The URL can be used to link to this page

Home My WebLink AboutMiscellaneous - 911 JOHNSON STREET 4/30/2018_N O Date... ............ v ... . �,wetiO TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION i This certifies that ........................ .................... has permission for gas installation .... ............. in the buildings of .. ...��`.; ............................ at ! .....:.. �. !L^ :.. :..: . ,North Andover, Mass. Fee.. !. �.... Lic. No...... ... ............. . GAS INSPE&OR Check # q /,�P- MASSACHUSETTS UNIFORM APPI.TCATON FOR PERMIT TO DO GAS FITTING (Type or print) NORTH ANDOVER, MASSACHUSETTS Building Locations (/l Dy'y-p� X �- Owner's Name Renovation � Replacement NewF1 ri Date i b /ot 7 / _moi Permit # Amount $ Plans Submitted (Print or type)//�� (/ Chic one: Certificate Installing Company Name (J'/'q2 y it �ilJ ru, Corp. Address a /`9�� Partner. Business Telephone ,R7 c/ 77 of E]Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [] No� Ifyou have checked M, please indicate the type coverage by checking the appropriate box. F•`avili ;• i �u:u:n^..: p,;,Od-Itt" tyL1e Ofiil iC:Sinity Bond 0 Owner's Insurance Waiver: I am aware that Mass. General Laws, and that my signature I ' I Signature of Owner or Owner's A licensee does not have the Insurance coverage required by Chapter 142 of the us permit application waives this requirement. W� /) Check one: ,�/ Owner 0 Agent 1 hereby certify that all of the details and informatioV6 hay/submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in tallatu performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Se Gas Cody and Chapter 142 ofthe General Laws. 41 (Title VED (OFFICE USE ONLY) Ignafure of 1 Plumber rl Gas Finer 0' aster ri Journeyman ped ber Or GasFitter ense Number • (Print or type)//�� (/ Chic one: Certificate Installing Company Name (J'/'q2 y it �ilJ ru, Corp. Address a /`9�� Partner. Business Telephone ,R7 c/ 77 of E]Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes [] No� Ifyou have checked M, please indicate the type coverage by checking the appropriate box. F•`avili ;• i �u:u:n^..: p,;,Od-Itt" tyL1e Ofiil iC:Sinity Bond 0 Owner's Insurance Waiver: I am aware that Mass. General Laws, and that my signature I ' I Signature of Owner or Owner's A licensee does not have the Insurance coverage required by Chapter 142 of the us permit application waives this requirement. W� /) Check one: ,�/ Owner 0 Agent 1 hereby certify that all of the details and informatioV6 hay/submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and in tallatu performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts Se Gas Cody and Chapter 142 ofthe General Laws. 41 (Title VED (OFFICE USE ONLY) Ignafure of 1 Plumber rl Gas Finer 0' aster ri Journeyman ped ber Or GasFitter ense Number . Tr WN OF NORTH'ANDOVER SYST N� PUMPINGRECORi� s1's'7'EM 01'I'NFR &ADDRESS �. SYSTEM LOCATION ' (example: left front of house) . h • • U:t'I'>; OF PUMPING:100`QUANTI'T'Y PUMPEDALLO.'s % V-101OUI.: NO —�ZYES` SEPTIC TANX: NO YE a �ATURE'OFSERVICE; ROUTINI�� EMERGENCY utIaERYAT(ONS;- ' GOOD CONDIT14N. FULL TO COVER HEAVY GREASE - BAFFLES IN PLACL ROOTS LEACHFIELD AUNBACK- EXCESSiVL SpLiDS FLOODED SOLIDS CARRYOYER R�qHKR (EXPLAIN) iys, im PUMPO t3Y: • �' ' �•�� 1�r tie FITS: _— c U'1'1'isk?'S TRAHSRORRED T0: Commonwealth of Massachusetts North Andover, Massachusetts System Pumping Record System Owner & Address: Elaine Kirby 911 Johnson St North Andover, Ma 01845 Location of system: Front Date of Pumping: October 21, 2011 Type of system: Septic Tank Gallons Pumped: 1000 gallons System pumped by: Service Pumping & Drain Co., Inc. 5 Hallberg Park North Reading, Ma License 9: BHP -2011-0413,0412,0411,0410,0409,0408 .T �i �UlI TOWN OF NORTH ANDOVER HEALTH DEPARTMENT Contents transferred to: Greater Lawrence Sanitary District Date: October 21, 2011 Pumping Technician: BL This is PROPRIETARY and CONFIDENTIAL information that may be used only by the Board of Health for regulatory purposes V& yORT" TOWN OF NORTH ANDOVER p PERMIT FOR PLUMBING ,SSACMUS� 1 i This certifies that ................... has permission to perform A ............... plumbing in the buildings All at .......... - , North Andover, Mass. Fee -...... Lic. No././ 7/.... .... /................ . ` PIL�111SA ING INSPECTOR Check # �^ 577) MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING (Type or print) NORTH ANDOVER, MASSACHUSETTS / / Date Building Location Ql` v/ <9///v do t� Awners Namele v4 ,vim Permit # Amount Type of Occupancy New rz Renovation Replacements x Plans Submitted Yes No K W 111 1 -173 I ...-. ---------------- MOMMOMMOMMOMMMMM MMMON iiiiiii�� .., ........ .i...... .. NNOWNWOMOMMMMMMMM iMMON NMS (Print or type) Check one: Installing Company Name �A2 /J / ❑ Corp. Address 6 `�� El Partner Name of Licensed Plumber: Insurance Coverage: Indicate the type of in Liability insurance policy ❑ o. r'u Other type of indemnity ❑ Li Firm/Co. ite box:. Bond ❑ Certificate Insurance W er: I, the undersigned, ave been made aware that the licensee of this application does not have any one of the above three ins Ic ignatur Owner ❑ Agent I hereby certify that all of the details and information 1 have submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and instaitations performed under Permit Issued for this application will be in compliance with all pertinent provisions of the Massachusetts S�aV Plumbipg Cade and Chapter 142 of the General Laws. IBy: Title VBD (OFFICE USE ONLY Type of Plumbing License t176� icel* nse Num er Master a Journeyman ❑ Crawford & Company 1001 Summit Blvd Atlanta, GA 30319 Phone 877-346-0300 Re: 6/9/2015 Inspector of Buildings 1600 Osgood Street North Andover, MA 01845 Insured: Claim Number: Policy Number: Our File: Date of Loss: Type of Loss: Elaine Kirby 033592178 51619400004 6776-2629522 2/12/2015 Ice Damming Location of Loss: 911 Johnson St North Andover, MA 01845 To Whom It May Concern: A claim has been made through Arbella Mutual Insurance Company which involves loss, damage, or destruction of the above captioned property, which may either exceed $1,000 or cause Massachusetts General Laws, Chapter 143, Section 6, to be applicable. If any notice under Massachusetts General Law, Chapter 139, Section 3B is appropriate, please direct it to the attention of the writer. Kindly include a reference to the captioned insured, location, date of loss and claim number. Very truly yours, James Warren Crawford & Company CC: City/Town Fire Dept, City/Town Health Dept