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HomeMy WebLinkAboutMiscellaneous - 1200 SALEM STREET 4/30/2018 1200 SALEM STREET 4 210/106.A-0088-0000.0 t I Date. . . .�r,� 70 NoRT„ TOWN OF NOF TyH ANDOVER OF 1.tee° .a gti0 l� 02 hE: 0� PERMIT FOR-OAS INSTALLATION m �9Ism SSACHUSEt�. This certifies that . : . . i ja t 1.. �. . . has permission for gas installation, �.1 in the buildings of .<. .1 c, . . . . . 7. at 1� f : . . ... . . . . North Andover, Mass Fee. . :r''.'. .-Lic. No.. ,..1 >�. . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:Appll(aA CANARY: Building Dept. PINK:Treasurer GOLD: File Commonwealth of Massachusetts Form 4--System Pumping Record, Massachusetts RECEIVED System Pumping Record A000 12015 TpWN OF NORTH ANDOVER HEALTH DEPAF:' 'LST System Owner System Location Hajjar Ed Primary Home 1200 Salem Stree 1 1200 Salem. Street North Andover, MA, 01845 North Andover, MA, 0184.5 (SOB)-451-4970 x (508)-4-1--l-4970 x Najjar Type: Emergent Routine Cesspool: No Yes Septic Tank: No Yes Date of Pumping: Quantity Pumped: Gallons System Pumped By: Wind River Environmental,LLC Permit#: Contents Transferred to: Contents Disposed at: ' nth Andover. MA. x Date: 1 Pumper Signature: Condition of System/Other Comments Printed on recycled paper Dep Approved Form-12/07/95 b OR•T�I Age eco'rd 0 7-2008 y ;�!,1,, .fir r .1;�•j ,lll�1(. JUL Ir'I.,,r'e:. DER has provided . jhtiyform for use by local Boards fi1�� RTH ANDOVER. be lsubml({ed to the.local Board of Hoalth or other ap roN rH r"S T �I'n'� " = A; Facility lnforr��tlon � --- �',,,wr (I,19 oVS'. .'.t; : Sy$tem Lou Uon: wry tis �Xaddra9, C37: .i LTi C'i 0 r 0'w'' �..�A�VCJ• -----. rI ' /(.l"'i';�t'•,. J" yg ern lOWner .!, ;,.. •,.,,, Nuns ,,�..';� I- •r•.t,r�<N I_ ..:., r"Addre44 (If dltfsrsnl rom bcaUon) C kq/Town , g - �' T°lapnvne NQM061 l TlBl'pUmp�./!n; 690rd, --- ,:A'�-'l�'}rlti(I,i'••Il„ �� T ' Dato of Pumpin9 ' . Quan Do!e 2• tJry Pumped: • , G7�lon! 3'. `TYp9 Pf.aya(orn;, ❑ Cesspool(s) Sep(lc Te --- >'/' }' �•,, nk ❑ Tight Tank %011ier(des ------------- crlbe�; 4 Me Tee Flilat present? ❑ Yes No If yes, was It cleaned? ❑ ('�. i� +I\ \!��+W{l� r'�rr '4j4+�I171t!'"i'•, / ye$ I � .i ,.✓ ����1'Jfll rf,ti�t � II;i�, vS�r.,.: � /� �j)�J/1/j��\ � 0 Vehlde Uca is Numb — .,•. + y''/(`V'v�•�`, SSrl � �I:I I�Jy�,',t(I',/,. I•. J , ,t �.;��,��,'b^,`' �i',`µ1Ml�laA I\'�,all''A:,'�dl;!����j+�1• i f. II '' t�t' �'� 7'. on.wher@ cor�lents',Were dl�posed, � .. „�,, } �(, f�r„1 rcl ./ � `q,'�,� •I;1, r �IVtrMr � /1n� , II _�J :r 1r S I, r rjr,!'�iJ tlyi'f�.'':�tr,y l,'•: ;,;,, ltt���J .�(� e I. r)r lr lI OI HJVIO pnalw (>�j;';;Irr.Y,•, hr �hvwvi:mass,9ov/daaNrele'r/approvaJslf6(orma,hLm#1n5pacl -- Syclam Punpinp . UNIFORM APPLICATION 45 \ MA55AUHUSET...,:... a; #,•+l.