HomeMy WebLinkAboutDumpster Application & Permit - Permits - 100 HICKORY HILL ROAD 11/10/2016 The CG MG�Iwea h Of Mazaachusefts
Department of Fhxe Services
r=' Offics of the State Fire Marshal
P.0.Box 1025 State Road,Stoi MA 01775
APPLICATION FOR PERMIT
Date:
Permit No(City or Town __) (If Applicable)
Dag Safe Number
In accordance with the provisions of M.G.L. Chapter 10 as
providO in Section 527 CMR 34 application is hereby made start Date
by
(Full nalhe of person,Firm or Co Poratio )
State clearly Address `?
Purpose for (Street or P.O.Box City or Town)
which permit Forpermissionto Locate dumpster for construction/renovation/demolition
is requested
Of structure
Comments; dumpster must be 25 ' from structure or covered when not in use
at i
(Give location by street and no.,or describe in such manner as to provied adequate identification of location)
Name of competent operator c
(If Applicable) �� I(�" Cert.No.
77 /J
Date Issued-rejected
By �
(Signature of Ap ' ant)
Bate of expiration Fee$ Paid Due
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The Commonwealth of Massachusefts
Department f Firs Services
Office of the State Fire Marshal
P.0,Box 1025 State Road,Stow,MA 01775
� PERM.IT
bate:
� a)��1-e Permit No
(City of Town) (If Applicable) Di:Saafe N mnber
In accordance with the provisions of M.G.L. Chapter 10as provided in section 5 2 7 CMR 34
This Permit is granted to: EStaftte
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 d v s6 C
( location by street d no.,or describe in such manner as to pro-vied adequate identification of location)
GiveFee Paid$
r
This Permit will expire /—/c - (Signa4kcif
granting legit) 01 granting permit (Title)
T1-IIC PPPUI'T MI t_Q'i" MP rr)N_gP1r1 1n1 ICI V Pr1_QTi=n 1 IPnKI TI-IP PPP=UJCJ=C