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Home My WebLink AboutMiscellaneous - 11 GREENE STREET 4/30/2018 11 GREENE STREET 210/043.0-0044'0000.0 9'1 45 Date.A/v/.. . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING 49 SSACNUS� ,,, i This certifies that . . `. . . . . . . / . . . .a. has permission to perform . .tom-otx.p®rc . plumbing in the buildings of . ./. .r./�?. . uf�!1 . . . . . . . . . . . . at. .fl fI;- le f'1 . . .77. . . . . . . . . . . . . .. North Andover, Mass. Fee.G��i,,D�!.Lic, No.�..��a�S . �l!r'�r/K-< . . . . . . . 5-014-3PLUMBING INSPECTOR Check # I f MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING City/Town14"rj)o VC/Z MA. Date: l0 Permit# Building Location: / �� l:t-J C S k Owners Name: V,,r V� �( ►J Type of Occupancy: Commercial❑ Educational❑ �Industrial❑ Institutional❑ Residential L=1/ New:[] Alteration:❑ Renovation: Replacement:[] Plans Submitted: Yes❑ No❑ FIXTURES 0 • DEDICATED Jw z SYSTEMS O W z H cn Ln a cn 2 to Gi 0 z a w _cc Z a _Z 4 Q w C7LU Z W 0 m Ln w Q H cn Bi a Y 0 n h N < W w w v Z y 0 O . w O U Q E0.n Ln 0 1- U LL 0 0 a Zj z N w w w V dI O w a m m o o LL x° Y g 3 y L X 3 3 3 0 ° a -SUB BSMT. Q BASEMENT IST FLOOR ND FLOOR 3RD FLOOR 4T"FLOOR a_ Sm FLOOR 6'FLOOR 7T"FLOOR 8'FLOOR Installing Connpz;ny � (//� /NG-1_c.� Chec c� e :j tvam�. VM t one iIy G�:rlr•,e, e is Address:J ', P, D&t,,,C(_ f '^ ElCorporation (� ( Ciiy/Town: VC•./(�i,// State: /� ,� Business Tel: ( �1r�� f��Z El Partnership Fax: � 13�� / 4J Name of Licensed Plumber: �(,>J fti f o Firm/Company f INSURANCE COVERAGE: 1 have a current liabilityinsurance policy or its substantial equivalent which meets the requirements of MGL.Ch.142 Yes No If you have checked Yes,pleas71nd! a the type of coverage by checkingthe ❑ ppropriate box below. A liability insurance policy Other type of indemnity ❑ Bond OWNER'S INSURANCE WAIVER:I am aware that the licensee does n t have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owners A ent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)r garding this application are Prue and accurate Knowledge and than all pl��mhing work and Installations performed under the per it issued for this appli i n will he in compliance with all Pertinent provision of the Massachusetts State Plumbing Cade Cha r14 f the General La a' liar a the best of my Type f License: •itle P iyn re of Licensed Plumber P`PRown Master `�j rr PPROVED(OFFICE USE ONLY) ❑Journeyman License Number: /S t J t The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorsXlectricians/Plumbers A licant Information 1 please Print Legibly Name(Business/Organization/fndivid 1): Address: City/State/Zip: J G / Phone#: Z- Are you an employer?Check the appropriate box: I-El I Type of project(required): mployer with 4. ❑ I am a general contractor and T ployees(full and/or part-time).* have hired the sub-contractors 6 E]New construction 2. I am a sole proprietor or partner- listed on the attached shget.t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. [❑Demolition working for me in any capacity. workers'comp.insurance. [No workers'comp.insurance 5. ❑ We are a corporation and its 9• ❑Building addition required.] ,officers have exercised their 10•❑Egectrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11. lumbing repairs or additions Myself, [No workers'comp. c. 152,§1(4),and we have no insurance required.]t employees. 12.❑Roofrepairs [No workers comp,insurance required.] 13.❑Other `Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractorsand their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: ��r,r✓ S? . City/State/Zip:_y- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ado Izereb cer 'PYn r thepains andpe t' s ofperjury that the information provided above! true a d orrect. .i nature: �I Date: v / 7 hone#: 7 k- Official Q Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical In umbing Inspector 6. Other Contact Person: Phnne#• Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written.,, An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartinents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance-or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the,commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers',compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have - employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy;please call the Department at the number listed below. Self-insured companies should enter their self-insurance Iicense number on the appropriate lin e. pity or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/liceuse applications in any given year,need only submit one affidavit indicating current Policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: U e Col-n.MOTMealth of Ylsssaeni setts Department of ladustrial Accidents Office of Investigations 600 Washington Street Boston;MA 02111, Tel.#61.7-727-4900 ext 4406 or 1.-877-M.ASS.AFE Revised 5-26-05 Fax#617"727-7749 6132.4 S osi or destroy4-' ,e, �' v`` - 1 rs�kovl '+fcen: OF MASSAC�U&ETA S if this Incense ONW EdLTH pivisin or,gOstryr'+, cha``ar`' • ' " 7th'Fi-° PLUMB °r `araddcess to incur. r cc S p JOURNEYMAN ew v (. If your name Ai �vs ref 1or1 vn rre t NSE A °f correc ficat1on. Wt e Pr°FIs "n° nr THE ABOVE t CENSE TO. al APIs subl naf privi eu `r ISSUES Renew ect tO 1 e 'n pEARSON This naed.It`5 a persef ens° . r,,:E S A r as-amen to ark oche Pe" 1a� ` _ = DOUGLA _. �s reAurr R D J'f or assI9ne�osted" a. , ,Ori "S p. OWDERMILL perso' 50 y� ��5�{ •�: � . � MA 01830-437 H'AVERHIL►- 7916 D 22073 05/01/12 v.. CplT oi# _ . . � • • if G® H 2___ thi 4 q o '`-1 , • , 0 f . . ®jVjsSO lfCe�'1S� js /lypp � ::. - ..• • -. • )th aSro %st Or des{° p�ir�� l.10ENSED fe ASA MASTER PLUMBER If Your or?, y�?L,ceys x /r t ISSUES THE ABOVE LICENSE TO: ti i Of narrr 0< s N Re c°r'ect ne°r acldr ° . '0000 LAS wal ql q'7O c " ELAS' A :PEARSON - I �J �Sarn dee s urr'Or" � .{ 50 POWDERMILL : I A�SS�rpne� 11`S-, �t m, "C-,, r t t RD r cr,O tO <r F r On ArO�r o y f s f.. Aute , otlr l/al vil S'6ns kc„ J MAVE'RHILL co 1 p d re4Urr �r7e; MA 01830-4& .. I ea by/,?w 1.5655 79.1 79 ;.r Y-,. I I Date..l�l!.Yk .. ...... 3 3 ppRTly d 3? TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION p This certifies that . . Q . . . . . . . . . . . . . . has permission for gas installation . ° �. . ! in the buildings of . ./��!' h .47 . . . . . . . . . . . . . . . . . . . . . . . f.!. at . . . ,?tr. 0wUrq.�,r,. . . . . . . . . . . . . .. North ndover, ass. Fee!rbZ-P Lic. No�S4��r' /.c•� Irl. . r- GAS INSPECTOR Check# 7835 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GAS FITTING City/Town:J ' - tulA_ MA. Date: L7111 Permit# Building Location: // 6'9"Pj C fl . Owners N`ame:_11A1 Type of Occupancy: Commercial❑ Educational ❑ Industrial ❑ Institutional ❑ Residential New: ❑ Alteration: ❑ Renovation: Replacement: ❑ Plans Submitted: Yes❑ No 19� FIXTURES / co W W0) i� zQ co co � 5 0' 0 I— �` m = 0 w W 0 W 0 _ W w te 0 z Z O of Lu W W O FW- n 55 W Uw m 0 I`_ LU 0 a 1— W H N ix 0 LU W Lu tY z = Lu Lu 0 W H a = LL Z W Lu z u J H I— 0 z -j 0 LL � = W H W W 0 a a m w 0 z 0 y t > z I— _ U o o L=L tag _ _ O a0 IW— > > > O SUB BSMT. BASEMENT —;Fr—FLOOR 2 ND FLOOR 3 FLOOR — 4 FLOOR 5 FLOOR 6 FLOOR 7 FLOOR 8 TH FLOOR Installing CompanyName: /)S/VPAJL-I �� fG� Check One Only Certificate# Address: '. /'UC-✓)()£A-1411 // ❑Corporation � �/ City/Town: �(�, State: ,��' Business Tel: / ��, l� 63f Fax: Li Partnership Firm/Company Name of Licensed Plumber/Gas Fitter: Vlj- T/�-.2.f�✓J 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 ind' ate the type of coverage by checking the appropriate box below. A liability insurance policy Other t a of indemnity Y ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only ❑ Signature of Owner or Owner's Agent Owner El Agent By checking this box❑;I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my Knowledge and that all plumbing work and installation performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State PI bing C e and Chapter 142 o General Laws. By `0 �� ,/I Typ of License: // Plumber Title �s Fitter Signare of Licensed Plumber/Gas Fitter Master City/Town pJourneyman License Number: APPROVED OFFICE USE ONLY ❑LP Installer 9978 Date...?.-� 1........ NOR7ry, 3:;•';�``° AL TOWN OF NORTH ANDOVER PERMIT FOR WIRING �,SSACNUSE� This certifies that ..............................................LG! ..�....G.-: ( ��r has permission to perform ........,` ................. .......... ........ ........................ wiring in the building of.............. / 2E sr- at............ . ...... ...... ......................................../.. ,North Andover,Mass. Fee....7...5..'""".'. Lic.No. ELECTRICAL INSPE&OR ' Check # p�OS Commonwealth of_massachusetts Official U e Only Department of Fire Services Permit No. BOARD OF FIRE PREVENTION REGULATIONS Occupancy and Fee Checked _ [Rev- 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(Iv1EC) 527 CMR 12.00 (PLEASE PMT INNK OR TYPE ALL NFO TION) Date: �f�r 7 !�O� City or Town of: By this application the undersi Wires: ed To the nspector of ivees one of his or her intention to perform the electrical work described below. Location(Street&Number)------------- Owner or Tenant Telephone No. Owner's Address Is this permit in conjuncts n with Ja building permit? Yes / � MI No BLDG PERT# Purpose of Building_ �d j Utility Authorization No. Existing Service Amps / _Volts Overhead ❑ Undgrd❑ No.of Meters New Service Amps _/ _VO]ts Overhead ❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: 01 Completion of the following table maybe waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil.-Susp.(Paddle)Fans No.of Total. No.of Luminaire Outlets No.of Hot Tubs Transformers KVA Generators KVA No.of Luminaires Swimming Pool Above ❑ In- ❑ o.o mergency ig ting rnd. rnd. Batte Units Na. of Receptacle Outlets No.of Oil Burners FIRE ALARMS No.of Zones No. of Switches No.of Gas Burners No.of Detection and No. of N Ranges Total InitiatingDevices o.of Air Cond. No.of Tons No. of Waste Disposers Heat Pump Mumber Tons KW Alerting Devices No.of Self-Contained Totals: Detection/Alertin Devices No. of Dishwashers Space/Area Heating KW Local❑ Municipal Connection ❑ Other No.of Dryers Heating Appliances KW Security Systems:* No. of WaterK�, No.of No.of Devices or Equivalent No.of Heaters Si Data Wiring: Signs Ballasts No.of Devices or,E uivalent No.Hydromassage Bathtubs No,of Motors Total HP Telecommunications Wiring: OTHER: No.of Devices or Equi—lent Attach additional detail if desired, or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived b the Owner,no Y permit for the performance the licensee provides proof P rmance of electrical work may issue f of liabili unle P P ty insurance including completed operation"coverage or its substantial equi alent. Th undersigned certifies that such cWBOND a is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ OTHER. ❑ (Specify:) I cert, under the p 'ns;<D-4 d�alties of p rju ',that the//�*n0ormation on this application is true and complete, FIRM NAME: �, /mac y LIC.NO.: 6& Licensee: Signature (If applicable, en r " empt"i the liceum er line.) LIC.NO.: 7� Address: S �j,l , D Bus.Tel.No.:Jr��d� *Per M.G.L c 147 �, 57 �1 „ +, Alt.Tel.No.: ,s �.�ty work requires Department of Public Safety"S"Licen LIC.NO.: OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(chec Owner/Agent k one)❑owner El owner's agent Signature Telephone No. PERMIT FEE: ,� e ELECTRICAL PERMIT NO. INSPECTION REPORT: ELECTRICAL INSPECTOR-]DOUG SMALL x 1.ROUGH INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors'comments: (Inspectors'Signature-no initials) Date r2.FINAL INSPECTION: ssed— Failed— Re-inspection required($50.00)-pectors'comments: (Inspectors'Signature-no initials Date 3.UNDER GROUND INSPECTION: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ j Inspectors' comments: (Inspectors'Signature-no initials) Date 4.INSPECTION—SERVICE: DATE CALLED NATIONAL GRID: NAME: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: (Inspectors'Signature-no initials) Date r 5.INSPECTION-OTHER: Passed—[ ] Failed—[ ] Re-inspection required($50.00)-[ ] Inspectors' comments: Signature-no initials (Inspectors' � ) Date DOOR TAGS ARE TO BE FILLED OUT AND LEFT ON SITE IF THE AREA TO BE INSPECTED IS NOT ACCESSIBLE AND A RE-INSPECTION OF$50.00 IS TO BE CHARGED. r r The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV www.rnass:gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information. )Please Print Legibly Namo(B.usiness/Organization/Individual): (/� e�pC ��, ��y� /�, �'✓� � Address: 9 te, City/State/Zip: f&e,rh/ll/A Phone#: 917 Fmp an employer?Check the appropriate box: Type of project(required): a employer with 4. ❑ l ama general contractor and T 6 New construction yees(full and/oxpart time),x have hired the sub-contractors sole proprietor oxpartner- listed on the attached sheet.? 