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UR-RIE R FORM 4_SYSTEM PUMPING RgCORD
107
SEPTIC & DRAIN SERVICE
FOREST STREET; MIDDLETON
(978) 774-2772 01949
/C�O�MM/O�NWEaALTH Qu OF MASSACHUSETTS •-
MASSAC$YISETTS
SYSMAIPUMPING R
ECO
SYSTEM OWNER:
Q A d,c ,e , SYSTEM LOCATION:
S� IP � Sr . �(-�L��
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LATE OF PUMPING:
_ X,
QUANTITY PUMPED: Soo
IESSPOOL: NO GALLONS
YES a.
SEPTIC TANK: NO '
'STEM PUMPED By: C O YES
URRI
ER SEPTIC & DY�IN SERVICE
NTENTS TRANSFERRED TO:
�J O
INSPECTOR: ��� `
FORM 4-SYSTEM PUMPING RECORD
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SEPTI C & DRAIN SERVICE
107 FOREST STREET;MIDDLETON, MA 01949
(978)774-2772
COMMONWEALTH NWE
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MA
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SETTS
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MASSA
CHiJS
ETTS
r' SYSTEM PUMPING RECORD
SYSTEM': . .
OWNER-_ R: SYSTEM LOCATION•
Ii a �c4'/5g CIC /S-lO
557, &J
DATE OF PUMPING:
QUANTITY PUMPED: r GALLONS
CESSPOOL: NO YES 0 SEPTIC TANK: NO a YES
SYSTEM PUMPED BY: CURRIER SEPTIC & DRAIN SERVICE
CONTENTS TRANSFERRED TO:
I `
DATE. INSPECTOR:
TC Nil OF{�1DRY" �+�fDS�' = t
(BARD QF�-iEALT,`a
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I THE PROFIE5510NAL EXPERTS
IN THE SEPTIC AND �p,1�
GRAIN INDUSTRY GGE FORM 4- SYSTF,III MITII�G RECORD
5s 5E
Commonwealth of Massachusetts
Massachusetts
system -amprng Rec6M
y i
' yste }Amer 6ystem Location
Date of Pumping: ��1 - / ��. Quantity Pumped: Q gallons
Cesspool:
i
Cesspool: iso ❑ Yes .❑ Septic Tank: No ❑ Yes/ '
System Pumped by License,#:
Contents transferred to:
1
Date Inspector
a
I
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107 F astst. ORP�t, r
Mi4tktM MA 01949 FORM 4- SYSTF.>\i PLJMPL'�G RECORD
Oo\N nF g1O�F
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Commonw%th f Massachusetts
Massachusetts
System Pumping Record
ystem H'nerSystem Location
6A ?
Date of Pumping: Quantity Pumped: gallons
Cesspool: No Yes ❑ Septic Tank: No ❑ Yes
System Pumped by: C- License #:
Contents transferred to:
Date Inspector'
107 Forest St. PSN FORM 4-SYSTEM PUMPING RECORD
Middleton,MA 01949
(508) 774-2772 5�Q-�S�w�CE �;.
Commonwealth of Massachusetts ark ;
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- Massachusetts x�a
SYstem PumPin R cord'
.z
System Owner
ystem ocation
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• yttF-i
Date of Pumping: Quantity Pumped:-,Igallons
Cesspool, 1\o ❑ Yes7.:
❑ Septic Tank: No ❑ Yes
SN-stern Pumped by
License
Contents transferred to: p lel ,
i
Date
Inspector. c `ti
.:
f
• THE PROFESSIONAL EXPERTS IN THE SEPTIC AND DRAIN INDUSTRY• 5
sC 1pl"
y,�{ �y�„ .jam '�✓
Date
t-
of<".� TOWN OF NORTH ANDOV =R'
PERMIT FOR PLUM NG
SSACHUS�
This certifies that . . . . . . . . . . . . . .
has permission to perform . .Y.", .1--. . . . . . . . . . . . . . . . . . . . . . .
plumbing in the buildings of Jl e -r'n . . . . . . . . . . . . . . .
at . . - -.... . . . . . . . . . . . . .. North Andover, Mass.
Fee. 3Q. Lic. No.. a z 1. <!
