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Home My WebLink AboutMiscellaneous - 169 SUTTON HILL ROAD 4/30/2018 169 SUTTON HILL ROAD tad 210/-60.0-0094-0000.0 I k HORTM 3� TOWN OF NORTH ANDOVER O � 9 PERMIT FOR GAS INSTALLATION ,SSACMUSEt i This certifies that . �. ,. . . . S G L: . . . .} . . . . . . . ' r has permission for gas installation . . .( 4.r. c. ,: . . . . . -in the buildings of . . . -, C h.G. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . at . ./,q. . . Vit. � �. .!, ./. , A. , North Andover, Mass. Fee. . .�. . Lic. . . . . . . . t� . .L��, . . . . . . . GAS INSPECTOR),--- Check NSPECTORCheck a02 m� e:-3 --o3o6- 77 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) �✓ 9,A/,b 0 04 4;Mass. Date jG ✓�'�Permit# > L G, lding Location 1E / u- -o A t L ��' BuiOwner's Name T b b Owner Tel#0 ^9� '� -- Ti Type of Occupancy New ❑ Renovation [Replacement ❑ Plan Submitted: Yes ❑ No EY" FIXTURES W M og z F < a X00 = aA � g � SUB- MT BASEMENT I OT FLOOR e FLOOR 3RD FLOOR 4Tlf FLOOR ` T"FLOOR TMFLOOR. .. Tn FLOOR 0 FLOOR Installing Company NameA.0 ff G T Q -�' L Check one: Certificate Address 1 0 &07-H M)9/Iv Sj - ❑Corporation z)D L,E"1 o N MR . o 1 9 '9 ❑Partnership Business Telephone e 7& ) E33 -130 / Firm/Co. Name of Licensed Plumber or Gas Fitter / / C�4 1;,E L Q 2 y S 0 r INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL h'.142. Yeschecked No ❑ If you have eye,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: Owner ❑ Agent ❑ 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 beat of,my knowledge and that all plumbing work and installations performed under the permit Issued for thin appll ! will txxn artce with all rtinent provisions of the Massachusetts State Gas.Code and Chapter 142 of tM By Type of License: -Plumber Signa re of Licensed Plum fitter Title Gas litter IJ I {Master License Number ? Cityrrown •-Journeyman APPROVED(OFFICE USE ONLY) BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX(978)740-9109 December 20, 2002 B FORM OF NOTICE OF CASUALTY LOSS TO BUILDING DEC 2 3 2002 UNDER MASS. GEN. LAWS, CH. 139, SEC. 3B TO: Building Commissioner or Board of Health or Inspector of Buildings Board of Selectmen City/Town Cit /Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Bing -Ko, M.D and Suk-Yi Ho Address : 168 Sutton Hill Road North Andover, MA 01845 Policy No. : W0208737 Loss of : 12/14/02 File or Claim No. : 24-' 0 _ X649 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 .00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 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. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. - Greg Cusich Adjuster n BUTTERWORTH & O'TOOLE, INC. P.O.BOX 8294 SALEM,MA 01971-8294 ADJUSTERS/APPRAISERS FOR INSURANCE COMPANIES ONLY TELEPHONE(978)741-5731 FAX(978)740-9109 December 20, 2002 FORM OF NOTICE OF CASUALTY LOSS TO BUILDING UNDER MASS. GEN. LAWS, 'CH. 139, SEC. 3B Board y. T 7 7 TO: Building Commissioner or Boated of realth or Inspector of Buildings Board of Selectmen City/Town Hall City/Town Hall ADDRESSES North Andover, MA 01845 North Andover, MA 01845 RE: Insured: Bing Ko, M.D. and Suk-Yi Ho Address : 168 Sutton Hill Road North Andover, MA 01845 Policy No. : W0208737 Loss of : 12/14/02 File or Claim No. : 024-1649 Claim has been made involving loss, damage or destruction of the above captioned property, which may either exceed $1, 000 . 00 or cause Mass. Gen. Laws, Chapter 143, Section 6 to be applicable. If any notice under Mass. Gen. Laws, Ch. 139, Sec. 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. If no reply is received from your office within ten days, we will assume you have no liens of any type against this property and we will recommend to the insuring company that this claim is paid. Greg Cusich Adjuster Lr j Casualty&Surety Division F3 e 40 Broad St.-P.O.Box 2356 _ Boston,Massachusetts 02109 LIFE&CASUALTY • (617)357-7000 Date Building Commissioner or Board of Health or In�s/pector of Buildings AND Board of Selectmen 0 - RE: - RE: Insured; Property address: Policy No. r/ f�-7< <��/� 7a j Date of Loss: File or Clain 24d: ai Claim has been made involving loss, damage or destruction of the ' above captioned property,' which may either exceed $1,000.00 or cause 11'ass.Gen.Laws, Charter 143. S :ction b to be applicable. If any notice under i,.ass.Gen.Laws, Ch-139, Sec. 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. led Si ature & Title 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 nail. M1 I(W 7�%� • vs-el� r Sigr�ture & "date WATERSHED TO QUESTIONNAIRE 1. Name leiC AA 0 0 O M K 6 2. Street Address �(�CI ��( I l- t- &,0 VAA)12d U 6 3. How many members are in your household? _ X 4. What type of sewage disposal system do you have? ❑ cesspool ❑ septic tank and leaching area Q--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 N--do not know 6. How old is your sewage disposal system? ❑ 0-5 years ❑ 6-10 years ❑•!411-20 years ❑ over 20 years ❑ do not know 7. Has your sewage disposal system been rebuilt or repaired? ❑ yes ❑ no [i --do not know If yes, approximately how long ago? years. What was done? 8. How frequently is your sewage disposal system pumped out? ❑ annually ❑ every 2-4 years ❑ every 5-10 years ❑ over 10 years ❑ never 9. Have you had any problems with your sewage disposal system? ❑ yes C� 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 shower/bathtub i.- 11. Please state the brand and type (liquid or powder) of detergent you use for: dishwasher 6 clotheswasher o c.d .3 12. Does your property have a lawn? Ct�- yes ❑ no If yes, approximately what �izsize? F-1CEJ less than 1/4 acre 1/4 acre ❑ 1/2 acre ❑ 1/4 acre ❑ 1 acre ❑ more than 1 acre (Specify) acres 13. How often do you fertilize your lawn? No. of applications per yer S Season(s) of the year ZI�� -' 14. Please state the brand and type (liquid or granular) of lawn fertilizer you use: _flr=❑ Check here if r la s maintai ed by a pr fessional landscape contractor. z X x Z o " ° A G x cn u z ° N W ►� d w a � z Q x w � 0 0 z St8IO VIN `JaAOPUV UPON aaa.Ias uWA OZI V'H LIMOI ulluaH ;o Pzeog zanpPud WON Ci T cG �" c.,rr +urrrw v 4AUS 0� — North Andover Board of Health Town Hall, 120 Main Street North Andover, MA 01845 SEPTIC SYSTEM INSPECTION FORM ADDRESS DATE INSPECTED lz - �^ PROPERLY FUNCTIONING? N WEATHER CONDITIONS COMMENTS : DYE TEST PERFORMED? Y N DATE? SKETCH: