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HomeMy WebLinkAboutMiscellaneous - 47 MOODY STREET 4/30/2018 47 MOODY STREET 210/081.0-0014-0000.0 i I i C ii i I Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Inspector 1600 Osgood Street North Andover, MA 01845 RE: Insured: Glenn Richard Moody Property Address: 47 Moody Street Policy Number: HP1288332 Date/Cause of Loss: 3/2/2015, Water/Ice Dams File or Claim Number: 32387-P Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 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. Pat Garrett On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. /kA- - Signature an ate ANDERSON ADJUSTMENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Form of Notice of Casualty Loss to Building Under MASS. GEN. LAWS, Ch. 139, Sec. 3B To: Building Commissioner or Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 RE: Insured: Glenn Richard Moody Property Address: 47 Moody Street Policy Number: HP1288332 Date/Cause of Loss: 3/26/2014, Windstorm File or Claim Number: 29399-R Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1,000.00 or cause MASSACHUSETTS GENERAL LAWS, CHAPTER 143, SECTION 6, to be applicable. If any notice under MASSACHUSETTS GENERAL LAWS, CHAPTER 139, SECTION 313 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. Ryan Werner On this date, I caused copies of this Notice to be sent to the persons named above at the addresses indicated above by First Class Mail. SigITTIM a and Date ANDERSON ADJUENT CO., INC. 50 Nashua Road, Suite 303 PO Box 1098 Londonderry, NH 03053 Location No. Date G' &OWTN TOWN OF NORTH ANDOVER ►°- .: s i Certificate of Occupancy $ �'�S'^••°•Eta Building/Frame Permit Fee $ -3� P- S wcHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #141- 1 '17 C� Building Ins�Ce6or TOWN OF NORTH Aj NDQVER BUILDING DEPARTMENT APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING a� 11dS Sectift for Of!'dd Vie Oily M BUILDING PERMIT NUMBER: l DATE ISSUED: SIGNATURE: Building Commissioner/1 for of Buildings Date z SECTION I-SITE INFORMATION C 1.1 Property:address: 1.2 Assessors Map and Parcel Number: __Vlt) .. . -Ste_— e!V e96 I c/ Map Number Parcel Number 1.3 Zoning Infortnatiot —-- — —— 1.4 Property Dimensions: 7_ontn District Pr used Usc Lot Area sf) Frontage(ft) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide RegLured Provided ' Re wired Provided 1.7 Water SupplyM.G.L.C.40.5 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: Public 0 Private 0 Zone Outside Flood Zone ❑ Municipal 0 On Site Disposal System C SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT IT 2.1 Owner of Record q� Name(Print) Address for Service , t Signature TelephoneO V 2.2 Owner of Record: Name P t Address for Service: IT Signature Tele hone Ar SECTI 3-CONSTRUCTION SERVICES �` 3.1 Licensed Construction Supervisor: Not Applicable ❑ 4 Licensed Construction Supervisor: c6, J/ b License Number 6T Addr y Expirati n Dae -- Si tature Telephone 3.2 Registered Home Improvement Contractor Not Applicable ❑ Company Name ] Registration Number -1�/� �. 1= �i�W: /(.Ism^�'f A Address a7rt�6 ,��� ' Expirafion D Siena re Telephone SECTION 4-WORKERS COMPENSATION(AtG.L CA 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. -Signed affidavit Attached Yes......4V No.......❑ SECTION 5 Description otProposed Work(check all applicable) New Construction ❑ Existing Building ❑ Repair(s) ❑ Alterations(s) 0 Addition Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify Brief Description of Proposed Work: AX r;04j i SECTION 6- ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be OFFICIAL USE ONLY Completed by permit applicant I. Building (a) Building Permit Fee Y7,ra Multiplier 2 Electrical (b) Estimated Total Cost of Construction 3 Plumbin Building Permit fee(a> X (b) 4 Mechanical(HVAC) Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS AGENT ORCONTRACTORAPPLIES FOR BUILDING PERMIT 1, `W _1\� �� QZ17� as Owner/Authorized Agent of subject properiv Ilereb% authorize_ to act on My °r f, in all matters relative to rk authorized