HomeMy WebLinkAboutMiscellaneous - 337 HILLSIDE ROAD 4/30/2018Commonwealth of Massachusetts -'4
..
City/Town of
AUG '► 2013
System Pumping Record
Form 4 TOWN OF NORTH ANDOVER
HEALTH DEPARTMENT
DEP has provided this form for use by local Boards of Health. Other forms may be used, but the
information must be substantially the same as that provided here. Before using.this form, check with your
local Board of Health to determine the form they use. The System Pumping Record must be submitted to
the local Board of Health or other approving authority.
A. Facility Information
1. System Location: Left/ Right front of house, Left/ Right rear of house, Left/ right side of house, Left/
Right side of building, Left / Right front of building, Left / Right rear of building, Under deck
Address
<3B r] u�, e r. 4��
Citylrown > }� l State Zip Code
2. System Owner: 4
Name
Address (if different from location)
City/Town
B. Pumping Record
1. Date of PumP g in
3. Type of system: ❑
Date
Cesspool(s)
State(�'VC do,
Telephone Number
—2. Qua tity Pumped:
Septic Tank
Gallons
❑ Tight Tank
❑ Other (describe):
4. Effluent Tee Filter present? ❑ Yes No If yes, was it cleaned? ❑ Yes ❑ No
5.
System
6. System Pumped By:
Neil Bateson
Name
Bateson Enterprises Inc
Company
7. Loca ' contents were disposed:
GLS. Lowell Waste Water
t5form4.doc• 06/03
F5821
Vehicle License Number
Date
System Pumping Record • Page 1 of 1
TOWN OF NORTH ANDOVER
PERMIT FOR PLUMBING
This certifies that
has permission to perform`
plumbing in the buildings of ..................................
at ''� 2. � . i �-�-�'�' �'....(( �I ....... ,North Andover, Mass.
Fee-�d.. , ... Lic. No... .0 ...............
/ 1/1
L/ PLUMBING INSPECTOR
Check # �L
7930
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
� (Print or Type)
I Mass. Date Permit #-
i ( Building Location_ Owner's Name J A 5 cs_•.i fa
a Owner's Phone # _ V 1 t Type of Occupancy 1!�-9
ew.
N
�.,,� s�•'�a ❑ Renovation � Replacement ❑ Plans Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Ebacher Plg & Htg, Inc Check one: Certificate
Address 40 Portsmouth Road PO 13Ox
�I Corporation
Ameshury MA 0913 ❑ Partnership
Business Telephone 978-388-4086
❑ Firm/Co.
Name ok-icensed Plumber Richard Ebacher
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes I2 No ❑
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 app+ication waives this requirement.
check one:
Signature of Owner or Owners Agent
Owner ❑ Agent ❑
t nereoy certify !nat all or the details and information I have submitted for entered) in above soplication are true ano accurate to the best
of my knowledge and that all plumbing work and installations performed under .he oermii issued for this application will be in compliance
with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14^ f the eral ! aws.
By i Si nature of Licensed P umber
Titlee of License: PAasier
— t ` p XL journeyman
City/—f own_-- i
;'cense tJumber__�Q�
.-?PPgOVED !OFFIC= USE ':)NL") ! ----
z
z
Z
Cr
n
I
m
U)O
U)
z
I
~
(
> V
o
I3
0
a
W
�
1'
J
}
.Q
U
Q
F
z
D
(7
W W
¢ ¢
U
i W
¢
(n
O
Z
l
W
a
¢
i
vi
¢
t-
=
U
¢
cn
z
Q
O
w
z
z
z
z
a D
r
z
z
a
U
N
Z
¢
CO
¢
rn
¢
W
>-
2
W
F"
rn
(n
Y
Z
¢
n
a
Q
Q.
a
¢
x
O
O
U
w
¢
W
w TO
x
w
4
O
Cr
Q
Q
3
J
v7
¢
Q
¢
(n
J
z
¢
Q
¢
U
LLp.
Cr
F-
U
a
x
f-
O
x
p-
z
x
I--
Y
a
I--
a
Y
Q
w
u_
Y w
w
¢
>
3
m
Ox
z
F
O
O
rn
WO
w
t-
O
Y
U)
p
0
(i
0
n
4
�
¢
m- O
m
C¢7
SUB-BSMT.
BASEMENT
1ST FLOOR
2140 FLOOR
3RD FLOOR
4TH FLOOR
Tt-1
5TH FLOOR
6TH FLOOR
7TH FLOOR
i
STH FLOOR
Installing Company Name Ebacher Plg & Htg, Inc Check one: Certificate
Address 40 Portsmouth Road PO 13Ox
�I Corporation
Ameshury MA 0913 ❑ Partnership
Business Telephone 978-388-4086
❑ Firm/Co.
Name ok-icensed Plumber Richard Ebacher
INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes I2 No ❑
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 app+ication waives this requirement.
check one:
Signature of Owner or Owners Agent
Owner ❑ Agent ❑
t nereoy certify !nat all or the details and information I have submitted for entered) in above soplication are true ano accurate to the best
of my knowledge and that all plumbing work and installations performed under .he oermii issued for this application will be in compliance
with all pertinent provisions of the Massachusetts State Plumbing Code and Chapter 14^ f the eral ! aws.
By i Si nature of Licensed P umber
Titlee of License: PAasier
— t ` p XL journeyman
City/—f own_-- i
;'cense tJumber__�Q�
.-?PPgOVED !OFFIC= USE ':)NL") ! ----
r
J
z
O
w
N
LU
U
U -
LL
O
c
O
LL
G
J
w
n
z
o "
v
w
a
N
z
N
N
w
a
O
0
c
IL
z
0
U
w
a
co
J
G
z_
LL
a
Ty
ai
0
O
a
z
z
O
F
F
a
�
LL
U
N
w
a
O
O�
O
N
0
0
F
a
_F
o
0
w
La
z
a
F
CL
O
U.
<
z
c w
O
F
G
c7 <
U
F R
a
a
cr
a
w
w
La
a
LL
N
w
z
U
F
w
X
N
z
0
U
w
a
co
J
G
z_
LL
a
Ty
ai
0
0
a
z
O
J
F
a
�
a
O
F
I
U
w
CL
O�
N
N
a
0
0
La
F
z
<
c w
F
c7 <
F R
cr
w
a
eg
Date .. /f ....... .... .
01
TOWN OF NORTH ANDOV
O F
t - PERMIT FOR GAS INSTA TION
Cj .Y
his certifies that ...................... ....! ... .
has permission for gas installation . ��1''" ' ........
.
in the buildings of j4 ....... ~'` ................... .
at '� .2.7...F�-� �. � .... , North Andover, Mass.
Fe2Lic. No...'?&;..........
GAS IN; PECTOR
Check # '��
6615
20, d�
MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING
(Print or Type)
Ste t, -4 0 eo ,til
AS 0 .rte+ �, to A C- L-% cr ,Mass. Date i i i i 20 v ?, Permit # V/&/,0
3 3 -7 14 i t s: d¢.. F. d,
Building Location �, _ A� Owner's Name nS *— �- t -o n C-
9 '7 ej Z �� .
Owner Tells
New ❑ Renovation ❑
Type of Occupancy " o -1 5 --L
Replacement ❑ Plan Submitted: Yes ❑ No ❑
FIXTURES
Installing Company Name Ebacher Plg & Htg, Inc Check one: Certificate
Address 40 Portsmouth Road * PO Box 5.48 ¢Corporation
Amesbury, MA 01 91 3 o Partnership
Business Telephone# 978-388-4086 ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter Richard Ebacher
S INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy tX 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 11 Agent ❑
1. 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 permit issued for this application will be in complia with all
ertinent rovisions of the Massachusetts State Gas Code and Chapter 142 of ral ws.
By Type of License:
❑ Plumber Sighbt0fe of Li ns Plumber or Gas Fitter
Title ❑ Gas fitter
X Master License Number 8926
City/Town ❑ Journeyman
APPROVED (OFFICE USE ONLY)
MENEMENN
WOMEN
00
MEMEMEMEMEMEMEMEM
NONE
MEMMENEEMEMEM
=00
NOME
EMNEMEM
OEM
Installing Company Name Ebacher Plg & Htg, Inc Check one: Certificate
Address 40 Portsmouth Road * PO Box 5.48 ¢Corporation
Amesbury, MA 01 91 3 o Partnership
Business Telephone# 978-388-4086 ❑Firm/Co.
Name of Licensed Plumber or Gas Fitter Richard Ebacher
S INSURANCE COVERAGE:
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142.
Yes No ❑
If you have checked yes, please indicate the type coverage by checking the appropriate box.
A liability insurance policy tX 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 11 Agent ❑
1. 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 permit issued for this application will be in complia with all
ertinent rovisions of the Massachusetts State Gas Code and Chapter 142 of ral ws.
By Type of License:
❑ Plumber Sighbt0fe of Li ns Plumber or Gas Fitter
Title ❑ Gas fitter
X Master License Number 8926
City/Town ❑ Journeyman
APPROVED (OFFICE USE ONLY)
z
O
r
U
U,
C,
N
z
N
N
w
fL
0
O
C
0.
U.
Me
U
a,
C
O
r
U
w
CL
N
z
N
a
O
0
z_
h
r
U.
N
J
O
z
O
O
tJ
cl
N
O
r
LL)
r
U
�
LL
O
w
O
z
CL
c
�
O
O
U.
U.
z
c
J
_O
w
r
n
<
U
J
CL
0 -
Li w
w
4.
I
NN
W
2
U
r
Lu
X
U.
Me
U
a,
C
O
r
U
w
CL
N
z
N
a
O