HomeMy WebLinkAboutDumpster Application & Permit - Permits - 184 CARLTON LANE 10/3/2016 The Commonwealth of Massachusefts
Zi Department of Fire Ser-vices
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stoat;MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
T City or Town T— (If ip-p-Mable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapterj_ 1_0 as
provided in Section -5 27 CMR 34—application is hereby made Start Date
by 14 6 L,..,e ST()W--EU 7L Y-0_ S C
(Full name of person,Firm or Corporation)
State clearly Address _ 3&0 Met-r1MC4C_('-1- Sr Lqjrece Mfiq
purpose for (Street or P.O.Box City or Town)
whichpermit Forpermissionto "Locate dumpster for construction/renovation/demolition
is requested I of st—r—u-c-Fu—re
Comments: dumpster must be from structure or covered when notin use
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator e a t C 5
I
�e Cert.No.
(If Applicable) _
Date Issued-rejected By
Signature of Applicant
Date of expiration Fee Paid Due
--—-------—------ -----------------
The Commonwealth of Massachusetts
Department of Fire Services
Office of the to Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT Date:
Permit No
(City of Town) T1f—Applicable) Dig-Safe Tu—mber
In accordance with the provisions of hiG.L. Chapter I Oas provided in section 5 2 7 C M R 34
This Permit is granted to: �Gv"-// L�_ ' Start Date
Full name of person,Firm or Corporatiola
Permission to locate dumpster for construction/renovation/demolition of structure
Comment' 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 identification of location)
Fee Paid
n
i'lin
This Permit will expire (Signature of o �antingpZ4 TJJ�! Wgn:111:13 gpermit
Title
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