&.,%�iati�S�oef^x'arafr.3:c's.; t.'C-Vl'i3ira9' TSWFOR PERMIT TO DO µGASFITTING ;*r. (Print or Type) ` V NORTH ANDOVER , Maas. I Building Permit # 760 �-t2v Location4L 0 _ , Owner's Name eJ New C] Renovation p Replacement p Plans Submitted: Yea ❑ No p a °r� - vs de h rs o h x o a F' < a' s a O h a do $I r I Ic 's o x w a sae an d v a : X ►°• p it to s F a F s et F- 1� a i r 7C 4 a A s a 11- bl O tL J w o �i ��i. tai awe y ro a o >3UQ—BOMT. ©AGeMLNT i 10T FLOOR 2NO,FLOOR 1 SRO FLOOR 4tH FLOOR 8TH FLOOR ! 0tH FLOOR i e 7TH FLOOR , OTH FLOOR /'dJ Check one: Certificate Installing Company Name �' Q Corp. Address S� ��., y �a s�L �� d Partnership --I't v 'VL 7,h +,,J cJ-e 4 ✓-T 0-riiim/co. Business Telephone Name of Licensed Plumber or Gas Fitter_IE '5�' ,.` INSURANCE COVERAGE: Check one I have a current liability Insurance policy or its substantial equivalent. Yes Com— No O If you have checked yes, please Indicate the type coverage by checking the appropriate box. A liability Insurance policy Other type of Indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: nature of owner or owner's en Owner p Agent ❑ I=hereby certify that an of the details and Information I have submitted(or entered)M above appllcallo are true and accurate to the best of my knowledge and that ail pplumbing work and Installations performed under the permit Issut�tor`lhis Icatlo - I)be In compliance with all pertinent provisions of the Massachusetts State ass Code and Chapter 142 of the ai Wt. T of License: umber '-Title Gastitter na t o cense um at or as er \�-, aster wn Journeyman License Number_ �� T(OFFICE Q USE ONLY) 13EL0W FOR OFFICE USE ONLY .FINAL INSPECTION SKETCHES PROGRESS INSPECTION FEE NO. APPLICATION FOR PERMIT TO DO GASFITTING NAME TYPE OF BUILDING LOCATION OF BUILDING PLUMBER OR GASFITTER _..- LIG NO. . . ..' _ ... PERMIT GRANTED DATE_ 19 GAS INSPECTOR r,.,,,�•..---_-�,...,.,._.,. ,.....,,ti-:�r--��.,..�.,,.,.,,`s,-•�-.,:.._.=ten:-,.-�:. _.>.-..._,.,.__. .._- --_.__.. .--: -- - -. .. . - -.. -- - - .._ .. .__, _ - .. ..... ._.. . . r Bay State Gas Company GAS INSTALLATION AU,,THORIZATION Date �--1 Issued to Address For Installation of: A� _ BTU Input Restrictions BSG Representati PERMIT ISSUED BY INSPECTOR 1db (�9 � This Portion of Authorization To Be Returned to BSG. Inspection Has Been Made of the Following Gas Equipment- ❑ Heating System (BTU Input ) ❑ Range ❑ Water Heater ❑ Clothes Dryer ❑. Room Heater Location All Work Has Been Done In Accordance With The Massachusetts State Gas Code And Is Ready For Use. INSPECTOR ------- --- -7 NO POSTAGE NECESSARY IF MAILED IN THE UNITED STATES BUSINESS REPLY CARD FIRST CLASS PERMIT NO.721 LAWRENCE,MA POSTAGE WILL BE PAID BY ADDRESSEE BAY STATE GAS COMPANY ATTN: SALES DEPT. 55 Marston Street Lawrence, MA 01840 I