HomeMy WebLinkAboutDumpster Application & Permit - Permits - 15 MERRIMACK STREET 9/28/2016 The Commonwealth of Massachusefts
Shif t Department ®f Mrs Services
`r a Off!CG Of the State Firs Marshal
P.0.Box 1025 State Road,Stow;MA 01775
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APPLICATION FOR PERMIT
A � Date:
&vV-- eraaif No
{City or NYE (If A licable
_ pP ) ]Dig safe Number
In accordance with the provisions of M.G.L. Chapter 00 as
provided in section 527 C MR 34 application is hereby made Start Date
by Sys 0 5 2,
(Full name ofperson,Firm or Co oration)
State clearly Address
V
purpose for (Street or P.O.Box City or Town)
Srequestech d For ermissionto yLocate dumpster for construction/renovation/demolition
s requested p of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give location by&1rert and no.,or describe in such manner as to provied adequate identification of location) .
Name of competent operator Cert
(If Applicable)
N�'
Date Issued-rejected—IL By
ignatura dApplicant)
Date ofe&Tiration Z// LI�L— Fee$ Paid �
Due
The Commonwealth of Massachusetts
' oDepartment of Fire Services
StateOffice of the it Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Date:
PeY'ffidl� 0
PERMIT{City o£Town) (If Applicable) Dig Safe Number
In accordance with the provisions of MG.L. Chapter 10as provided in section 5 2 7 C MR 34
This Permit is granted to: Start Date -
Full name of person,Firm or Corporation
Permissionto locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 251 from structure or covered with tarp or plywood
Restrictions: at end of workday
at
ve locationn by s(xeet and no.,or scribe in such manner as to provied adequate identification o location)
Fee Paid S
This Permit will expire (Signature of oflioa[grantingpermit) Offical gran 9-permit (Te)
TWIR PPPMIT U1 t T CE'N 11r1 i t l l V Pn-QTI=n 11 M T&41= PRX 1C -Q