HomeMy WebLinkAboutPermit to Dispense Propane - Permits - 50 PETERS STREET 8/4/2016 The 'ommonwealth of Massachusetts
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Fire Servces
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Office of the State Firs Marshal
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P. .Box 1 ta. o[d, '
APPLICATION FOR PERMIT Date:
0 Permit N
City or Town If Applicable) Dig Safe Number
In accordance with the provisions of M. _L. Chapter a
provid Se 'on application is hereby made tart to
by .
W11 n e of��on,Finn or Corporation
Address � � � � 6Ijb6ilEv
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State clean ��
Pose for (Street or P.0.13ox City or Tom.)
r w e permit For pern isgion to ��1)pjvc,
is requested LyLd
Comments:
at
Give location by street and no.,or describe in such mmner as to pro-vied adequate identification of location.
Name of competent operator Cert.No.
(If Applicable
Date Issued
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fgaatLz� �pl�G�z�t
Date o e o Fee Paid Due
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The Commonwealth of MassachusettsF
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Department of Fire Services
Office ofthe State Fire Marshal
P,0.Box 1025 State Road,Stow,MA 0 1775or —7
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IV.ef�g!d� Permit No PERMIT Date:
City of Town Apphcabli Dig Safe Number
In accordance with the provisions of KG.L. Chapter as provided in section
P, — Sty Date
This Permit is granted to .1.1.1-------ljc
name of person,Firm or Corporation
Pe %sion to
Comments:
Restrictions- NOPRODUCT PLACED ON SITE UNTIL PERMTT ISSUED BY FIRE DEPT.
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(Give location by street and no.,or describe in such manner as to pro-vied adequate identification of location)
m Paid.
This Pormit will expire Signa a ran ng pert OffiC grantmg per t Title
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