOR I stalling Company Name Youngblood Co. , Inc. Check : CectiFcate Jdress 132 Ashland Street Haverhill, MA 01830-4143 KX Corporation ❑. Partnership isinesz Telephone 978-373-5607 Ci Firm/Ca. ime of licensed Plumber or,Gas Fitter David Youngblood SURANCE COVERAGE. lave a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 542. Yes (K N ❑ you have checked Yes, please Indicate the.-type coverage by checking the appropriate box. liability insurance policy L%X Other type of indemnity❑ 6ond ❑ NNER'S INSURANCE WANER: I am aware that the licensee does not have the Insurance coverage required by tapter 142 of the Mass. General Laws. and that my signature an this permit application waives this requirement. Check one: nature of Gwner or Owner s Agent Owner❑ Agent ❑ areby certify that all of the details and information I have submitted (or entered) in above aoplicatien are true and-accurate to the best of my wiedge and that all plumbing work and installations performed under the anent provisions of the Massachusetts State Gas Cone and Gh permit Issued far this application will b in compliance with all aDter ld2 of the Gene i laws. T�e of license: Plumber Signature of Lce umoer or Gas r ltter �Gastitter /Town �srMaster Ucense Number :qaV D I V Soumeyman ,c U.�C (SNI_'. BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE NO, APPLICATION FOR PERMIT TO DO GASFITTING NAME A TYPE OF BUILDING LOCATIOti OF BUILDING PLUMBER OR GASFITTER i { LIG NO, 1 PERMIT GRANTED DATE 19 OAS INSPECTOR Date. NORTp ' TOWN OF NORTH ANDOVER y 1 PERMIT FOR PLUMBING •'SSACNUS� ► L c �' This certifies that . . . .�(, . . . . ;. . . . . . . . . . . has permission to perform . . . . . . . . . . . . . . . . . . plumbing in the buildings of . . .l.r.14.0. !.-..... . . . . . . . . . . . . . . . . . at. D. . . . . . . . . ... . . . North Andover, Mass. Fee.�4 . .: . .Lic. No.. . 1 `'. . . . . . . . . . . . .;�.- �. . . . . . . . PLUMBING INSPECTOR c Check # 6688 'MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING a'rint or Type) Mass. Date 1 - ?_ 't 19.2_ovS Permit # Budding Lcca1Ion I 0 d ACdr� n t- Owner's Name�/q Ile �'� I��, Oen I L _ Type of OccupancyG _ IJwo U•a , New L�1 Renovation ❑ Replacement ❑ Ptans Submitted: No ❑ FIXTURES = q p. q J W Y J q 7. U < N W W J N q Q W F U W 3e < 92 U. = a: — a_ rL W C 7 ¢ < m ¢ W ? O < of = ¢ CL ¢ O Y. W < CL W h <. iff h N C 2 o o H = .W �.. OW V W sub—Bs MT. BASEMENT • ISTFLOOR ')6 \ 3 I I 2N0 FLOOR 12 3 3RD FLOOR i 3 i ATH FLOOR STH FLOOR 5TH FLOOR , TTH FLOOR aTH FLOOR Installing Company Name Youngblood C o . , Inc . Address 32 Ashland Street Check one:. Certificate. X® Corporation Haverhill , MA 01830-4143- ❑ Partnership Business Telephone 978-373-5607 ❑ F � Name of Licensed Plumber David Youngblood INSURANCE COVERAGE: I have a current liability Insurance policy or Its substantial equivalent which meets the requirements of MGL Ch. 142: Yes ®X No ❑ It you have checked yes. please indicate the type coverage by checking the appropriate box. A liabdity insurance policy MK Other type of indemntty ❑ Bond ❑ I 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 or Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that alt of the details and inrormation I have submitted(or entered)in above application are true and&=rate to the gest of my knowledge and that all plumbing worts and instaliatims performed under the permit issued for this application will be in Pertinent provisions of the Massachusetts State Plumbing Code and Chapter 142 of the Ge Lnws.Pertinent with all Title gnawre-of lrcensed City/Town Type of License: Master® JourneymanAPPPOVE5 G r c NL license Number 9264 DELaw FOn OFFICE USE ONLY PROGRESS INSPECTION FINAL INSPECTION SKETCHES FEE APPLICATION FOn PERMIT TO 00 OASFITTIFIO IIAME A TYPE OF OUILbING L 0 C A T 10I OF DUIIbING PLUMDER OR GASFITTEn t LIC. NO. I PERMIT ORAIITED DATE 19 J ons INSPECTOn Location_ 131A 3S7 No. �a 3 Date NOR1H TOWN OF NORTH ANDOVER h F sit"R A Certificate of Occupancy $ 33Q MUs� Building/Frame