HomeMy WebLinkAboutDumpster Application & Permit - Permits - 10 SILSBEE ROAD 11/6/2016 The Commonwealth of Massachusetts
71i�(�: > 6 Department of FiTs Services
Office of the State Fire MarsW
- P.O.Box 1025 State Road,Stow MA 01775
APPLICATION FOR PERMIT
Date:
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 Start Date
by
(FiT name ofperson,Firm,or Corporation.)
State clearly Address
purpose for (Street or P.O.Box City or Town)
whichpemut For permission to 'Locate, dumpster for construction/renovation/demolition
is requested 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.
(lf Applicable)
Date issued-rejected By
(Signature of Applicant)
Date of e%piration Fee$ Paid Due
The Commonwealth of Massachusetts
UipDepartment of ire ice
Office e ire Marshal
P.O.Box 1025 State Road,Stove,MA 01775
PERMIT
/� d`2J�� ,.��Vz�/4 12!� Permit�0 Date:
��T Dig Safe Number(City 011 own) (If Applicable)
In accordance with the provisions of MG.L. Chapter 10as provided in section 5 2 7 CMR 34
Start Date p l
This Permit is granted to: S,NI l T-4,k Co.—s7 zi-t c T-i o O
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 1 I Si S �j
. (Give location by street and no.,or describe in such manner as to pro-vied adequate identification of location)
Fee Paid S > y r
This Permit will expire KV,( Alt (Sign f cal'granting permit) Offical grantingpermit (Title)
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