HomeMy WebLinkAboutDumpster Application & Permit The Commonwealth of Massachusetts
7 L�- Department of Rim Semaces
a t- Office of the State Fire Marshal
P.0.Box 1025 State Road,Stov;MA 01775
VAPPLICATION FOR PERMIT
Date:
Permit No
City or Town) (If pplicable) Dig Safe Number
In accordance with the provisions of M,G.L. Chapter 10 as
provided' Section 527 CMR 34 app, ?yL is hereby made Start Date
by `f
( i11 name of son,Fiun or Corpora' )
State clearly Address
purpose for (Street or P.O.Box City or Town)
whichperrnit Forpermissianto 'Lotate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not in use
at
(Give lccation by sixeet d no.,or describe in suchmanner as to provied adequate identification of location)
Name of competent operator Cert.No,
(If Applicable)
Datelssuediejeeted BY _-
'(Signature of A 'cant)
Date of expiration Fee$ Paid Due
The Commonwealth of Massachusetts
ir
e
e of ire ervices
ice of t e to ire ars a
P.0.Box 1025 state Road,Stow,MA 017.75 /
PERMIT Date: ✓ r`�/�
Permit No Dig Safe Number
(City of Town) If Applicable)
In accordance with the provisions of MG L. Chapter 10as provided in section 527 CMR 34
--�� StartDate
This Permit is granted to:
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: a t, e nd of workday
at
(Crive location,by street dno.,or describe in such manner as to pro-vied adequate identification of location)
Fee PaidThis Pamit will.expire — L (Si�atu g permit tix�pernit (Title)
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