HomeMy WebLinkAboutFire Sprinkler permit - Sprinkler Permit - 11/7/2012 FP6(rev.3/00) V- ✓VQ� 90��� U L C! i �OGL� C'%LL0�77�
APPLICATION OR PERMIT
=Date:
UMBER
City or Town g
Date /—- ;— R/
1
In accordance with the provisions of M.G.L. Chapter 148, as provided in Section application is hereby made
(Full name of person,'Firm or Corporalian)
Address ZYC 9 )
(Street or P.O.Box)(City orTawn)
For permission to (state clearly purpose for which permit is requested) 1� 1t— I`V12 c GZ. J 2' . �.
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Name.of,competent operator(If Applicable) o Cent. No.
Date Issued-*e . — ~� By
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(Signature of Applicant)
Date of expiration � Fee $ Paid Due
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3(rev.3/00) . ✓vOZ % �G�� �%� fXGc�� V , �ila�7�5
FEND°
City or Town i%�14 - - j U1 DIG SAFE NUMBER
Date
:Start Date:
Permit Number (if applicable)
In accordance with the provisions of M.G�.L. Chapter 146, as provided in this permit is granted
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(Full name at person,Firm or corporation)
`Or I") .7
restrictions:
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(Give location by street and no.,cr describe'in such manner as to provide adequate identification of location) .
=ee Paid $ This Permit will expire on
Signature of,Official Granting Permit Title
_. I ---. -.1 .——. 1 ai rn 7l
Department of 6c Safety
One Ashburton Place, Rm 1301
Boston, Ma 02108-1618
License: Sprinkler Contractor License
Number: SC 006924 Expires:03/10/2013 Restricted To: 00
EDDY CARON
41 TIRRELL HILL RD
GOFFSTOWN, NH 03045
Tr.no: 631.0
Keep top for receipt and change of address notification.
DPS-CA1 0 35M-1 0/09-1 01 62009LICENSEFORMI