Fillable Form 87-11 - REV 5-15 - Master Plumbers License Application MPL - 1

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Form 87-11 - REV 5-15 - Master Plumbers License Application MPL - 1

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TOWN OF HUNTINGTON
APPROVED:
NEW
RECIPROCAL
TO THE PLUMBING LICENSING BOARD:
Name:
Street Address:
City:
Tel. No.:
Date of Birth: Email:
Years employed as a journeyman Plumber:
Years as Master of Employing Plumber:
Location of Shop: Years Operated:
Names and addresses of licensed or unlicensed plumbers who have employed you to do plumbing work at any time during
the past 7 years, or if self-employed, give 3 references who know you have been in business for 7 years:
Are you at present conducting business or doing Plumbing work on your own account?
Have you read and do you understand the plumbing licensing ordinance of the Town of Huntington?
Yes No
Business Name & Location:
Are you now licensed?
Bus. Tel. No.:
Lic. No.:If so, where?
STATE OF NEW YORK
COUNTY OF SUFFOLK
SS:
}
Address:
I here declare, under oath, that I fully understand and have answered all of the above questions truthfully, that I am the person
who is to be examined if examination is required and that I have affixed my signature to this application.
Signature of Applicant
Sworn to me this day
of , 20
Notary Public
(OVER)
Zip Code:State:
FORM 87-11 - REV 5/15 - pg.1
Email:
VOUCHERS TO BE COMPLETED ON ALL APPLICATIONS FILED AFTER
June 14, 1968
BOTH VOUCHERS MUST BE LICENSED AND REGISTERED PLUMBERS
(Not Required For Reciprocal Licenses)
CERTIFICATE NO. 1
STATE OF NEW YORK
COUNTY OF SUFFOLK
SS:
}
I hereby swear that I am engaged in the plumbing business and that I have employed, (I have known)
the applicant herein as a Master Plumber (Journeyman Plumber) from
; that I have found him/her to be competent, industrious; and that I considerto
him/her qualified to be a Master Plumber.
I further swear that I have read the statements made by him/her in this application and I believe them to be true.
Remarks:
Place of Business: City (Village):
Current Year Plumber's License No.: Issued City (Village):
Certificate of Competency No.:
Sworn to me this day
of , 20
Notary Public
Plumber's Name (Please Print)
Plumber's Signature
Residence
CERTIFICATE NO. 2
STATE OF NEW YORK
COUNTY OF SUFFOLK
SS:
}
I hereby swear that I am engaged in the plumbing business and that I have employed, (I have known)
the applicant herein as a Master Plumber (Journeyman Plumber) from
to
I further swear that I have read the statements made by him/her in this application and I believe them to be true.
Remarks:
Place of Business: City (Village):
Current Year Plumber's License No.: Issued City (Village):
Certificate of Competency No.:
Sworn to me this day
of , 20
Notary Public
Plumber's Name (Please Print)
Plumber's Signature
Residence
FORM 87-11 - REV 5/15 - pg.2
; that I have found him/her to be competent, industrious; and that I consider
him/her qualified to be a Master Plumber.
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Form 87-11 - REV 5-15 - Master Plumbers License Application MPL - 1

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Completed 13 July 2020

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