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HomeMy WebLinkAboutLP aboveground storage tank permit - LP Gas Tank - 78 PALOMINO DRIVE 10/7/2015 r NF ri.2�2vL!!fiZ.'-P '��z���.�n_�' ✓l u.',��`-�..," �i;�/.� 1 1025, : //�0-1776" �M sve D(G SAFE NUMBER. Date` APPLICATION F" FERMIT STARTDATE: C.82 S,40 M.G.L. To: Head of IFire Department: ko City/Town In accordance with the provisions of Chapter 148,M.G.L. as provided in Section application is hereby made by: Name: 1 d t• (Full name ofperson,Fmn or corporation) Address: (Street or P.O.Box) i (Civrown) (State) ('Zip Code) For Pen?7.ission to:` _ �_ <7 �' _ •- � �'� � �d .r,c �r��� ,1'")6_ State clearly the purpose for which the permit is requested: 114 Location: 1� Name of competent operator if applicable: GAF,. "! r " Certificate of Competency#: (; 2 Date Issued { } Date Rejected { }: By: Date of Expiration: Fee Paid { } Fee Due { } Amount: ApplicantSignature: ` t 'ems ; . Fire Department Number: (IPApplicable) ❑0 0 0 3 n 0 0 a M a 0 0 la Q 0 0 0 0 6 0 0 0 a 0 0 0 0 0 0 n 0 0 a Q U 0 0 0 a 0 0 a 0 0❑❑Ct 0❑q-tl 0 0 n 0 ra M U 0 C9❑U 0 0 0 0 R.D M❑q❑©M Q 0 13 R 0❑0 0 0 9 0 0 0 U 0 ' l-'�!'!K 4 �Z�r/�(.�.C{� � �✓!/�GG��W(/GCC6�LLe ,�-.. _ ° e/wirn�nC o�C? ore �urvcceb-(/ cce a� 2eGcr�e -�sxe �/ 2a� sv6„° ]PERMIT DIG SAFE NUMBER lC Date: / t E tt�MIT �e 82 SA 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: CA "(Full ame of p rson,firm or core ation) or Permission to: S�4 s �^ �: r c -d �� State clearly the purpose for which the permit it-granted: `" Restrictions: l Location: Fee paid: This Permit 1 Expire Qn' Si=nature and Title of Official Granting Permit: Sitewalk Checklist for Sketch Sketch Checklist D Tank to House D Leech Bed o All Windows that apply D Second Sage Regulator o Driveway o All Doors that apply to Windows o Temporary Tank Location o All Sources of Ignition o Second Stage Regulator c Only 1 temporary tank o Second Sage Regulator to Doors needed/allowed o All..Measurements o Second Stage Regulator o 2 temporary tanks o Tank 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): .ode r ?coed 3— As rk,t- el-, d 4 l--rla C V I(,. - e-x- - dc- f Office Notes/Correspondence (customers/technicians/other customers): Sitewalk Drawing: . �lrv;r"YC-Q 8