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Home My WebLink AboutMiscellaneous - 381 STEVENS STREET 4/30/201851.1 Date.................1.�................ TOWN OF NORTH ANDOVER PERMIT FOR WIRING This certifies that 'i ii JcawU . has permission to perform .. yv {� S+i ....................................................................................... wiring in the building of.....;..i /~.` C"dire �-- at ..........3�.. \ ? v a �5 5 :...................... orth Andover, Mass ......................................................... ee . ...... Lic. No. 2o.... ..."".11 ........... ........ . ELECTRICAL INsPECTo ;Check # Z-- 11568 Commonwealth of Massachusetts Official Use only y Department of Fire Services Permit No. i — Occupancy and Fee Checked BOARD OF FIRE PREVENTION REGULATIONS [Rev. 11/991 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 IN INK OR TYPE ALL I7VFORMATIOl9 Date: 616-g g City or Town of: Alh r I h A yPr To the Inspector of Wires: By this application the undersigned gives notice of his or her intention to perform the electrical work described below. Location (Street & Number) -981 STtvtyl s 6� Owner or Tenant \), y Telephone No. q7 Fr -61(,9-_'](641K Owner's Address 2,0 eoxh MA 01 kJ , Is this permit in conjunction with a building permit? Yes Ef No ❑ (Check Appropriate Box) -7Z1--1� Purpose of Building S i /� y Utility Authorization No. 1 W 86 p 67-7 14 Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service a �00 Amps IZO / AgOVolts Overhead ❑ Undgrd No. of Meters Number of Feeders and Ampacity R 4 Location and Nature of Proposed Electrical Work: �(/p to �1u� S2 S�t+i�t �Gv►��'ly Completion of the following table may be waived by the Inspector of Wires. No. of Recessed Fixtures No. of Ceil: Susp. (Paddle) Fans No. s Total Transformers KVA No. of Lighting Outlets No. of Hot Tubs Generators KVA No. of Lighting Fixtures Swimming Pool Above ❑In- El rnd. rnd. o. o Emergency Lighting Batteg Units No. of Receptacle Outlets No. of Oil Burners FIRE ALARMS No. of Zones No. of Switches No. of Gas Burners o. o etean InitiatingD Devices No. of Ranges No. of Air Cond. Total Tons No. of Alerting Devices No. of Waste Disposers Heat Pump Number I. Tons I KW I No. of Self -Contained Totals: Detection/Alerting Devices No. of Dishwashers Space/Area Heating KW Local ❑ Municipal ❑ Other Connection No. of Dryers Heating Appliances KW Security Systems: No. of Devices or Equivalent No. of Water KW o. of No. of Data Wiring: Heaters Signs Ballasts No. of Devices or Equivalent No. Hydromassage Bathtubs No. of Motors Total HP Telecommunications Wiring: Na of Devices or Equivalent OTHER: Attach additional detail if desired, or as required by the Inspector of Wires. INSURANCE COVERAGE: 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 cov ge is in force, and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE QTBOND ❑ OTHER ❑ (Specify:) /Vi,(J, (Zob�e(- S 7 1IS-I13 (Expiration Date) Estimated Value of Electrical Work: 4 110;000 (When required by municipal policy.) Z Work to Start: S17 (13 Inspections to be requested in accordance with MEC Rule 10, and upon completion. ti I certify, under the pains and penalties of perjury, that the information on this application is true and complete. FIRM NAME: I UO(--tc LIC. NO.: 1001—r Licensee: Signature LIC. NO.: 20WA A r (If applicable, enter "exempt" in the lice a number line.) Bus. Tel. No.,• Address:_o29$,lyer Qarook Q� S�tieW� Al H' 030701 Alt. Tel. No.:177t-747-0748 OWNER'S INS-- ---- -- -- -- - - required by law Owner/Agent Signature — LFxANCE W Al V Eke. 1 am aware that the Licensee does By my signature below, I hereby waive this requirement. Telephone No. not have the liability insurance coverage normally I am the (check one) ❑ owner ❑ owner's agent. PERMIT FEE. $ `� _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Uwww mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 6M8 altuwaz Address: QA S,1%-,xer 6 rook Q -c\- SoA4Yv% W E+ 03 075 Citv/State/Zit): A14, 03 079 Phone #: q7t —7G?-O?4f Are you an employer? Check the appropriate box: Type of project (required): L ❑ I am a employer with 4. E] I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling 2. L"J I am a sole proprietor or partner- ship and have no employees These sub -contractors have g. Demolition workingfor me in an capacity. Y P h'• employees and have workers' 9. E] Building addition [No workers' comp. insurance required.] comp. insurance. � 5. F-1 We are a corporation and its 101-1 Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12. ❑ Roof repairs insurance required.] t c. 152, § 1(4), and we have no 13.❑ Other employees. [No workers' coma. insurance reauired.l *Any applicant that checks box #I must also fill out the section below showing their workers' compensation policy information. f 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 state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. - I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /A P , R6�a,¢ (tS T nS. Policy # or Self -ins. Lic. #: 6 W C1 aq 1070q Expiration Date: Job Site Address: L/ CE1 S- -fvert.S 54 A. A✓ Gov te- City/State/Zip: O l f 4S - 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 ,fof 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 thepains and penalties of perjury that the information provided above is true and correct Phone #: 97t - 7 &1-0-7 912 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 #: This certifies that .✓.... ........................... has permission to perform ... 0—o ... ST{ I plumbing in the buildings of. G,,\/.-9,.. K :,,�Q !C'r,e at ...... .. '.� -�, :. , , , ... , North Andover,} Mass. Fee. . Lic. No..� 2 .. !M ................. .. . PLUMBING INSPECTOR Check #- ) D t S �� 7 Z� — 1 � ✓�, 5� 31 i 3 INSURANCE COVERAGE: 41 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO M IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ®I 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 —i AGENT 0 SIGNATURE OF OWNER OR 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 beinRS)npliance vyl Pertinent sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER'S NAMEI�LICENSE # .f�� SIGNATURE MP n JP S CORPORATION F14 PARTNERSHIP 01 #= EI COMPANY NAME ADDRESS CITY �,,¢� 'STATE lrl,¢�� ZIP Q/ TEL FAX _ (CELL EMAILsp N MASSACFIUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM PLUMBING WORK POWNER TYPE OR PRINT CLEARLY CITY i6ov v r _ MA DATE "-1 G 3 I PERMIT # JOBSITE ADDRESS OWNER'S NAME ADDRESS _ _ TEL FAX j OCCUPANCY TYPE COMMERCIAL Q EDUCATIONAL ® RESIDENTIAL Q—�— NEW: RENOVATION: E] REPLACEMENT: Ell PLANS SUBMITTED: YES NOQ FIXTURES 7 FLOOR- BSM 1 2 3 4 5 6 7 8 1 9 10 11 12 13 14 BATHTUB CROSS CONNECTION DEVICE DEDICATED SPECIAL WASTE SYSTEM DEDICATED GAS/OIL/SAND SYSTEM ! DEDICATED GREASE SYSTEM DEDICATED GRAY WATER SYSTEM ! _:.._. _! (__ DEDICATED WATER RECYCLE SYSTEM DISHWASHER _! ._._ _ __.._ __._! __^1 ! ._._.__! ____._.__f ___.___) DRINKING FOUNTAIN _ _! ..._._..._.) __...__� ( I �! ! I .-_..__f -_.__...) E ) .__..__.0 ____ ! ....-..._. FOOD DISPOSER FLOOR /AREA DRAIN INTERCEPTOR INTERIOR --I __.___1 L_j - _-..-J _.-___-_) KITCHEN SINK _-__J LAVATORY _ (_....._..J .._..... _.. € ...._—_! ---._.__-) ---_.__1 € _-_._J ) .._...__.) __. ROOF DRAIN ! (i _ ( ! J .__ € ____._! .__..__ 1 -__ f _.__�! 1 (OWER STALL_ _._E SERVICE I MOP SINK TOILET I _j URINAL WASHING MACHINE CONNECTION WATER HEATER ALL TYPES WATER PIPING OTHER f INSURANCE COVERAGE: 41 have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch.142. YES NO M IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE OF INDEMNITY ®I 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 —i AGENT 0 SIGNATURE OF OWNER OR 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 beinRS)npliance vyl Pertinent sion of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. i PLUMBER'S NAMEI�LICENSE # .f�� SIGNATURE MP n JP S CORPORATION F14 PARTNERSHIP 01 #= EI COMPANY NAME ADDRESS CITY �,,¢� 'STATE lrl,¢�� ZIP Q/ TEL FAX _ (CELL EMAILsp N o El z W w LU LL s The Commonwealth oflMassachusetts Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El Please Print Legibly, Applicant Information Name (Business/Organization/fndividual): 611-V Address: e-1 City/State/Zip: oVViPo4� �y Gyt�4 S SPhone #: �' �� `�/ ?/ Are you an employer? Check the appropriate box: 4. El am a general contractor and I I. ❑ I am a employer with em I . s (full and/or part-time).* have Hired the sub -contractors listed on the attached sheet. 2, am a sole proprietor or partner- ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. C. 152, § 1(4), and we have no employees. [No workers' insurance required.] r comp. insurance required.] Type of project (required): 6. ew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that checkthis 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 thepolicy and job site information. Insurance Company Name:. Policy # or Self -ins. Lic. #: Expiration 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 requiredunder 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 maybe forwarded to the Office of Investigations of the DIP, for insurance coverage verification. Ido hereby certi rider the pal and penals of perjury that the information provided above is tr a anti correct. Date: Signature: t offccial 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 #: CONTROL #. H IMPORTANT i this license is Inst oredestroy'-6'd, notify your Board at the: -Division of Professional Licensure, 1000 Washington St., Suite 710, Boston, MA 02118-6100. If your name or address shown is changed, notify 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 license on your person or posted as required by law. 9 Date . 