HomeMy WebLinkAboutRed Roof Inn 12/31/2003TOWN OF MANSFIELD
I - ARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
PERMIT TO OPERATE A SWIMMING POOL
In accordance with the provisions of Chapter 111. Section 127A of the Massachusetts
General Laws, and Regulations established by the Massachusetts Department of Public
Health (105 CMR 435.00). permit is hereby issued to:
Red Roof Inn, Inc.
for the operation of a ❑ Public
at:
Method of water treatment is:
❑ Semi -Public ❑ Special Purpose Pool
60 Forbes Blvd.
Diatomaceous
Bathing load not to exceed: 55 bathers
Number of Lifeguards required at all times the pool is open is: None
"NO LIFEGUARD ON DUTY" sign is required.
Permit No.: 10
Date of Expiration: December 31, 2003
Dat Iss ed
Scott Leit , ealth Agent
TOWN OF MANSFIELD, BOARD OF HEALTH
SIX PARK ROW, MANSFIELD 02048
SWIMMING POOL APPLICATION
Name of Owner: Red Roof Inn, Inc.
Address:
14651 Dallas Pkwy. #500 972-702-5987
City:
Dallas
State: TX
Zip:75254
Telephone:
508-339-2323
Fax:
Fed ID/SS No.:
31-1393666
Pool Location:
60 Forbes Blvd.
Type/pool:
Concrete, In -ground
Length: 40'
Width: 20' Volume: 'l poo
Min/Max. depth: '� ��;� a• v '�` N. 0,)C
Swim Area:
800sf
Dive Area:
None
Water Source:
Town
W/W Disposal:
Town Sewer
Type of Finish:
Gunite
Scum Gutter:
None
Deck Type:
None
Skmmr weir length:
Two baskets
Treatment System:
Diatomaceous
Disinfect Method:
Automatic Chlorine
Chemical Treatment:
Manually as required
No. of Bathers:
55
Remarks:
Per daily testing pool maintained.
Permit No.:10
Fee per pool:
$75.00
1314"Z10
DATE:
mber 31St yearly
Please make appropriate changes. Sign, date and enclose check payable to Town of Mansfield. Mail to:
Board of Health, Town of Mansfield, Six Park Row, Mansfield, MA 02048.
RAHealth\Paf s DocumentsTERMIT APPLICATIONS\SWIMMING POOLS APP.doe
I certify under the penalties of perjury that I, to my best knowledge and belief, have filed
all State tax returns and paid all State taxes required under law.
* Signature of Individual or
Corporate Name (Mandatory)
By: Corporate Officer
(Mandatory, if applicable)
** Social Security Number (Voluntary) or
Federal Identification Number
* This license will not be issued unless the certification clause is signed by the applicant.
** Your Social Security number will be furnished to the Massachusetts Department of
Revenue to determine whether you have met tax filing or tax payment obligations.
Licensees who fail to correct their non -filing or delinquency will be subject to license
suspension or revocation. This request is made under the authority of Mass. General
Laws, Chapter 62C, Section 49A.