Petitioner: Applicant Information
Rooming House & Manager Information
| Name of rooming house |
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| Rooming house address |
439 Broadway, Chelsea MA 02150-2802
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| # of floors |
2
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| # of rooms |
12
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| # of lodgers |
12
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| Rooming House Telephone |
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| Manager Name |
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| Manager Home Address |
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| Manager Telephone |
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| Manager Email |
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Renewals (please complete all fields if this is an application for a renewal)
| If this is a renewal, has any information changed from your original license application? |
No - renewal without changes
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Owner Information
| Owner Name |
Jimmy Chan
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| Home Address |
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| Home Telephone |
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| Owner Email |
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Principal Officers (if owner is a corporation)
| President Name |
Jimmy Chan
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| President Address |
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| President Telephone |
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| President Email |
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Certificates (required)
| Certificate of Worker’s Compensation OR Certificate of Compliance (must be notarized) |
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| Wage Theft Certification Form |
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| Certificate of occupancy or application for same |
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| Business Certificate or Articles of Organization |
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| Certificate of Good Standing from the Massachusetts Department of Revenue; |
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Petitioner: Acknowledgement
Applicant Certification
| I have read and agreed |
Yes (Yes - accept terms and conditions)
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| Federal ID Number |
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| Enter telephone number |
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City: Document Check
Document check
| All documents submitted |
All documents submitted
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Application fee review
| Application fee status |
Not required (renewal application)
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City: Internal Tracking
City Tracking
| License Commission Review Date |
2020-12-10
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| License Commission Decision |
Award License
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City: Issue License
City Tracking
| License application result |
Approved (issue license)
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