1! .... . TOWN OF NORTH ANDOVER PERMIT FOR GAS INSTALLATION I } S This certifies that . �� . � ! .. � �^..'�.............. . has permission for gas installatiori�.``�/.: `j t . in the buildings of . v e- ...`. `..r. ......:...... . at . ... .. .. . ,North Andover; Mass. Fee `........ Lic. No U-! .ti ... t " t ..: ... _ ....... ... GAS INSPECTOR j Check 4 D ` \1 MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK CITY � _j MA DATE _ ] PERMIT # Z JOBSITE ADDRESSS_/FC/i1lS �. �kloWNER'S NAME GOWNER ADDRESS _ TEL _ _ �______]FAX TYPE OR OCCUPANCY TYPE COMMERCIAL 0 EDUCATIONAL RESIDENTIAL PRINT CLEARLY NEW: 0 RENOVATION: 0 REPLACEMENT: 0 PLANS SUBMITTED: YES F-11 NOD APPLIANCES Z FLOORS— BSM 1 2 3 4 5 6 7 8 9 10 1 11 1 12 13 14 BOILER BOOSTER CONVERSION BURNER _- COOK STOVE �_. ,.� _. r- :a I �_ _.:-1 I _ DIRECT VENT HEATER DRYER FIREPLACE-- FRYOLATOR _ L— .� — — l _ FURNACE GENERATOR GRILLE I .--: ..r E—D =i—^ _..I __V.I i-7—AL—J.__..... .�— INFRARED HEATER LABORATORY COCKS I/w',A,KEUP AIR UNITJII YEN -- T ,HEATER-.-- ROOivj'/SPACE HEATER —f a= � — - - ROOF TOP UNIT TEST UNIT HEATER UNVENTED ROOM HEATER ,_ _. (� WATER HEATER OTHER �, T Y -� INSURANCE COVERAGE I have liability insurance its the MGL. Ch. 142 YES a current policy or substantial equivalent which meets requirements of 'I IF YOU CHECKED YES, PLEASE INDICATE THE TYPE OF COVERAGE NECKING THE APPROPRIATE BOX BELOW LIABILITY INSURANCE POLICY OTHER TYPE INDEMNITY 0 BOND I__f 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 Q AGENT Ej SIGNATURE OF OWNER OR AGENT 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 co nce with a I rtinent pro ' of the Massachusetts State Plumbing Code and Chapter 142 of the General Laws. PLUMBER-GASFITTER NAMELICENSE # l%z8 _ ( SIGNATURE MP GF [;--Jl JP J G F LPG] _.._s CORPORATION 0# E= PARTNERSHIP 0#[ LLC []#� . COMPANY NAME: _Lf��ti-----�II ADDRESS CITY/�__. -----------._ -. STATE ZIP D/. TEL _ �q FAX EMAILSt�_ t, c—; Gc»r�tc it d .✓.. ' ._.:.__..... - - \1 A H O z 0 H U W a w a zoEl O yD } W un � W Ix F a Z U w :m 3 w ~ W CO) W 5 a ® W w C a o a a a � U �y J E. a IL � w x w F- u.. W H z z o U w a C7 - The Commonwealth of Massachusetts Department of IndustrialAceWnts Office of Investigations 600 Washington Street Boston, MA. 02111 Uf www massgov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): A14 -v Address: C-1 City/State/Zip: 'hone #: `�� 2� Are you an employer? Check the appropriate box: 1. ❑ I am a employer with 4. ❑ I am a general contractor and I em loyees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. # 2. am a sole proprietor or partner- ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. i 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 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 requiredunder 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 cert Uder the pai and penal ' s of perjury that the information provided above is tr a and correct. Date: 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 Information and Instruction --s 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 apartments 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-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 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 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 reference number. In addition, an applicant that must submit multiple permit/license 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 bum 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: The Commonwealth ofMassachusetts Department of fadustrial Accidents Office of Investigations 604 Washington Street Boston., SIA 02111 Tei, # 617-727-4900 ext 406 or 1-877rMASSAFB Revised 5-26-05 Fax # 617-727-7749 www.znas%8oV1dia L1CtJ-.Lj -ED C 1SSUEs THE ABO E LICENSE TO x I 2 j.:• 1 NIEL C. FLSFP1ILL.ER �:.�..OL'D`:AAMKEE RD V� MA 0I.a3.2: 1'0:6 '. .1288 05/0.1/14 147729: ,I CONTROL # � H3.55-�+�+ IMPGRTAHT " Gif .this license is. 1;�st ort d,'astroyed, notify your Board at the: Division of Professional Licensure, 1000 Washington St., Suite 790, Boston, MA 021118-6100. If your narne or address shown is changed, notify 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 license on your person or posted as required by law. I .i y{ J / • J 1 f J Check # n 26351 -Z f/Building Inspector