HomeMy WebLinkAboutDumpster Application & Permit - Permits - 2 UNION STREET 9/13/2016 The COMMOnwealth Of Massachusetts
DePartment of Fbe Services
Off!CG of the State Fire Marshal
P,0-BOX 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
U City or lbym) _7(If—Applicable)
Dig Safe Nuumber
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 D of iu A,VT�_e e r
(Full name of person,Firo�orp
State clearly Address bt er 0 A/ 'P oration)
Ablz 14 A^-/
purpose for
Nhich permit (Street or P.C.Box City or Town)
s requested For PeMiSgiOa to a c a t e" dumpster for construction/renovation/demolition
Of St-LUULUlt:�
j
Comments: dumpster must be 25 - from structure or covered
at Z ('(&t "0A.1 S, - &_ 17
(Give location by street and no.,or describe in such m
;;tOr as to provied adeguat®identification of'location)
Name of competent operator
(If Applicable) Celt No,
Date Issued-rejected
By
plia
Date of expiration of c )antnt)
Fee s Paid Due
The Commonwealth Of MasSachu' setts
DePartment of Fire Services
0ff'1CG Of the State Fire Marsha I
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT
k t'-Iry Or Town) Permit No Date;
(If Applicable) Dig Safe Number
In accordance with the provisions of MG.L. Chapter 10as provided in section 5 27 CMR 34
This Permit is granted to: C/Z e-c-�,'ve_ Start Date
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition Of Structure
Comments: dulmpster be 25 ' from structure or covered with tarp or Plywood
Restrictions: at end Of workday
at
(Give location by street and no.,o describe 00 e in such manner as to provied adequate identification oflocation)
Fee Paid 4E0-L��K
This Permit will expire (Signature ox"offioal granting gennit) ffical granting permit
(Ti�tle)
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