HomeMy WebLinkAboutDumpster Application & Permit - Permits - 35 MEADOWVIEW ROAD 10/26/2016 The Commonwealth of Massachuseft-9
Department of Fire Ser-vices
Office of the State Fire Marshal
P.0.Box 1025 State,Road,Stm,,MA 01775
APPLICATION, FOR PERMIT
Date:
Permit No
City orTown (If Applicable) 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
975 9-72 IS26
Full naive of erson,Firm or Corporation)
State clearly Address Z Z
purpose for (Street orP.0.Box City or Town)
whichpormit For permissi.onto "Lo.cate- dumpster for construction/renovation/demolition
is requested of st—i—u'cture
Comments: dumpster must be 25 ' from structure or covered when not in use
at
Give location by street 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
(Sigmtuw oi Applicant)
Date of e%piration Fee Paid s Due
The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
Uip P.0.Box 1025 State Road,Stow,MA 01775
PERMIT Date:
(City of Town) Pernift No (If Applicable)
Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10as provided insectim527 CMR 34
Start Date
This Permit is grantee to: /Z'/x7
Fan name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comment'-' dumpster be 25 ' from structure or covered with tarp or plywood
Restrictions: at end of workday
at
Give location by street and no.,or describe,in such manner a;to provied adequate identification of location)
Fee Paid eirn
This Permit will expire
z/, {Signature of offioal granting jTer-nnt 0 ff!cial granting permit Titir
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