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Miscellaneous - 134 SOUTH BRADFORD STREET 4/30/2018
r^ _ 134 SO BRADFORD STREET 210/103.0-0013-0000.0 Date.�Zl:�. . . .. .... TH OF NOR ,41 o? ° TOWN OF NORTH ANDOVER ' PERMIT FOR GAS INSTALLATION . o y,SSACHU5Et This certifies that . �c�t.�. . .i. V. . . . . . . . . . . . . . . ,p a has permission for gas installation >6 S. .Y of l x. .-. . . . . . . in the buildings of . . CS � /-�: .So�J. . . . . . . . . . . . . . . . . . . . . North ��nd�over.,. . .ass.atFee.3o! sLic. No. . GAS INSPECTOR Check# � 7948 �I AA%AMUSETTS UNUOPMAPPUCATON FOR P M1'IlT TO DO GAS F!'ITING (Type or print) Date — — NORTH ANDOV ER,MASSACHUSETTS Building Locations �3y S• Qd'W� �-�, c'�j�- Permit# 16�_ Owner's Name Amount$CA\\ New Renovation ❑ Replacement Plans Submitted ❑ w U v� C. li O C4 F" C. n F Qy Z90 W W v0 o+ O =1 [FF W W v� C CC GG W p; w F Q F F z F z E, W cO� > w E. `:�1 a v� cY. z C W C rx z " n C O C a O k E+ O ] 3 a a U a > a w F C SUB -BASEM ENT B A S E M ENT IST. FLOOR 2ND . FLOOR 3RD. F L O O R 4TH . FLOOR 5TH . FLOOR 6TH . FLOOR 7TH . FLOOR STH . FLOOR _ ELL (Print or type) Check one: Certificate Installing Company Namee4u� rw ��+�tw•f Corp. Address 17 1 r"�+�pe�+►� Partner. MIA o3q6S 13usmess fe ephone&D3 Firm/ o. Name of Licensed Plumber or Gas Fitter 'tdg�(�� rn (�hotC.4 INSURANCE COVERAGE Check one: I have a current liability Insurance policy or it's substantial equivalent. Yes 1:3 No If you have checked ,please indicate the type coverage by checking theappropriate box. ❑ 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 application waives this requirement. Check one: Signature of Owner or Owner's Agent 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 m� knowledge and that all plumbing work an alla io herforme:d under Pc!rrnit Issued for this application will be in cinnpli;uace with all pertinent priwisions of the�l� sachusu ate Ga cle and Chapter 142 of the General Laws. By; ..'Iture of Licensed Plumber Or Gas Fitter Title - � Plumber 2 3 City/Town [3 Gas Fitteric�aet�IiIM Master APPROVED OFFICE USE GNLY) fel Journeyman J,. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name (Business/Organization/Individual): V%- �,rg _V%, Address: l? r�►��,,--�awc �r� City/State/Zip: (���;� b,,,, , 01� 63f65 Phone #: 403 _397-- 6-733 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.0 I am a sole proprietor or partner- 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 are a corporation and its required.] officers have exercised their 10.E] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l l.❑ 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' 13.0 Other comp. insurance required.] *Any applicant that checks box#11 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/7ip: _ 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. I do hereby n r the pa' and penalties of perjury that the information provided above is true and correct. Sign �- Date: - Phone 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 Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 9224 Date. A•7 `�. . . . TOWN OF NORTH ANDOVER PERMIT FOR PLUMBING ,SSACMUSf This certifies that . . . . .o.. . . has permission toperform . . . ..mil. . . .. . . . . . . . ... . . . . . . . plumbing in the buildi s/o�f . . �7.'. . . . . . . . . . . . . . at. .�-3�i.�.,S. �!'. . :��. . . . ., Norfih ndove'r, Mass. Fee.-3�w��.a '.Lic. No.4�-.Z5�..3 . ./ .�i! . . . .�� . . . . . . . PLUMBING IN ECTOR Check # ' MASSACHUSETTS UNIFORM APPLICATION FOR PER 11 MIT TO DO PLUMBING City/Town:• AA0 ,,-� MA. L 2 (�' Q Date: Permit# Building Location:_134 S. �3r rol. 54 Owners Name: a �. — OA J 5ory Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation: Replacement: r Yi ❑ Plans Submitted: Yes❑ No FIXTURES DEDICATED a Z SYSTEMS 2 ° 'r N LU >LU D U z a w Z 1a Y 'QLn 0 N v a t Z JX Q o) V al W C a ' w V s a ° u z Q w 3 in a a = w w J a'f O w a s `�' E1 ° H n > ° O c) x z N j— i-- w N w a m m ❑ ❑ LL z Y g 3 ° x d a a a z 3 N N ° 3 3 0 -SUB BSMT. BASEMENT 11T FLOOR k 2ND FLOOR X 3RD FLOOR 4'FLOOR P 5TH FLOOR 6TH FLOOR 7TH FLOOR 8TH FLOOR 111stall7n z;nj? �: r ► Checlf One Oils :-r.4 g0��1�p frame. aw.� cd-- i.all=-lie l:= Address:_A!� "r,,� ,gf� p El Corporation City/Town:_ f (A.'S•�W State: Business Tel:—662 3kZ .C733 Fax: ElPartnership �'�2 -57yy El Firm/Company Name of Licensed Plumber: INSURANCE COVERAGE: 1 have a current Iia- bilifv insurance policy or its substantial equivalent which meets the requirements of MGL.Ch.942 Yes ❑ No❑ If you have checked Yes,please indicate the type of coverage by checking the appropriate box below. 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Si nature of Owner or Owner's Agent Owner ❑ Agent ❑ 1 hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate Knowledge and that all plumbing work and installations performed under the permit issued for this application will be in accura a tort a all t o,my Pertinent provision of the M sa usetts State Plumbing Code and Chapter 142 0fllo General Laws. 3y F Type of License: 'itle µ' ❑Plumber n re of Licensed Plumber :ity/Town ❑Master PPROVED(OFFICE USE ONLY) Journeyman License Number: :! q r�A The Commonwealth ofMassachusetts Department oflndustrialAccidents Office oflnvestigations 600 Washington Street Boston,MA. 