HomeMy WebLinkAboutDumpster Application & Permit - Permits - 15 WALNUT AVENUE 10/24/2016 The COMMOnweafth Of Massachusetts
Pepartment-of Mrs Se�v ceq
Offics of the State Fire Marshal
P.0.Box 1025 State Road,Stog,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No
City or T0V—M ---(If A—pplicable�) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter�10 as
provided in section 527 CMR 34 application is hereby made Start Date
(Full name ofperson,Firm or Corporation)
_
fate clearly Address _ Z 1,104 Z-AA� S-T;f,-i-'!
urpose for CjJ
(Street or P.O.Box City or TO—)
hiclipermit Forperinissionto 'Locate, dumpster for construction/renovation/demolition
requested Of StEucture
Comments; dumpster must be 25 ' fr o mm
at
(Give location by steet—and`=ioor describe in such in=�er as to�provied�adequate�idcntif�kation of�Iccation�) �
Name of competent operator Cert.Na.
(If Applicable)
Date Issued rejected By
Date of expiration Signature of Applicant)
FFeePaid Due
b e 2 —7structure�o or covered- when us-e-
�The
—---------
Commonwealth
Of Massachusetts
Department of Fire Services
Office of the to Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
PERMIT �Y—�2-1
Permit No Date: -Z
Dig:a:feNumber(City of Town) (If A�pplioablo) u77
In accordance with the provisions of M.G.L. Chapter� 10as provided insecdon527 CMR 34
This Permit is granted to: Z&L7�7X- /�"V C- EStaitDate
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
7— S;;;;—,<g-
Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
This Permit will expire (Signature of 40f Wail_g'A"a—midin.
7 gpermit) OfG*'cm--iFn-g—permit (Title)
THIR PI=PUIT ml 1.q`r'AP C"r)N-Qp1r,1 fnl I_ql V PrIRTgn 1113MI TWR PPJ=fifiJ-Q1z_q 4NEM