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HomeMy WebLinkAboutMiscellaneous - 140 WINTER STREET 4/30/2018 (2)r N I C) Date ..... .. .... . r f} g:. ,aORTM •`_ it Oy..ao ,•1tiQL TOWN OF NORTH ANDOVER `- - PERMIT FOR GAS INSTALLATION This certifies that ... .1P!r�.... N. has permission for gas installation ....f�/t.l .% in the buildings of ......... M 4 4.t. A../.f5 .................. at 19 ... W..� w77E9... 5?7........ III North Andover, Mass. Fee. 30.�?> Lic. Nw. 45"!`j .. SPECTO Check # o�09 6075 0 MASSACHUSETTS UNIFORM APPUCATON FOR PERMIT TO DO GAS FITTING (Type or print) Dateu s NORTH ANDOVER MASSACHUSETTS (K- Building Locations 1� IST Permit # f�fi�\� 4 Amount $; ®© 11YL-� ► T �-U Owner's Name � 1 New D Renovation Replacement ]Zk Plans Submitted (Print or Name Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M NoO If you have checked Les, please indicate the type coverage by checking the appropriate bof. Liability Insurance policy U Other type of indemnity D 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: Signature of Owner or Owner's Agent Owner n Agent n herehv Pprt;A, thof all .,Ftho .fie+. a.. A : C- I _ - ---_ __._.. _..................,..1,,,,,,,,� kU, V„LcrCu) In aoove appucation are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts kkja ^as Code and Chaptgr 142 gt)he General Laws. r Title City/Town ED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 2LI�� Gas Fitter License Number DMaster Journeyman F, F Cx V Iw- z F z x w w CW7 > LT. w U x a z w > w x z a Q O O w O vFi x A O x A 3 A C7 .a U rx > A a F O SU B -BA SEM ENT B A S E M ENT 1ST. FLOOR 2ND. FLOOR 3RD. FLOOR 4TH. FLOOR 5TH. FLOOR 6TH. FLOOR 7 T H. F L O O R 8TH. FLOOR (Print or Name Name of Licensed Plumber or Gas Fitter Check one: Certificate Installing Company Corp. Partner. Firm/Co. INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes M NoO If you have checked Les, please indicate the type coverage by checking the appropriate bof. Liability Insurance policy U Other type of indemnity D 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: Signature of Owner or Owner's Agent Owner n Agent n herehv Pprt;A, thof all .,Ftho .fie+. a.. A : C- I _ - ---_ __._.. _..................,..1,,,,,,,,� kU, V„LcrCu) In aoove appucation are true and accurate to the best of my knowledge and that all plumbing work and installations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts kkja ^as Code and Chaptgr 142 gt)he General Laws. r Title City/Town ED (OFFICE USE ONLY) Signature of Licensed Plumber Or Gas Fitter Plumber 2LI�� Gas Fitter License Number DMaster Journeyman I DAVID P. ,WILLIAMS 3699 CAROLYN.A. WILLIAMS 140 WINTER ST. NORTH ANDOVER MA 01645 %.mss 19 53-235/113 Pay -to. the order.of 4 BayBank MemoA 7 PC +4041 130 2 3 5 71: 2? 1 3 130 1111 3699 11'00000 18 5001" i a.. SEPTIC SYSTEM INSPECTION FORM ADDRESS �, 40 DATE INSPECTED p PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS: WA`T'ER QUALI i Y TES T Eb ? RE"SUL'TSS DYE TEST PERFORMED? Y N DATE? SKETCH: (1Rfl of NdI�TN ,Q�v IiDVE1� � Nl,�. SS 4ppl-{O\Jev D� 5,4PPx� vED R�-,,QSONS ER SOPFLI wt l ❑ WEU- Zp,cR( 5EPT1c SYS IEA , VE51G�.i t'Zw G?479-; Go,�pjr�a�s 94 Te t k1 s i -,,O I--A-T, nay IA)5P6—�-1-10ly FIPE FROt-\ -.TA01- Fj F= JJL 4WITQIJAL1 A15F6�.1�' (O�jc RV4L APPROVAL DArC 9 ouc SEWER 119 West Street SERVICE Methuen, MA 01844 (508)683-5709 lu�nkeA S-+. NO. Olvm, rM1'k� lola��s% II ).'' w-��� Pq4%rcQ Of 1)6,0 �*AzA,� WATERSHED RESIDENTS QUESTIONNAIRE 1. Name 2. Street Address 3. How many members are in your household? 4. What type of sewage disposal system do you have? ❑ cesspool C� septic tank and leaching area ❑ connection to municipal sewer ❑ other (describe) ❑ do not know 5. Are the plans (drawings) for your sewage disposal system on file with the Board of Health? ❑ yes ❑ no ®, do not know- 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years 11-20 years- == " ❑ over 20 years ❑ do not know 7. Has your se wa a disposal system been rebuilt or repaired? ❑ yes . no ❑ do not know If yes, approximately how long ago? years. What was done? a ' 8. How frequently is your sewage disposal system pumped out? ❑ annually f2� every 2-4 years ❑ every 5-10. years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes no _ If yes, what problems? - -�- ❑ repeated pump -outs needed ❑ system clogs, backs up, or drains slowly ❑ odors ❑ sewage surfaces through ground 10. How many of each appliance are connected to your sewage disposal `system? washing machine dishwasher ✓ garbage disposal 'dehumidifier drain sump pump toilet roof/pavement drains showerlbathtub ✓ 11. Please state the brand a d type (liquid or powder) of detergent you use for: dishwasher C0 Cd clotheswasher 12. Does your property have a lawn? yes ❑ -no If yes, approximately what size? ❑ less than 1/4 acre ,K 1/4 acre ❑ % acre ❑ 3/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per year OSeason(s) of the year IS Piz i NG 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: ❑ Check here if your lawn is maintained by a professional landscape contractor.