HomeMy WebLinkAboutLP Permit - Combustible Storage Tank - 8 EVERGREEN DRIVE 3/1/2016 Kla,,,ac/aaa z
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DIG SAFE NUMBER.
Date: � - APPLICATION FOR.PERIHT
START DATE:
C. 82 S.40 M.G.L. i
To: Head of Fire Department: AN) t)� '3f'•c�3' ' -
City/'Town
In accordance with the provisions of Chapter 148,M.G.L.as provided in Section application is hereby made by:
Name:
(Full name ofperson,firm or corporation)
Address: � s '� v�/' r.c>.- sr l' #
(Street or P.O.Box) (City/Town) (State) (Zip Code)
For Permission to: t� / >�-
State clearly the purpose for which the permit i rl�juested:
.Location: r �?
Name of competent operator if applicable: _ 3 Certificate of Competency
Date Issued{ } Date Rejected { }: ( By:
Date of Expiration: Fee Paid { } Fee Due { } Amount:
Applicant Signature; 7, ,g _ Fire Department Number: .
(If Applicable)
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Dio SAFE NUMBER
Date: ]PERMIT
C.82 S.40 M.G.L. START DATE:
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section this permit is granted to:
game:
'(Full name of pcqbn,fum or corporation)
For Permission to:,,.T'r'rc--k-zL --
State clearly the purpos for which the permit is ted:
Restrictions' d it's v /wiz di•"� r���G- /`��� �i��Ut v� ��t£
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Location:
Fee Paid: en pire On:
Signature and Title of Official Granting Permit: ° � �
Sitewalk Checklist for Sketch
,ketch Checklist: o Tank to House o Leech Bed
o All Windows that apply o Second Stage Regulator o Driveway
o All Doors that apply 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 neededfallowed
o All Measurements o Second Stage Regulator o 2 temporary tanks
o Tanl 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):
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Office Notes/ Correspondence(customers/technicians/other customers):
Sitewalk Drawing:
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