HomeMy WebLinkAboutDumpster Application & Permit - Permits - 101 DUNCAN DRIVE 7/26/2016 The Commonweafth of Massachus9fts
D'epartment of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or Town)
(If Applicable Dig Safe Number
In accordance with the pro-visions of M.G.L. Chapter . 1_0 as
provided in Section 527 C M R 34 application is her by made Start Date
by e(e%e -, K, -1 -yv-c7 1)
_el '�J
(Full name of'person,Firm or Corporation)
State clearly Address C" 0 C - r-
purpose for (Street or P.O.Box City or Town)
which permit Forpermissionto Locate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give location b 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
(Signature of Applicant)
Date of expiration Fee Paid Due
-------------------cut------—-------------------------1------
The Commonwealth of Massachusetts
Department of Fire Services
OffiCe of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775
PERMIT
Permit No Date:
(City of Town) ----7If�Applicable) Dig Safe—Number
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 C M R 34
This Permit is granted to: Start Date
Fiffi 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 0
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid S
This Permit will0
granting permit" ffili
expire 0 0
TWIR PPG? IT' M1 I-QT RIZ rr)N-qP1r1 Inj I_ql V Pt'1-QT1=n 1113MI TWI= PP9U1-Q1=-Q 4=W