7. ❑Remodeling . ship and have no employees These sub-contractors have 8. [❑Demolition working for me in any capacity, workers'comp.insurance. 9. ❑Building addition [No workers'comp,insurance 5. ❑ We area corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑.I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing-repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.[]Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. `t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new-affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensafion insurance for my employees Below is the policy incl job site information. Insurance Company Name: Policy#or SeIf-ins.Lic.#: Expiration Date: Sob Site Address: City/State/Zip.- Attach ity/State/Zip:Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a flue up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDBR and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DTA for insurance coverage verification. i Ido hereby certify under epain penalties ofperjury that the information providedabove is true and correct. Si ature: Date: �.r . /7 Jall Phone#: 97t_ 6 M Official use only. Do not write an this area,to be coin ,p by city or town official City or Town: Perm!tUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contactrer son• Phone#: . ... ...,,:,.a4•.w-n..�..=+.e��"�b'�s':.,.we':'''..•r"t.r,,. �e,;�..9,.r.,,.s�^"'""'---*-.�-. *T - 222 Date..,9' . .-.'r9h.... aF SO RT e,ti TOWN OF NORTH ANDOVER o 0 ",. �p PERMIT FOR GAS INSTALLATION� 9Oq,.r°j0"�l5 j�6U1 This certifies that,. . . . . . . . . :. 7. . . has permission for gas,i stallation !. .r.:/: '`'. . in the build'ngs of . . . . .,�l.��.c,. . .�(:�t-�. . . . . . . . . . . . . . . .'� at . ./�. ,!� �� , North Andover, Mass.� Fee.Z.-. . . Lic. No'YL), `. . . . . . . . . . . . . . . . . . . . . . . . . . . . GAS INSPECTOR WHITE:�pptieafil CANARY: Building Dept. PINK:Treasurer GOLD:File r MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO 00 GASFITTING t (Print or Type) 22 O NORTH ANDOVER Mass. Date t$uilding Location Permit # Owners Name FF12f1k+IEA>IME COtVTI • S _, New 7 Renovation Replacement Plans Submitted D .r FIXTUPS's � W N �• � Cf W C O a W < O O C W d to H r W O a W �- 2 ui F- pf > 4 to N O U W r 07 •` Q Q O D W W W Qf 1 Q C W W W G1 = O O N Q O CJ v 0101 -4 Q tr > Q a F— O • Sal$-3S..LT. I i I I ! ti I I I II SASEl4lEPLT I I I I ( I I I I ( I { I I I I IST FLOOR I ) {I I I I I L I I I I ! I I I 2KD FLOOR I I I I I I I I I I I I I I I I I f I 3RD FLOOR 4TH FLOOR ( I I I I I I I I ( I ( I STH FLOOR I I I I I I I I I I I I tt I 6TH FLOOR I I I I ( I I I I 1 TTK FLOOR I I ( I I I I I I I I I 8TH FLOOR I I (Print or Type) Check one: Certificate Installing Company Name (9AlwN0 M606L4 Q Corp. Address�(7li �2_ , 1-40 F Partner. / ) �' 4D/11,/G1�' E14C� IR SFirm/Co. Business Telephone: Name of Licensed Plumber or Gas Fitter L/? ) 6 126L6 Insurance Coverage: Indicate the type of insurance coverage by checking the appropriate box: Liability insurance policy = Other type of indemnity = Bond Insurance Waiver: I , the undersigned, have been made aware that the licensee of th applicatiqMdoes not have anv one of the above three insurance coverages. Signature of owner/agent of pr erty Owner Agent El 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 ;erformcd under ftrmit issued for this apptintsao will-be in compiianoa witls all patineat Provisions of rho Massachusetts State Cas Code and C uptes 14Z of the Genera!Laws. .. By TYPE LICENSE: Plumber Title t Gasfitter Signature of Licensed City/Town- I Master Plumber or Gasfitter Journeyman 4Z4-P.29 APPROVED (oFFIcE USE ONLY) License Number