HomeMy WebLinkAboutDumpster Application & Permit - Permits - 30 MABLIN AVENUE 11/2/2016 The Commonwealth of Massachusetts
®apartment of Rre Semites
Office of the State Fire Marshal
R 0.Box 1025 State Road,Stm,,MA 01775
APPLICATION FOR PERMIT Date:
Permit No
City or Torn) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
provided iu�ctiou 527 C MR 3 4 appgo`. is hereUy made Start Date
by J'�®�y�' SVol
(Futlname ofperson,Firm or Coloration) /
State clearly Address 3 , �A le� J✓'✓L' /\a -4 ,, 0 6 V el a4 • ® �� ��
purpose for (Sinot or P.O.Box City or Town)
whichpenmt For permission to 'Lo_ate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at f'Yl L l/�
(Give location by street and no.,or describe in such manner as to pxovied adequate identification of location)
Name of competent operator Cart.No.
(If Applicable)
Date Issued-rejected By
(Signature of App&ant)
Date ofempiration Fee$ Paid Due
The Commonwealth of Massachusetts
u
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road PERMIT
MA 01775
Date:
U y�� Permit N0 Dig Safe�tutnber
(City of Town) (If.Applicable)
In accordance with the provisions of M.G.L. Chapter 10 as provided in section 5 2 7 CM R 34
Start Date
This Permit is granted to: ` ----h, �'6-/,-fi Sir',
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
atD >r�
(Give location by street andno.,or describe in such manner as to provied adequate identification of location)
Fee Paid$
Si at .—�Gl
This Permit will expire m? -`7 ( gn a granting pemait) 0 granting permit (Title)
)
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