HomeMy WebLinkAboutMiscellaneous - 475 WINTER STREET 4/30/2018Date . S -.1.: �. I?...
N° 44U7
TOWN OF NORTH ANDOVER
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PERMIT FOR PLUMBING
This certifies that ... `, c: !? ........
has permission to perform .....7 . . 7 -
plumbing
plumbing in the buildings of.. ............
at ... IV. 2-J7 ... 51 ... � 7�7 ......... North Andover, Mass.
Fee. 7, '".. Lie. No.. 4--.V Z. ..... .......�.�-c.�{n ..........
PLUMBING INSPECTOR
WHITE: Applicant CANARY: Building Dept. PINK: Treasurer
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MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING
(Pr' t or Type) ,�^I ' /
1 —� , Mass. Date `7 '2_1WL-)oWPermit # Y 07
Building Location `i �J ] A DwT R Owner's Name GR-kN D 1(00,
Type of Occupancy
New ❑ Renovation ❑ Replacement N
FIXTURES
tial
Yes ❑ No ❑
Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, i' a 02180 �7 Partnership
Business Telephone 781 —438-7776 n Firm/Co.
Name of Licensed Plumber Gordon Switzer
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 3 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 ❑
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 permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbinge d Ch ter 142 of the Ge ral Daws
By
Signature of Ticensed Plumber
Title
Type of License: Master Journeyman
City/Town 8322
APPROVE 0 FIC NL
S OY License Number
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Installing Company Name Heritage Htg. &Plg. CO. Inc. Check one: Certificate
Address 35 Pleasant Street IX Corporation 714
Stoneham, i' a 02180 �7 Partnership
Business Telephone 781 —438-7776 n Firm/Co.
Name of Licensed Plumber Gordon Switzer
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 3 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 ❑
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 permit issued for this application will be in compliance with all .
pertinent provisions of the Massachusetts State Plumbinge d Ch ter 142 of the Ge ral Daws
By
Signature of Ticensed Plumber
Title
Type of License: Master Journeyman
City/Town 8322
APPROVE 0 FIC NL
S OY License Number
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TOWN OF NORTH ANDOVER
SYSTEM PUMPING RECORD
DATE:
'STEM OWNER & ADDRESS
co -A4,66
L( is W IA� (S�—
SYSTEM LOCATION
(exam le: left front of house)
DATE OF PUMPING: uc�—L3 QUANTITY PUMPED C GALLONS
CESSPOOL: NO YES SEPTIC TANK: NO YES
NATURE OF SERVICE: ROUTINE EMERGENCY
OBSERVATIONS:
GOOD CONDITION
HEAVY GREASE
ROOTS
EXCESSIVE SOLIDS
SOLIDS CARRYOVER
SYSTEM PUMPED BY:
COMMENTS:
FULL TO COVER
BAFFLES IN PLACE
LEACHFIELD RUNBACK
FLOODED
OTHER (EXPLAIN)
TOruNl OF NORT H �iND0h
Pnnan ="7 ,LTH
CONTENTS TRANSFERRED TO:
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