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443property Record Card
Parcel ID :2101045.B-0008-0000.0 FY:2013 Communitv : North Andover
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t
30 ADAA4
V�N-Ut, r
http://csc-ma.us/PROPAPP/dis-olay.do?linkld=2252891 &town=NandnverPiihArt-.
xation: 30 ADAMS AVENUE
wner Name: ROUND, BRUCE D
KIMBERLEE L ROUND
wner Address: 30 ADAMS AVENUE
City: NORTH ANDOVER State: MA
Zip: 01845
-ighborhood: 5 - 5 Land Area:
0.23 acres
;e Code: 101-SNGL-FAM-RES Total Finished Area:
1716 sqft
ASSESSMENTS CURRENTYEAR PREVIOUS YEAR
)tal Value: 306,100
286,400
filding Value: 144,800
122,000
ind Value: 161,300
164,400
arket Land Value: 161,300
iavter Land Value:
http://csc-ma.us/PROPAPP/dis-olay.do?linkld=2252891 &town=NandnverPiihArt-.
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Date
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that /<' —,A 2Q .7le—
... I . .............................. I ...... . ......................................
has permission to perform %-5-tollo ............................... 7
............................... ........
wiring in the b Wilding q
........................ t . . .............................................................................
at ..... .... ......... ..... ........ ....... ................ rt Andover, Mass.
Fee,�.3� .. . ........ Lic. No.,-�r'
........ ...... .. . ........ L iii�p .. .... .....
Check # 33 lfk*ll�CAL INSPE 0
--, f-
,771.
Commonwealth of Massachusetts PermitNo. Official Use OnI
17,1 fj
Department of Fire Services
Occupancy and Fee Checked
BOARD OF FIRE PREVENTION REGULATIONS [Rev. i/o7]
(leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be performed in accordance with the Massachusetts Electrical Code (NIEC), 527 CMR 12.00
(PLEASE PRflVTJNflVK OR YTTEALL LWORMA TION) Date: 94 4 6
City or Town of: NORTH ANDOVER To the Inspector of Wires:
By this application the -undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street& Number) ?,,o A,,khw,—N Aj.A,
OwnerorTenant Telephone No.f A U
Owner's Addmss
Is this permit in'conjunction with a building permit? Yes F] No/r] (Check ApTro�priate Box)
f —
Purpose of Building_ YO AAL— Utility Authorization No.
Existing Service JdO Amps Z�6 Volts OverheadQ- Undgrd 0 No. of Meters
New Service tp2___ Amps .21-f6 Volts OverheadEl Undgrd [:1 No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Attach additional detai
Estimated Value of Electrical Work: /6to— (when required by mi
W,zrk to Start: --Q- 4 -/ � 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 cover is in force, and has exhibited proof of same to the permit issuing office.
BON
CBECK ONE: INSURANCE BOND n OTBER [] (Specify:)
.1 certify, un der th e a Ws an en alties ofp erjury, th at th e information on th is application is true an d com t
fie ple e
FIRIIA NAM : y I/ I
Licensee: l� . Ze-JtC- tcd LIC. NO.: 'W5
P -C 'm Signature LIC. NO.:
(1fapplicable, enter "exeinpt" in Pe license number line) Bus. Tel. No. -
Address: D AtY, t
Z Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61,'sccurity work requires Department of Public Safety "S" License: LiG. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement, I am the (check one) n owner El ownor's agent.
Owner/Agent �S
Signature Telephone No. P)?RWT -FEE: $
Completion ofthefo7lo in table maybe waived by the Inspector a s.
No. of Recessed Luminaires
No. of Cell.-Susp. (Paddle) Fans
No. of
Transformers
Total
KVA'
No. of Luminaire Outlets
No. of Hot Tubs Generators
Swimming Pool Above o In-
grnd. grnd
No. of Oil Burners
No. of Gas ]Burners
No. of Air Cond. Total
Tons
Heat Pum
Totajs� ber I Tons
Space/Area Heating KW
Heating Appliances KW
No. of No. of
Signs Ballasts
No. of Motors Total HP
of Luminaires
No. of Receptacle Outlets
of Switches
No. of Ranges
No. of Waste Disposers
No. of Dishwashers
No. of Dryers
No. of Water KW
Heaters
�No. Hydromassage Bathtubs
Attach additional detai
Estimated Value of Electrical Work: /6to— (when required by mi
W,zrk to Start: --Q- 4 -/ � 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 cover is in force, and has exhibited proof of same to the permit issuing office.
