HomeMy WebLinkAboutDumpster Application & Permit - Permits - 12 ALCOTT WAY 11/8/2016 The Commonwealth of Massachusetts
�M: - Department of Hire Services
Office of the State Fare MarsW
- e` P.0.Box 1025 State Road,Stogy,MA 01775
APPLICATION IT
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, is Secli 527 CMR 34 application hereby made start Date
by -t c
(Full name of person,Firm or Corp'
r tion) /'
State clearly Address �' (�,, t 1� h e— -i�
?urpose for (Street or P_O.Box City or Town)
Nhichpermit For em�issionto 'Locate dumpster for construction/renovation/demolition
srequested l? of structure
Comments; dumpster must be 25 ' from structure or covered when not in use
at _l Z (cG � WG
(Give location by street and no.,or describe in such manner as to provied adequat®identification of location)
Name of competent operator Cert.No.
(If Applicable)
Date Issued-rejected B
Y
(Signature of Applicant)
Date of e%piration Fee$ Paid Due
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The Commonwealth of Massachusetts
u
Department of Fire Services
Mice of the State Fire Marshal
P,0.Box 1025 State Road,Stow,MA 01775
/ Date:
QOyfl� Permit No
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 1 Oas provided in section 5 2 7 CMR 34
This Permit is granted to: �_/�j�u/"✓ �rtDate
.2�ccc°T�!/G'.,�"/®ice �C.'
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
(Give location by street d no.,or describe in such manner as to pro-vied adequate identification of location)
Fee Paid S S Z' f
d /
��� a d2 J
This Permit will expire .7l— L— (Sign. o offioal grantingpermut) 0 ca1 graniingpermit (Title)
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