PLUMBING INSPECTOR
Check # 1
f <
7112
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Y-
-9- T'U'--'ES
X
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2: if Uj a: "I Z I n
W to cn 21 Z
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0M 0 2: 0 01 q-15
-C X 2 tires
-1-
S SE�AENT
IST FLOOR
1_2HD FLOOR rr
3RD FLOOR
4TH FLOOR
STH FLOOR
GTHI FLOOR
R FL0 Ff
CLIMATE DESIGN HEATING and AIR CONDITIONING, LLC
1! Installing Company Name 5 South Summer Street Check one: Lertificate
Address Bradford,MA 01835
978-372-9999(phone) 1/Corporation C
978-372-0882 (fax)
Partnership
Business Telephone Lic. P'lumb'er. A Alvy&pA)
Name of Licensed PI-timber
INSURANCE COVERAGE:
I have a current liability insurance policy or Its substantial equKratent Which Meets the requirements Of MGL Ch. 142.
Yes IZ No 0
If YOU eve checked Yes, please indicate the type coverage by checking the approlarmte box.
A I!a- bilfty insurance policy jz Other type of indemnity 0 Bond El
OWNER'S !K'SURANCE WAIVER: I am ave-dre Mat the licensee does not have the insurance coverage required by
C11apter 142 oil the Mass.. General Laws. and that my--Ignature an this permit appilcation Waives this requirement.
Check one:
- owner Agent Cil
��49tlatuFe 01 5�7�t�Dwner's Agent
I 6elebY Wrtifl that 911 of tha details and infognifiw 1 have submit rad(or antersa).in.above applicztbn US true and acuate to the best of my
knowiti-dge and that a-11 plurnb;n-g work and instal . ri n-ved under Part is.wGd for this application,vA 11 bg in complitrce with aj,
peft-inent prmisims of uw koas Achusetj� J11a -,ag ,
5z to Pn. tg '��7aned
I of the General Lays.
nature of Ljoen5e.d7l- n-aber
TJUo
T�"of 1-icense: F-Aastar -Ioutneymanz
bc;cnso Nuinber
Date. . . . 1. �.�... ..
NORTH x
* 1 O
tirOy` TOWN OF NORTH ANDOVER �
• PERMIT FOR GAS INSLLATION
'ZigSSAC MUSEt � >�'.
This certifies that / . . . . . . . . . '`
41
has permission for gas installation . ./• •w it. S . . . .
in the buildings of . . . . !4. .J.rf:-.H. . . . . . . . . . . . . . . . . . . . . . . . . .'
at . . .1 .):.! ?. . . .. -f.n. . . ` . ., North Andover, Mass.
Fee. .. . Lic. No..J:PR. . . . . . -TA
.. �
CaAS INSPECTOR
l ;r:
Check# 1�
5729
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
--� (Print or Type)
t
111,o 1v �jyd�yT� Mass. Date 19 a� Permit # ) t
Building Location 15–A4 sT Owner's Name 0a Z,
Type of Occupancy _
New ❑ Renovation ❑ ,. Replacement 0 Plans Submitted: Yes[] No ❑
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Q
W > ¢ W Z Q ¢ Q t O O W C O W H
¢ S' O c7 2 LL m 3: O d J U C > D a F- O
SUB"—aS MT,
BASEMENT
1 ST FLOOR
2ND FLOOR
3RD FLOOR
4TH FLOOR
STH FLOOR
6TH FLOOR
` 7TH FLOOR
CLIMATE DESIGN HEATING and AIR CONDITIONING,LLC Check one: Certificate
Installing 5 South Summer Street
Address Bradford,MA 01835 '"Corporation -
9.78-372-9999 (phone) = Partnership
978-372-0882 (fax)
Business Telephone Lic. r�lumber. 4in; Firm/Co.
����ct�i 'L =
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial .equivalent which meets the requirements of MGL Ch. 142.
Yes 21 No G
If you have checked yes, please Indicate the type coverage by checking the appropriate box.
A liability insurance policy 0 Other type of indemnity O 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 requireirnent.
Check one:
Owner-0 Agent Q
Signature of Owner or Owner's Agent
I hereby certify that all of the details and information I have,submitted (or entered) in above application are true and accurate to the best of my
knowledge and that all plumbing work and installations performed under the Pe, tissued for this appli tion will be in compliance with all
pertinent provisions of the Massachusetts State Gas Code and Chapter rZ of e ener La
Tyue of License -
'Plumber nature of Licensed Plumb or Gas Fitter
Title Gasfiher
Master.. License Numbers
G-ly/`Town _ —burne;m,
APP�(OFFICE USF ON[YI
9