HomeMy WebLinkAboutDumpster Application & Permit - Permits - 120 OLD FARM ROAD 10/4/2016 The Commonweafth of Massachusetts
Department of Sarre SeT-vices
Office of the State Fire Marshal
P.O.Box 1025 State Road,Stm,,MA 01775
APPLICATION FOR PERMIT
Date:
1��OrTo�m�) �Permit No
City --- (,f—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
�(�Fuffln name e 7of p e,,,=,F- to-rrCrp!or4tin
State clearly Address fl
Ld I/
purpose for (Street or P.O.Box City or Town)
whiftermit For 1prmlss ioato Locate- dumpster for construction/renovation/demolition
is requested
of structure
T--"-F
Comments: dumpster must be 25 ' from structure or cove-r—ed- wFe—nnot in use
at
(Give Iocation.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 13Y
Date of expiration Signature of Applicant
Fee, Paid Due
X The %Commonwealth of Massachusefts
I
Department of Fire Services LIN
OffiCe Of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
PERMIT
0/(City of Town)0 �I( Permit No Date:----(If-Applicable) D:ig:,8Sa9:feN:umbe7r7
In accordance with the provisions of MG.L. Chapter� 10as provided in section 5 2 7 CMR 34 Start Date
e)
This Permit is granted to: 2
Fullname of person,Firm or Co ration
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 0
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid S
This Permit will expire. (Signatffff6-of-
officalgranting permit) Off�imt�inaperna�it �
(Title)
TI-41-Q PPRUIT MI IAT,RP r-nK1-qJ3lr1 ItIl I.q1 V PORT I=n I IDnM TWI= PP1=U1-QJ=-Q 4MMI