BON
CBECK ONE: INSURANCE BOND n OTBER [] (Specify:)
.1 certify, un der th e a Ws an en alties ofp erjury, th at th e information on th is application is true an d com t
fie ple e
FIRIIA NAM : y I/ I
Licensee: l� . Ze-JtC- tcd LIC. NO.: 'W5
P -C 'm Signature LIC. NO.:
(1fapplicable, enter "exeinpt" in Pe license number line) Bus. Tel. No. -
Address: D AtY, t
Z Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-61,'sccurity work requires Department of Public Safety "S" License: LiG. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this requirement, I am the (check one) n owner El ownor's agent.
Owner/Agent �S
Signature Telephone No. P)?RWT -FEE: $
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be. uniform throughout the Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid 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.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 20 10 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
• Rule 8 — Permit/Date Closed: Note: Reapply for new permit 0
• Permit Extension Act — Permit/Date Closed:
Trench Inspection
Pass M
Failed
Re- Inspection Required ($.) 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTWN:
Pass
Failed
Re- Inspection Required($.) n
Inspectors Comme"
17
/Y
Inspectors Signature:
Date:
PARTIIAL ROUGH INSPE TION:
Pass
G
Failed --?At
Re- Inspection Required ($.) 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass
Failed
Re- Inspection Required ($.) 0
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass M V
Failed
Re- Inspection Required ($.) 0
Inspectors Comments:
4 9
Inspectors Signature:
Date: '717
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
07111RAIA
Commonwealth of Massachusetts
Department of Fire Services
BOARD OF FIRE PREVENTION REGULATIONS
Official Use Only
Permit No. I �1 (I
Occupancy and Fee Checked
[Rev, 1/071 (leave blank)
APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK
All work to be perfornied in accordance with the Massachusetts Electrical Code (NMC), 527 CMR 12.00
(PLEME PRiWTDVJAW OR TYPE,4LL JXFORMATIOA9 Date: -&, 6
City or Town of- NORTH ANDOVER To the Inspector of Wires:
By Us application the -undersigned gives notice of his or her intention to perform the electrical work described below.
Location (Street &Number) ?,,b AADI�N A,,&-,
OwnerorTenant O�" fb0,,-AQ— Telephone No. f7k 6k/ 74-t
Owner's Address 54U<1 —
Is this permit in conjunction with a building permit? Yes El No/f] (Check Appropriate 13ox)
Purpose of Building_& Al� Utility Authorization No. t -7 � '-I
Existing Service 160 Amps (ev / Volts Overhcad,[4 Undgrd F1 No. of Meters
New Service (pg� Amps P- / Volts Overhead Undard El No. of Meters
Number of Feeders and Ampacity
Location and Nature of Proposed Electrical Work:
Completion ofthe following table ma -v be waived bv the InsDector of Wires.
No. of Recessed Luminaires
No. of Ceil.-Susp. (Paddle) Fans
No. of Total
Transformers KVA'
No. of Luminaire Outlets
No. of Hot Tubs
Generators KVA
o. of Luminaires
Swimming Pool Above Ei In- 1:1
Lyrnd. grnd.
'No. of Emergency Lighting
Battery Units
No. of Receptacle Outlets
No. of Oil Burners
IFIRE ALARMS
IN'o. of Zones
of Switches
No. of Gas Burners
No. of Detection and
Initiating Devices
No. of Ranges
No. of Air Cond. Total
Tons
No. of Alerting Devices
No. of Waste Disposers
Heat Pump
Totals:
..... .....
J.K.W ...........
