HomeMy WebLinkAboutDumpster Application & Permit - Permits - 1600 OSGOOD STREET 10/7/2016 The Cammonweagth of Mazsachuzer�z
f-4123020M
Department of Fire SeTvoces
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Office of the state Fire Marshal
R 0.Box 1025 State.Road,Stow,MA 01775
APPLICATION FOR PERMIT
Date:
4AI&Mf Permit No
City or Town T- - (If A—pplicable-) 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 4, -71--"1177
(Full name fpe/rson,Firm or Corporation)
State clearly Address
purpose for (Street or P.O.Box C*-T..)
which permit For permissionto Locate dumpster for construction/renovation/demolition
is requested Of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
(Give location by street and no.,or �crjhejn��h
'I,fscribe inqllr,,
such manner as to provied adequate ideatification,of location)
Name of competent operator > 9 > 1��" Cert.No.Z--\
(If Applicable)
Date Issued-rejected Z By
Date of expiration /:Pr?� (Signature of Applicant)
Fee Paid I— -- �-.__»•_»--__
0
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ut---------------� -------}2 The Commonwealth of Massachusetts
o
Department of Erg Services
Office of the State Fire Marshal
eye P.0.Box 1025 State Road,Stow,MA 017.75
Permit No PERMIT Date:
(Giiy of—Town) ---71f�Applicoable, Dig Safe�Number
In accordance,with the provisions of M.G.L. Chapter- 1 Oas provided in section 5 2 7 CMR 34
This Permit is granted to: a,44.) Start Date
RM 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 locatKon by street and no.,or describe in such manner as to provie adequate identification of location)
Fee Paid$ _
This Permit will expirc (419r
rmi Offical granting permit (Title)
at ire of offfifical gran gpe
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