HomeMy WebLinkAboutDumpster Application & Permit - Permits - 69 PROSPECT STREET 9/21/2016 The Commonwealth of Mazaachusefts
r . Department of Rre Services
— Office ®f the State Faze Marshal �
P.O.Box 1025 State Road,Stoup,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 00 as
provided` Section 5 2 7 CMR 3 4 p•Cao ' hereby made Start Date
by 6 S R
(Fun naive of ersoA Finn or C or tion)
State clearly Address `
pinpoi for (Street ar P.O.$apt City a Town)
Whichpemsit eam Fox issionto Locate,- dumpster .for construction/renovation/demolition
is requested p, of s t r u c t u r e
Comments; dumpster must be 25 ' from structure or covered when not in use
at
(Give location by street and no,,or describe in such manner as to provied adequate identification of location) .
Name of competent operator Cert.No,
(If Applicable)
Date Issued �� �� By
Signature of Applioant)
Date ofe�piration —�� Fee$ Paid Due
The Commonwealth Of Massachusetts
> Department of Fire Services
Office of the State Fire Marshal
P.O,Box 1025 State Road,Stow,MA 01775
PERMIT
Date:
(City of Town) Permit No
(If pplicable) Dig safe—Number
In accordance with the provisions of M.G.L. Chapter 10as provided in section 527 CMR 34
This Permit is granted to; Start Date
Full name of person,.Firm.or Corporation.
Permissionto locate dum ster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at f
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire — 6- (Signature of ✓%`f F��` .�
grantmgpermit) Offical graffmgpermit (Tide)
T1=1R.� PRPUIT i41111_ T Al 1�'°1 1C111G°.1 Y n-gTg=n I MnM T14F 1q9:_q