HomeMy WebLinkAboutDumpster Application & Permit - Permits - 90 APPLETON STREET 9/20/2016 The Commonwealth of Mazaachusefts
DOPartment of Mire SeTvices
Office of the State Fire Marshal
pro e" P.0.Box 1025 State Road,Stm,,,MA 01775
APPLICATION FOR PERMIT
&V (ton,WIP Date:
Permit No
or To ) ----7If�Applicable) Dig Safe Number
In accordance with the provisions of M,G.L. Chapter L 1_0 as
provided in section 527 CMR 34 H *
by --- -------- app cation is hereby made Start Date
1�P—Uclo—
(Full name ofpersor Irm r Coloration
State clearly Address
purpose for
(Street or P.O.Box City or Town)
which permit For permissiouto "'Locate, dumpster for construction/renovation/demolition
is requested Of st-17u—cture
Comments: dumpster must be 25 ' from structure or covered when not inuse
at
(Give location by street and no.,or describe in such manner as t provied adequate identification of location)
Name of competent operator Q&UL--5� te lae- Cert.No.
(If Applicable) —2z
Date Issued-rejected By
Signature of Applicant) •
Date of expiration 162z Fee$ Paid —
Jir
The Commonwealth of Massachuse
X Department of Fire Services
Offl'CG of the State Fire Marshal
P.O.Box 1025 State Road,Stavv,MA 01775
Permit No PERMIT Date:
(If Applicable) Dig Safe Nmmber
In accordance with the provisions of UG.L. Chapter 10as 0,videdmi section 527 CM 34
This Permit is granted to: LStem Date
Pull name of person, . 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
(thye location by street and no.,orfiescribeinsuch manner as to provied adequate identification of location)
Fee Paid V. CC)
AIEF
This Permit will expire
SignMireo officalgr ting-pumit) Offical granting permit (—Tide
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