No. of Self -Contained
Detection/Alerting Devices
No. of Dishwashers
Space/Area Heating KW
I Municipal El Other
Local El Connection
No. of Dryers
Heating Appliances KW
Security Systems:*
No. of Devices or Equivalent
No. of Water KW
Heaters
No. of No. of
Signs Ballasts
Data Wiring:
No. of Devices or Equivalent
No. Hydromassage Bathtubs
No. of Motors Total HP
Telecommunications Wiring:
No. of Devices or Equivalent
7.4 Attach additional detail ifdesired or as required by the Inspector of Rres.
Estimated Value of Electrical Work: (When required by municipal policy.)
Work to Start: (� 4 —/ �/ Inspections to be requested in accordance with MEC Rule 10, and upon completion.
INSURANCE VERAGE: 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 cover is in force, and has exhibited proof of same to the permit issuing office.
er "
cov�
CBECK ONE: INSUIRA-N( BONDEI OTHBREI (Specify:)
Icertify, und th d alt' ofperjury that the information on this application is true and complete.
FIRM LIC. NO. -
Licensee: Signature LIC. NO.:
(If applicable, ter t" in Pe license number line) Bus. Tel. NO.*
Address- - ) ( t &OU -Af� I�L V Z3 Alt. Tel. No.:
*Per M.G.L c. 147, s. 57-6l,'scourity work requires Department of Public Safety I'S" License: Lic. No.
OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive. this requirement. I am the (check one) [I owner El owner's agent.
Owner/Agent
Signature Telephone No. P.9AWTFEE.- $
2012 Massachusetts Electrical Code Amendments 527 CMR 12.00 § Rule 8: In accordance with the provisions of M.G.L. c. 143, § 3L, the
permit application form to provide notice of installation of wiring shall be uniform throughout the, Commonwealth, and applications shall be filed
on the prescribed form. After a permit application has been accepted by an Inspector of Wires appointed pursuant to M. G.L c. 166, § 32, an
electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the
notification of completion of the work as required in M.G.L. c. 143, § 3L.
Permits shall be limited as to the time of ongoing construction activity, and may be deemed by the Inspector of Wires abandoned and invalid if he
or she has determined that the authorized work has not commenced or has not progressed during the preceding 12 -month period. Upon written
application, an extension of time for completion of work shall be permitted for reasonable cause. A permit shall be terminated upon the written
request of either the owner or the installing entity stated on the permit application.
El The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of
the Acts of 2012. The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this
purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property. With
limited exceptions, the Act automatically extends, for four years beyond its otherwise applicable expiration date, any permit or approval that was
"in effect or existence" during the qualifying period beginning on August 15, 2008 and extending through August 15, 2012.
• Rule 8 - Permit/Date Closed: Note: Reapply for new permit 0
• Permit Extension Act - Permit/Date Closed:
Trench Inspection
Pass M
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
SERVICE INSPECTWN:
Pass R?
Failed
Re- Inspection Required El
Inspectors Cornme"
del
Inspectors Signature:
Date:
PARTIAL ROUGH INSPE�TION:
Pass
Failed
'WL L Cl CC. Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
ROUGH INSPECTION:
Pass R
Failed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date:
FINAL INSPECTION:
Pass M V
Failed Ed
Re- Inspection Required 0
Inspectors Comments:
Inspectors Signature:
Date: 7- 7
DEB WEINHOLD ... TOWN OF MERRIMAC, MA . ....... dweinhold@townofmerrimac.com
The Commonwealth ofMassachusetts
Department of lndustria[AccWnts
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print LcObly
Name, (Busintss/Organizationffndividual):
Address:
City/State/Zip: Phone
A ployer? Check the appropriate box:
Type of project (required):
I.. Zloyer with
4. F1 I am a general contractor and 1
6. F1 New con.struction
(fall and/or part-time).*
have hired the sub -contractors
7. D Remodoling
2. proprietor or partner-
listed on the attached shoot. T
ship and'have no employees
Those sub -contractors have
8. E] Demoliff
working for me in any capacity.
workers' comp. insurance.
