HomeMy WebLinkAboutDumpster Application & Permit - Permits - 894 GREAT POND ROAD 9/19/2016 The Commonwealth of Massachusetts
SIC' Department of E re Services
a try Office of the State Firs Marshag
lei_ a
. P.0.Box 1025 State Road,Stcq,MA 01775
APPLICATIONFOR PERMIT
Date:
Permit No
City or Town) (H pplicable) Dig Safe Number
In accordance withthe provisions of M.G.L. Chapter. . 10 as
provided,in Section 527 C MR 34 application is hereby made Start Date
by
(Full name of person,Firm or Corporation) l J
State clearly Address L' //
pmpose for (Street or P.O.Box City or Town)
which permit For pemvssionto ''Locate. dumpster for construction/renovation/demolition
is requested I of s t r u c t u r e _
Comments: dum�p+sLter/must be 25 ' from structure or covered when not in use
at J /' C�-�9 AV-1— � l -
(Give location by street and no.,or desen7ae' such manner as to provied adequate identification of location) .
Name of competent operator Cent.No.
(If Applicable)
Date Issued- —� .-�� BY
(Signature of Applicant)
Date of expiration C _ 6/ G Fee Paid Due
The Commonwealth of Massachusetts
Department of
Fire Services �
Officethe State FireMarshal
P.0.Box 1025 Stato Road,Stow,MA 01775
PERMIT Date:
Permit No Dig Safe Number
(City of Town) (If Applicable)
In accordance wiffi the provisions of M.Q.L. Chapter 10as provided in section 5 2 7 CMR 34
� Start Date
This Permit is granted to: -�% y
Pull name of person,Firm or Corpor ,o� n
Permission to locate dumpster for construction/renovation/demolition of structure
Commerns: dumpster be 251 from structure or covered with tarp or plywood
Restrictions: at end of workday
at "
(Give location by street and no.,or describe in such manner as to}rovied adequate identification of location)
Fee Paid S _J-7) --
®)e
This Permit will expire (Signature of. cal grantingpermit) Offical gr ting permit ( ide)
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