HomeMy WebLinkAboutLP Permit - Combustible Storage Tank - 825 DALE STREET 2/26/2016 �r
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DIG SAFE NUMBER,
.Date: a-, 5 APPLICATION FOR.PERMIT sTARrDATE:
C.82 S.40 M.G.L. 1_ t
To. Head of Fire Department; \ A r1 d a op c y n A
City/Town
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section� application is hereby made by:
Name: ,�^J
// (Full name ofperson,fum or corporation)
Address: s,n�rYl�i�[,��tScr l '--���P L /'i�nC e
(Street or P.O.Box) (City/Town) (State) (Zip Code)
For Permission to: " Cn ,t,ra r
State clearly the purpose for which the permit is re uested:
Location: DC)Te �
Name of competent operator if applicable:J vqv ` Certificate of Competency
Date Issued{ } Date Rejected { }: By:
Date of Expiration: Fee Paid { } Fee Due { } Amount:
Applicant Signature: 11 r, ,��,�,, , ,;; Fire Department Number: .
If Applicable)
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Dafe: / _ ,2 ` 5 ]PERMIT
DIG SAFE NUMBER
C.82 S 40 START DATE;
In accordance with the provisions of Chapter 148,M.G.L. as provided in Section this permit is granted to:
/ t "(Full name of Jerson,turn or corporation) I
For PenTllssion to: 1 "1 q4,1?UP_f f)-
State clearly the purpose for which the pe ` is granted:
Restrictions: D /lo v�T 4 �d� i L/v£iL
J
Location: 5 �C tl
Fee Paid: s P ill Expire Oj
Signature and Title of Official Granting Permit:
Sitewralk Checklist for Sketch
,:etch Checklist: rank to I louse o Leech lied
3 .III Windows that apply o Second Stage Regulator o Driveway
0 III Doors that apply to Windows 0 remporary rank Location
o %li Sources of Ignition o Second Stage Regulator o Only I temporary tank
a Second Stage Regulator to Doors needed allowed
:3 All Sfeasurcmcrits o Second Stage Regulator o '_ temporary tanks
o Tank to Windows to Sources of Ignition needed
o rank to Doors o Second Stare Regulator
o Tank to all Property Lines to rank(including
o rank to Sources of temporary tanks where
Ignition .applicable)
Comments(notes from technician to ogee):
Office Notes/Correspondence(customers/technicians/other customers):
1k; 0 ;,
Sitewtalk Drawing:
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