HomeMy WebLinkAboutMiscellaneous - 185 GREAT POND ROAD 4/30/20180
Date ........
TOWN OF NORTH ANDOVER
PERMIT FOR GAS INSTALLATION
This certifies that
has permission for gas installation .............................
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in�the buildings of ../.. �. �:�.-!'........................ .
at Ab... -f ... , North Andover, Mass.
Lic. No..L"PJz�.�X.A-e...........
GAS IN P • OR
Check # jG y.s
MASSACHUSETTS UNIFORM APPLICATON FOR PERMIT TO DO GAS FITTING
(Type or print)
NORTH ANDOVER, MASSACHUSETTS
Date 718/05
Building Locations 185 Great Pond Rd I
permit#
Kenneth Peelle Owner's Name 978 685 8181 Amount
New ❑ Renovation Replacement ❑ Plans Submitted ❑
$30.50
G
SUB -BASEMENT
BASEMENT
1ST.
FLOOR
2ND.
FLOOR
3RD.
FLOOR
4TH.
FLOOR
5TH.
FLOOR
6TH.
FLOOR
7TH.
STH.
FLOOR
FLOOR
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(Print or type) Eastern Propane Gas Ch k one: Certificate Installing Company
Name
Corp.
Address 131 Water St.
❑ Partner.
?�gnyAr-, MA n1 qPM,
19usmess Telephone 1 X00 3Pp r.h�)R ❑ Finn/Co.
Name of Licensed Plumber or Gas Fitter
INSURANCE COVERAGE Check
I have a current liability Insurance policy or it's substantial equivalent. Yes ^ No ❑
Ifyou have checked yes, please indicate the type coverage by checking the appropriate box
Liability insurance policy b_11 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:
"signature of Owner or Owner's Agent Owner ❑ 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 permit Issued for this application will be in
compliance with all pertinent provisions of the Massachusetts State Gas Code and.Chapter 142ofthe General Laws.
Title
City/Town
OVED (OFFICE USE ONLY)
Signature of LicenJ Plumber Or Pas Fitter
Plumber p te
Gas Fitter Icense um er —�
❑ Master
❑ Journeyman
S
SEPTIC SYSTEM INSPECTION FORM
ADDRESS I C�- G neat - NnC�
DATE INSPECTED --j`&To
PROPERLY FUNCTIONING? 6 N
WEATHER CONDITIONS
COMMENTS:
WATER QUALITY TESTED? RESULTS?
DYE TEST PERFORMED? Y .N
DATE?
SKETCH:
WATERSHED RE
1. Name
1
2. Street Address '
DENTS QUESTIONNAIRE
3. How many members are in your household?
4. What type of sewage disposal system do you have?
❑ cesspool
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? I K 0-5 years ❑ 6-10 years ❑ 11-20 years
❑ over 20 years ❑ do not know
7. Has your sewage disposal system been rebuilt or repaired?
❑ yes :kg. no ❑ 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 ,J, 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 shower/bathtub 3
11. Please state the brand and t pe (liquid or powder) of detergent you use for:
dishwasher ('a -46a cX-11- —tl ; C'xZ
clotheswasher T CL- _ Co c.c -
12. Does your property have a lawn? L9 yes ❑ no
Iff yes, approximately what size?
0- less than 1/4 acre ❑ 1/4 acre ❑ 1/2 acre ❑ 3/4 acre ❑ 1 acre
❑ more than 1 acre (Specify) acres
13.
How often do you fertilize your 4wn? I /
No. of applications per year —av •'`� �" �
Season(s) of the year
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.