HomeMy WebLinkAboutDumpster Application & Permit - Permits - 17 FAULKNER ROAD 7/26/2016 "X The COMMOnwealth of Mazaachusefts
-vices
Department of Firre Sw
iW_ 7 Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date: _' L
71s
Permit No
City or Town) (If App Dig Safe Number
In accordance with the provisions of M.G.L. Chapter� . 10 as
provided.jg,.Section 527 CMR 34 application is hereby made [Start:Date
by U!")L i
Full name ofperson,Firm or Corporation)
Address t
State clearly 'Ke!
purpose for (Street or P.O.Box City or Town)
which pennit Forpermissionto Locate dumpster for construction/renovation/demolition
is requested of s --'Fu c t ur
Comments: dumpster must be 25 from structure or covered when-E-otin 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-rejected elze' By
7/
Signature of Applicant)
Data of expiration
Fee e2'Paid Due
T
The Commonwealth Of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date:
(City-OfTown) ___TIf�Applicable) Dig Safe Number
In accordance with the provisions of MG.L. Chapter_ 1 Oas provided M- Aection 5 2 7 CMR 34
This Permit is granted to: Start Dig
A�)Z
Full name of person,Firm or Corporation
Permissionto locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: a t end of work day
. ............_��
at
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
_Pen t (Title M
a granting ffical-grm
ern-31
This Permit will expire (Signature of officall R permit ting,
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