Fillable Commonwealth of Massachusetts Application For Plumbing Corporation Certificate

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Commonwealth of Massachusetts Application For Plumbing Corporation Certificate

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The Commonwealth of Massachusetts Application For Plumbing Corporation Certificate form is 2 pages long and contains:

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  • 8 check-boxes
  • 27 other fields

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File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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The Commonwealth of Massachusetts
DIVISION OF PROFESSIONAL LICENSURE
BOARD OF STATE EXAMINERS OF PLUMBERS AND GAS FITTERS
1000 Washington Street, Suite 710 – Boston, Massachusetts 02118-6100
TELEPHONE: (617) 727-9952 FAX: (617) 727-6095 TTY/TDD: (617) 727-2099 http://www.mass.gov/dpl
PLUMBING CORPORATION LICENSE APPLICATION
$225.00 Application Fee by check only – Payable to “Commonwealth of Massachusetts”
MUST BE FILLED OUT BY THE MASTER PLUMBER OF RECORD
PLEASE PRINT CLEARLY
I would like to:
Apply for a New Plumbing Corporation License
Change the Master Plumber for an existing Corporation License
Application Date:
_
Master Plumber:
Last Name First Name MI
Address:
Street Number & Name City/Town State Zip Code
License Information:
Master License Number Original Date of Issue Serial Number on Master License
Full Name of Business:
Business Address:
Street Number & Name City/Town State Zip Code
Business Federal Tax identification Number (FIEN):
Business Phone: Cell Phone: email:
Social Security Number (Mandatory):
_
Date of Birth: _
Pursuant to G.L. c.62C, s. 47A, the Division of Professional Licensure is required to obtain your social security number and forward it to the
Department of Revenue. The Department of Revenue will use your social security number to ascertain whether you are in compliance with the tax
laws of the Commonwealth.
How many years has this company been incorporated?
If the company is currently doing business under another name (DBA) please provide the name on the line below:
I certify, under pains and penalties of perjury the information provided on this form is true and accurate:
Signature of Master Plumber Date
FOR ALL CORPORATIONS
YOU MUST INCLUDE THIS CHECKLIST WITH YOUR APPLICATION
I have included with this application a signed and stamped copy of the Articles of
Organization from the Secretary of State for the Commonwealth of Massachusetts
The installation of “PLUMBING WORK” is clearly stated as one of the disciplines in the
Articles of Organization from the Secretary of State for the Commonwealth of
Massachusetts
As the applicant and the Master Plumber of record, I am listed as an Officer of the
Corporation. (Directors are not acceptable)
I have included the $ 225.00 non-refundable application / license fee payable to the
“Commonwealth of Massachusetts”
IF YOU ARE CHANGING THE MASTER PLUMBER OF RECORD ON AN EXISTING
CORPORATION REGISTERED WITH THE BOARD, AND WOULD LIKE TO RETAIN
YOUR CURRENT CORPORATION LICENSE NUMBER YOU MUST ALSO COMPLETE
THE CHECKLIST BELOW
If the former Master Plumber has been terminated or resigned: I have included with this
application a notarized letter showing that the former Master Plumber of record has
resigned, been terminated or is otherwise disassociated from this Corporation and the
reason you wish to keep the existing Corporation License Number
If the former Master Plumber has passed away: I have included a copy of the death
certificate for the former Master Plumber of record.
I have included the current Corporation license issued to the former Master Plumber of
record in this application.
I have included a copy of the amended Articles of Organization showing my appointment as
an officer of this Corporation with in this application.
Mail your completed application to:
Board of Examiner of Plumbers and Gas Fitters 1000
Washington Street – Suite 710
Boston, MA, 02118-6100
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Commonwealth of Massachusetts Application For Plumbing Corporation Certificate

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Completed 8 May 2020

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