HomeMy WebLinkAboutDumpster Application & Permit - Permits - 135 BEAR HILL ROAD 8/12/2016 The COMMON eal h of Massachusetts
s44 Department of Fire Services
Off9CG of the Site Fire Marshag
r P.0.Box 1025 State Road,Stops,MA 01775
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ICATION FOR PERMIT
A, ]]ate:
.kA ® Permit No ! 17 o _®
Czty or Town) (If Applicable)
Dig Safe Ivassnber
In accordance with the provisions of M.G.L. Chapter 10 as
provided in section 527 C MR 34 application is hereby made / StartDate
by VLl MC>�C i L o n5 i C' f C 0 t_ LC-
(Full name ofperson,Film or Corporation)
State clearly Address - � + I &J
purpose for (Street or P.O.Box City or Town)
whichpeimit For ermissioato 'Locate dumpster for construction/renovation/demolition
is requested p Of Structure
Comments: dump ster must be 25P from structure or covered when not in use
at 1 2 lA('�:;'(n W- I'c s`
(Give location by street and no.,or describe in such manner as to provied adequate identification of location) .
Name of competent operator K lort y1 rQ Cert.Na.
(If Applicable)
Date Issued-rejected �° By
(Signature of Applicant)
Date of expiration Fee$
--.�_.....�..Paid
The Commonwealth of Massachusetts
Department of Fire is �
E 1
P.0,Box 1025 State Road,Stow,MA 01775
d Permit No PERMIT Date:
-
(City of.Town) (If g Safe fe Number
In accordance with the provisions of M.G.L. Chapter 10 as provided in section 5 2 7 C MR 34
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This Permit is granted to: e/1st L/ /U�57— ���`�- Start Date
.
Full name of person,Firm,or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or cn9,cl ad with tarp or plywood
Restrictions: at end of workday
at y
(Give location by streEd .,or describe in such manner s to proms ed_.adequate identification of location)
Fee Paid S
This Permit will expire (S gnature of offio gran. g permit) Offic anting permit (Title)
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