HomeMy WebLinkAboutDumpster Application & Permit - Permits - 55 LYMAN ROAD 9/7/2016 The Commonwealth of Mazaachusefts
m Department of E re Services
h Office of the State Firs Marshal
P,O.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town) (if Applicable)
Dig Safe Number
In accordance with the provisions of M.G.L. Chapter . 10 as
provided in S ction 527 C MR 34 application is hereby made Start Date
by m
(Full nmm ofperson,Firm or Co oration)
State clearly Address t--7 C)/`" �--�
purpose for (Street or P.O.Box City or Town)
whichpemnt For ermissionto yL /
ocate,' dumpster for construction renovation/demolition
is requested permission
Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at -' 7y,.�cy
E v
( ' e location by"street no.,or descn'be in such manner as to provied adequate identification of location) .
Name of competent operator Cerk No.
(If Applicable)
Date Issued-rejected By
(Si re of Applioanfi
Date of expiration / Fee$ Paid DueDepartment of — _
The Commonwealth of Massachu' se
Fire ices
tCe of the StateitMarshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT
Permit NO Date: . i�
(City of Town) (If Applicable) Dig Safe Number
Tu accordance with the provisions of M.G.L. Chapter 10as provided in section 527 CMR 34
This Permit is granted to: �� - �Ca.��i�6��o a��� �
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: at end of workday
at
( ' e location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire / /®�® ,
�.=.t �� (Signature of o c gnnnfingp 41iznio�gperrait
(Title)
'3141-q OPT`?MIT M1 i_Q'[` RP C'-0N-Q0jt''_I in1 fql V Pn-qTPnl t f' M TWP