by this building permit application. Signature of'Owner Date SECTION 7 WNER/AUTHORIZED AGENT DECLARATION as Owner/Authorized Agent of subject property Flercb. declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief q Print N• Si to e of Owvter/A ent Date NO. OF STORIES SIZE I3ASEMl.:NT OR SL,A13 KD SVF OF FLOORIM TBERS 1 2 3 SPAN DIMENSIONS OF SII,LS DIMT:NSIONS OF POSTS DIMENSIONS OF GIRDERS IH:IGIff OF FOUNDATION THICKNESS SVT"OF FOOTING X MA fERIAI,OF CI IIlv1NEY 1S 13MLDING ON SOLID OR FILLED LAND IS 13U11,DING CONNECTED TO NATURAL GAS LINE FORM - U - COT!R ALEAQE FORM 1 INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. APPLICANT G I A ' PHONE 3 ASSESSORS MAP NUMBER LOT NUMBER SUBDIVISION LOT NUMBER STREET `/7 1A op Sr`• STREET NUMBER �................. ......Mason Nadeau.....................zone.... .Nadeau... �.......................... OFFICIAL USENONLY.............. .. ... . �RECOaMA ENDATIONS OF TOWN AGENTS �����7 .... DC /rJ/�a �C� DATE APPROVED CONSERVATION ADMINISTRATOR DATE REJECTED - COMMENTS }� iN�'� "'��� i'•'� t'� �_6C? DATE APPROVED TOWN PLANNER DATE REJECTED COMMENTS DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVED SEPTIC INSPECTOR-HEALTH DATE REJECTED COMMENTS _ PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT. t DATE APPROVED FIRE DEPARTMENT ' DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE Town of North Andovera� tA°RTH t N6t Building Department 0 27 Charles Street North Andover, Massachusetts 01845 �` e 978 688-9545 Fax (/ � 978 688-9542 l 'ts �°R�reo �Pa •(h 4SSACNU`��� DEBRIS DISPOSAL FORM In accordance with the provisions of MGL c 40 s 54, and a condition of Building permit# the debris resulting from the work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c11, s150a. The debris will be disposed of in/at: ,-Sow :Z� c J✓- iAI qJ&Vt 3 P Facility location Si ature of Applicant 7—,17-00 Date NOTE: A demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. The Commonwealth of Massachusetts Y Department of industrial Accidents Office of Investigations Boston, Mass. 02111 Workers'Compensation Insurance Affidavit • Please Print Name: Location: City Phone aam a homeowner performing all work myself. 01 am a sole proprietor and have no one working in any capacity tam an employer providing workers'compensation for my employees working on this job. Company name: )Ro ^-131)1�J-CO S—A.- t �t,S i Ci AJ d - Address U0. ?t 00—"'c4 i--t-it—)at) 4 ALI City: � 0. A A;cba :4-rt f OTA Phone Insurance Co. Policv# Company name: Address City:. Phone#: Insurance Co. Policy# Failure to secure coverage as required under Section 25A or MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of($100.00)a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do herby certify under the pains and penalties of perjury that the information provided above is true and correct Signature Date Print name Phone# Official use only do not write in this area to be completed by city or town official' ❑ Building Dept ❑check if immediate response is required Building Dept ❑ Licensing Board ❑ Selectman's Office Contact person: Phone A• ❑ Health Department ❑ Other 9 WORKMAN'S COMPENSATION SCOTT L. GILES, R.P.L.S. 50 Deer Meadow Road c North Andover, MA 01845 683-2645 June 26, 2000 Building Department C/P Mr. McGuire Town of North Andover 27 Charles Street North Andover,MA. In reguard to 47 Moody Street,the existing buildings to the left are less than the zoned requirements of 30 feet. The foregoing are a summed average of 25 feet. The building to the immediate right of 47 Moody Street conforms to the 30 foot setback. The buildings in general in the vicinity are collectively less than the required zoned 30 foot setback and are believed to be a summed average of approximately 25 feet. See Plan submitted. Applicant: Glen(George)Moody 47 Moody Street North Andover, MA C Sincerely, Frank S. Giles N Scott L. Giles,P.L.S. 13972 a '�CrStERE� SAL LAAO NORTH Town1of _ 4Andover No. ~ 70 T Q LA o - dover, Mass., C OC HIC HE WICK DRATED S H BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... .N...... !..... .. ... . .I.. ...... .P.. y............................ Foundation has permission to erect.... .s.. .ag........ uildings on .... ..n........ .... ..o.e ...... ... ........................... Rough to be occupied as..p�....aoi0 AJ J� . �rN For S�N ....TA.. � ' ......V ��............ Chimney 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 Bil-aws relating to the I spection, Alteration and Construction of Buildings in the Town of North Andover. ft) I » 'y a 1a.aw PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S Rough .............. .. ... .. ....................... ............................................ Service .. BUILDING INSPECTOR Final Occupancy Permit Required t0 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. M f ' LL ,1% LA 1 I j I I I1 � 1 . Ij I ! I , ` ff ; i i I � ii f . r , E a is 1: 'A i ' J i, 0-4 °I c 1 I I -----T- ' I i I l , r I II i i I ," r -- - -- -t- I /- _ 1_ j � T� OV i� I I � f ' ...`_...___.... -41 4 i ;t IIy I — rs IF _ r � /�- Location Y/ AokS No. oyo Date MaRTM TOWN OF NORTH ANDOVER 3? • • OL f 9 i Y + " Certificate of Occupancy $ Building/Frame/Frame Permit Fee $ s�cHusT, 9 Foundation Permit Fee $ _ Other Permit Fee �o©� $ S TOTAL $ 3 Check # 5'L. 7 2 +Building Inspector TOWN OF NORTH ANDOVER BUILDING DEPARTMENT � R APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING BUILDING PERMIT NUMBER: i7 /h DATE ISSUED: X r SIGNATURE: A/Y4,C a,<14� Building Commissioner/I for of Buildings Date SECTION 1-SITE INFORMATION z 1.1 Property.Address: 1.2 Assessors Map and Parcel Number: O Map Number Parcel Number i i 1.3 Zoning Ir6armation: 1.4 Property Dimensions: \, Zonin g District Proposed Use Lot Area 00 Frontage(fl) 1.6 BUILDING SETBACKS ft Front Yard Side Yard Rear Yard Required Provide Required Provided Re red Provided to . to 65- - /o' 5/0' 1.7 Water Supply M.G.L.C.40.§54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System: D Public 0 Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0 SECTION 2-PROPERTY OWNERSHIP/AUTHORIZED AGENT m 2.1 Owner of Record Name(Print) Address for Service: Signature Telephone 1' 2.2 Owner of Record: IN\,0 01-/ N not Address for Service: §Ignahuld ele hone M SECTION 3-CONSTRUCTION SERVICEI19h 3.1 Licensed Construction Supervisor: Not Applicable ❑ Licensed Construction Supervisor: O License Number Mn Address Expiration Date Signature Telephone r b 1 3.2 Registered Home Improvement Contractor Not Applicable ❑ v` Company Name rn Registration Number r Address r z Expiration Date 0 Sienature Telephone Y SECTION 4-WORKERS COMPENSATION(M.G.L. C 152 § 25c(6) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed affidavit Attached Yes.......0 No.......0 SECTION 5 Description of Proposed Work check all applicable) New Construction ❑ Existing Building ❑ Repair(s) 0 Alterations(s) 0 Addition ❑ Accessory Bldg. ❑ Demolition ❑ Other Specify .St,, J7 X " iBrief Description of Proposed Work: ice-c-r g �7 ' 9,o. A a6o,e- gt�,,,,.ol� Sa ' �aC-k Pr K's ?00� bu, IT aV. -ro 1 �TPi rS YAP, St,lCAC'SS- %04t- wl-0— a Lack. A SECTION 6-ESTIMATED CONSTRUCTION COSTS Item Estimated Cost(Dollar)to be kx lFFICIAL II ,ONLY , Completed by permit applicant 1. f�riwing (a) Building Permit Fee s 0 gcaa /000 Multiplier 2 Electrical (b) Estimated Total Cost of i o D Construction a D 3 Plumbing Building Permit fee cal X (b) 4 Mechanical HVAC 5 Fire Protection 6 Total (1+2+3+4+5) Check Number SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNERS/AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I, (� �Q n INt cod y as Owner/Authorized Agent of subject property Hereby authorize to act on My ppeha1t; in all matters relative to worl1yc�authorized by this building permit application. [_� -- (Z WW1 e=L7, S 11/-o Signature of Owner Date SECTION 7b OWNER/AUTHORIZED AGENT DECLARATION I, �� yv'�-0-0 V as Owner/Authorized Agent of subject property Hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and belief Print Name G Si ature of Owner/A ent Date NO. OF STORIES SIZE BASEMENT OR