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): --------------� Address: �',-N,b u-�,�► City/State/Zip: ,� , ��� 6365 Phone#: Sa � - 33 Are you an employer?Check the appropriate box: 1.❑ I am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2. I am a sole proprietor or partner- listed on the attached shgaet. 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 com .insurance 5. 9. ❑Building addition ' p ❑ We are a corporation and its required.] .officers have exercised their 10.❑EIectrical 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 insurance r 12.❑Roof repairs e required. employees. p ] p es, o work Y [N workers, cmP insurance red] 1311 Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mu #Contractors that check thismust submit a new affid ' box must attached an additional' Poli indicating inrsuch. drtiona I sheet showing the name of the sub-contractors and the' their workers'comp.polic information. Y lam an employer tliat is providing workers'compensation insurance for my employees. Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: • Job Site Address: City/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 ofMGL c. 152 can lead to the imposition of criminal fine u to p 1 penalties p $1,500.00 and/or one-year imprisonment,a p lhes of i Y p , swell as civil penalties in of a STOP of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to theffifie ORDER and d a fine Investigations of the DIA for insurance coverage verification. t do hereby n r the pal nd penalties of perjury that the information provided above is true and correct._ 3i nature: ,,t Date: 'hone#: OfTacial use only. Do not write in this area,to be completed by ci or town o ac' tJ' ff ral. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 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 j oint 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 insuranc6 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-contractor(s)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 ca workers'q carry ers compensation insurance.ante. 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 shou be returned to the city or town that the application for the ermit or lice ld P nse 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 license number on the appropriate line. City 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 referencd number. In addition,an applicant that must submit multiple permit/liceinse 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: h e conunaoirwealth o,���ssac"o isetis Department of Industrial Accidents Oce Of InVeStigatxonS 600 Washington Street Boston;MA 02111 Tel. #617-727-4900 ext 406 ox 1-877-". SAFE Revised 5-26-05 Fax#617,727-7749 WWW.raass.jZ-ovfdia COMMONWEALTH OF MASSACHU ETTS- LICENSED AS A JOURNEYMAN P UMBER ISSUES A'B&6VE LICENSE T' ,-J.OS (PAGEAU 417T:I'm BERLANE RD �i 4P.LAISTGW�°,•�-_�-NH, 03865 2543 1^(I 22543 65101112 . 837,51 r a Date./c27:.?.—//...... �,ORTN TOWN OF NORTH ANDOVER o PERMIT FOR WIRING. ,SSACMUSE� This certifies that .... f71.. ..f... ..... ........ has permission to perform .,Se :!�!...v/0..��'rx4�....T .. e. . wiring in the building of...` L....s .. !! .. -................. at... 4..., ....Ac. . . .. , rth Andover. 2 c Fee116............. Lic.No.... /Oi� {L...5....... .................... . . . ... .. ...... E CTAICAL I E Check # 10519 i Commonwealth of Massachusetts Official Use Only Permit No. Department of Fire Services Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 1/07] leave blank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Code(MEC),527 CMR 12.00 (PLEASE PRINT ININK OR TYPE ALL INFORMATION) Date: Iz/� /// City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersigned gives notice of his or her inte ion to perform the electrical work described below. Location(Street&Number) �3 / S. �j►ud ,� �' !(J�/jth�a�� Owner or Tenant of t_i s O Telephone No.51 79 695- Owner's Address L Is this permit in conjun 'on with building permit? Yes � No ❑ (Check Appropriate Box)) Purpose of Building Utility Authorization No. pc / l ` 0 Existing Service Amps Volts Overhead Undgrd ❑ No.of Meters New Service / Z r Amps /Z 6 Volts Overhead Undgrd ❑ No.of Meters . Number of Feeders and Ampacity Lo`tion and Nature of Pr osed Ele rical Work: 4�;Q✓U�Ce_ c�q0 } C� ,� Completion of the ollowing table may be waived by the Inspector o Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No.of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA AboveIn- o.o Emergency Lighting No.of Luminaires Swimming Pool rnd. ❑ rnd. ❑ Battery Units No.of Receptacle Outlets No.of Oil Burners FIRE ALARMS I No.of Zones No.of Switches No.of Gas Burners No.of Detection and Lo Initiating Devices No.of Ranges No.of Air Cond. Total No.of Alerting Devices Tons g No.of Waste Disposers Heat Pump Number Tons KW No.of Self-Contained Totals: ....................... Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal ❑ Other Connection It No.of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: 1 Heaters Signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or E uivalent OTHER: 000Attach additional detail if desired, or as required by the Ins or of Wires. Estimated Value of Elec ical Work: (When required by municipal policy.) ,� Work to Start- Inspections to be requested in accordance with MEC Rule 1.0,and upon completion. 1 INSURANCE CO ERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force d has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE BOND ❑ OTHER ❑ (Specify:) I certify,under the pains and penaltieso perjury,that the information on this application is true and complete. FIRM NAME: Xvtc �Ce 0,k ok-v LIC.NO.: Licensee Signature LIC.NO.: (If applicable, enter "exempt"in thele se num line Bus.Tel.No. - -3C -Z// Address: A, � Alt.Tel.No. - 3l *Per M.G.L c. 147,s.57-61,security work requires-Depaikment of Public Safety"S"License: 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(check one) ❑ owner ❑owner's Owner/Agent P ERMIT FEE: $ Signature Telephone No. r 1' �-iZ ✓ Z- r C , A Y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations kv. 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: l City/State/Zip: one #: 9` 7� `7 -5 �_- 11414e- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction art-time o ees full and/or .* have hired the sub-contractors y ( part-time).* E]Remodeling 2. I am a sole proprietor or partner- listed on the attached sheet. 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 are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ 1 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' . 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 a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showingthe name of the sub-contractors ctors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/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 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. I do hereby certify under the pais s nd nalties of perjury that the information provided above is true and correct. Sip,nature: �/� Date: 1! 1 Phone#: �l'7 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 Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Ac, 21/ 5 x 870 Date. .Ph/I O TOWN OF NORTH ANDOVER ' PERMIT FOR PLUMBING ,SSACMUSE� t, This certifies that . . ./ (I.4 n. has permission to perform . . . .P.Q A. j'4. I t.&. . . . . . . . . . . . . . plumbing in the buildings of . . .DN u. S P.!ti at . . .l . , North Andover, Mass. Fee Lie. No.. .?' -� . . . . . . PLUMBING INSPECTOR Check # r 2 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO PLUMBING F` City/Town: © Q V ,MA. Date• UG Q Permit# Building Location: j� s 6RD mo Owners Name:C-P-M4M(WZ- IAVJS© Type of Occupancy: Commercial❑ Educational❑ Industrial❑ Institutional❑ Residential New:❑ Alteration:❑ Renovation:❑ Replacement: Plans Submitted: Yes❑ No❑ FIXTURES DEDICATED Z SYSTEMS LU z Y O Ln O Z a w Z Z of Z Q Q Ln Z O N Q z w 3Ln CA �, '' W a N ° a ~ _ a s C LA OJ Q W 0 Q Z C 0 0 W Z W Z U a LL W 3 VI J 0 o z 3 W o Q S W W O W Q Y = 2 a O Z Q 0 3 a Y Z Ln H H W I Q } I- W U H H 0. Ct ~ U > > 0 Z = 0 H W QCA a m m o c LL °x x g g 'n � 3 3 3 o a 3 SUB BSMT. BASEMENT AST FLOOR 2"D FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR STH FLOOR � Check One Only Certificate# Installing Company Name: [�{ W�,L.C.,�, ❑Corporation Address: L City/Town: l�V State: V ' 1 U' ❑ p, Partnership BusinessT�, ��}}C CJ!lam•6-� 1 Fax: ltd,���� 'Firm/Company Name of Licensed Plumber: 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 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 Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent 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 installations performed under the permit issued for this application will be in compliance with all Pertinent provision of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. � r By Type of License: 11AIAA4", 4--1 Title ❑ Plumber Signature of Lic sed Plumber Q' City/Town ❑Master License Number: 7 ! U APPROVED OFFICE USE ONLY ❑Journeyman t� CONTROL# H 0 8 7 6 3 7 IMPORTANT If this license is lost of destroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 710,Boston,MA 02118-6100, r If your name or address shown is changed, notify + �. g fy your board of correct name or address to insure proper mailing of next Renewal Application. Always refer to your license number. This license is subject to the provisions of the General Laws , as amended. It is a personal privilege,and must not be loaned or assigned to any other person. Keep this Iice6se on your n r '' person or posted as required by law. WARNING THIS DOCUMENT HAS ENHANCED SECURITY FEATURES ' 'r r u ZI/i0'/50. 8�it-51 �7d QSry: i� f i 0, d,W 1210 6 dal 21 �MN C f r OJ.3St`f3�l�F�Ap8y3H�"S311S5L: ��.s�u�7d Nttf�Vk3N�rtor a�:e �3S�3�t7 i u��nt ass -- Sb'W d0 j