HomeMy WebLinkAboutDumpster Application & Permit - Permits - 61 ESSEX STREET 8/20/2016 The Commonwealth of Massachusetts
1,4-1.
Department of Fire Services
Office of the State Fire Marsha#
P,O.Box 1025 State Road,Sto-w.,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No I
City or Town) --- (IKA�pplicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter . 1_0 as
provided in section 527 CMR 34 application is hereby made Start Date
byC—
(Full name ofperson,Firm or Corporation)
State clearly Address 7-
purpose for (Street or P.O.13ox City or Town)
whiclipennit Forpermissionto Locate- dumpster for construction/renovation/demolition
is requested Of st—r:—u—cture
Comments: dumpster must be 25 ' from structure or covered when�not in use
at
Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator
t'0, Cert.No.
(If Applicable)
Date,Issued-rejected J 13Y
Signature of Applicant)
Date of expiration
-3e) Fee Paid Due
—----—----—
The Commonwealth of Massachusefts
ink
Z Department of Fire Services
Office the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERIVI.IT Date:
City of Town—) Dig Safe Number
In Ila accordance with the provisions of MG.L. Chapter- 10as provided in section 5 2 7 CMR 34
This Permit is granted to: --Q7-1r f"&7 C, ®�4 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 covered with tarp or plywood
Restrictions: a t end o f workday
at e--z rSE'-5'— E"7—
Crave location by street I and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will expire
............... Signature of oilical granEFP—ermit) M—fic—al—granting�permit Tide—)
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