Fillable Commonwealth of Massachusetts SM-VOC School Approval Form

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Commonwealth of Massachusetts SM-VOC School Approval Form

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BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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Commonwealth of Massachusetts
OFFICE OF CONSUMER AFFAIRS
DIVISION OF PROFESSIONAL LICENSURE
Board of Examiners of Sheet Metal Workers
1000 Washington Street, Suite 710
Boston, MA 02118-6100
PROJECT APPROVAL APPLICATION
PROJECT APPROVAL APPLICATION 2011 1
APPLICATION FOR APPROVAL AUTHORIZATION TO PERFORM SHEET METAL WORK
BY STUDENTS OF A STATE AIDED ALL DAY VOCATIONAL SCHOOL
PLEASE NOTE: THIS APPLICATION IS NOT APPROVED UNTIL A BOARD STAMPED APPROVAL
AUTHORIZATION IS RETURNED TO THE SCHOOL ADMINISTRATOR OR DESIGNEE.
LOCAL SHEET METAL PERMITS and INSPECTIONS ARE REQUIRED
NAME OF SCHOOL: TEL:
ADDRESS: CITY: STATE: ZIP:
Has this lesson been approved by the local school administration? Yes No
(A COPY OF THE ABOVE LESSON APPROVAL MUST ACCOMPANY THIS APPLICATION.)
Name of Licensee who is employed by the school as the Massachusetts Instructor/Department Head
who will be the Sheet Metal Permit Holder of Record for this Project:
Name: Master License No. or Journeyman License No.
Address:
_____________________________________________________ Date: _______________
(mm/dd/yyyy)
Sheet Metal Department Head: (Signature Required)
MA
Vocational School
PROJECT APPROVAL APPLICATION 2
LESSON/PROJECT LOCATION INFORMATION
Name and Address of Parties for whom work is to be performed:
Name and Address of Project Lesson Location:
Type of Project Lesson: [Briefly explain Sheet Metal fixture(s) appliance and equipment installation.
Include: Types of materials to be used.
If Applicable to the Anticipated Project:
(A COPY OF THE LOCAL BUILDING PERMIT AND SHEET METAL
BLUEPRINTS/DRAWINGS MUST ACCOMPANY THIS APPLICATION.)
1. Type of Building: Residential New Old
2. Number of Stories: 1 2 3 4 Other
3. Basement: Yes No
4. What is the projected date to begin the Project? (mm/dd/yyyy)
5. What is the projected date of completion? (mm/dd/yyyy)
Students Shall perform work at the project lesson site accompanied by and under the direct
supervision of an Instructor who is a Massachusetts licensed sheet metal worker in the
employment of and authorized by the Educational Institution of record in this document.
Vocational School
PROJECT APPROVAL APPLICATION 3
Briefly Explain:
(A) How is this Project Lesson intended to benefit the students of your Program?
(B) How will Students be permitted to participate in this Project Lesson?
(C) What Grade Levels will Participate?
(D) What is the Number of projected Students Per Sheet Metal Instructor at the Project Lesson Site?
(E) Additional Licensed Massachusetts Instructors for this Project:
Name: Master/Journeyperson License #:
Name: Master/Journeyperson License #:
Name: Master/Journeyperson License #:
Name: Master/Journeyperson License #:
FOR OFFICIAL BOARD USE ONLY
APPROVED BY: _________________________________________
DATE: _____________________
BOARD APPROVAL STAMP
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Commonwealth of Massachusetts SM-VOC School Approval Form

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Completed 15 May 2020

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