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Application/Permit to Install Water Service

2. 
3. WATER PERMIT # _____________
4. Email Application Submission
   Applications submitted via Email will be reviewed by Water Operations Manager Kurt Gaffney for approval. Contacts Once review is complete, applicant will be contacted.
6. Business Name: *
7. Date:
   Date: Start Date

   —

   Date: End Date
9. Contact Person:*
10. Email Address*
12. Address*
14. City*
15. State*
16. Zip Code*
18. 24 Hr. Phone Number*
20. WORK TO BE PERFORMED AT: *
    Provide street address or location where water service is being installed, repaired, etc.
22. Property Owner Name:*
23. Property Owner Tel: *
25. Type of Service

    1. Residential Single
    2. Residential Multiple
    3. Fire Line
    4. Commercial/Industrial (Area in feet)
    5. Size of Meter
    6. Water Service Turn on
    7. Water Turn off
27. Instructions:
    Contractors applying for a water permit must complete this form and obtain Water Manager approval. See Kurt Gaffney 500b East St. Mansfield, MA; 508-261-7376. *Valid Water Installer license in the Town of Mansfield is a prerequisite for performing water utility work associated with the public water system. Applicable fees (payable to the Town of Mansfield) shall be paid at the Department of Public Works office located at Mansfield Town Hall, Six Park Row, Mansfield, MA. Once fee is paid, the DPW office will issue Permit. Contractors need to call for work inspections Tel. 508-261-7330 (24hrs advance notice preferred).
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit Submit and Print

* indicates a required field