HomeMy WebLinkAboutDumpster Application & Permit - Permits - 731 JOHNSON STREET 10/5/2016 _ The Commonweafth of Massachuserm
Department of Fire Services
Office of the State Fare MarsW
P. .Box 1025 State Road,Stow,MA 01775
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APPLICATION FOR PET
' Date:
]Permit No
(City or Town) (If Applicable)
FStart
g Safe IS'umber
In accordance with.the provisions of M.G.L. Chapter . 10 as
provided inn section 527 C MR 34 application is hereby made
by
(Full name ofperson,Firm or Corporation)
State clearly Address
purpose for (Street or P.O.Box City or Town)
whichpermit For ermissionto Locate dumpster for construction/renovation/demolition
is requested p' Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give location by street and no.,or describe insuch mariner as to provied adequate identification of location)
Name of competent operator � /Lc ,i S Lett v A- Cert.No
(If Applicable) --- --
Date Issued-rejeeked--= / e2l B
ignature of Applicant)
Date of expiration Fee$ Paid Due
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The Commonwealth of Massachusetts
J
Department of Fire Services
Office of the State Fire Marshal
P.C.Box 1025 State Road,Stow,MA 01775
PERMIT
Permit No Date:
/�
(City of Town) (If Applicable) Dig Safe Number -®
In accordance with the provisions of MG.L. Chapter l 0as provided in section 5 2 7 C MR 34
This Permit is granted to: 7) '4,tj�„ �---- [StaartDate
�% �P T-y-ra , —
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
orkday
at
(Give location by street and no.,or describe in such manner as to pro vied adequate identification of location)
Fee Paid �
This Permit will expire s'- (Signatur �ocalgran�gpermjt) c�ezg pelt T �
( tl )
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