HomeMy WebLinkAboutFire Dept Permit - Permits - 254 GREAT POND ROAD 8/1/2012 FP6(rev.3/00) ✓ .�. 93OLG '®2s, V&' &Road, L.l�Q , ®f775
APPLICATION I
City or Town DIG SAFE NU BER
Date
[Start Date:
In accordance with the provisions of M.G.L.Chapter 148,as provided in Section application is hereby made
by
(Fu®name of person,Fim or Corporation)
Address
(-,*a&orP.O.fox)(cffyor Tom)
For permission
pe to(state clearly purpose for which permit is requested)
Name of competent operator(If Applicable) Cert. No.
Date Issued-roeeted_ t� By
(Signature ofApokent)
Date of expiration Fee 5. 6x� $Paid Due
OkL
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FP6(rev.3/00) 9. Mox -,1025, V&&Road, V�ow, ®'7�5
PERMIT
City or Town DIG SAFE NUMBER
Date
Permit Number(if applicable) FStart :
In accordance with the provisions of M.G.L. Chapter 148,as provided in this permit is granted
to m. to' L' <`i
(FuH name of person,Ffem or Corporation)
for Zra4 !/01-7-.4j� C l itr ,r y/- -7-0
Restrictions: -
at c - a
(Give kxakn bys& m)d no.,or dwcabe in s rch as to provide adaquats dwdfwbm ofbcadon)
Fee Paid$ y3 This Permit will expire on 4/ l Os�(��� ®b�
Signature of Official Granting Permit Title
This permit musts i slpremises 4"