HomeMy WebLinkAboutDumpster Application & Permit - Permits - 573 MASSACHUSETTS AVENUE 9/28/2016 The Commonwealth of Massachusetts
OWA Department of Fire Services
rat Cffice of the State Fire rshag
P.O.Box 1025 State Road,Stow,MA 01775
APPLICATION FOR PERMIT Date:
Permit No
7 City—OrToym ----(If�Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 1_0 as
provided in section 527 CMR 34 application is hereby made [Start Date
by A 4 ��/
C,
(Full name of'person,Firm or Corporation)
State clearly Address
�/� �
pwpose for
(Street Or P.O.Box City or Town)
which.permit For permissionto Locate- dumpster for construction/renovation/demolition
is requested Of St—fu—cture
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 pro-vied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable) -----------------
Date Issued-rejected By
Date of expiration (Signature ofApplicant)
Fee; Paid Due
The Commonwealth of Massachusetts
Department of Fire Services
Off'[CG Of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775 it
Permit PERM.IT Date-,
No
City of Town) —1,6
--- (,f Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter—1 Oas provided insertion 5 2 7 CMR 34
EStaitDatv
This Permit is granted to:
-
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 251 from-m structure or covered with tarp or Plywood
Restrictions: at end of workday
at
(Give location by street and no,,
Fee Paid J� or describe o in such� manner 3ne�, as to p�rovi e d adequate ate identification� of location
This Permit will expire (Signature
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