HomeMy WebLinkAboutDumpster Application & Permit - Permits - 815 CHESTNUT STREET 9/30/2016 The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire MarsW
-------- P.0.Box 1025 State Road,Stem,,MA 01775
APPLICATION FOR PERMIT
ae-1-Permit No Date:
City or Town) --- (If Applicable) Dig Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 1_0 as
provided in Section 527 CMR 34 applic i t.
by on is hereby made Start EDate
(Full name ofperson,Firm or Corporation)/
I /
State clearly Address 17A-
pulpose for
(Streator P.0.13ox City orTown)
whichpennit Forpermissionto Locate, dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered whennot —in use
at
Give location by str4et 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
Date of expiration (Sigoature of Applicant)
2 Fee Paid
---------------------------
The Commonwealth of Massachusetts
Department of Fire Services
OfflCG of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT
-Zuolld Au oed Permit No Date:
r(City of ---71f�Applicable Dig Safe Nmm b e—r
In accordance with the provisions of MG.L. Chapter 10as provided in section 527 C M R 34 Start DateDate
This Permit is granted to, Wl<�� �al _
Full 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
(Give location by street and no,or describe in such manner as to provied adequate identiffeation of location)
Fee Paid$
This Permit will expireo oLf6fal et�g�ragnti,,gp,.r.�it m )I 10�ic al gran(Signature of
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