HomeMy WebLinkAboutDumpster Application & Permit - Permits - 16 FAULKNER ROAD 9/14/2016 The COMMOnealh of Mazaachusefts
� �A Department ®f Fire ServOces
Office of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
APPLICATIONFOR PERMIT
Date:-/V Permit No
City or Town)
(If Applicable) Dig Safe i>7tutzber
In accordance with the provisions of M,G1, Chapter 10 as
provided in Section 527 C MR 3 4 apph tion is hereby made Start Date
by PU� 1 U s�
( ull name of person, itm or Corporation) j� t
State clearly Address -FaUl kln!y-L ��_ vV �1`(1(�UV�� A (1� ��5
purpose for which permit p (Street or P.O.Box City or Town)
y'
For ermissionto Locate dumpster for construction/renovation/demolition
is requested o f s t r u c t u r e
Comments: dumpster must be 25 ' from structure or covered when not in use
at d16 e,, g
(Give location by street and no.,or describe in such manner as to provied adequate identification of location) .
Name of competent operator Cert,No.
(If Applicable)
Date Issued-rejected By
re of Applioaat)
Date of expiration 3/—f Fee$ Paid Due
The Commonwealth of Massachusetts
Department f Fire Services
a ECG of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT
Date:
_ £ Pcrnit No
(city of Town) (If Applicable) Dig Safe ISTumber
Iu accordance with the provisions of MG•L. Chapter 1 Oas provided insertion 5 2 7 CMR 34
,�- Start Date
This Permit is granted to: .`s✓��f:2l� , ryo r'W'/(�� "S/, 1, V
i
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 ,r! -e
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid S /J
This Permit wi11 expire (Signature o£offioal grantingpermit) O�fficaI gr g eimit Title p ( )
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