HomeMy WebLinkAboutDumpster Application & Permit - Permits - 116-118 HIGH STREET 11/10/2016 9773
he COMMOnweafth of Mazaachusafts,
Department of Fire Services
Office of the State Fire Marshal
R G.Box 1025 State Road,Stovi,,MA 01775
APPLICATION FOR PERMIT
Date:
Permit No 1-6
City or Town ---Tff-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 Data
by
I n
-h L�C—
Full name of person,
Address Firm or Corporation)
State clearly
purpose for (Street or P.O.Box City or Town)
whiclipermit Forpermissionto Locate dumpster for construction/renovation/demolition
is requested of structure
Comments: dumpster must be 25 ' from structure or covered when not inuse
at
iq - L. (9 1 (�-� S
(Give.location by strec, d�no.,or describe in such manner as to pro-vied adequate identification of location.)
Name of competent operator Cert.No.
(If Applicable)
Date Issued-r*ett By
(Signature of Applic
Date of expiration Fee Paid Due
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The C;ommonwealth of Massachusefts
Department of Fire Services
Office of the State Fire Marshal
P.O.Box 1025 State Road,Stow,MA 01775
PERMIT -Z
A Permit No Date:
(City of Town) ——— (I—fA—pphcable) Dig Safe:Num7ber —
In accordance with the provisions of M.G.L. Chapter 10as provided in section 527 CMR 34
Date
This Permit is granted to: EStartDate
V 7-;�"
FA 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 114,Ir.1/c
(Give location by Keet and no.,or describe in such manner as to provied adequate identification of location)
Fee Paid
This Permit will expire (Signature- JoRE
Frlmt� OfffffyRg permit Title
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