HomeMy WebLinkAboutRadio Box installation permit - Permits - 1211 OSGOOD STREET 10/27/2015 i 4The Commonwealth of Massachusetts
Department of Fire Services '
Y �-off Office of the State Fire Marshal
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P.D.Box 1025 State Road Stow,MA 01775 1;iD
APPLICATION FOR PERMIT
Date:
11�j�4W,I� A/&VFAL Permit No
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter as
provided in Section application is hereby made Start Date
by LJAA 4Z _&,
(Full name of person,Firm or Corporation)
State clearly Address ;,�f�SS'UI sj 4y0
purpose for (Street or P.O.Box City or Town)
which permit For permission to ems'fl11. x- o f-0 � wl Usk/C✓��c�- �`ic
is requested Ile- /
�.,���'�`E=�+? Dar' r���
Comments:
at /j// (1,S66aa
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator et�� / �� Cert.No. � /7
(If Applicable)
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Date Issued-rejected By
(Signature of Applicant)
Date of expiration Fee$ Paid Due
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The Commonwealth of Massachusetts
a Department of Fire Services
Office of the State Fire Marshal
P.G.Box 1025 State Road,Stow,MA 01775
PERMIT
4n 6/0/F��-- Permit No Date:
(City of Town) (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: /L),4 UzJ E ��/�/✓/ C L/ /ylS
F �name of person,Firm or Corpora on
Permission to
Comments:
Restrictions: //
at �OS
(Give location by street and no.,or desZograntm
' uch manner as to provied adequate identification of location)
Fee Paid -This Permit will expire ( v (Signature of gr"g permit g permit (Title}
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