Permit Fee $ 13 S`SD Foundation Permit Fee $ Other Permit Fee $ pp TOTAL $ Check # E 18610 Building Inspector � Cr- z�Q3Z TOWN OF NORTH ANDOVER BUILMIG B2PARTM ENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE,CHANGE THE USE OR OCCUPANCY OF, OR DEMOLISH ANY BUMMING M OTHER THAN A ONE OR TWO FAMILY DWELLING Section for OftwW Use Onl BUILDING PERMIT NUMBER: e�3 DATE ISSUED: Ct oZ p `Co SIGNATURE: =Connnissioner or of Buddings Date 1.1 Property Aridness: 1.2 Assessors Map and ftvd Number. Map Numbs Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Q Zcoio District Use Lot Area Fanta fl m 1.6 BURDING SETBACKS(ft) Front Yazd Side Yard Rear Yard Required Provide Rcquired Provided Romfired Provided 1.7 Wda Supply MQL.C.40. 54) 1.5. Fbod Zama Ioiarmatiam: 1.E Saw-p Disposal System: public ❑ FM190 ❑ Zane OuYide Flood Zona ❑ Maniapd On Site Dbpwd Systam ❑ HistoricDistrict: •eS 0 2.1 Own of Record IA o Name(Print) Address for Service Signature Telephone N 2.2�0rized Agent 1 �" �✓ Name Print Address Service: Z i _ q 7kz re Telephone M 3.1 Licensed Constru Su Not Applicable ❑ License Number O In Licensed Constructi Su Allyl 7 Expiration Dau I Si Telephone 7 —Z '/ �� •� 3.2 Registered Home Improvement Contractor Not Applicable ❑ �S G Company Name Registration Number M r r Address — Expiratroa Dau z Signature Telephone �1� I O Workers Compensation Insurance affida>piust be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building it. Si ed atit"viit{AAtttaycched Yea....... No.......0 OM 5.1 Registered Architect: Name: Address I Signature Telephone I 4Y Area of Responsibility Name: Registration Number Address: Expiration Date Signature Total Not applicable ❑ I Name: Registration Number Address i Signature Telephone Expiration Date Name Area of Responsibility I Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Not Applicable ❑ Company Nam Responsible in C11irp of Constr ction f New Construction Existing Building ❑ Repair(s) ❑ Alterations(s) ❑ Addition 0 Accessory Bldg. ❑ Dem lition ❑ Other ❑ Specify Brief Description of P9posed Work: I USE GROUP Check as applicable) CONSTRUCTION TYPE A Assembly ❑ A-1 0 A-2 0 A-3 ❑ IA ❑ A-4 ❑ A-5 ❑ 1 B ❑ B Business 0 2A 0 C Educational ❑ 2B 0 F Factory 0 F-1 ❑ F-2 0 2C ❑ H High Hazard ❑ 3A 0 IInstitutional ❑ I-1 ❑ 1-2 ❑ I-3 0 3B 0 M Mercantile ❑ 4 ❑ R residential 0 R-1 ❑ R-2 0 R-3 ❑ 5A 0 S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility 0 Specify: M Mixed Use ❑ Specify: S Special Use 0 Specify: COMPLETE THIS SECTION IF EXISTING BURDING UNDERGOING RENOVATIONS,ADDITIONS AND OR CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34: Proposed Hazard Index 780 CMR 34: i BUILDING AREA EXISTING Cifapplicable) PROPOSED Number of Floors or Stories Include Basement levels Floor Area Floor Total Areas f Q Total Height ft Independent Structural Engineering Structural Peer Review Required Yes ❑ No ❑ SECTION 10a Owner Aaftrization- TO BE COMPLETED WHEN OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property Hereby authorize / to act on My behalf,in all matteA relative two vj6rk authorized by this building permit application C--1 Z A�— S6uwre of Date I r 4 t Hereby declare that the statements and info as Owner/Authorized knowledge and belief. information on the li Signed under the pains and penalties of pe7 ul foregoing aM cation are true and aa;urate,to the best of my l ame ture of Owner/Agent to ; xr Item il ll illilill 11111 121i Estimated Cost(Dollars)to be 1. Building Completed by Permitl; �'� aPP cant I 4. 2 Electrical (a) Blawialdm g Pemut Fee Multi lier 3 Plumbing (b) Estimated Total Cost of ConshirctiOn from(6) 4 Mec1 cal(HVAC) Btnldmg Permit fee (,)x(b) 5 Fire Protection /43 ��d 6 Total (1+2+3+4+5) Check Number R SLAB a � E EIVIENT SIZE ,R BASO }1rrs F'. SIZE OF FLOOR TIMBERS SPAN I 2 3 DEMlSIONS OF SILLS DETwVSIONS OF POSTS DA'IENSIONS OF GIlZDERS HEIGHT OF FOUNDATION SIZE OF FOO TAIG THICKNESS MATERIAL OF CHIMNEY x IS BUII DING ON SOLID OR SIZED LAND IS BUILDING CONNECTED TO NATURAL GAS