HomeMy WebLinkAboutLP aboveground tank - LP Gas Tank - 20 MOUNT VERNON STREET 12/29/2015 i
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Dic SAFE NUMBER.
Date: ��m,� �� �` APPLICATION F(OR.PERM T
� START DATE:
C. 82 5.40 M.G.L. ;1'
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To: Head of.Fire Department: A)Q TY?e( o,-.-e!'
City I Town
In accordance�rwii�th the provisions of Chapter 148, M.G.L. as provided in Section application is hereby made by:
Same:
(Full name of person,firm or corporation)
Address: � c
(Street or .O.Box) ( ityrrown) I rate} (Zip Code)
For Permission to: .J c d /' G r a ke -�o(",, -Ir.elvJ�r-
State clearly-the purpose for whic the permit is re ested:
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location: �` A
Name of compete operator if applicable: c t'AEG� c Ce ificate of Competency#:
Date Issued{ Date Rejected { }: Alt -SO^/s By:
Date of Expiration: ra C/ Fee Paid}-Fee Due { } Amount: S—ZI
Applicant Signature: , Fire Department Number: .
(If Applicable
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Drc SAFE NUMBER
Date: PERMIT
G. 82 5.40 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:
Name: )7�Hyss ee-Jr-e 6-e M- ai 1ec1
(Full name oJfperson,fum or corporation)
For Permission to: 4�lr� m ' C,,-,14,, -ev ✓ �c� a a
Stale clearly the purpose foy�which the permit is ranted:
Restrictions: I a2 r,;-3, 4 0 7 ,�fitr�.✓ �S ,`S Sv�� ti' i
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Location: C ►* !�'�''s°^ c �t
^ee Paid: %'/ This Pe t ill Ex.ire Oa. --
3ignature and Title of Official Granting Permit: