HomeMy WebLinkAboutDumpster Application & Permit - Permits - 69 BRIGHTWOOD AVENUE 10/18/2016 The Commanweafth of Mazaachusafts
Department of Fire Services
ISER E
Office of the State Fire Marshal
P.0.Box 1025 Statp,Road,Stm,,MA 01775
APPLICATION FOR PERMIT
Date:
(City or Town) Permit No 7ff Applicable—) Dig Safe Number
_
In accordance with the provisions of M.G.L. Chapter�_ 10 as
provided in section ---527 C M R 34 applieption is hereby made Start Date
by Lz )
(Full name of erson,Firm or CorporationT_
State clearly Address
purpose for (Street or P.O.Box City or Town)
whichpermit For errnission 10
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 an o.,or describe in such manner as to provied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable) -7T77
Date Issued-rcJecta2i By
Date of expiration Signature of Applicant
Paid Due
The Commonwealth Of Massachusetts
Department of Fire Services
OffiCe Of the State Fire Marshal
R 0.Box 1025 State Road,Stow,MA 01775
PERMIT Date:
ILI Permit No
(City of Town) Dig,Safe Number
(if p—plicable)
In accordance with the provisions of M.G.L. Chapter� 1 O as provided in section 527 C M R 34
Start Date
This Permit is granted to: Y" 7 rD
Tull nameme of of person,Firm or orporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 ? from structure or covered with tarp or plywood
P-estdcdOns: at end of workday
at 2 A
(Give location by stree(and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
4-
This Permit will expire, (_Signs_4WWcaf'grantIAngpeAmdt %—ting p—ermit
(Title)
TWIG P;=PMIT U1 Vq+'PIP rnKj_qpjr%j Inj j_qj V pn_qTgn I MnM TWI= PPPUj_QP' _Q *am