HomeMy WebLinkAboutDumpster Application & Permit - Permits - 69 WATER STREET 8/10/2016 ,I:
The Commonwealth of Massachusetts
Department of Rre Sairvices
Office of the State Fire Marshal
P.0.Box 1025 State Road,StOW.,MA 01775
APPLICATION FOR PERMIT
Date:
Town) Permit No or --- (l—f A�pplicable) Dig Safe Number
In accordance VU the provisions of M.G.L. Chapter 1_0 as
��52 7�CMR�34 �jj provid �Sectio4-' application is hereby mad I Stan Date
by --Lp;
,(Full name of person Firm or Corporatio
State clearly Address C�
p whichpemait P.O.B-1 city IzIr T-11-3
purpose for (S1reeE or
is requested Forpennissioato "'Locate- dumpster for construction/renovation/demolition
Of structure
Comments: dumpsterstructurecovered when not in use
at
(Give location by street and no.,or describe in such manner as to provied adequ i tification of location)
Name of competent operator Cert.
(If Applicable)
Date Issued-rejected
BY
(Si ature of pplioant
Date of expiration Fee Paid Due
The Commonwealth of Massachusetts
Department of Fire Services jab.
Office of the State Fire Marshal
P,O,Box 1025 State Road,Stow,MA 01775
PERMIT Date:
Permit No
D:ig Safe Nu m
City of Town) (If Applicableber
In accordance with the provisions of MG.L. ChaPter�-_l Oas provided in section 5 2 7 CMR 34
This Permit is granted to: Start Date
FUii name of person,Firm or Corporation
Pennission to _locate dumDster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at 5�; 9' &2Z 7-7
S (Give location by street and no.,or describe in such manner p to provied adequate identification of location)
Fee Paid
zllt'Irnd?,17
This Permit will expire 9-, o-1 e.1 4
�a AL-- !f�—
Of OM04 gran Mcalgrm Mgpern�: � '2��(�Tifl �
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