POLICE DEPARTMENT

160 SOMERS ROAD

EAST LONGMEADOW, MASSACHUSETTS, 01028

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APPLICATION FORM

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WORK PERMIT APPLICATION

Complete this request form. Select the items that apply.

Print and fax the form to Chief of Police at (413) 525-5445.

Name

Title

Company

Company

Address

Work Site

Address

E-mail

Phone

Fax

Work Date 

 

Necessity for work or labor on SUNDAY:

        could not be performed on any other day without serious suffering, loss, damage or public inconvenience

        or which could not be performed on any other work day without delay to military defense work.

 

Necessity for work or labor on HOLIDAY:

        which could not be performed on any other day without serious suffering, loss, damage or public inconvenience

        or which could not be performed on any other work day without delay to military defense work.

        or due to special circumstances relating to manufacturing, serious production inconvenience will result if such work is not performed.

        or work by clerical and office personnel in offices which are corporate offices or branches of interstate manufacturing operations working in other states.

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