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Dumpster Appliction & Permit - Permits - 262 SOUTH BRADFORD STREET 11/8/2016
_ IQThe Commonwealth of Massachusetts � Department of Pius Serrvkas a tY i Office of the State Fire Marshal _ P.0.Box 1025 State Road,Stops;MA 01775 �r APPLICATION FOR PERMT Date: /•' �/ Permit No (City or Town) (If Applicable) Dig Safe Number In accordance with the provisions of M.G.L. Chapter 10 as proyid eetion 527 C--M R-3-4- application is hereby made Start Date A >~ullname ofperson,Firm or Corporation) State clearly Address ® , \`D Wr ��� , „ - - © ) - purpose for (Street or P.O.33ox City,-Town) whit pormitd For permission to 'Locate dumpster for construction/renovation/demolition is of structure 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 '�_.___.� (Signature of Applicant) Date ofe%piration Fee Paid _>e,—,� Due . .cut--------------------- The Commonwealth of Massachusetts Department of Fire Services U roe f e Ire ars sl P.0.Box 1025 State Road,Stow,MA 01775 r =g'70 VEIL Date: Peru PERMIT Dig Safe Number (City of Town) If Applicable) In accordance with the provisions of M.G.L. Chapter 1 Oas provided in section 5 2 7 CMR 34 Start Date This Permit is granted to: ,L 4�77�- 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 at 07 F , Kx�ZzE iG e 65" (Give location by street and no.,or describe in such manner as to provied adequate identification of location) Fee Paid This Permit will expire e?— ` (Signature of offioal granting permit) Of6 grantingpermit (Title)