SLAB SIZE OF FLOOR TIIVIBERS 1 ST 2 ND 3 RD SPAN DIMENSIONS OF SILLS DD ENSIONS OF POSTS DIIVIENSIONS OF GIRDERS HEIGHT OF FOUNDATION THICKNESS SIZE OF FOOTING X MATERIAL OF CHEVINEY IS BUILDING ON SOLID OR FILLED LAND IS BUILDING CONNECTED TO NATURAL GAS LINE i FORM - U - LOT RELEASE FORM QA ?0 o � S� iy1o( INSTRUCTIONS: This form is used to verify that all-necessary approval/permits from Boards and Departments having jurisdiction have been obtained. This does not relieve the applicant and or landowner from compliance with any applicable requirements. ............................................................................ APPLICANT (e�.r Z IM(3oJ PHONE 6` 3-Q 69q i ASSESSORS MAP NUMBER $( LOT NUMBER f L( SUBDIVISION pp LOT NUMBER STREET rO O d d�y 5T• STREET NUMBER q7 OFFICIAL USE ONLY RECOMA ENDATIONS OF TOWN AGENTS DATE APPROVED J CON. R TIN AMMUTRATOR. � ) DATE REJECTED j COMMENTS DATE APPROVED TOWN PLANNER DATE REJECTED CON DAENIs DATE APPROVED FOOD INSPECTOR-HEALTH DATE REJECTED DATE APPROVE SEPTIC INSPECTOR-HEALTH DAeREJECTA COMMENTS PUBLIC WORKS-SEWER/WATER CONNECTIONS DRIVEWAY PERMIT DATE APPROVED FIRE DEPARTMENT DATE REJECTED COMMENTS RECEIVED BY BUILDING INSPECTOR DATE ,ORT, E Town of ... over 0 No. a y o - - f- ' LA dover, Mass., 40 ORATED p �C3 S H � BOARD OF HEALTH Food/Kitchen PERMIT T D . Septic System �r�� /�O,� BUILDING INSPECTOR THISCERTIFIES THAT....... .. . ........................................................... .....................:..................................... . Foundation w� I0/ has permission to erec ....4 ..� buildings �........ .......... . .................. Rough y ' &-v.!5..... ,. .... .1....).0......#4t�r......�//4004 Chimney to be occupied as ... ./.V............................. 7 provided that the person accepting this permit shall in every respectl 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, iteration and Construction of M 8 3 Buildings in the Town of North Andover. � '4 � d/ t ow PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough MA 1 Nt 6 `N PERMIT EXPIRES IN 6 MONTHS Final 10' go*" ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARS �� ��N� S e Rough .........,�� ....................................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required t0 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. s SEE REVERSE SIDE Smoke Det. i j�° G V 51 Date. ...:/1�................ t Np p7,1 1 ps TOWN OF NORTH ANDOVER PERMIT FOR WIRING CHU This certifies that ..:-..,...:.'....................... ........................................................ has permission to perform.. ...........:' .. ` �'f.. ' < 1 wiring in the building of.:...... .........:..'..".. ............................................ at..6�7...... ` -L�-�' .. - -...................North Andover,Mass. Fee! . ...../.... Lic. .............. '�:.... '. ELECTRIC ALINSPECTOR Check # f� WHITE: Applicant CANARY: Building Dept. PINK:Treasurer Official Use Only Permit No. ,�cL 2 1-75 BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 12:00 Occupancy&Fee Checked/c, APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code 527 CMR 12:00 (Please Print in ink or type all information) Date &//���-&//,., Town of [North Andover To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location Street&Number Owner or Tenant _ 6L/ e�7 i1 1f 06' d�z Owner's Address V 7 Is this permit in conjunction Re- a building permit Yes P No ❑ (Check Appropriate Box) Purpose of Building / e-S r ole,? 