HomeMy WebLinkAboutPermit - Above Ground LP Storage 2016 - Flammable Storage Permit - 79 CAMPION ROAD 8/12/2016 u p /
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C. 32 S.40iVI.G.L, APPLICATION Ij j�` Jtl Lt' �`��� � START DATE: r '
1'
To: Read of Fire Department: }`e � i. �i Ae)uE -f` m
City/Town
In accordance with the provisions of Chapter 148, M.G.L. as provided in Section
application is hereby made by:
Name: / 4' '�n y ` • ) .
(Full name of person,fu•m or corporation)
Address: Alc ., t'�
(Street or P.U.Box)
(State) (Zip Code)
For Permission to: '
State clearly the purpose for which the permit is requested:
•Location: .
Name of competent operator if applicable'
Date Issued Certificate of Competency#: 1
{ } Date Rejected { }: P Y
Date of Expiration: By:
Applicant Signature; Fee Paid { } Fee Due { } Amount:
Fire Department Number: .
(If Applicable)
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Date: `® �_ / D� T�i,T1T�1i� [DlcSSA:FFINI:UMBER
C.82 S.40 M.G.L. ART
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section
this permit is granted to:
Name: � �'�" � •
_ 4-7� LI
'(Full name of persory,rumor corporation)
For Permission to:
State clearly the purpose for which the permit is granted.
6.1
Restrictions:
Location: c jC z
Fee Paid.
Signature and Title of Official Granting Permit: This Permit Will Expire On:
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Sitewalk Checklist for Sketch
Sketch Checklist: o Tank to House o Leech Bed
o All Windows o Second Stage Regulator n Driveway
o All Doors to Windows o Temporary Tank Location
o All Sources of Ignition o Second Stage Regulator o Only I temporary tank
o Second Stage Regulator to Doors needed/allowed
o All Measurements o Second Stage Regulator o 2 temporary tanks
o Tank to Windows to Sources of Ignition needed
o Tank to Doors o Second Stage Regulator
o Tank to all Property Lines to Tank(including
o Tank to Sources of temporary tanks where
Ignition applicable)
Comments (notes from technician to office):
Tank % at time of Sitwalk:
Office Notes/Correspondence (customers/technicians/other customers):
Follow Up (timing on when office should contact the customer):
Sitewalk Drawing:
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