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INSURANCE COVERAGE:
I have a current liability insura e policy or its equivalent which meets the requirements of
M.G.L. Ch. 112 Yes insura
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If you have checked Yet 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 112 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 •
By checking here4 ,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 sheet metal work and installation performed under the permit issued for this application
will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws.
Inspections shall be called for prior to insulation installation.
Duct inspection required prior to insulation installation: Yes No
Date: Comments:
Date: Comments:
•
Type Icense: /�
By: • - Master •
• Title: Master-Restricted t Signature of Licensee t
• City/Town: Journeyperson - - ^'/
Permit#: Journeyperson-Restricted License Number: 9� /
Fee: $ Check at www.mass.gov/dpi
t Inspector Signature of Permit t -
of Permit Approval
eJ
State Offices&Courts State A-Z Topics State Forms Accessibility FAOs
...k M Oficial website of the Commcoweenh of Massachusetts
`s,•u } eLicensing and ePermitting Portal
Need Help?For technical assistance in using this web application,please call the Announcement.l Reoister for an Account I Lmiin
ePLACE Help Desk Team at(844)733-7522 fir,or(844)73-ePLAC between the Search._ i1.1
hours of 7:30 AM-5:00 PM Monday-Friday,with the exception of all Commonwealth
and Federally observed holidays.If you prefer,you can also e-mail us at
ePLACE helodesk@Ostate.ma.us.For assistance with non-technical issues,please
contact the issuing Agency directly using the links below. •
Contact Alcoholic severaoes Control Commission
Contact ev i-'•. e , u. • ..-. :.. u •t:n -
Contact Department of I ebur Standards
Contact Division of Professional Licensure
Translation Information•Click Hers
To apply for an Energy and Environmental Affairs(DEP,MDAR or OCR)permit or
license,please click here.
Document Attachment:In order to upload required documents,this system
requires Microsoft Silverlight,which can be downloaded for free here,
Convenience Fee:Please note there may be a convenience fee for all online credit
card transactions.There is no fee for online payment by check.
Home Manage Licenses,Permits&Certificates File&Track Complaints
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Please refer to the Licensing EMitjs website for additional information regarding the stales and discipline information shown below.
For DPL Information,please Wait the DPI.website.
For ABCC Information,please visit the ABCC websitt
Information Pertaining To: •
Sheet Metal Master 9674 • - '
•
Licensee Detail •
License Number: 9674
Licensing Entity: Board of Examiners of Sheet Metal Workers
License Type: Sheet Metal Master
Type Class: MI
License Issue Date: 04/12/2011
License Expiration Date: 11/28/2020 Status: Current
Current
Discipline:• .
Prior Discipline:
Name: MICHAEL 3 WELNINSKI
Business Name:
DBA Name:
► Public Documents
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02015 Commonwealth W Massadiuseils. Mass.Caos®Site Poides
Mass.Gove is e registered aware met(AIM eommnnwe.eh of Massachusetts.