HomeMy WebLinkAboutDumpster Application & Permit - Permits - 1463 GREAT POND ROAD 8/2/2016 The COMMOnweafth Of Massachusefts
Department of Fire Services
Off!CG Of the State Fire Marshal
P.0.Box 1025 Stat-,Road,Stour;MA 01775
APPLICATION FOR PERMIT Date:
Permit No
City or Town) ----(If A�pphcable) Dig Safe Nu=mber
In accordance with the provisions of M.G.L. Chapter�10 as
provided in section 527--- CMR 34 application is hereby made Start Date
Date
by 37
(Full name ofperson,
Firm o Corporation
State clearly Address
purpose for �(Street or�Po.J1,3-1 City whiclipermit Town)
is requested Forpermissionto 'Locate dumpster for construction/renovation/demolition
Of structure
Comments: dumpster must be 251 from structure or covered when not in use
at
-Z 11 P. j
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-n4eet-ed By
Date of expiration ignatLuiredApplicant)
Fee Paid Due
-------------------
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)
----(If Applicable) D:ig18129f:eNumber-
Ila accordance with the provisions of MG.L. Chapterl 1 Oas provided in section 5 2 7 CMR 34
This Permit is granted to., 1-7 -7-7;-�;,0 Dig
Date
�Fou-,U,--,8ame Of PT':�'son,F-irm.or Corporation
Permissionto _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
at J V
(Give location by street and no.,or describe
Fee Paid$ in su ch manner as to provied adequate identification of location)
This Permit will expire
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