HomeMy WebLinkAboutDumpster Application & Permit - Permits - 192 LACY STREET 10/13/2016 ^^ The COMMOnwealth of Massachusetts
Department of Fire Services
�r o Office of the State Fire MarshaP
s` r P.O.Box 1025 State Road,Stow,MA 01775
APPLICATION T
r Date:
Permit No
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter . 10 as
provided in Section 527 C MR 34 application is hereby made Start Date
by _ /S
(Full name ofperson,Firm or Corporation)
State clearly Address 2 �q Q4 .LD C� v
purpose for (Street or P.O.Pax CityorTown) !®
whichpennit For ermissiontoLocate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give location by stree 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
(Signature of Applicant)
Date of expiration i —//—/ Fee$ Paid Due
...
The Commonwealth of Massachu* setts
Department of Fire Services
Office ®f the State Fire Marshal
P.0.Box i025 State Road,stow,MA 01775
a Cl®ky!� Date:
%
Permit I�Io(City of To (If Applicable) Dig Safe Number
:]
In accordance with the provisions of M.G.L. Chapter 10 as provided in section 5 2 7 C MR 34
This Permit is granted to: �`.1 Start Date
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 street and no.,or describe in such manner as to pro-vied adequate identification of location)
Fee Paid$
This Permit will expire /^//— (Signature gran g permit) OfCcal ting permit {Title)
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