HomeMy WebLinkAboutDumpster Application & Permit - Permits - 149 MIDDLESEX STREET 8/29/2016 2�
The Commonwealth ag Massachusafts
Department of Fire Semoces f DUI_
Office f the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town) ---Tlf—A�pplicablo) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter , 10 as
provided in section 527 CMR 34 application is hereby made [Start Date
by 0 Z T- &i t>r-
(V
(Full name of person,Firm or Corporation)
State clearly Address )99 /01 ) I r -
purpose for (Street or P.O.Box City or Town)
V
wbichpormit Fop,,missiouto Locate-- dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be -25 " from structure or covered when not inuse
at
(Give location by street and no.,or describe in such wanner as to provied adequate identification of location)
Name of competent operator Cert.No,
(If Applicable)
Date Issued-rejected By
Signature of Applioant)
Date of expiration Fee Paid __ � C'oDue The Commonwealth Of Massachusetts
Jn
Department f Fire Services
OffiCe Of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
PERM.IT Date:
(City 19
Permit No
of—Town) (If Applicable) Dig Safe Number
In accordance with the provisions of MG.L. ChaPtcr--1 Oas provided insertion 5 2 7 CMR 34
Start Date
This Permit is granted to:
Full name of person,Firm oerrC oration
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 251 from structure or covered with tarp or Plywood
Restrictions: at end of workday
at
"-'5r
7
Give location by street and no.,or describe in such ma r as to zovied adequ identification of location)
Fee Paid$,
This Pennfwill expire 4* —Signature of oJTi0T granting permit V 0 gr permit I Title
Z/)
=W110- TI-41-Q r)PPMIT MI IRT"91P MM-Q9)1r%1 Inj I_ql V Pn-QTi=n I Wn I M T14P PPPU1-Qr-Q 4MIM