HomeMy WebLinkAboutDumpster Application & Permit - Permits - 19 CHADWICK STREET 11/8/2016 The Commonwealth of Massachusetts
Department of Fire Services
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Office of the State Fire Marshal
P.0.Box 1025 State Road,Stove;MA 01775
APPLICATION FOR PERMIT
Date:
rum v Permit No
City or Town) If Applicable) Dig Safe Number
In accordance with the pro-visions of M.G.L. Chapter . 10 _as
provided in Section 527 CMR 34 application is hereby made Start Date
by Si-1(TTA Ce
(Fiffi name of person,Firm or Corporation)
State clearly Address C( � 0/1 C�) i i ( N
purpose for (Street or P.O.Box City or Town)
whichpormit For re,mission0 'Locate, dumpster for construction/renovation/demolition
is requested of st—r-u—'Eture
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.Na.
(If Applicable)
Date Issued-rejected BY
(Sipature of Applicant)
Date of eiTiration Fee Paid Due
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The Commonwealth of Massachusetts
Department of Fire Services
Office of the State Fire Marshal
P.0.Box 1025 State Road,Stow,MA 01775
Permit No PERMIT Date: ill�k
(City of Town) (HApplicable) Dig Safe Number
In accordance with the provisions of MG.L. Chapter 10as provided in section 5 27 CMR 34 Start Date
This Permit is granted to:
Full name of person,Firm or Corporation
Permission to locate dumpster for construction/renovation/demolition of structure
Comment': dumpster be 251 from structure or covered with tarp or plywood
Restrictions: at end of workday
at V'j
(Give location by street?nd no.,or describe in such manner as to provied adequate identification of location)
Fee Paid S C-D 0
This Permit will expire Sign e 0 caTVantingpermit) Offical granting permit (Title)
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