HomeMy WebLinkAboutDumpster application & Permit - Permits - 52 RUSSELL STREET 8/2/2016 The Commonwealth ag Massachusetts
Department of Fire Services
OfficG of the State Fire Marsha#
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
-rCity or Town) — (If�Applioable) Dig Safe Nummber]
In accordance with the provisions of M.G.L. ChapteK_. 10 as
provided in section 527 CMR 34 li * * I Start ate application is hereby made LS LD
by
'0�
(Full name ofperson,Firm or Corporation)
State clearly Address
purpose for (Street or P.O.Rox City or Town)
which.pennit Forpernlissiont, "'Locate` dumpster for construction/renovation/demolition
is requested of st-17ucture
Comments: dumpster must be 25 ' from structure or covered when not--l-n—use
at IV_JiL_1()
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable)
Date,Issued-rejected
BY
Signature of Applioant)
Date of ex-pira
tion Fee 01.L
Paid Due
r-------
—---------
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date:
(city of Town) _(TA—pplicoable) Number
In accordance with the provisions of MG.L. Chapter1 Oas provided in section 5 2 7 CMR 34
Start Date
This Permit is granted to:
Full name of person,Finn or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
-Restrictions: at end of workday
Dig Safe
at A
kn
05 describe at identification f location)
(Give location by street and no d Omsuchmannerastoprovied d_p equ e i en cation o
Fee Paid
Q.
antina.De
'ron Will expire permi� 'r�permit
This Perini will expire oSigpna Voof offical granting Of�flcal granting permit (�Title
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