HomeMy WebLinkAboutDumpster Application & Permit - Permits - 59 SALEM STREET 9/10/2016 The Commonwealth of Mazaachusefts
Department of Fire Services
Office of the State Fire Marsha#
P.O.Box 1025 State Road,Staw,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No 1 or Town)—
(If A�pplhioabl7e) D i g Safe fe Nw m,be r
In accordance with the provisions of M.G.L, Chapter as
provisions
1_0 as lie
Provided in Section 527 CMR 34 Chapter
is hereby made Start=Date
by
(Full name ofperson,Firm or Corporation)
Stato clearly Address .2 ZIA44_0
purpose for
(Street or P.O.Box City or Town)
whichpermit For permissioato 'Locate-, dumpster for construction/renovation/demolition
is requested of structure
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)
Nam of competent operator Cert.No.
(If Appliodble)
Date Issued-rejected By _�
Date of expiration Fee
Fee Paid Due
The Commonwealth of Massachusetts
Department of it Services
Off'ICG of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775 it
dO PERMIT Date:
Mv Of—TOYM) Perniit NO ____(If Tp_plicable) Dig Safe 7&miber
In accordance with the provisions of MG.L. Chapter 1 Oasprovidedin section 5 2 7 CMR 34
This Permit is granted to: " Start Date
Full name of person, Corporation Yor�� —
Permission to locate dumpster for I construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: a t e n d 0 f: W o r k d a y
at
(Give location by street and no.,or describe in such
FeePaidS 6-_iP — :Zn)neps P� ovied equate identification of location)
*
This Permit will.expire Signature--o-f-o-ffi--O-al-granting—permit) �fffralg�rantingpermit
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