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HomeMy WebLinkAboutLP aboveground storage tank permit - LP Gas Tank - 245 BOXFORD STREET 4/27/2015 (3) C s, w'?'�c'r<.::-acAauae�s �M sv Die SAFE NUMBE.12. Date: _ " APPLICATION FOR-1PERMIT START DATE: C.32 SAO M.G.L. .' To. Head of Fire Department, `u o f lodo 3-p-r � City/` 'own In accordance with the provisions of Chapter 148,M,G.L. as provided in Section application is hereby made by: p // Name: (Full name ofpeerson,firm or corporation) Address: r rPA `CNtc- '<tJ L. .We-Q�"\C-e - le, o (Street or P.O.Box) / /jCitylI own) (State) ('Zip Code) For Permission to:s. f! ""' �/ � Z/ G a' �1 State clearly the purpose for which the permit is requested: Location: Name of competent o e f appIicable: Cf,xa Certificate of Competency#: �d .' - Date Issued { ate Rejected { }: .I— By: Date of Expiration: i� i€� Fee Paid { } Fee Due { } Amount: Applicant Signature: �r •� �. Cat,+-Z�-,'�L z-� Fire Department Number: . (If Applicable) n U 136 u0M 13 Uas 19000 naa 09 a00 M a a a a a 00 M0a a 000 0'na 0 a M a 13 D an,'n 0013aM F3 a 0 a n 00 n a 0 n.a 0 a 0 a©Maa Da 00 a 01aa0auum ' C=>�/Ze t�'oonorcoautrea�i o�(?��aaeac/utQe�t,�. - - vr�rcce6—!C &a� 2e(J e C-7cxe 4 �} 1 r Date, ? + PERMIT DIGSAFENUMBER� C.0`2 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 {grrantted to: Name: -4 1 / t-5 .-LOL 6'1�z ` it v '(Full name o person,fum or corporation) y For Permission l State clearly the purpose for which the permit' granted: Restrictions: %/a �� yc�� 6 i✓�_ 7?L/Jf.�sn�i y F- r �� /�:/ �.o✓ l 1 t_ location: �� ter%( � Ij ,ee Paid: This Permit Will Expire On: )iguatura and Title of Official Granting Permit: �- Sitewalk Checklist for Sketch Sketch Checklist: o Tank to Noose 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 1 temporary tank o Second Stage Regulator to Door neededlallowed 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 pm technician to office): Office Notes/Correspondence(customers/technicians/other customers): Sitewalk Drawing: c. ��� W ICU° ye,U 1�� �( T