7 1��/ Utility Authorization No. Existing Senrice q Amps Voits Overhead ❑ / Undgrnd ❑ No.of Meters New Service a7 VbV Voits Overhead Undgmd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work 7 I-0 No.of Lighting OutletsTotal No.of Hot fuse VGeneratEors mers KVA Above ❑ In ❑ No.of Lighting Fixtures y Swimming Pool grnd ❑ grnd ❑ KVA No.of Receptacles Outlets a �l mergency Lighting / No.ofOil Burnersatte Units No.of Switch Outlets /13 No of Gas Burners FIRE ALARMS No,of Zone Total No.of Detection and No.of Ranges No of Air Cond Tons Initiating Devices Heat Total Total No.of Di osalEE No. Pum s .Tons KW No.of Sounding Devices No.of Dishwashers No./of Self Contained S of Heatin KW Detection/Sounding Devices .40 No.of Dryers ❑ Municipal ❑ Other Heating Devices KW Local Connection No.of No.of Low Voltage N .of Water Heaters KW Signs Bailases Wirin No.Hydro Massage Tuds No.of Motors Total HP OTHER: INSURANCE COVERAGE. Pursuant to the requiremen6ts of Massachusetts General Laws I have a current Liability Insurance Policy including-Completed Operations Coverage or its substantial equivalent YES) NO = h e-subatitted valid proof of same to the OfficeEE$= NO = If you have checked YES please indicate the typ�-of coverage by checking the appropriate box. INSURANCE s BOND = OTHER = (Please Specify) stimated Value of Electrical Work$ (Expiration Date) Work to Start Inspection Date Resquested Rough Final Signed under the Penalties of perjury- FIRM FIRM NAME �-W/�'Tw-,�y/�c�/�r7G LIC.NO. Lf ensee c_ra-le-y .l t/��/Gh Signature LIC.NQ_� f ,1 / Bus.Tel No. Address 7, f�y% �%/�re��i/� �j iF j U Alt Tel.No. OWNER'S INSURANCE WAIVER:&Tim aware that the Licenses does not have the insurance coverage or its substantial equivalent as required by Massachusetts General Laws.And that my signature on this permit application waives this requirement. Owner Agent (Please Check one) Telephone No. PERMITTEE $ (Signature of Owner or Agent) zr4- 2 ,. _. Date..... N°RTM °�,�``° :•'"° TOWN OF NORTH ANDOVER PERMIT FOR WIRING 41 �,SSACMUSE� This certifies that .........! L{ �f� . �{���' C .............. . ....... ... ........................................1. .......... �....�....... .. �����cf:............ a has permission to perform l v�� Lt < wiring in the building of ...... � at........ .....r..l......... ................ ..... .North Andover, ass. .��:.�>. Lic.No.��./J. ..... 7rz.a. ZS .......... Fee....,,r�. .. � ELEcrRICALI Check # v l..ommonwaafth o�/t/a��ae�>t�alfs Oficial Use Only (' �✓�/ cc�� Permit No.c��7 1JeParfnienl o�.}ira �ervica� -- BOARD OF FIRE PREVENTION REGULATIONSOccupancy and Fee Checked (Rev. 111991 Heave blank) APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All wurk to be performed in accordance with the Massachusetts Electrical Code(iiMEC),527 C11R 12.00 (PLEASE PRINT IN INK ORTYPE.•IL iNFOR,V.ITION) Date: r b /U ZyU City or "Town of: Al 1,�, �C To the Inspector of 1Vrr0 By this application the undersigned notice of his or her intenTon to perform the electrical•work described below. Location (Street & :l'untbcr) v(] � Owner or Tenant Telephone No. Pl (�3— 5(r Owner's Address <z Alyn Is this permit in conjunction with a buildinb permit? Yes No (Check Appropriate Box) Purpose of Building 5tyl��4 Utili v., uthorizatiou Na a�'Z�(tl j Existing Service �0 Anips 2U/ 2gJ}'olts Overhead �; Und°rd ❑ e No.orMeters New Service Z-00 Anips jj l 2 UVolts Overhead Und°rd ❑ b No. of Meters. Number of Feeders and Atnpacity Location and Nature of Proposed Electrical Work: to rc fi 2 Contnletioe of the folluivinQ table may be ii•aived by the Ins actor of 1 viers. 'Yo.of Recessed Fixtures Ilio.of Ccil.-Soap.(Paddle)Faus No.ol" Iota) Transformers KVA No. oCLighting Outlets INo. of llut Tubs Generators KVA No. of Lighting Fixtures Slyinimino Pool Aboye ❑ ln- ❑ i o.o mergencv tg tang °rrtd. °rnd. Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE AL�ULNIS No.of Zoites No.of Switches No.of Gas Burners IN-6--W—Detection and Initiating Devices No.of Ranges No.of Air Cond. TotalI Tons No.of Alerting Devices No.of Waste Disposers I Hca Totals:I }ti_untber I_I:ons !K1Y_ No.of Self-Contained Detection/Alertino Devices No,of Dishwashers Space/area Heating KVV Local 11 Diutticipal Connection Other s No.of Dryers Heating.appliances 1i}}: Security Svstems: No.of Devices or Equivalent No.of Water INo. of Nn. of Data Wiring: I•Ieatcrs hw Sins Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of llotors Total IiP •telecommunications Wiring: No.of llevices or E qui t, OTHER: t a..ch additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: unless waived by the o.vlier. no penriit 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 iii force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSUR-ANCE BOND O'1,11ER El (Snecify:) Estimated Value of Ela trical W (EsOiration Date) ork: (When required by municipal policy.) Work to Start: Z Inspections to be requested in accordance with MEC Rule 10,and upon completion. I certifj•, corder the pa"t •and penalties of perjun•, that the infor»tation nit this application is tate and complete. FIILII NAME: �/ �i<�i T,�/� �ji 1 C: �l _ LIC.NO.: Licensee: S. /'iI• ,T✓ ,c° /2 Signature ,��/�o�t��� L1C.NO.: (If applicable. enter "e.renrpt••iir the license nr11116e•line.) �/ Address: S� %�i�'�!2//YC ���'<? /�//./,&G)�) / , D/S�j Bus.Tel.No.:•'�%7 Alt. Tel.No.: OWNER S INSURANCE NVAIVER: I ant aware that the Licensee does notlrave the liability insurance coverage normally required by lag. 13 my signature below. I hereby wai%-c this requirement. I am tate(cheek-onc) ❑ owner ❑ owner's acen . Owner/Agent ` Signatw'e1"rlcphor.c\u. P1'R:IIIT FE•E•: S (fes% From:North Andover Police Dept. 978 686 1212 02/09/2012 09:35 9239 P.001/002 TOWN OF NORTH ANDOVER µORTh J C Office of COMMUNITY DEVELOPMENT AND SERVICES •' '�'d°° HEALTH DEPARTMENT { .27 CHARLES STREET • NORTH ANDOVER,MASSACHUSETTS 01845 .2 CHU'S Susan Y.Sawyer,REHSMS 978.688.9540—Phone Public Health Director 979.688.9542—FAX 1Lealthdaptrwtownotnortliandoyer com www.townofnorthandover.com Animal Bite Resort Form —Please_attach_co les-0f�n-v-Hos ital or-P-olic�De a-r4ment re orfs-in-addition to com letinE, -this report, and fax to the Health Department at the above number PersonBitten: c� �. j,. o vi) V Age: Name of Parent or Guardian if victim is a Minor: Dome Address: LYI S .e �• /, d u a ,4_ b _ k LVA:, Contact Phone Numbers: / >S-(8 3 Location of Wound: , h�F Sr d d ocun 1 Location of Incident: . S t- Type of Animal: a e r Pet Owner's Name; /1)/-* -Pet Owner's-Address: S�4!e la L( Pet Owner's Telephone. 21 -9-5_,-2 �10a. . /)i• Reported By: Date Incident Occurred: Date Reported: Where Treated: Date Treated: ,, 3 0 t z� Medical Contact Name:, Medical Contact Number.: Office Use Only: Reported to Animal Inspector:Faxed or E-Mailed Copied to public Health Nurse: Recorded in Database: J�J �' �f/G ��sem'C L�v✓-- . From:North Andover Police Dept. 978 686 1212 02/09/2012 09:35 #239 P.002/002 North Andover Public Safety D Printed: 2/8/2012 13:08 Dispatch Incident Detail Printed By: JLUNDQUI CAD Incident No: 2012000003130. Police Incident No. 201 000002945 Fire Incident No: 2QI20QOOOQ41A How Reported: Telephone Reported Type: FD-Medical Call(not MVA) Received Date: 2/8/2012 12:35:22PM Priority: Low Dispatched Date: 2/812012 12:36:04PM Call Taker: No Entry Arrived Date: 2/8/2012 12:38:05PM Shift Supervisor: Sergeant Staude,Jay S Cleared Date: Reporting Officer: Patrolman Quinlan,Daniel J Active Date: 2/6/2012 12:36:22PM Dispatchers: Communications Officer Burke, Jo Domestic VIoTence: Nd - - —— -Gommunications-Officer-L-undquisl Nature: FO-Medical Call(not MVA) Police Response: Low Priority Landmark: Fire Response: No Entry Incident Address: 47 Moody Street,North Andover,MA 01845 Action Taken: Report Sector: Stat,Area: Incident Types: Assist Fire Department Animal Complalnt-Domesticated FD-Medical Call(not MVA) Sub Stat.Area: Census Tract: ..................... •------------------------•----....•...... ............................................. ----------------------.-. ........................................... Caller Seq.## Caller Name CallerAddress Caller Phone 1 MOODY,PHYLLIS A 47 Moody Street,North Andover,MA 01845 (978)683-2394 Other Involved Persons: Name Address Tele2hone Involvement MOODY,REBECCA 47 Moody Street, North Andover,MA 01845 No Entry Victim CREAN, DANIEL J 657 Salem Street,North Andover,MA 01845 No Entry Owner -- ---•---------- ------------•---•--•-----......--•-•-----...--.................. ...........-----....--.-•-...................