HomeMy WebLinkAboutDumpster Application & Permit - Permits - 32 CHRISTIAN WAY 11/9/2016 The Commonwealth of assachuse -9
Department of Rre Services
a 1: Office of the State Fire MarsW
R D.Box 1025 State Road,Stops;MA 01775
Al APPLICATION FOR PERMIT
Data:
]Permit No
(City or Town) (If Applicable) Dig Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
provided in Seen 527 C MR 34 application is herebymao Start Date
(Ftr]I name ofpe-son Firm or Corporation)
State clearly Address//(
purpose for ` (Street o P.O.Box City or Town)
whichpemsit For permission to 'Locate' dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 251 from structure or covered when not in use
at '/Gt/)
(Give location by street and no.,or describe in such.manuer as)6 provied adequate identification of location)
Name of competent operator Cert.No.
(If Applicable)
Date Issned-rejected By
(Signature of App' t)
Date of expiration d d — /—/ Fee S Paid Due
The Commonwealth of Massachusetts
E �
Departmentf Fire Services
Office of the State Fire Marshal
P.C.Box 1025 State Road,Stow,MA 01775
PERMIT
� ]Pexm�if 1,T0 Date:
(City of Town) (If Applicable) Dig Safe Number
In accordance with the provisions ofALG.L. Chapter 1 Oas providedin section 5 27 CMR 34
Start Date
This Permit is granted to: /clolsc
Full name of person,Firm or Corporafio
Permission to locate dumpster for construction/renovation/demolition of structure
Comments: dumpster be 25_f_from structure or covered with tarp or plywood
Restrictions: at end o f workday
at AK_Id i` At-/d
(Give location by street and no.,or desrxi6r,in such manner as to provied adequate identification of location)
Fee Paid S ,j"-D i
This Per will expire _ (Signature offioal granting pezmit) Offical anting permit (Title)
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