HomeMy WebLinkAboutRadio Box installation fee - Permits - 2324 TURNPIKE STREET 1/2/2012 he cafflmonweaKh of mazaachusafts
-4 LL Department of Flae Services
Y_ 6MF E'_. Office of the State Fire Marshal
P.O.Box 1025 State Road,StoW,NIA 01775
APPLICATION FOR PERMIT. Date:
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(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of uaL. Chapter —as
provided in Section —application is hereby made Start Date
by 'B T A LQ lt!tl 1;4 b-r&OL-t S z7c%., C_
(Full name of person,hm or Corporation)
State clearly Address LAFr+%_tV_L_rrr_ 9%0 5.4L,'5'.SLPC4C':J
purpose for (Street or P.O.Box City or Town)
which permit C a
is requested For permissionto tN5T24'-6_ A b!5%r'k"_ 0,4j (Z
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Comments:
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Give location by street and no.,or describe in such manner as to provied adequate identification of location
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Name of competent operator -aACZ7- Cert.No. !k C_
(If Applicable) _J
Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee Paid Due
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The Commonwealth of Massachusetts
Department of Fire Services now.
Office of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
R, Permit No PERMIT Date:
(City of Tom) (If Applicable) Dig Safe Number
In accordance with the provisions of M-G.L. Chapter as provided in section Start Date
This Permit is granted to: -wa' 'Ca'!Z5-r45: s --r-. 0--
Full name of person,Firm or Corporation
Permission to [L(15-r*- A MAC- or
Comments:
Restrictions:
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(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire Signature of offical granting permit Offical granting permit Title
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