HomeMy WebLinkAboutFire Sprinkler permit - Sprinkler Permit - 39 HIGH STREET 5/24/2013 R
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APPLICATION FOR PERMIT
City or Town DEG SAFE NUMBER
Date
Start Date:
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section
by application is hereby made
(Farfi name of person.Foam or Corporation)
Address i
f�' ( 1 (_ ,
(Street orP.O. x)(city orToavn)
For permis ion to ( a clearl ,purpose for which permit is requested) uao
Name of competent operator (If Applicable) lei
i Cert. No.
Date Issued-rejected By
(Stgnsture of Appllcant)
Date of expiration Fee
z--- _—i ,_.__--_._.—..._ --_...._— _.._ __ $ Paid Due
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PERMIT
City or Town _ �,'�''����""
DIG SAFE NUMBER
Date_v /
r
Permit Number(if applicable) Start gate:
In accordance with the provisions of M.G.L. Chapter 148, as provided In
1 r this permit is granted
to
n /
(Full name of person,Firm or Corporation)
for
J
Restrictions:
at 3 � ra
(Give locatlonb�r.asap-aad no.,or describe in such manner as to provide adequate identtf Jon of location)
Fee Paid $ oe7
This Perm t expir one loe
Signature of Official Granting Permit l
Title
This permit'.must be conspicuously posted upon"the premises
' SC-004508r,
PAUL T SWANF"ELDT
9 RICHARD ROAD
BURLINGTON MA 01803
04/21/2014