----• ...................................................... Business Name Business Address Business Type Business Phone 1 Business Phone 2 No Entry No Entry No Entry No Entry No Entry .....................................................................-----------------......................................... -----------• ....... .......................----........ Police Alarm ID Police Alarm Description No Entry No Entry ....--•------•....................................................................•----•----------•-.....................--------............_..........._......................--------........ Fire Alarm ID Fire Alarm Description No Entry No Entry .........................................-----------------------•-----............................. --- ......._................. ........ . . . .. ---•-.................. . ... .... Structure ID_ Structs NaMg Structure Address No Entry No Entry No Entry -------------------•--•-•-.......---------...........-•----------........------------------.....................-......--------------------------•--------------------------------------------------- Units Assigned Personnel 301 Sergeant Eric J Fouids 302 Patrolman Daniel J Quir 303 Patrolman Daniel P Lan 321 Community Service OM A3 Flrefighter/EMT Ronald Flreflghter/EMT Jeffrey I .............................................................-......------------------------------------- --------- .............................................................. Vehicle Make Vehicle Model Plate No Tow UP Tow Bualness No Entry No Entry Displigbgr 2012102/0812:37 Burke,John 526: 12 Y/0 FEMALE:,DOG BITE TO THE FACE. Al RESPONDING. 2012102/0812:45 Burke,John 526: A3 TRANSPORTED TO LGH, SM:82360 EM:82363 ----------------------------------------------------------------------•--....................----•------------------............_...................................----.......---.................--- Call Taker Remarks Page 1 of 2 DIFormSingle 02/15/09 i ATTACHMENT 8 RABIES PROTOCOL MANAGEMENT OF DOGS & CATS WHICH BITE HUMANS (Wolf Hybrids and other exotic pets are considered to be wild animals) Vaccination Status of Exposing Animal Exposure Category Not Relevant to Recommendations Category 1 1. Notify local director of health and local animal inspector Visible bite or scratch from a dog or cat, which has been 2. Biting animal will be placed under strict confinement for 10 identified and is available for quarantine days 3. A) If biting animal is healthy at the end of 10 days, victim is not at risk for rabies 3. B) If biting animal begins to exhibit signs compatible with rabies, biting animal should be euthanized and submitted for rabies testing 4. A) If test results are negative, victim is not at risk for rabies 4. B) If test results are positive, notify Massachusetts Department of Public Health, Division of Epidemiology Category 2 1. Animal must be assumed to be rabid Visible bite or scratch from a dog or cat, which has NOT 2. Notify Massachusetts Department of been identified and is NOT available for quarantine Public Health, Division of Epidemiology 3. Notify local director of health and local animal inspector 4. Furnish local Animal Control with a description of the dog or cat and location where animal was last seen • Domestic animals other than dogs or cats biting humans should be handled on a case by case basis • Any non-domestic animal biting a human needs to be reported to the Department of Public Health • Protocol for ferrets is similar, but notification must be made to the Division of Fisheries and Wildlife • Do not vaccinate any dog or cat which is under a 10-day quarantine • Any animal euthanized while under a 10-day quarantine MUST be submitted for rabies testing 1. Massachusetts Department of Public Health, Division of Epidemiology: (617) 983-6800 2. Massachusetts Department of Agricultural Resources, Bureau of Animal Health: (617) 626-1786 3. Massachusetts Division of Fisheries and Wildlife: (617) 626-1575 This document was prepared by the Massachusetts Department of Agricultural Resources, Bureau of Animal Health Revised: 11/10/08 Questions? 617 626-1786