HomeMy WebLinkAboutDumpster Application & Permit - Permits - 201 RALEIGH TAVERN LANE 11/3/2016 The Commonwealth of assachuse
Department of Fire Serr-Acea
Office of the State Fire MarsW
P,0.Box 1025 State Road,Stm,,MA.01775 APPLICATION T Date;
Permit No
{City or Town) (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 StartDate
by E (,L �L l l }�ji I/
(Flantame ofpe®rsoon,Firm,or Corporation)
State clearly Address Z A/ TQI� /_ �0 4
purpose for (Street or P.O.Box City or Tova)
wluch.permtt porp ermissicnto 'Lo,�ate- dumpster for construction/renovation/demolition
is requested of s t r u c t u r e
Comments: dumpster must be 25 t from structure or covered when not in use
at 2 0 H Tf�F�f Al L N - /'I °V 0
(Give locationby street and no.,or describe in suchamnner as to provied adequate identification of location)
Name of competent operator Cert.No. _
(If Applicable) v6s,
Date Issued rejected. By
(Signature of Appliomt)
Date of expiration Fee$ Paid Due
DepartmentThe Commonwealth of Massachusefts
ire Services
Office of the Statte Fire Marshal
° P.0.Box 1025 State Road,Stow,MA.01775 Ir
PERKIT Date:
£ x— Pern it No
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions of MG L. Chapter 10as provided in section 5 2 7 CMR 34
StartDate
This Permit is granted to: Q t _ G4 1-4
Full name of person,Firm or Ction
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25 r from structure or covered with tarp or plywood
Restrictions: a t e nd of workday
at
(Give loci by street and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid Lr? ,
This Permit will expire (Si o e0_iEt antingpermit
"!"HIA PI=R 1iIT f411I I. TT PIP r`_i"°9N_gr3jr__1 Ir11 Iles V Pn-Q Pn 1 II3C1I4i " W;= PP1=RlilQPq