HomeMy WebLinkAboutDumpster Application & Permit - Permits - 470 MAIN STREET 10/25/2016 The Commonwealth am' Massachusetts
n -vices
Department of Fire Serr
Office of the State Fire Marshal
yob P.G.Box 1025 State Road,Stm,,MIA 01775
APPLICATION FOR PERMIT
Date:
Permit No
(city or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of uaL. Chaptex�_ , 10 as
provid!d�eotioa 527 CMR application lication.is hereby made Start Date
-i—
by We/y-e-V
(Fiffiname ofperson,Firm or Corporation)
State clearly Address _L170 jj&6/1-,r
purpose for (Street or P.O.Box City or Town)
whichpornrit Porpermiss,1011,structure
t0 -'Locate, dumpster for construction/renovation/demolition
is requested of s tTU--(H-—U-r-e-
Comments; dumpster must be 25 ' from structure or covered when not in use
at
Give location by street and no.,or describe in such as to provied adequate id=tifi of location)
V
Name of competent operator _5.1 Cert.No,
4-16 7/1
(If Applicable)
Date Issued-rejected , A�1� 116 By
7 84WE'r,of Ap'pliaant)
Date ofexTiration Fee$ Paid Do
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.G.Box 1025 State Road,Stow,MA 01775
We4 Date:
Permit No PERMIT
Dig Safe Number
(city of Town) If ApplicabIG)
In accordance with the provisions of M Chapter�- 10as provided in section 527 CMR 34
Start Date
This Permit is Branted to: W")lm0,-V- 4f-12 V"Or-
I ; -I
Full name of person, 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 IV70 Alald"e�llwl-,--
Fee Paid. S ,�2Give location by street and no.,or describe in such manner as ttqprovied adequate identification of location)
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This Permit will expire Signature of offloal granting permit) -7(—Title)
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