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HomeMy WebLinkAboutMiscellaneous - 8 Paddock LaneROMA WAVE TOWN OF NORTH ANDOVER SYSTEM PUMPING RECORD DATE: - SYSTEM OWNER & ADDRESS SYSTEM LOCATION (example: left front of house) DATE OF PUMPING: / n - 0- - ©) QUANTITY PUMPED 1.5"-D GALLONS CESSPOOL: NO YES SEPTIC TANK: NO YES NATURE OF SERVICE: ROUTINE --EMERGENCY OBSERVATIONS: GOOD CONDITION FULL TO COVER HEAVY GREASE BAFFLES IN PLACE ROOTS LEACHFIELD RUNBACK EXCESSIVE SOLIDS FLOODED SOLIDS CARRYOVER OTHER (EXPLAIN) SYSTEM PUMPED BY: A n oo Ver COMMENTS: CONTENTS TRANSFERRED TO:y rn s+ grcicdf M, Date.. .- � TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING i ! A— K -./ This certifies that ::.. '" ` ....................... . . r 's' �., has permission to perform .::- .. �^: ................. . plumbing in the buildings of !............... . at Sl" ............. .... !t-'�� .. <�^ : -+. , North Andover, Mass. Eee.:'5. j' .. Lic. No.!-'.��?.. Y.Lp...:. . ....... PLUMBI � SPECTOR Check # `�� 9�/ (/ 5691 c t MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Print or Type) /� �,Cj�7 /) Z /)d QV&,Mass. Date Permit # `3L7i 6 Building Location\ISA 814dpril- 041111Q Owner's Namely O)1/') Type of Occupancy Residential New O Renovation ❑ Replacement N Plans Submitted:/Yes ❑ No ❑ FIXTURES Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Address 35 Pleasant Street CR Corporation Stoneham, Ma 02180 D Partnership Business Telephone 781-438-7776 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No U If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy M 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 cert'if'y 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 Plumbing Code and Chapter 42 of thq General laws. By Signature of cefl,r ►um er Title _ Type of License: Master [g Journeyman ❑ City/Town 8322 APPROVED(O ICE S ONLY) License Number. Z n nY n N O 2 W X Q 0 2 d ur �4 i4 oIn N W Uj ¢ X ¢ N — i W a -t�-j� n ca 0 X 0 a~� >- W n � Z ¢ a tf '= CC e CC 3 10 raj N N (a �nBCC �•{ 2 W O 7 W d N ¢ Q W N a J Z Q x W �4 JaJ o Z p 0 N X X W tu F— O O fel rl W n n Q O J Q CC CL a Q O Q iii Q Q J Sun—BSMT. BASEMENT JL IST FLOOR ' 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR Installing Company Name Heritage Htg . &Plg . Co. Inc. Check one: Address 35 Pleasant Street CR Corporation Stoneham, Ma 02180 D Partnership Business Telephone 781-438-7776 F1 Firm/Co. Name of Licensed Plumber Gordon Switzer Certificate 714 INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes ® No U If you have checked Yes, please indicate the type coverage by checking the appropriate box. A liability Insurance policy M 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 cert'if'y 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 Plumbing Code and Chapter 42 of thq General laws. By Signature of cefl,r ►um er Title _ Type of License: Master [g Journeyman ❑ City/Town 8322 APPROVED(O ICE S ONLY) License Number. O z m J a O O O h" N = ¢ O J z a ¢ m �U z O a 4 C6 ~ V �tl W Q a w j