9. E] Bu' addition
E
[No workers' comp. insurance
5. El We are a corporation and its
10. lectrical repairs or additions
E] required.]
3. 1 am a homeowner doing all work
officers have exercised their
right of exemption per MGL
11. F Plumbing repairs or additions
myself. [No workers' comp.
c. 152, § 1(4), and we have no
12.E] Roofrepairs
insurance required.] t
employees. [No workers'
13.Fl I other
comp. insurance required.]
'AZ�Alpplicant that checks boxBl must also fill out the section below showing their workers' compensation policy information.
t
I Howtowners who submit this affidavit indicating thpyaire doing all work and then hire outside contractors must submit anew affidavit indicating such.
tConir�ctors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information.
Iam an employer that isproviding worAers'compensation insurancefor my employees. Beloiv isthepolicy andjoh site
information.
Insurance Company
Policy # or Self -ins. Lic.
Expiration Date:
Job Site Address: -,City/state/Zip:
Attach a copy of the workers' compensation -policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a
fine up to $1,500.00 and/or one�year imprisonment, as well as civil penalties in the form of a STOP. WORK ORDER and a fine
of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Inv,Nigations of theTIA for insurance coverage verification.
-1doh I erehyftrd)� an der th e pai4 andpenattles ofperjury th at th e information provided above is true an d correct.
Offifeial use only. Do nit write in this area, to he completed by cl(p or town offilcial.
City or Town:
Permit/License 9
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 M
Information and Instructiois
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as ..... every person in the service of another under any contract ofhire,-
express or implied, oral or written."
An employerls defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in ajoint enterprise, and including the legal representatives of a -deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced -acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivi ; sions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have b eon presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub-contractor(s) name(s), address(es) and phone number(s) along with their cortificate(s) of
insurance. Limited Liability Companies (LLQ or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. IfanLLCorLLPdoeshave
employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial
Accidents for confrma�tionof insurance coverage, Also be sure to sign and date the affidavit. The affidavit should
�7
be returned to the city or town that thei application for the permit or license is being requested, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the appli cant.
Please be sure to fill in the permit(license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (ifnecessary) and under "Job Site Address" the applicant should write "all locations in -(city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is� on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or"permit not related to any business or commercial venture
(i.e. a dog license or p ermit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigationswould like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The Commonwealth of Massachuseats
Department of ludustriW Accidents
Office of Investigation,%
60G Washiugton Street
Boston, MA 021 It
Tel, 0 617-727-4900 oxt 406 or. 1-877�MASSAFE
Revised 5-26-05 Fax 4 617-727-7749
20
nationalgrid
Municipal Wiring Inspector
1600 Osgood Street
Building 20 Ste 2035
North Andover, MA 0 1845
Re: Incomplete Inspection
Dear Municipal Wiring Inspector,
0
-(�
A US H A -x)
Please accept this letter as notification of the outstanding inspection requirement
on one or more work requests. Until an inspection is released we are unable to complete
the necessary field work. The preferred method for approval'is via ernall at
workrequest&nationalgrid.com. You may also fax us at 888.266.8094 or, call us at
800.375.7405, Option I to use the automated system or Option 2 to speak to us directly.
Please find a list of work request numbers below.
ork Request Nurn V�a!te �In � Addrm M, Town
17845556 30 Adams Ave Electricia
"ec'ric a
WM12U14 NorthAndover� �e—i—thDolvl
f )=
Laura Napolitano A"�� I— /�-
Team Lead 10V 0 0Ve d' n-e—
Order Initiation
Phone: 508.357.4514
Fax: 888.266.8094
nationalgrid
Phone NurnW
�8-1-279-8763
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: Bruce & Kimberlee Round
Property Address: 30 Adams Avenue
Policy Number: HP2004010
Date/Cause of Loss: 9/6/2014, Windstorm
File or Claim Number: 30143-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 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.
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. . I I
Date
ANDERSON ADJUSTMENT CO., INC.
50 Nashua Road, Suite 303
PO Box 1098
Londonderry, NH 03053